2.1. Search Methods

Inclusion and exclusion criteria were established in accordance with the study aims (Table 1). Parents were defined as any primary caregiver (social or biological) of a child. Foster or kinship carers who were legal caregivers of a child following statutory removal were excluded because their experiences are unique. Foster and kinship carers interact with supports before and/or after taking custody of children who were removed by child protection services, which is different from other parents.

To ensure a consistent understanding of parental adversities across the research team, we developed list of adversities (Table 2) from key international documents, namely, the World Health Organization [26], Centre for Disease Control’s Adverse Childhood Experiences [27], Australia’s Safe and Supported: National Framework for Protecting Australia’s Children [28] and Public Health England’s No child left behind [29]. This list was comprehensive because no further potential parental adversities were identified during study screening and synthesis.

3.1. Study Selection

Next, citations were collated in Endnote and uploaded into Covidence where 6315 duplicates were removed. Independent title and abstract screening was undertaken by two authors and disagreements resolved through discussion. Next, 388 full texts were retrieved, imported into Covidence and assessed against the inclusion criteria. Full-text screening identified that many (n = 136) studies met the inclusion criteria but were not directly applicable to the context of interest (Australia). Therefore, only 16 studies which were conducted in Australia were included in the review synthesis (Figure 1). Key differences included (1) health and social care structures and services, (2) educational preparation and roles of professionals and (3) health and social issues not relevant to the Australian population. Consequently, the authors synthesised only Australian studies to enable meaningful recommendations for policy and practice. Thus, 16 qualitative manuscripts were included, with a full summary of search and study inclusion represented in Figure 1 (PRISMA chart). One challenge experienced when implementing inclusion and exclusion criteria was inadequate reporting of children’s ages. The authorship team decided to include studies where children’s age was unclear if studies otherwise met eligibility criteria to ensure relevant findings were not missed. Only three studies clearly reported children’s ages, but in other studies (n = 7), the service context (postnatal) or study inclusion criteria meant it was apparent all children were under 5 years. In the remaining six studies, it was not possible to determine children’s ages.

4.1. Theme 1: Adversarial Relationships Disempower Parents

Theme 1 “Adversarial relationships disempower parents” described how parents’ perceptions of interactions with professionals as adversarial rather than supportive. Parents reported lack of empathy and often felt prejudged or blamed by professionals or situations where communication was inadequate or inappropriate.

At the core of parents’ experiences of adversarial relationships was a lack of empathy and compassion ( n = 7) [31, 32, 40–43, 45, 48], including where they were not listened to or understood ( n = 10). A lack of empathy included patronising attitudes [31, 41] and disregard for parents’ feelings [40, 43, 48]. Some professionals implemented supportive interventions but helpfulness was diminished if not paired with empathy. For example, one mother acknowledged helpful intent but explained: “You are looking for the human understanding, not the man or woman behind the seat that tells you what you have to do to feel better” [41]. Parents frequently felt professionals did not listen, or when they did “listen,” parents did not feel “heard.” For example, “I did not feel understood. They listened but were quite dismissive” [35]. Parents emphasised the value of listening to build understanding of “different stories” [40] for a nuanced picture of complex circumstances [13, 34, 35, 44].

Parents also experienced a lack of communication or exclusion ( n = 11) [13, 31, 32, 34–36, 40–44, 48]. Examples of lack of communication included failure to seek parental perspectives: “I am pretty much in the dark as to what is happening… there is not much communication” [35]. Difficulties also included parents feeling their input was rejected when professionals set boundaries on participation, “we were not allowed to ask her what school she’s at, if she’s progressing, where she’s got friends, whether she’s happy” [43]. At other times, communication was inadequate for parents’ needs, leading to confusion; moving goalposts (n = 8) [31, 32, 34, 36, 40–43, 48]. One parent needed ‘step by step’ explanations, saying “I could not see what they were trying to say in black and white. It was so confusing” [43]. At other times, parents experienced broken promises or betrayed (n = 8) [31, 32, 34, 35, 40, 43, 44, 48] after being misled: “They led us to believe we are keeping her [the baby] … [and later] handed me a piece of paper and said, we’re taking your baby” [48].

In addition to poor communication, some parents also experienced a lack of agency, coercion and threats (n = 8) [13, 31, 32, 34, 35, 43, 45] from professionals. Parents felt the lack of courtesy stemmed from unfair judgements, labels and expectations (n = 10) [13, 31, 32, 34–36, 40, 41, 48]: “they would not talk to us. They avoided us like we had herpes” [32]. At times, this meant parents felt they were seen as “part of the problem” [31]. First Nations families also experienced racism and discrimination: “we have different ways of looking after our children—they do not know how we act” [31]. Professionals’ negative judgements were not only unhelpful but also unfair because they did not acknowledge the complexity of parents’ circumstances. Many parents were impacted by past trauma [13, 31, 45, 46] and/or felt held responsible for their partner’s choice to use violence [36]. When parents did not meet expectations, they were scolded and/or coerced into “appropriate” behaviour which they had little power to challenge [13, 31, 32, 34, 35, 43, 45].

In summary, parents experiencing adversity often encountered poor communication and lack of respect from professionals. Consequently, instead of feeling supported to respond to challenges impacting parenting, parents felt ignored, blamed and without effective support.

4.2. Theme 2: Relational Practice Empowers Parents for Change

This theme reports positive relationships with professionals which helped parents feel validated and supported, introducing the possibility of change. All studies reported some examples of positive interactions with professionals. Key elements included the professionals’ interpersonal skills such as being there; providing emotional support (n = 7) [33, 35, 40, 44–46, 49] while listening, valuing and including parents (n = 11) [13, 34–36, 40, 41, 44–46, 49]. For example, one parent described the professionals as “just being supportive—emotional support, letting us know they are interested, knowing if we are having difficulty we can call them for help” [35]. Parents impacted by highly distressing circumstances needed a listening ear: “they let you express yourself and talk it all through … I was sitting here blubbering my eyes out, I was a mess and they care, I can tell them what problems I am having and they give me ideas of what to do” [44]. Professionals facilitated building a friendly and close bond (n = 9) [33–35, 44–46, 49]; this was especially valuable for parents with lower social capital: “Without them, I do not know what I would do, I have nobody else” [44]. Although relationships were friendly, some parents mentioned the importance of clear and goal-focussed interactions (n = 3) [33, 34, 36] clearly centred around parents’ health and wellbeing.

Other elements contributing to positive relationships included affirming parents’ capacity; strengths based (n = 5) [34–36, 44, 49], where professionals emphasised parents’ merits: “they praised me for the job I was doing” [35]. Professionals built parental agency by offering choices; partnership approach (n = 9) [13, 31, 33, 34, 36, 44, 46, 48], for example: “she would never tell me what to do” [33]. Given parents’ immediate social, financial and/or health needs, they also valued providing practical supports (n = 10) [13, 31, 34, 35, 37, 44, 46–49] and connecting parents to supports (n = 6) [31, 37, 41, 46–49]. Practical supports were tailored to parents’ circumstances to improve parental capacity: [Child protection] helped us out immensely, … they advocated on our behalf to get a house… gave us hampers, toys and tucker [31]. When professionals could not directly provide assistance, they linked parents with relevant services including parent support, playgroups, healthcare and counselling [37, 41, 49]. Helpfulness included being proactive and advocating for the parent (n = 5) [13, 32, 37, 45, 48] based on professionals’ anticipation of parental needs.

Through positive relationships with professionals, parents’ practical needs were met and their confidence and sense of agency were boosted. Parents were given opportunities to reflect on past experiences to consider ways to move forward. Thus, professionals were empowering parents for change, giving hope (n = 10) [13, 31, 33, 34, 36, 44–48] and enabling parents to reflect and learn (n = 7) [33, 34, 40, 43, 44, 46, 49]. Parents came from immensely difficult situations, but professionals’ support could build parents’ hopes of a better life: “she used to give me hope” [48]. In addition, parents appreciated how professionals enabled parents to reflect upon their assumptions and learn more positive ways of interacting, as outlined by one mother: “If I am calm, he [son] will be calmer … I have learnt it depends on how I talk to him too and he will answer back” [44]. Through positive interactions, professionals facilitated change for parents with flow-on benefits to parenting capacity.

This theme reported parents’ experiences of helpful, therapeutic interactions that made parents feel validated and supported to respond to challenges. For some parents, professionals’ supportive responses empowered parents to reflect and gain new perspectives, opening possibilities for change.

4.3. Theme 3: Challenges to Building Therapeutic Relationships

Although this review primarily explored elements of individual professional interactions, broader factors beyond individual professionals impacted parents’ experiences. Factors included service influences and parental characteristics. This final theme outlines parents’ key challenges to building therapeutic relationships as context for understanding parents’ experiences.

Parents reported barriers to accessing support (n = 6) [13, 32, 37, 41, 45, 49], including apprehension [13, 32, 37, 45], logistical challenges [13] or not knowing where to access help [41, 49]. Once parents did engage, they explained it takes time to build trust (n = 6) [13, 31, 36, 37, 45–48], especially because many parents had difficult histories [13, 31, 37, 45].

Although parents could establish trust with one professional, this did not necessarily carry through to other professionals or services. Parents highlighted service capacity for cohesive and competent support (n = 10) [13, 31, 34–36, 40, 43, 45, 48], such as helpful individuals [35, 45], but expressed frustrations about repeating their story [40] and poor coordination [13, 36]. At other times, parents’ experiences were clouded when service criteria did not fit parents’ complex needs [34, 36, 40, 48] or lead to unwanted child protection intervention [32, 43]. For example, one mother recognised her need for support but did not meet the criteria: “I asked for help for [daughter] because of her special needs and they pretty much said “Well, you’re not on a case, we can’t help you” [32].

Parents’ attempts to access support were often met with a lack of support or follow-up (n = 9) [31, 32, 34, 35, 37, 40, 41, 45, 48]. Sometimes, services had extensive waiting lists [41, 45], only provided short-term support [34] or did not follow-up [37]. Services parents engaged with were statutory child protection agencies (n = 8) or compulsory parenting services (n = 2), or other services where professionals were mandated reporters [50]. Consequently, tensions between supporting and reporting (n = 7) [31, 32, 34, 35, 43, 44, 48] arose when professionals prioritised child safety over parent support needs. Some parents disputed the validity of reports; other parents acknowledged professionals’ duty to respond to concerns of child harm: “I fully understand their duty of care…” [44]. Irrespective of perceived validity, parents expressed a desire for a greater transparency [34, 44].

In summary, parents’ interactions with professionals are influenced by individual professionals but also broader organisational and social factors. It is important to understand these factors to inform future service innovations and professional development.

5.1. Recommendations for Policy and Practice

This review has highlighted key challenges for Australian parents when accessing support for adversities that impact their parenting. The complexity of systems and service delivery means change will require sustained and collaborative action from all professionals and services responsible for children and families. For frontline professionals, this could include professional development opportunities to critically reflect upon their language and approaches for engaging with parents and building skills for difficult conversations. However, there are challenges around accessing suitable professional development because many current programs overemphasise risk-averse, child protective responses without incorporating skills for partnering with families experiencing adversity [74–76]. Consequently, building professionals’ capacity will require investment in development of professional education that teaches supportive, relational responses to parents to enable effective parenting [75, 77].

Professional knowledge and skills are important but must be underpinned by workplaces that enable relational practices. Organisations need strong leadership and commitment to implementing best-practice parental engagement, inclusive of clear guidelines, supervisory support and professional development for all staff. Specifically, this requires developing and enacting organisational cultures that promote partnerships with families in place of stringent adherence to risk-averse policies that marginalise parents and do not increase children’s safety [78, 79]. Examples of approaches that can promote engagement parents when embedded into services include strengths-based, trauma-informed, solutions-focussed and culturally safe practices [75, 77, 80]. Embedding these approaches into organisational practices requires a foundational culture of reflection and learning so professionals are not punished for unforeseeable poor outcomes for parents or children [79]. More broadly, best-practice strategies for engaging with parents must be consistent across services and sectors to inform shared approaches to parental support [81].

Furthermore, policy change should be founded upon a public health approach focussing on whole-of-population prevention and early support so fewer children require statutory child protection intervention [82]. In doing so, this public health lens can inform an Australia-wide service and sector orientation to explicitly acknowledge the complex interplay of current and historical socioeconomic conditions on families and reject narratives of individual blame [74]. Changes at all levels must to be guided by lived experiences of parents to ensure we effectively reduce experiences of stigma and blame that hinder help seeking and perpetuate cycles of marginalisation [83]. Further research is needed to identify effective intersectoral approaches to implement sustained change by all professionals, organisations and sectors working with families.

5.2. Limitations

This review has several limitations. First, the included studies do not represent the full range of sectors and services where parents may access support from health and social care professionals. Studies were primarily from statutory child protection services or compulsory parent support (10 of 16), while the others were from specialised services for parents experiencing severe adversities (mental health and terminal illness). There was minimal representation of parents’ experiences interactions with professionals within universal services which are the first point of contact. Second, studies did not always explicitly report children’s age, which made strict application of exclusion and inclusion criteria difficult. Consequently, it is possible some study findings also represented parents seeking support when experiencing adversities later in their parenting journey, such as with school-aged or adolescent children, where needs are different. Finally, our review excluded studies where the focus was on parents’ experiences of interactions when accessing routine health care rather than for support for a parental adversity. Although outside the scope of our review, studies about parents accessing routine healthcare services whilst also experiencing adversity may have further insights into parents’ diverse experiences. Despite these limitations, our review makes important contributions to understanding how parents experience interactions with professionals when accessing support, specifically in the Australian health and social care context. Therefore, it will inform future practice, policy and service innovation to improve parents’ experiences with accessing support from professionals when experiencing adversity.