Vietnam study finds school abuse screening lacks reliable follow-up services

Vietnam’s child-protection system can identify violence against children through schools, but a convergent health-systems study finds that the chain connecting detection to referral, treatment and follow-up weakens or breaks at nearly every major link. Researchers combined a national desk review with 25 in-depth interviews and 16 student focus-group discussions conducted in eight public lower-secondary schools in Bac Giang province. The review mapped the national service chain, while the qualitative component examined how teachers and students experienced it. Because the participants were purposively selected in one province and the study was not designed to estimate national prevalence, the accounts illustrate mechanisms rather than show how common each experience was across Vietnam.

The central finding was that detection did not reliably become protection. Schools were expected to screen students for maltreatment and mental-health concerns, and many had a room designated for psychological counselling, but none of the eight participating schools employed a dedicated professional counsellor or social worker. Teachers or administrative staff often performed these functions despite limited relevant training, and schools had no standardized bridge to services outside the school. The review also found that no single actor was clearly accountable for following a case after it left the classroom. This fragmentation mattered because an unanswered disclosure did not only fail to provide care; it also gave students little evidence that speaking again would produce a reliable response.

The gap extended into specialist care. Vietnam had a nationwide mental-health examination and treatment system, but the desk review found limited child-specific facilities and workforce capacity, while general hospitals in the study province did not have clinical or pediatric-psychology units. The main specialized destination was a provincial psychiatric hospital that participants associated with severe conditions and the stigmatized label of “mental illness.” Its distance was especially consequential for rural students, and no nearby, non-stigmatizing alternative was available. As a result, some young people and families avoided formal referral and instead turned to peers, other informal support or the internet. The study did not measure the prevalence of this avoidance, but student accounts showed how a service’s location and social meaning could deter uptake even when it technically existed.

Interviews and focus groups showed that trust was often invested in people rather than institutions. Students described confiding mainly in close friends because abuse within a family could be normalized, loyalty could conflict with disclosure and a caregiver might be the source of harm. One student said, “We don’t usually talk about it unless it gets really bad, and even then only with close friends. It’s hard to talk about family stuff.” Another explained, “It’s hard to tell anyone, because no one wants to say bad things about their own parents. And anyway, even if we did speak up, there’s usually no one who can really help.” These qualitative statements align with an earlier survey phase of the same research programme, in which about one-third of adolescents who had experienced physical abuse had disclosed to someone but only 2.95% had told a formal recipient, such as a teacher, counsellor, social worker or health worker.

Formal reporting could also expose the child and the adult attempting to help. A teacher described a case in which a family accused the school of interfering in private matters after violence at home was reported. Participants said abuse was often recognized only when it became severe, and that parental authority as legal guardian limited what a school could do without family cooperation. Physical or emotional abuse could also be treated as a private family matter, with formal action depending heavily on visible evidence. These accounts describe a pathway in which disclosure might provoke family conflict without producing assured protection. The research did not establish that reporting routinely increased harm; instead, it identified structural conditions under which children and teachers could reasonably perceive the risks of disclosure as greater than the expected benefit.

The national child helpline, 111, was the closest thing to a broadly available formal channel, but it did not function as a complete specialist referral service. Operational statistics reviewed by the researchers showed 368,444 calls in 2022 and 323,615 in 2023. Yet reporting from the helpline indicated that only about 2–5% of contacts were escalated for emergency referral to local child-protection services, including commune authorities, police, health facilities and social-work centers. Access was also uneven. Lower-secondary students often did not own a private phone, making use of a parent’s device impractical or unsafe when the parent might be causing the harm. Although 111 could also be reached through a mobile app and messaging platforms such as Zalo, students and teachers were often unaware of those routes, which were potentially more private than a telephone call.

Coordination failures compounded the shortages at each service tier. Child-protection responsibilities were distributed among ministries and agencies operating different management models, including health, education, labour and social affairs, police and local government. Formal inter-agency coordination existed largely on paper, while commune-level officials often lacked specialized training and no professional was clearly responsible for case follow-up. The service-gap map traced a sequence in which schools identified concerns without a dependable referral bridge; child mental-health care was thinly staffed, distant or stigmatized; the helpline rarely connected callers to specialized services; and no mechanism consistently closed the loop. A child who disclosed abuse could therefore leave school without knowing who had received the concern, whether anyone was following it or what support would follow.

Vietnam’s 2025 administrative reform adds uncertainty, not a demonstrated solution. The reform merged provincial units, abolished the district administrative tier and moved some child-related functions toward the health sector. Because the qualitative fieldwork ended in March 2024, before the reform took effect, the researchers did not evaluate its effects on children. Their desk-review interpretation was prospective: abolishing the district tier might initially remove a coordinating layer before replacement services were fully in place, potentially placing greater pressure on commune social-welfare staff with uneven professional capacity. In the longer term, integrating social-work and psychosocial functions into the health system could give post-screening support a clearer institutional home. These were possibilities for post-reform research rather than observed outcomes.

The study highlights an ethical tension in screening as public-health practice. Identifying need without an acceptable, accessible and non-stigmatizing service at the output can cause secondary harm by showing children that disclosure changes little and by placing additional pressure on those who try to assist them. The authors therefore caution against expanding detection faster than referral and follow-up capacity. They propose making one actor accountable for post-screening care, creating clear referral protocols and feedback to students, and placing child- and adolescent-friendly psychosocial support close to schools rather than relying on distant psychiatric facilities. Schools also need a routine, non-stigmatizing way for students to be heard, while information about helpline 111 should cover private app and messaging channels as well as telephone access. These are policy implications from the study, not interventions whose effectiveness was tested.

The evidence has clear boundaries. The desk review was a structured narrative synthesis of publicly available legal, administrative, statistical and agency documents, so its conclusions depend on the completeness and quality of those records. The interviews included eight school-board members, eight homeroom teachers, eight teachers who served as counsellors or social-work focal points and one provincial education leader; the student focus groups included grade 7 and grade 9 participants in mixed-sex groups. They came from four rural and four urban public schools, and no private schools were represented because the province had none in the sample frame. The findings are therefore not statistically generalizable to Vietnam as a whole. Their principal value is analytical transferability: they identify a testable mechanism for other fragmented systems in which detection expands before specialist services, case ownership and accountable follow-up are available, potentially concentrating access inequities among children least able to navigate the system independently.

Subject of Research: Post-screening gaps and inequitable access to child-protection services in Vietnam

Article Title: Screening with a limited safety net: post-screening service gaps and inequitable access to child protection in Vietnam

Article References: Le, T. M., Bui, P. T., & Nguyen, T. (2026). Screening with a limited safety net: post-screening service gaps and inequitable access to child protection in Vietnam. Frontiers in Public Health, 14, Article 1930066. https://doi.org/10.3389/fpubh.2026.1930066

Image Credits: AI Generated

DOI: 10.3389/fpubh.2026.1930066

Keywords: Vietnam, child protection, school screening, service access, institutional trust, mental health services, help-seeking, health equity, administrative reform, qualitative research, Screening, limited