Table 4

Third-order constructs—recommendations at each socioecological level

Socioecological levelRecommendation
Public policy
(laws and policy)
Research about mandatory reporting laws should attend to the unintended negative consequences of reporting, such as the creation of adversarial care environments.
Community factors
(relationships among organisations, institutions and informal networks)
All sectors involved in responding to reports of maltreatment should improve collaboration and the coordination of their responses, in order to minimise punitive, threatening and fear-inducing service responses.
Institutional factors
(institutional characteristics and rules for operations)
Health and social service institutions should address tensions between their child-focused and mother-focused services, remembering that ensuring the safety and well-being of the mother is often essential in prioritising the safety and well-being of the child.
Interpersonal relationships
(formal and informal relationships)
HCPs should listen to caregivers’ and children’s communicated concerns; respond to caregivers and children with empathy, warmth, understanding, support and appropriate referrals to the community; and, when appropriate, provide caregivers with information about the impact of exposures, such as intimate partner violence or addictions, on children in a manner that is non-judgemental.
HCPs should communicate with caregivers/children about the limits of confidentiality and the types of situations that could or would not lead to a report.
CPS responses should prioritise listening to caregivers’ stories, opinions and aspirations; building relationships based on collaboration, partnership, honesty, trust and shared decision-making; enabling caregivers to gain access to material goods and other services (eg, housing, food, clothing, childcare, counselling, drug treatment); and caregivers’ bond with their children. CPS responses should also strive to be hopeful instead of bureaucratic.
In cases of intimate partner violence, CPS responses should focus on perpetrator accountability and support of adult victims, while monitoring the safety of children.
Individual factors
(knowledge, attitudes, skills, etc)
HCPs and CPS personnel should understand the marginalised locations from which mothers seek care, which includes comprehensive knowledge about experiences with addictions and intimate partner violence and appropriate, non-judgemental responses to individuals with these experiences.
  • CPS, child protective services; HCP, healthcare provider.