PDF(Pubmed)
Abstract：
BACKGROUND: The perinatal period is known as time of transition and anticipation. For women with social risk factors, child protection services may become involved during the perinatal period and this might complicate their interactions with healthcare providers.
OBJECTIVE: To systematically review and synthesise the existing qualitative evidence of healthcare experiences of women and healthcare professionals during the perinatal period while facing child protection involvement.
METHODS: A systematic search of databases (Web of Science, MEDLINE, EMBASE, PsychINFO, CINAHL, ASSIA, MIDIRS, Social Policy and Practice and Global Health) was carried out in January 2023, and updated in February 2024. Quality of studies was assessed using the Critical Appraisal Skills Programme. A Critical Interpretative Synthesis was used alongside the PRISMA reporting guideline.
RESULTS: A total of 41 studies were included in this qualitative evidence synthesis. We identified three types of healthcare interactions: Relational care, Surveillance and Avoidance. Healthcare interactions can fluctuate between these types, and elements of different types can coexist simultaneously, indicating the complexity and reciprocal nature of healthcare interactions during the perinatal period when child protection processes are at play.
CONCLUSIONS: Our findings provide a novel interpretation of the reciprocal interactions in healthcare encounters when child protection agencies are involved. Trust and transparency are key to facilitate relational care. Secure and appropriate information-sharing between agencies and professionals is required to strengthen healthcare systems. Healthcare professionals should have access to relevant training and supervision in order to confidently yet sensitively safeguard women and babies, while upholding principles of trauma-informed care. In addition, systemic racism in child protection processes exacerbate healthcare inequalities and has to be urgently addressed. Providing a clear framework of mutual expectations between families and healthcare professionals can increase engagement, trust and accountability and advance equity.
OBJECTIVE: To systematically review and synthesise the existing qualitative evidence of healthcare experiences of women and healthcare professionals during the perinatal period while facing child protection involvement.
METHODS: A systematic search of databases (Web of Science, MEDLINE, EMBASE, PsychINFO, CINAHL, ASSIA, MIDIRS, Social Policy and Practice and Global Health) was carried out in January 2023, and updated in February 2024. Quality of studies was assessed using the Critical Appraisal Skills Programme. A Critical Interpretative Synthesis was used alongside the PRISMA reporting guideline.
RESULTS: A total of 41 studies were included in this qualitative evidence synthesis. We identified three types of healthcare interactions: Relational care, Surveillance and Avoidance. Healthcare interactions can fluctuate between these types, and elements of different types can coexist simultaneously, indicating the complexity and reciprocal nature of healthcare interactions during the perinatal period when child protection processes are at play.
CONCLUSIONS: Our findings provide a novel interpretation of the reciprocal interactions in healthcare encounters when child protection agencies are involved. Trust and transparency are key to facilitate relational care. Secure and appropriate information-sharing between agencies and professionals is required to strengthen healthcare systems. Healthcare professionals should have access to relevant training and supervision in order to confidently yet sensitively safeguard women and babies, while upholding principles of trauma-informed care. In addition, systemic racism in child protection processes exacerbate healthcare inequalities and has to be urgently addressed. Providing a clear framework of mutual expectations between families and healthcare professionals can increase engagement, trust and accountability and advance equity.
摘要：
背景：围产期被称为过渡和预期时间。对于有社会危险因素的女性，儿童保护服务可能会在围产期参与，这可能会使他们与医疗保健提供者的互动复杂化。
目的：系统回顾和综合妇女和保健专业人员在围产期面临儿童保护参与的医疗保健经验的现有定性证据。
方法：对数据库的系统搜索(WebofScience，MEDLINE,EMBASE,心理信息,CINAHL,ASSIA,MIDIRS,社会政策与实践与全球卫生）于2023年1月进行，并于2024年2月进行了更新。使用关键评估技能计划评估研究质量。与PRISMA报告指南一起使用了关键解释性综合。
结果：共有41项研究纳入本定性证据综合。我们确定了三种类型的医疗保健互动：关系护理，监视和回避。医疗保健互动可能在这些类型之间波动，不同类型的元素可以同时共存，表明在围产期期间，当儿童保护过程在发挥作用时，医疗保健相互作用的复杂性和互惠性。
结论：我们的研究结果为儿童保护机构参与医疗时的相互互动提供了一种新颖的解释。信任和透明度是促进关系关怀的关键。机构和专业人员之间需要安全和适当的信息共享，以加强医疗保健系统。医疗保健专业人员应获得相关培训和监督，以便自信而敏感地保护妇女和婴儿，同时坚持创伤知情护理的原则。此外,儿童保护进程中的系统性种族主义加剧了医疗保健不平等，必须紧急解决。在家庭和医疗保健专业人员之间提供明确的共同期望框架可以增加参与度，信任和问责，推进公平。
目的：系统回顾和综合妇女和保健专业人员在围产期面临儿童保护参与的医疗保健经验的现有定性证据。
方法：对数据库的系统搜索(WebofScience，MEDLINE,EMBASE,心理信息,CINAHL,ASSIA,MIDIRS,社会政策与实践与全球卫生）于2023年1月进行，并于2024年2月进行了更新。使用关键评估技能计划评估研究质量。与PRISMA报告指南一起使用了关键解释性综合。
结果：共有41项研究纳入本定性证据综合。我们确定了三种类型的医疗保健互动：关系护理，监视和回避。医疗保健互动可能在这些类型之间波动，不同类型的元素可以同时共存，表明在围产期期间，当儿童保护过程在发挥作用时，医疗保健相互作用的复杂性和互惠性。
结论：我们的研究结果为儿童保护机构参与医疗时的相互互动提供了一种新颖的解释。信任和透明度是促进关系关怀的关键。机构和专业人员之间需要安全和适当的信息共享，以加强医疗保健系统。医疗保健专业人员应获得相关培训和监督，以便自信而敏感地保护妇女和婴儿，同时坚持创伤知情护理的原则。此外,儿童保护进程中的系统性种族主义加剧了医疗保健不平等，必须紧急解决。在家庭和医疗保健专业人员之间提供明确的共同期望框架可以增加参与度，信任和问责，推进公平。
