The aim of this mixed methods study is to gain knowledge about how a program for identification of family violence works within child health services. The main research questions are:

• To what extent are questions about family violence asked to mothers and fathers visiting the child health services in the Region of Stockholm?
• How can area level socioeconomic factors affect whether parents are asked questions about family violence in the child health services?
• How do child health nurses experience asking parents about family violence?What challenges and opportunities do they meet when they identify family violence?

Being exposed to family violence (FV) as a child is associated with an increased risk of negative impact on development and health both in the short and long term. Research shows that FV occurs in all cultures and in all social classes. However, there is an increased risk of FV in areas with a higher degree of social vulnerability. For children, FV means being directly exposed to psychological, physical, sexual violence or neglect. It can also mean experiencing violence between adults in the home, which leads to the same negative consequences for the child. Parents with current or previous experiences with FV have an increased risk of difficulties in parenting skills, which in turn can affect the child negatively.

In Sweden, almost all children 0-5 years old are enrolled in the child health services (CHS). As part of the CHS-program, all parents are offered an individual visit within the first six months of their child's life to address parenting topics and parental mental health. Questions about FV are asked during that individual visit. The CHS thus has a unique opportunity to detect FV in the family at an early stage in the child's life.

This mixed methods study evaluates how a program for identification of family violence works within child health services. The quantitative part is a registry based observational study to investigate the extent to which both mothers and fathers are given the opportunity to respond to questions about FV within CHS in the Stockholm region. Furthermore, it examines whether there is an association between being asked about exposure to violence and the socioeconomic status of the catchment areas of CHS centers. The qualitative data consist of interviews with child health nurses.

De-identified medical record data regarding questions about family violence addressed to the child's parents will be collected from approximately 90,000 child records at the CHS centers. Included CHS centers are located in areas with different socioeconomic status. Data cover the period 240630-250630. Background data on the organizational conditions (number of employees, training to identify FV) of the included CHS centers are also obtained. The results are also measured based on the clinic's sociodemographic, according to the Care Need Index (CNI). The data enables comparisons between different CHS centers, and the interviews contributes to an in-depth analysis of the study's results based on varying contextual factors that may assist or hinder the identification of FV.

Inclusion Criteria:

• Parents to children enrolled in the CHS
• Child health nurse working at one of the included CHS centers

Exclusion Criteria:

-

The population are parents to children enrolled in CHS in the Stockholm region and nurses working in CHS in the Stockholm region

IDP are not avialable due to the ethical approval. Access to data requires ethical approval and could then be provided upon request.