“A multitude of things”: A qualitative analysis of practitioner perceived barriers to identifying and responding to childhood adversity

Childhood adversity contributes to poor physical and mental illness across the lifespan. Given its multifaceted nature, responding to childhood adversity requires action across health and social care; but such action is complex. This study aimed to explore the barriers for practitioners across health and social services in identifying and responding to adversity. Individual and group semi-structured interviews with 26 practitioners working across health and social care providers in Melbourne, Victoria. Interviews explored challenges practitioners experienced identifying and responding to childhood adversity. Interviews were audio recorded, transcribed verbatim and analysed using reflexive thematic analysis. Four main themes were identified. (1) “Get clues as you go along”. Practitioners relied on gut instinct or caregiver disclosure to identify adversity. (2) Out of my control. Practitioners identified systems barriers that were out of their control including lack of service availability and funding. (3) Navigating complex systems. Practitioners acknowledged challenges in knowing about available services and how to access these services. (4) “Opportunity to engage”. While practitioners identified trust as important for relationships with families, they could not describe how to improve trust. Practitioners encounter a “multitude of barriers” across health and social care that impede identification of, and response to, childhood adversity. Improving practitioner confidence and capability to work relationally with families, including directly asking about adversity, is critical for overcoming these barriers to systematically identify adversity in practice. Improving practitioner knowledge about community services and service navigation will be a crucial starting point.