Endocrine Abstracts

Introduction: Managing a child’s diabetes is challenging. In some families, overwhelming life complications compromise their ability to realise the recommended management levels for diabetes in childhood. Reliance on the child protection system to provide additional support creates a need to prove maltreatment, specifically within the context of families neglecting medical care. This is the first study exploring how professionals experience identifying and navigating safeguarding concerns with families where there is backdrop of ‘medical neglect’.

Objectives: To understand how, and when, paediatric diabetes HCPs develop and manage safeguarding or child protection concerns and associated influencing factors when medical neglect, related to families management of their child’s diabetes, is suspected.

Methods: A constructivist grounded theory approach was used to analyse nineteen semi-structured interviews with multi-disciplinary HCPs recruited throughout the national diabetes network.

Results: HCPs perceive families’ support needs against multifaceted reasoning and degrees of severity. A grounded theory was inductively constructed comprised of 2 core categories: working above and below thresholds and navigating professional insecurity. Frustrations arise in dealing with the uncertainty associated with contextualising neglect within families diabetes care and balancing relationships with families. ‘Grappling personal and systemic thresholds’ to access support within a constrained system professionals implement alternative strategies; ‘working above and below the lines’ of thresholds, supporting families ‘over and above the diabetes management,’ or ‘holding responsibility for families’ under thresholds, whilst ‘wrangling social care’ and ‘persevering to gain support’. Poor understanding of the impact of long-term conditions, exacerbated by competing service priorities and a lack of anticipatory family support provision leaves HCPs ‘feeling, and fearing, that they are failing the child’. This results in HCPs becoming ‘professionally insecure’ balancing protecting both the child and themselves.

Conclusions: Diabetes HCPs are uniquely placed to identify medical neglect concerns, however differing thresholds of concern are at cross-purposes. This research highlights multiple recommendations for action pathways that support practice to mitigate absent joint risk comprehension between agencies for this unique patient group. Enhanced, contextual training and support to navigate maltreatment concerns for both systems is also needed. Recommendations for national policy and guidance to expand upon medical neglect recognition are also explored.