The Swedish social services' police reporting and children's access to protection and support in child abuse cases: A quantitative content analysis

Background: The UN Convention on the Rights of the Child prohibits all forms of violence against children. Sweden was early in introducing a ban on disciplinary violence; however, difficulties have been noted in identifying children in need of protection and providing help for children exposed to violence. Objectives: The purpose of this study was to explore the social services' police reporting and children's access to protection and support in cases of physical and sexual child abuse. Methods: The sample consisted of 291 child welfare reports from three Swedish municipalities. Data were collected from child welfare reports, investigations, and child social records and analyzed using quantitative content analysis. Results: A majority of the cases, including cases with a high indication for police reporting, were not reported to the police by the social services. Although the child in 60.1 % of cases provided information about violence, 70.7 % of all child welfare investigations were completed without support measures, and only 8.2 % led to protection or support linked to violence. Children's participation was limited, suggesting inadequate conditions for children's access to protection and support. Conclusions: Children's right to protection against violence requires the recognition of children as active participants with access to safe participation. Failure to report suspected crimes against children risks minimizing acts of violence or making violence invisible. Difficulties in handling conflicts of interest between children and parents risk neither protection nor support being provided for the child


Introduction
Although child abuse is regarded foremost as a child welfare (CW) problem, many forms are criminalized and hence involve the criminal justice system.Recent decades have seen increased research on cooperation between police and CW following the development of Child Advocacy Centers in many countries (Johansson et al., 2017).However, there is limited knowledge about CW professionals' police reporting of criminalized forms of child abuse and their decisions on providing children with protection and support.The current article aims to explore the police reporting by social services and the access children have to protection and support in cases of criminalized child abuse by parents or close relatives in the Swedish context.
Sweden is widely recognized as one of the first countries to introduce a ban on disciplinary violence (see, e.g., Durrant et al., 2020).However, criticism has also been leveled at the lack of adequate protection and support for children exposed to violence in their families (UN Committee on the Rights of the Child, 2009).The responsibility for child abuse matters belongs to the CW system, which includes child protection, and is administered by local municipal social services (Social Services Act 2001:453).The Swedish system has a strong family orientation with an emphasis on risk prevention through early service measures, cooperation with parents, voluntary support for the family, and placement of children as a last resort with family reunification remaining the goal (Gilbert, 2012;Gilbert et al., 2011;Svensson & Höjer, 2016).Although Sweden has been successful in meeting the basic needs of families through general welfare services (Gilbert et al., 2009), difficulties are indicated for the Swedish system in identifying children in need of protection (Cocozza et al., 2010;cf. Leviner, 2014).Its family orientation also risks parents' views being emphasized at the expense of the needs and views of the children (Svensson & Höjer, 2016).
According to the Swedish Social Services Act (2001:453), professionals involved in activities that affect children are unconditionally obliged to report child abuse and neglect to the social services (independent of police reporting) and CW investigations of violence and sexual abuse are mandatory to determine the need for protection and support (The National Board of Health andWelfare, SOSFS 2014:4, 2014:6).The CW investigation process includes consideration of police reporting, which forms an aspect of children's access to protection and support.A criminal investigation can provide an increased basis for assessing the need for protection and support, including access to interprofessional collaboration in Child Advocacy Centers (Government Inquiry 2009:68, 2009;The National Board of Health andWelfare, 2012, 2016).A child's right to protection against physical or mental violence, injury or abuse, neglect or negligent treatment, and maltreatment or exploitation, including sexual abuse (UN Convention on the Rights of the Child, Article 19), is covered by the Social Services Act (2001:453) and is the responsibility of social services.The Swedish Criminal Code (1967,700) is narrower but unequivocally covers physical and sexual abuse, thus also involving the criminal justice system in child abuse cases.The criminal investigation is conducted by the police and the public prosecutor's office, while the social services in parallel investigate the child's need for protection and support.To meet the need for interprofessional collaboration in these situations, a Nordic version of the Child Advocacy Center, the so-called Barnahus, has been introduced with two overarching goals: to improve criminal investigations and to improve protection, support, and treatment for the child (Johansson, 2012).Four different areas are covered: criminal investigation, child protection, physical health and mental health.At the core of the Barnhus are multi-professional consultation meetings to coordinate investigations and determine the child's mental, medical and social needs, with police reporting a requirement (Kaldal & Svedin, 2015).
However, not all cases of physical and sexual child abuse are reported to the police by the social services.The Government Inquiry 2009:68 emphasized the need for increased equivalence in assessments of child abuse and stated that the prevailing principle is that the social services should report to the police.Guidance is provided by the National Board of Health and Welfare (NBHW), with the general guidelines (SOSFS 2014:6) stating that suspicions of crime against a child according to Chapters 3, 4, or 6 of the Criminal Code (offences against life and health, offences against liberty and peace, sexual offences), or according to the law prohibiting female genital mutilation, should be reported immediately, unless it is contrary to the child's best interests.The professional assessment must be based on the child's need for protection, the severity and degree of suspicion of the crime, the child's relationship with the suspected perpetrator, and the child's attitude about or response to a possible police report (The National Board of Health andWelfare, 2012, 2016).Reasons for non-reporting must be in the child's best interests and must take these factors into consideration.A low degree of suspicion can be a reason for delaying or refraining from police reporting, while strong suspicions of physical and sexual abuse, as well as the risk of further abuse, indicate the need for police reporting.Abuse by caregivers signals special vulnerability; the child's response to the possibility of a police report must be considered but may not be decisive (The National Board of Health andWelfare, 2012, 2016).No comprehensive investigation should be conducted before deciding on a police report, and if the decision is to refrain from reporting, the reasons should be stated in the child's social record (NBHW, SOSFS 2014:5).
Legislation and guidelines are not the only decisive factors for decision making by authorities.Social workers' own attitudes to violence can affect the assessment of police reporting (Heinonen, 2015).Reporting to the police can also be perceived as damaging cooperation with parents and jeopardizing the opportunity to provide voluntary support (Heimer et al., 2017;cf. Mosegaard Sjoberg, 2017).At the same time, a criminal investigation can be crucial in providing the child with protection and support (The National Board of Health and Welfare, 2012).An important factor in the actions taken and the decisions made on protective measures is child participation (Jobe & Gorin, 2013;Linell, 2017a).There are, however, many barriers to a child's revealing abuse by a close relative (Jernbro et al., 2017), which put the child at risk of being excluded from decision-making processes (c.f.Thulin et al., 2020).Active pressure and threats from relatives and feelings of fear, guilt, and ambivalence are crucial factors to consider (Linell, 2017b;cf. Messing, 2011).A major challenge lies in creating conditions for obtaining an accurate understanding of the child's situation.A childcentered focus is recommended, meaning that children are recognized as individuals with the right to participate in major decisions about their lives (Munro, 2011;Backe-Hansen & Falch-Eriksen, 2018).Children exposed to violence by a parent or caregiver are particularly vulnerable (Pinheiro, 2006) and actualize the tension between children's and parents' rights (cf.Leviner, 2011).Increased knowledge of the Swedish social services' handling of child abuse is central to assessing the need for improvement and increased access to protection and support.It is also of general interest as family support elements are common in most systems (Burns et al., 2016).

Lack of knowledge about the social services' police reporting
According to the recurring national survey on violence against children in Sweden (based on a questionnaire for children in school; in 2016 answered by 4741 children), 12-14 % of children are exposed to physical violence by parents and 2 % to sexual abuse (Jernbro & Janson, 2017).Due to the lack of a uniform national social services register, the number of CW reports on physical and sexual child abuse is unknown, but a survey covering 80 % of Swedish social services reported that 20 % of 331,000 CW reports in 2018 referred to some form of violence in close relationships (The National Board of Health and Welfare, 2019).And according to a major study of child abuse, 38 % of CW cases concerned physical and mental abuse and 5 % sexual abuse, with 31 % leading to protection or support measures (Persdotter & Andersson, 2020).The lack of a national register also means a lack of knowledge about social services' police reporting of child abuse, but insufficient police reporting has been indicated (Government Inquiry 2009:68).However, the studies are few and generally difficult to evaluate due to possible inclusion of non-criminalized violence, non-assessment of severity and degree of suspicion, and non-separation of police reports made by social services or others.Two studies that formed the basis for the Government Inquiry 2009:68 should be mentioned.The first found police reports in 17 % of CW cases of child abuse, which was considered "insufficient police reporting" (Committee Against Child Abuse, 2009).The second study, an evaluation of a pilot project with Barnahus (Åström & Rejmer, 2008), indicated development in a positive direction.Nine out of ten child abuse cases were reported to the police by the social services or others, but numbers varied between municipalities (Friis, 2008).Nevertheless, trends in social services' police reporting are still unclear.A subsequent study found police reports in 38 % of CW cases of child abuse (Cocozza et al., 2010), and a recent study, which also included non-criminalized violence, reported police reports in 5 % of cases (Persdotter & Andersson, 2020).
The current lack of in-depth knowledge of police reporting by social services constitutes a knowledge gap in the handling of child abuse and children´s access to protection and support (cf.Mattsson, 2017).By excluding non-criminalized violence and estimating the severity and suspicion of violence, important knowledge can be gained about the situations in which police reporting is omitted.As reporting to the police is just one component of a full investigation of violence against children, access to protection and support measures is also important to explore and child participation thus becomes central.The current study expands on previous research by linking the social services' police reporting to the severity and suspicion of violence and by operationalizing the NBHW's guidelines for social services' police reporting.Two main questions are addressed: To what extent did social services report physical and sexual abuse of children to the police, and to what extent did CW investigations lead to decisions on protection or support measures?This study adds important knowledge about social services police reporting of criminalized child abuse and increases knowledge about access to protection and support.This new knowledge can provide a basis for social and legal policy considerations and the development and implementation of local policy.

Sample
The study was conducted in a Barnahus region in Central Sweden and included three medium-sized municipalities with a total population of 99,316 inhabitants, of which 21.0 % were children 0-17 years old (Statistics Sweden, n.d.).These municipalities reported the largest number of CW reports of physical and sexual abuse and were therefore strategically selected to achieve diversity and breadth of cases.The risk of bias associated with this selection criterion refers to the possible over-representation of less severe forms of violence, which was neutralized by assessing the severity of the violence.To enable exploration of police reporting, the sample consisted only of child abuse cases that were unequivocally covered by the Criminal Code (1967,700) in 2018.All CW reports in 2018 of direct physical or sexual abuse of children (aged 0-17 years) by a parent or close relative were included in the study, giving in total 291 CW reports concerning 211 children handled within 208 CW investigations (74 reports were processed within ongoing CW investigations included in the study, and nine reports did not lead to investigation).

Data collection/procedure
All CW reports and associated file material, consisting of immediate protection assessments, preliminary assessments, CW investigations, and child social records, were obtained from the social services.The file material for each child included approximately 20-100 pages and is protected by confidentiality in accordance with the Act on Public Access and Confidentiality (2009:400).Data were collected using a data collection form that was applied to all file material and all data were recorded digitally.The form was based on the various phases of the case management process, including decisions on protection (placement of the child with or without parental consent) and voluntary support measures (support for children and parents based on parental consent), and on estimates of the severity and degree of suspicion.All assessment of data was performed by one person.To avoid double registration, CW reports processed within ongoing investigations (n = 7) were given customized codes and response options.In addition, CW reports of child abuse committed abroad (n = 7) were excluded from the assessment of factors indicating a police report.The different types of file material enabled data control through triangulation and, if necessary, the social services were contacted for further information.After all cases were coded separately, all data were recorded in IBM SPSS Statistics.

Measurement
To enable a more detailed analysis of the extent to which the social services reported suspected crimes to the police, estimates were S. Quarles van Ufford et al.
made of the severity and degree of suspicion of violence.Based on these estimates, a weighting was made of factors that would indicate the need for a police report.

Severity of violence
The estimate of physical and sexual violence described in the reports was guided by the classification used in the Swedish national survey on violence against children (Jernbro & Janson, 2017).Physical violence was ranked as either "Severe form" or "Less severe form."Acts of violence relating to "having the hair/ear pulled or being slapped with an open hand" were classified as less severe forms.Being "heavily beaten with hand or fist; hit with a stick, belt, ruler, or similar; squeezed around the throat/neck; kicked, burned or scalded with hot liquid; or threatened with knife or firearm" were classified as severe forms.To adapt this classification to the file material, in which violence is sometimes less fully specified (e.g., "the child is beaten by his mother and father"), the option "Other violence/beaten" was used and, if the violence was not specified, the violence was classified as less severe.Sexual abuse was classified as "Severe form" and it referred to sexualized verbal interaction or sexually touching the child, forcing the child to sexually touch or kiss someone, forcing the child to watch someone showing their body or forcing the child to show their own body, having vaginal, anal, or oral sex with the child, or exploiting the child for sexual posing or sexual services."Other sexual act" was used for unspecified descriptions of sexual abuse (e.g., "the child is sexually abused by the father").
The overall severity of the violence was estimated by weighting four indicators, each of which was given a point of 0 or 1 to a total maximum of four points: 1) Character of the violence (Severe form/sexual abuse = 1, Less severe form = 0).2) Repeated or several types of violence (Yes = 1, No = 0).3) Child needed to seek medical care (Yes = 1, No = 0).4) Suspected perpetrator a caregiver (Yes = 1, No = 0).
Parents and parents' partners living with the child were considered caregivers.Other relatives were not considered caregivers unless it was clear that they had a caring role.

Degree of suspicion
The degree of suspicion was estimated using a three-point scale (high, medium, and low degree of suspicion) and was based on the The National Board of Health and Welfare's (2012) guidance on police reporting.A high degree of suspicion is defined as "a detected abuse or a very strong suspicion of crime" and suggests that a police report should be made urgently.A low degree of suspicion is defined as "diffuse suspicions based on vague data without concrete injuries or information from the child."To enable a more nuanced assessment, a medium degree was created based on the definitions of high and low suspicion: "no fully proven abuse, but not just vague information with neither injuries nor information from the child".

Factors indicating a police report
An estimate of factors indicating a police report was made by weighting five indicators, based on the The National Board of Health and Welfare's (2012, 2016) guidance, each of which gave 0-2 points to a total maximum of 10 points: 1) Need for protection from continued violence (Yes = 2, No information = 1, No = 0).2) Character of the violence (Severe form = 2, Less severe form/unspecified and repeated = 1, Less severe form/unspecified = 0).3) Degree of suspicion (High = 2, Medium = 1, Low = 0).4) Suspected perpetrator a caregiver (Yes = 2, No information = 1, No = 0).5) Child's attitude/response to a possible police report (Positive = 2, No information = 1, Negative = 0).The scale does not include an absolute "tipping point," but the higher the total score, the higher the indication for police reporting.The assessment of "Need for protection against continued violence" was determined by whether the risk of continued abuse could be excluded based on the social services' information or not.Continued contact/cohabitation with a suspected perpetrator was rated "Yes," while ceased contact with suspected perpetrator was rated "No."The response option "No information" refers to potentially difficult-to-assess situations without sufficient information."Character of the violence" was based on the estimate of the severity of the violence (see above) and "Suspected perpetrator a caregiver" was determined based on information in the report."Degree of suspicion" was based on information in the report to the social services, previous information, and possible information in connection with the immediate protection assessment.Detailed information from the child about the abuse or witnessed abuse was rated "High."Vague information without any concrete injuries or information from the child was rated "Low."Less specific information from the child or the presence of injuries to the child without specific information about the abuse was rated "Medium."The assessment of "The child's attitude/response to a possible police report" was dependent on whether or not the child's attitude to police reporting was evident from the social services material and whether or not an assessment of the child's response was made.Information that the child wanted the abuse to be reported led to a rating of "Positive."Information indicating that the child objected to, or was assumed to be harmed by, police reporting led to a rating of "Negative."The response option "No information" was selected when there was a lack of information about the child's attitude or reasoning about how police reporting could affect the child was missing.

Data analysis
Quantitative content analysis was used to analyze the data and, after registration in IBM SPSS Statistics, all data were analyzed using non-parametric statistical methods involving frequencies and cross tables.

Ethics
This study was approved by the Social Welfare Board of the municipalities and the Ethical Review Authority in Sweden, number 2019-04859.All case examples used in the current article were deidentified and less common case types that are easier to identify were excluded.

The violence described in the child welfare reports
The 291 CW reports concerned 116 boys and 95 girls.More than half of the children (54.5 %) were between 4 and 10 years old, and 78.2 % were under 13 years.Physical violence was the focus of 272 reports.Four reports concerned both physical and sexual abuse, 14 concerned sexual abuse (which included several repeated CW reports per child), and one concerned medical child abuse.All CW reports included suspicions of crimes in accordance with the Criminal Code (1967:700), chapters 3, 4, and 6, and could be reported to the police by the social services without impediment regarding confidentiality.In 86.3 % of the CW reports, one or both parents were identified as suspected perpetrators.In 2.7 %, the mothers' male partner was identified, in 5.2 % older siblings and in a further 5.2 %, other close relatives with whom the child lived and/or had a close relationship were identified.

The information about violence
The majority (94.5 %) of the CW reports came from non-anonymous sources (e.g., school, social services, police, relatives, private persons, organizations, or authorities) and the most common source of reporting was school/preschool (29.9 % of all 291 reports).More than half of the CW reports (57.4 %) were based on the child's own information on violence: in 40.6 % of the reports, the child had told the reporter about exposure to violence, and in a further 16.8 %, siblings had reported the child's (and often their own) exposure to violence.The remainder were based on parents, relatives, or someone else, such as school staff, having witnessed or observed signs of violence.

The severity of violence described in the child welfare reports
The acts of violence described in the CW reports were rated in 68.4 % of the cases as less severe or unspecified physical violence and in 25.4 % as severe physical violence.In 6.2 % of the cases there was reference to sexual abuse.A vast majority (84.2 %) included information about repeated or several types of violence, such as witnessed violence or other forms of psychological abuse.Information that the child sought medical care was found in 3.4 % of the cases, and in 92.8 %, the suspected perpetrator was a caregiver.The overall severity of the violence described in the CW reports was examined using the four indicators presented in the Measurement section.Table 1 summarizes the severity of the violence described in the CW reports.
A score of 1 point was estimated for 12.7 % of the CW reports.A report classified as 1 point could involve a description of physical violence on one occasion, classified as less severe (e.g., slapped with the hand) or unspecified (e.g., the child being "beaten"), with the suspected perpetrator being a caregiver.An example is the report (3:1:1) that described other young people witnessing a 14-year-old girl's father giving her a slap and pushing her into a wall at the leisure center.Another example is the report (2:05:1) that has a 13-yearold girl whose sister told her teacher that her father had beaten her older sister (the girl to whom the report applies).
In 63.2 % of the CW reports, 2 points were estimated.A report classified as 2 points could involve information about repeated physical violence, classified as less severe or unspecified, with the suspected perpetrator being a caregiver.An example is the report (1:21:1) that has a 7-year-old girl telling the teacher that she was beaten at home (unspecified), that she would be beaten when she got home, and that her father said that child abuse was allowed in his country.The report was supplemented with information that the father had beaten her on previous occasions.
In 23.4 % of the CW reports, 3 points were estimated.These referred to severe forms of violence (e.g., being beaten with fists or implements) and/or repeated use of force, with the suspected perpetrator being a caregiver.An example is the report (1:16:1) that stated that a 6-year-old boy was subjected to repeated physical and mental abuse by his father, who threatened to kill him, threw him

Table 1
The severity of violence described in the child welfare reports.off the trampoline, and hit him with fists in various places on the body.It also reported that the father had beaten and threatened the notifier in front of the boy (to cut her throat and burn the children) and that the boy had witnessed both violence against the father's girlfriend and suicide attempts by the father.Another example is the report (1:25:1) in which a 7-year-old boy told school staff that his father beat him all over his body with a shoehorn, and that his mother said he was not allowed to tell anyone.For only two CW reports (0.7 %), 4 points were estimated.These reports made reference to severe forms of violence, repeated violence, and were for cases in which the child sought medical care, with the suspected perpetrator being a caregiver.For example, one report (1:34:1) concerned the police being called to the 7-year-old boy's home because of ongoing violence.The father had hit the boy so hard that he could not lift his arms, had stepped on him, pressed his cheeks, and showered him in icy water so that he began to shake.Afterwards, the boy had marks all over his body and stated, "It felt like my body was broken."There was also information about violence against the mother and previous violence.
These estimates refer only to the information on violence described in the CW reports.During the CW investigations, information often emerged that indicated a more serious situation for the child linked to the violence.When the scoring for estimating the severity of the violence was applied to the entire set of investigation material, it was found that 88.5 % of the investigations received 2 points or more and 35.5 % received 3 points or more.Table 2 shows the estimated severity of the violence found in the 208 CW investigations, with nine reports not leading to investigations and 74 reports within an ongoing CW investigation.

Occurrence of police reports
To investigate the extent to which the information in the 291 CW reports was also reported to the police, the occurrence of police reports was examined.For only 13.7 % of the CW reports did the social services report suspicions of crime to the police.In a further 3.8 % the social services had already or later reported similar information.In 15.1 % someone else had reported, and in 3.1 % it was unclear whether the information was covered by previous police reports or not.However, for 64.3 % of the CW reports, no police report was made by either the social services or anyone else.Even after excluding all CW reports received during ongoing CW investigations (n = 74), even though these might refer to different suspected crimes and perpetrators, just over half (52.1 %) still did not lead to a police report.Table 3 shows the occurrence of police reports, revealing the extent to which the information in the 291 CW reports of physical and sexual child abuse was also reported to the police by the social services or others.

Factors indicating police reporting
This high incidence of cases of documented suspicion of physical or sexual child abuse not being reported to the police was further investigated.Using the scoring applied to estimate factors that, in accordance with the NBHW's guidelines, indicate a police report (1-10 points; see Measurement section), it was found that a majority of the CW reports received 7 points or more.Specifically, 25.1 % received 7 points, 14.8 % received 8 points, 14.8 % received 9 points, and one CW report received 10 points (0.3 %).Table 4 shows the score indicating a police report.The CW reports concerning child abuse committed abroad (n = 7) were excluded.
A CW report that received 7 points entailed, for example, the need for protection against further abuse, less severe/unspecified and repeated violence, a medium degree of suspicion, the suspected perpetrator being a caregiver, and no information being given about the child's attitude.An example is the report (2:54:1) that has preschool staff reporting that on several occasions a 3-year-old boy had bruises on his ears and marks on his groin, arms, and back.The boy had avoided answering questions about these injuries but had stated that his parents beat him.In this case, the violence was considered unspecified and repeated, there was a medium degree of suspicion and a risk of further abuse, the suspected perpetrators were caregivers, and no reasoning was provided about the consequences for the child of a police report.No police report was made.Another example is the report (2:11:1) that has a private person reporting that a 10-year-old girl was beaten by her mother with implements (wooden spoon, telephone cord, and belt) to the point that she screamed loudly, most recently, the day before.The violence was considered severe (use of implements), there was a low degree of suspicion (no information from the child or no observed injuries), but there was a risk of further abuse and the suspected perpetrator was a caregiver, without, however, any reasoning about the child's response to a possible police report being given.No police report was made.
A score of 8 points entailed, for example, the need for protection against further abuse, less severe/unspecified and repeated violence, a high degree of suspicion, the suspected perpetrator being a caregiver, and no information being given about the child's

Table 2
The severity of the violence described in the child welfare investigations.attitude.An example is the report (2:100:1) in which a 15-year-old boy told his teacher that he had been beaten on the chest by his father in the morning and did not dare to go home.There was a clear description of the abuse situation (leading to a high degree of suspicion) and there was information about previous abuse.The violence was considered less severe/unspecified and repeated, there was a risk of further abuse, the suspected perpetrator was a caregiver, and no information was provided about the child's attitude to a possible police report.No police report was made.Another example is the report (3:19:1) that has a 5-year-old boy becoming anxious when his nail broke and telling preschool staff that his mother would hit him.The boy further stated that his mother often got very angry and hit him with a kitchen utensil.The violence was considered severe (use of implements), with a medium degree of suspicion and a risk of further abuse; the suspected perpetrator was a caregiver, and no reasoning was given about the consequences for the child of a police report.No police report was made.Yet another example is the report (1:20:1) in which the sister of an 8-year-old boy stated that her mother and stepfather had taped the boy's hands behind his back and tried to tape his legs.The boy had also told his father about the abuse and reported that the mother had previously kicked him in the back so that he started bleeding from the nose.The violence was considered severe, there was a medium degree of suspicion and a risk of further abuse, the suspected perpetrator was a caregiver, and no reasoning was given about the child's response to a possible police report.A police report was made after 25 days.Reports receiving 9 points entailed the need for protection from further abuse, severe forms of violence, a high degree of suspicion, the suspected perpetrator being a caregiver, and no information being given about the child's attitude with regard to a police report.An example is the report (3:16:1) that has a 10-year-old girl telling the notifier that she and her siblings were abused by their parents and beaten with implements on the arms, hands, back, and legs, with marks sometimes being made.She provided a clear description of repeated violence and the implements used (leading to a high degree of suspicion).The violence was considered severe (use of implements), there was a risk of further abuse, the suspected perpetrator was a caregiver, and no reasoning was given about the child's response to a possible police report.No police report was made.Another example is the report (2:124:1) in which a 7-year-old boy told school staff that his father had kicked him hard in the legs and that he was still in pain.He provided a clear description of the abuse situation (leading to a high degree of suspicion) and later stated that his father had previously beaten him in the face with his fists.The violence was considered severe, there was a risk of further abuse, the suspected perpetrator was a caregiver, and no reasoning was given about the child's response to a possible police report.A police report was made after 124 days.
A score of 10 points requires that it is also clear that the child does not oppose a police report being made.Only one case (1:31:1) qualified for 10 points; it concerned the 17-year-old boy who had contacted the police after his father had subjected him to severe violence by beating him with his fists and threatening to throw him off the balcony.He had also previously been subjected to severe violence with implements.The boy provided a clear description of the abuse situation (leading to a high degree of suspicion), the violence was considered severe, there was a risk of further abuse, the suspected perpetrator was a caregiver, and the boy wanted a police investigation.There was an immediate police report by the boy himself.

Occurrence of police reports related to factors indicating police reporting
A cross-tabulation was made to investigate the extent to which the social services reported suspicions of crime to the police in relation to factors that indicate police reporting.Information about violence that received fewer than 6 points was not reported at all by the social services.Only two of the 90 CW reports that received 6 points were reported to the police by the social services, while 75 were not reported by either the social services or anyone else.For the 73 CW reports that received 7 points, the social services reported 12 cases to the police, and 42 cases were not reported at all.For the 43 CW reports that received 8 points, the social services reported eight cases, while 27 cases were not reported.For the 43 CW reports that received 9 points, the social services reported 18 cases, while 13 cases were not reported, and for the one CW report that received 10 points, the police report was made by the child.

Lack of stated assessments and reasons for non-reporting to police
An active assessment from the social services and stated reasons for not reporting to the police were found for only 4.5 % of the CW reports.These omissions also applied to most cases in which a police report had already been made, even though additional information must be considered for further reporting.In the few cases (n = 13) for which active assessments were found, the stated reasons for not reporting to the police can be divided into six categories (see Table 5).

Limited participation and access to protection and support for children
For almost all CW reports of child abuse (99.0 %), the statutory immediate protection assessment was made.In 4.5 % of cases, the social services assessed an immediate need for protection, with fewer than half of these resulting in temporary child placements.The child was heard in connection with this initial assessment in only 7.6 % of cases.During the entire CW investigation process, including the initial protection assessment, the child was heard in 70.2 % of the investigations, but in only half, approximately, (54.3 %) without the presence of parents.In 60.1 % of the CW investigations, the child reported exposure to violence to the notifier, the police, and/or the social services; yet the child's perception of support needs was visible in only 13.9 % of the CW investigations.In 68.3 %, it was unclear whether the child had received information about the direct cause of the investigation, and since the violence was not always explicitly addressed, the conditions for expressing support needs varied.Although a majority of the CW investigations included information from the child about exposure to violence, 70.7 % were completed without protection or support measures being decided.Only 8.2 % led to measures linked to violence, which specifically meant protective placement of the child with parental consent in 1.9 % of all cases and voluntary support measures in 6.3 %.The latter mainly consisted of conversational support provided by social workers, aimed at parents in 2.9 % of the cases, at both parents and child in 2.4 %, and the child in 1.0 %.These low rates of protection and support measures must be considered in the light of the fact that information in the CW investigation often indicated a more serious situation than stated in the CW report, with 88.5 % of the investigations receiving at least 2 points and 35.5 % at least 3 points.Furthermore, in 58.7 % of the cases there was information about violence against siblings and in 44.2 %, violence against other close relatives (especially mothers), indicating a need for protection or support linked to violence in more than 8.2 % of cases.

Discussion
This study aimed to explore the social services' reporting of criminalized forms of child abuse to the police and the access to protection and support for the children involved.The results showed that a majority of CW reports of physical and sexual abuse did not lead to police involvement, with only 13.7 % reported to the police by the social services.Information about repeated and severe violence was also not reported.Furthermore, 70.7 % of all CW investigations were completed without protection or support measures, and only 8.2 % led to measures linked to violence, even though the child in 60.1 % of the cases provided information about exposure to violence.The current study expands previous research by addressing severity and suspicion of violence and by operationalizing the NBHW's guidelines for police reporting.In this it contributes important knowledge about Swedish social services' police reporting and situations in which police reporting is omitted.The study also contributes knowledge about children's access to protection and support and indicates the need for increased access to adequate support in child abuse cases.These findings provide a basis for social and legal policy considerations and the development and implementation of local policies.In addition, the assessment criteria developed for this

Table 5
The social services' stated reasons for not reporting to the police.

Categories Content
Not in the best interests of the child In two cases it was considered not to be in the child's best interests to report to the police.In one, reference was made to the child's wishes, and in the other, a police report was considered a possibly traumatic experience for the child.

Vague information
In three cases, the reason for not reporting was "vague information."In two of these, with information on physical and sexual abuse coming from an older sister, it was stated that there was no information that actual abuse had taken place.
In the third case, in which the girl had stated that she was beaten at home, the only reference was to "too vague information.".

Police report already made
In two cases, the reason for not reporting was that a police report had already been made by someone else.Parents are positive about support In three cases, all with information about severe violence against siblings, it was stated that police reports should not be made because the parents were positive about receiving support measures from the social services.The investigations led to decisions on family support.The work of the social services helps the family better In one case, for which there was information about severe violence, it was stated that since the violence was not fatal, the family and the boy would receive better help through the work of the social services.The investigation was completed without support measures.The social services should see the child In two cases, the reason for not reporting was that the social services should see the child.In one of these, there were waiting times at Barnahus, leading to the belief that it would therefore benefit the child more to see the social services than to make a police report.In the second case, the reason for not reporting was that the social services wanted information from the child.
S. Quarles van Ufford et al.
study provide a basis for method development.These can be designed and scientifically tested for use in practice.
The findings of this study revealed a discrepancy between the NBHW's guidelines for police reporting of child abuse and the practice of the social services.Cases with a high indication for police reporting were not reported, and active stances on police reporting were largely lacking.Reasons given by the social services for not reporting to the police included parents being positive about receiving support and the belief that the social services can better help the family and child.These reasons are also described in previous research (Heinonen, 2015;Heimer et al., 2017; see also Cross et al., 2005, p. 8).It reflects the idea that police reporting and relevant support are in opposition to each other.However, the findings do not suggest that non-reporting meant support measures were provided through the social services to any great extent.Most of the CW investigations were completed without such measures, a result that is also evident in previous research (Cocozza et al., 2010;Persdotter & Andersson, 2020).Furthermore, only a small number led to protection or support linked to violence, an outcome not explained by support not being needed.A large number of the CW reports were based on disclosure by the child, and information about violence against close relatives was common (cf.Persdotter & Andersson, 2020).In addition, severe forms of violence were encountered to a relatively large extent.Overall, the findings indicate a need for support linked to violence in more than 8.2 % of the cases.Previous research suggests that police investigations increase the likelihood of various services being received (Cross et al., 2005).In this context, it should be noted that since many cases in the current study were not reported to the police, the interprofessional collaboration offered through Barnahus was not enacted for a large number of children, highlighting the need for broader forms of collaboration even when the social services refrain from reporting to the police (cf.Mosegaard Sjoberg, 2017).Taken together, these findings raise questions about the conditions for children's access to adequate protection and support, which is partly dependent on child participation (Barns, 2012;Heimer et al., 2018;McLeod, 2007).Although it was the children who largely provided information on exposure to violence, there was limited participation and poor access to protection and support.Previous research reports resistance among social workers to involving children in more severe cases (van Bijleveld et al., 2015).The research also reports that children risk being removed from their position as participants after intentional disclosure (Thulin et al., 2020).It is important for social authorities to recognize that abuse dynamics can prevent participation by the child, requiring cooperation directly with children instead of reaching them through their suspected abusive parents (Linell, 2017b).
In conclusion, the findings of this study suggest that failures to report to the police risk minimizing the violence or making it invisible.A police report per se entails suspicions of violence being addressed and potential conflicts of interest between the child and the parents thereby recognized (cf.Johansson, 2011).Dealing with this conflict may be problematic for a family-oriented system, with CW work also being largely dependent on cooperation with parents (Svensson & Höjer, 2016).It is widely acknowledged that the issue of how to balance children's and parents' rights is not sufficiently addressed in Swedish legislation; social services are given vague legal tools with a strong emphasis on investigations and support measures being carried out in cooperation with the parents (Leviner, 2011).The low proportion of decisions on protection and support can be partly understood against this background.The lack of an active stance on police reporting and non-reporting may be a way of dealing with (avoiding) the conflict of interest between children and parents.For the child, however, this avoidance risks protection and/or support not being provided.

Limitations and strengths of the study
The focus of this study is not on the child's overall life situation but on physical and sexual child abuse.This entails limitations in estimating the seriousness of the child's situation, which may include forms of child abuse and neglect other than this study aimed to capture.It is also generally difficult to estimate the severity of violence, as there is not always a high level of physical violence, but rather other power strategies that affect abuse dynamics (Linell, 2017c).The fact that it was relatively common for the violence in the CW reports to be "unspecified" implies a further limitation in capturing the severity of the violence.Such violence was classified here as less severe, whereas the actual violence may have taken serious forms.This limitation was partially counterbalanced by subsequent assessments that used the entirety of the investigative material.The low proportion of cases (4.5 %) with an active stance on police reporting should also be addressed, as these findings only gives some indication of the social services' reasons for not reporting to the police.The strengths of this study include the use of a total sample from different municipalities, the exclusion of non-criminalized violence, estimation of the severity and suspicion of violence, and the use of social services' complete file material, which provides reliable data on the actual information on which the CW investigations are based.Use of all file material enabled data control and limited the risk of bias due to possible inadequate documentation.Data coding was performed by one researcher, which carries the risk of individual researcher influence.Since a jointly developed, detailed, and step-by-step data collection form (see the Methods and materials section) was used to ensure rigorous coding, with any trade-offs discussed jointly, the possible impact of one-person coding was minimized.

Implications for practice
The findings of this study raise the issue of the need for increased guidance and regulation of the social services' police reporting of child abuse.The findings also raise questions about broader forms of organized interprofessional collaboration around child abuse, including non-police-reported child abuse.The low rates of police reports and the limited application of protection and support measures in this sample have important implications for the development and implementation of local policies.We see a need to ensure active, structured assessments of police reports.The use of assessment criteria can facilitate structured assessments of the relevant factors that could increase the likelihood of serious child abuse being reported to the police.To increase access to protection and support, we emphasize the importance of the social services clearly addressing suspicions of violence, recognizing the abuse dynamics that can affect children's conditions for participation, and ensuring safe child participation from the start (cf.Linell, 2017b).

Implications for research
In light of the above, we see a need for increased knowledge and research about the interplay between participation, protection, and provision, as well as the conditions for an accurate understanding of the child's situation (cf.Backe-Hansen & Falch-Eriksen, 2018).There is also a need for research on the social services' reasons for non-police reporting and difficulties associated with police reporting.In addition, further exploration of interprofessional collaboration for non-police reported violence is warranted.

Declaration of competing interest
None.

Table 3
Occurrence of police reports.

Table 4
Total points for factors indicating a police report.