Table 1

Whom (typology of narratives about families)?

‘Stable at this point in time but it's a never ending story’‘On the edge’‘Was it, wasn't it? ’‘Fairly straightforward’
Most common narrative, N=16*
  • Very serious and long-term parent drug/alcohol use, mental health problems and domestic violence

  • Extensive contact with CSC child protection services, police and drugs and alcohol services

  • Siblings taken into care or died

  • Concerns about physical neglect and emotional abuse

  • GPs believed that circumstances had recently improved for the children and felt hopeful about capacity to parent in the future

  • But new stability was seen as fragile and optimism about future was cautious and uneasy

  • Perceived need for continued vigilance to spot relapses (further neglect/emotional abuse) and prevent poor child outcomes

Second most common narrative, N=12*
  • Lack of boundaries for children; poor school attendance, missed medical appointments, concerns about nutrition and clothing

  • Families suffered from: unemployment; inadequate housing; poverty; parental alcohol use or mental health problems; and overwhelming physical health and behavioural problems

  • Concerns about neglect and emotional abuse

  • Accounts of intermittent and inadequate involvement from child protection services

  • Children described as ‘vulnerable’ and often as currently involved with CSC as a child in need

  • Problems experienced by GPs as overwhelming and frustrating

  • Worry about families ‘tipping over the edge’ at any moment

Third most common narrative, N=9*
  • Concerns focused on possible physical or sexual abuse

  • Participants were very uncertain whether suspicions ‘amounted to anything or not’ and believed that physical or sexual abuse probably had not occurred

  • They described having just enough concern to take further action

  • In the context of this low level of concern, GPs described CSC response as unnecessarily heavy handed and punitive

  • After varying amounts of time (a few days to a year), participants reached the decision, usually in conjunction with CSC, that the child was not likely to have been physically or sexually abused. In the four cases of injured children, participants described on-going concerns about parental supervision (i.e.,neglect)

Least common narrative, N=3*
  • These narratives were characterised by concerns about maltreatment described as ‘obvious’ or ‘barn door’ with a high level of suspicion from participants and decisive referrals to CSC or secondary healthcare

  • Narratives were characterised by participants believing that referral to social care or other agencies would result in appropriate and timely services

  • These cases were only mentioned in passing and usually as a contrast to one of the other family types, about whom participants talked in detail and at length

  • It is important to remember that these typologies of families only tell us about GP perspectives and understandings and cannot be relied on as accurate data about families.

  • *More narratives than families because some families had more than family classification as participant's views of the family evolved over time.

  • CSC, children's social care; GP, general practitioner.