Endocrine Abstracts

Introduction: Managing diabetes in a child is complex and demanding for parents, for some families this is exacerbated by additional demands. Compromised family capacity may lead to diminished management of a child’s diabetes, increasing the risk for acute and long-term complications. The UK has the highest rates in Europe of children (0-14years) living with Type 1 diabetes (International Diabetes Federation, 2019) however, it is concerning that less than 40% have a HbA1c less than 58 mmol/mol (HQIP, 2022). Where health care professional’s (HCPs) recommendations for children with health problems are not integrated into day to day care, neglect is increasingly considered (Dubowitz, 2011). However, the absence of frank signs of maltreatment and therefore, evidencing concerns presents challenges. Specialist children’s diabetes HCPs experiences of negotiating these multiplex situations have not yet been explored

Methods: This qualitative study analyses data from semi-structured interviews using grounded theory methodology. It explores HCP’s experiences of working with children where families care of diabetes is compromised. It aims to develop an understanding of how professionals recognise safeguarding issues and determine factors contributing to and influencing raising their safeguarding concerns.

Findings: Early findings suggest factors influencing concerns are complex and multifaceted and challenging for professionals. HCPs describe difficulty identifying child maltreatment, demonstrating the use of intricate skills to develop and understand concerns including, for some, intuition. Further difficulties arise in the absence of joint risk language as HCPs present frustrations communicating effectively between services. Participants confer common anxieties and challenges including managing risk where thresholds for intervention are not met, as well as feeling that they are holding responsibility for families. Participants report that despite recognition of the benefits of sharing practice and working together, this is limited, both within their own diabetes teams and across other agencies. Recommendations for practice include enriched professional development to include improving referrals and multiagency collaboration, alongside managing the physical and emotional demands of safeguarding.

Conclusions: Further exploration is required to understand diabetes professionals’ appraisal, and use of, less tangible signs to identify neglect early, and also how child abuse and maltreatment is managed within teams