Referral pathways as mechanisms of child maltreatment identification: evidence from a German Childhood-House

Background Adverse childhood experiences-related child maltreatment, including abuse and neglect, are major threats to children's safety, health, and development. Their identification depends on recognition and referral processes occurring across multiple professional systems. Childhood-Houses, based on Child Advocacy Center and Barnahus principles, provide multidisciplinary assessment and support for children with suspected maltreatment experiences. Objective This study examined whether identified child maltreatment profiles and multidisciplinary assessment processes differed according to referral pathways to a German Childhood-House. In addition, perspectives of external referrers regarding interdisciplinary collaboration were explored. Methods A quantitative observational study was conducted using two complementary data sources. Routine documentation data from children and adolescents referred to the Childhood-House Hamburg between January and September 2023 were analyzed ( n = 731). Furthermore, an exploratory online survey among external referrers from youth welfare services, healthcare, and law enforcement agencies was conducted in the same period ( n = 66). Descriptive and exploratory analyses examined differences in referral pathways, identified maltreatment profiles, multidisciplinary assessment procedures, and collaboration experiences. Results Referral pathways were associated with distinct child maltreatment profiles. Medical, physical, and emotional neglect were identified predominantly among youth welfare referrals, while physical abuse and sexualized violence occurred more frequently among healthcare and law enforcement referrals. Multidisciplinary assessment procedures also differed across referral pathways. Referrers reported generally positive collaboration experiences but identified needs for improvement regarding psychological assessment, feedback procedures, and interdisciplinary communication. Conclusions The findings indicate that referral pathways serve as important mechanisms of child maltreatment identification and influence access to multidisciplinary child protection services. Strengthening standardized identification procedures, referral structures, and cross-sector collaboration may support more comprehensive responses to ACE-related child maltreatment experiences.