Table 4

Second-order constructs (views of study authors) and the number (n) and per cent (%) of articles that address each construct

Second-order construct	(n, %)	Description and citations for supporting articles from the top quartile	Illustrative quotes
1. Training and knowledge	n=38, 86%	MRs must know how to identify all forms of child maltreatment, including common and less overt forms of child maltreatment (emotional maltreatment, physical neglect, emotional neglect, abuse against children with disabilities).42 43 75 95 107 110 112 MRs must know how best to respond to a child and family when child maltreatment is identified or disclosed.43 107 112 MRs must know common issues encountered when reporting, such as ethical conflicts, moments where MRs hesitate to report, confidentiality issues, jurisdiction-specific legislation, risks and benefits of reporting, strong feelings that arise from child maltreatment cases, consequences of failure to report.76 107 110 MRs must know the purpose of mandatory reporting, that is, child safety and well-being.107 109 MRs must know their duty to report and how this differs from their moral responsibility to respond.43 107	“All practitioners whose patients include children should avail themselves regularly of educational opportunities to increase their knowledge of the epidemiology and evaluation of child abuse and neglect.”112 “Professionals and authorities should have increased awareness of the legislation and their duties in all forms of violence.”104 “Good guidelines are important, but missing guidelines must not be an excuse not to care.”107 “Reporting, a legal requirement, must be separated from responding, which is a moral duty.”99
2. Consultation	n=23, 52%	For child protection to be successful, there needs to be better collaboration between all professionals in the reporting process.42 43 107 109 111 MRs should be able to discuss cases of suspected child maltreatment with others, whether that be members of their own team, a child maltreatment team at their institution or CPS personnel.75 76	“Another important finding from the study is the urgent need to improve systematic collaboration and a trustful relationship with CPS.”43 “An important resource to develop in an effort to improve child abuse and neglect detection and reporting may be the identification and ongoing support of child abuse and neglect content experts within nonpediatric and nonacademic hospital.”75
3. Communication	n=21, 47%	MRs should communicate clearly with the child or family about their reporting duties and the limits of confidentiality.108 112 MRs require feedback from CPS about reported cases.75 76 MRs should be afforded opportunities to formally and informally talk about child maltreatment with other MRs.40 42 75 95 107 109 110	“Forewarning is critical for ensuring that clients do not feel deceived into thinking that superior levels of confidentiality exist.108 “Mandated professionals require feedback from child protection agencies.”76
4. Support	n=12, 27%	MRs should be supported in their reporting process by their respective institutions, both in terms of the time and costs of reporting (including support of their personal safety). Support may require additional staff experts in child maltreatment.40 75 76 107 MRs should partake in self-care and be supported in stress and coping management.76 110	“Employing bodies are encouraged to provide a suitable support mechanism to decrease the stress and anxiety of individuals who are emotionally traumatised by the process of mandatory reporting.”76
5. Structural concerns	n=7, 16%	MRs need clear protocols for identifying child maltreatment and reporting it, as well as methods for reviewing and updating protocols.42 75 76 110	“It is recommended that a formalised national framework for reporting and feedback be established, which incorporates exemplar cases to demonstrate processes and outcomes which will positively influence future decision-making of mandated professionals.”76
6. Child rights & well-being	n=6, 14%	MRs should prioritise children’s rights and well-being throughout the reporting process.113	“If the intention is for children to have the full status of victim, the focus should not only be on reporting but also on the responses following reporting.”104
7. Cultural competence	n=4, 9%	MRs’ and CPS’ responses to child maltreatment should be culturally competent and families’ preferences for alternative ways of dealing with abuse (eg, restorative justice) should not be dismissed.53	“People’s preference for traditional ways of dealing with problem should not be taken lightly, especially as any dismissal of it could be taken as constituting a lack of trust and understanding by the establishment of the current African ways of dealing with abuse.”53
8. Evidence	n=4, 9%	MRs should report suspicions of abuse rather than wait for evidence of abuse, when this is their legislative duty.107	“Physicians and other healthcare workers are legally required to report cases if they have reasonable suspicion of child abuse.”92

CPS, child protective services; MRs, mandated reporters.