Table 3

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

Second-order constructFound in article (n, %)Description of constructIllustrative quotes
Appropriate HCP responses19, 54
  • HCPs should respond to caregivers in a non-judgemental, empathetic, and warm manner, including offering support and referral to key services.

  • HCPs should communicate with caregivers/children about the limits of confidentiality and the types of situations that can lead to a report.

‘Finally, fear of the authorities and of losing a child to them was strong amongst the interviewees, indicating that clearer policies on child removal and more information about the protocol of child protection services should be provided to pregnant women with drug problems as early in the pregnancy as possible.’115
Appropriate CPS responses10, 29
  • CPS workers should seek out the voices and perspectives of clients they are serving.

  • CPS responses should be based on principles of strengths, empowerment, honesty, partnership and cultural competence.

  • CPS responses should focus on material supports for clients and referrals to community supports.

‘Therefore, if it is deemed necessary to remove a child after a thorough strengths-based assessment that provides women with support, CPS workers need to address the trauma associated with apprehension.’41
Knowledge and training13, 37
  • HCPs and CPS personnel should have nuanced knowledge/training about the unique circumstances of vulnerable groups.

  • HCPs should know about their jurisdiction’s reporting requirements and impacts of reporting and caregivers and children.

‘Child welfare agencies also need continuing education regarding perinatal substance abuse and treatment options and can partner with courts, substance abuse treatment systems and child health agencies in therapeutic projects of child protection that promote recovery and family cohesion.’30
 HCPs7, 20
 CPS5, 14
Collaboration and coordinated systems of care12, 34
  • HCPs and CPS personnel should collaborate and work to minimise structural barriers and maximise coordinated systems of care.

‘Development of ‘accessible, comprehensive and integrated services in centralised settings… underpinned by trauma-informed systems of care’… requires the collaborative effort of all service providers as well as consumer participation so services are acceptable to mothers’44
Impact of reporting—research and legislation10, 29
  • Future research should address the complexities and impact of mandatory reporting.

  • Legislators and policy-makers should consider the impact of reporting legislation on children, caregivers, and reporters and on their therapeutic relationships.

‘Further research should be conducted with the specific purpose of examining these mandatory reporting issues in the context of home visitation, as the present study indicates that health care professionals involved in home visitation are not unaffected by the issues related to mandated reporting in these two controversial instances’56
Child safety and well-being8, 23
  • Children’s safety and well-being must be prioritised.

  • Ensuring the safety and well-being of adult victims of intimate partner violence (often the mother) helps to ensure children’s safety and well-being.

‘Programs must address the tension between child-focused and mother-focused providers and services. This tension is illustrated by the often adversarial relationships between child welfare agencies that seek to protect the children and substance abuse treatment providers who advocate for the mothers. As programs are developed, the mother–child dyad should be viewed from the beginning as the target unit to be served. This avoids later questions of ‘Who is the client?’37
 Focus on mother and child7, 20
 Focus on child1, 3
  • CPS, child protective services; HCP, healthcare provider.