Frameworks That Inform Professionals’ Communication and Early Support for Childhood Adversities: A Scoping Review

Identification of the Research Question

The research question was: What communication frameworks, protocols and guidelines are used by health, welfare and education practitioners to inform communication and early support with parents of children 0 to 5 years when there are ACEs? Specifically, the review objectives were to (1) identify and describe communication frameworks for professionals and (2) describe if/how they were evaluated.

Identification of Relevant Studies

A three-step search strategy was undertaken to locate published and unpublished studies. First, an initial limited search of Medline was undertaken by the lead author and a research librarian to identify articles on the topic. Words contained within the titles and abstracts of relevant articles and index terms were used to develop a full strategy for Medline (Appendix 1). This strategy was translated in Emcare, PsycInfo, Cumulative Index in Nursing and Allied Health Literature and Scopus with the research librarian and undertaken in January 2025; no date restrictions were applied. The full search strategy is presented in Appendix 1.

Studies were included if they presented a framework, toolkit, or guideline to aid professionals in communicating with parents during pregnancy or their child’s early years (ages 0–5 years) to offer support for ACEs. All geographical regions and primary research designs were included. Definitions for family adversities were informed by the authors’ past work (Lines et al., 2025b) and seminal works on ACEs (Felitti et al., 1998; Karatekin & Hill, 2019). Studies were excluded if they did not describe a framework, toolkit or guideline, were not applicable to ACEs in early childhood, were not primary research or occurred in involuntary settings (e.g. child protection). Studies focused on involuntary settings were excluded because this indicated that ACEs had escalated beyond the initial identification, primary prevention and early support. Full inclusion and exclusion criteria are presented in Table 1.

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Table 1.

Scoping Review Inclusion and Exclusion Criteria.

Inclusion criteria	Exclusion criteria
Health, welfare or education professionals.	Professionals other than health, welfare or education.
Professionals working with families perinatally or with children aged up to 5 years.	Professionals not working with families perinatally or with children aged up to 5 years.
Professionals working with families experiencing ACEs.	Professionals not working with families experiencing ACEs.
Communication frameworks, toolkits or guidelines that: • address one or more ACEs. • are applicable perinatally or with children up to 5 years. • have a conceptual evidence base and specific guidance for professionals. • are embedded within existing services.	Communication frameworks, toolkits or guidelines that do/are not: • address one or more ACEs. • apply perinatally or with children up to 5 years. • have a conceptual evidence base and specific guidance for professionals. • embedded within existing services.
Settings where health, welfare or education services are provided to children, parents and/or families on a voluntary basis.	Involuntary settings (e.g., statutory child protection).
All geographical regions; papers in English.	Papers in languages other than English.
All primary research designs, including quantitative, qualitative and mixed methods. Methodology can be development, implementation and/or evaluation of a framework.	Not primary research (e.g., reviews, policies, opinion papers).

Note. ACEs = Adverse Childhood Experiences.

Study Selection

All citations were uploaded into Covidence review software (n = 12,591). Duplicates (n = 2,931) were automatically removed (n = 2,765), with additional duplicates manually removed (n = 166) throughout the screening process.

After removing duplicates, titles and abstracts of papers identified in the search (n = 9,660) were screened independently by any two authors against inclusion and exclusion criteria; discrepancies were resolved by a third author or through discussion. Potentially relevant manuscripts identified by title and abstract screening (n = 318) were full-text screened by two authors, with discrepancies resolved through discussion.

After full-text screening, 25 manuscripts were identified for inclusion. Backwards and forwards citation screening on these initial manuscripts was performed on through the Scopus database. Potentially relevant additional manuscripts were recorded and also backwards/forwards citation screened. This process led to an additional 17 manuscripts being added into Covidence for screening; 8 were eligible for inclusion in the final review. Most manuscripts identified through backward–forward citation screening were additional studies of communication frameworks already captured in this review. These manuscripts did not appear in the original search because their titles and abstracts did not meet inclusion criteria. Ultimately, no new communication frameworks were identified through backward–forward citation screening. Further screening details are provided in the Preferred Reporting Items for Systematic reviews and Meta-Analyses flowchart in Figure 1.

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Figure 1.

PRISMA diagram.

Charting the Data

All relevant studies, regardless of methodological quality, were extracted and synthesised in line with scoping review methodology (Peters et al., 2020). A critical appraisal was not undertaken because this scoping review aimed to identify available evidence rather than providing actionable recommendations to inform practice (Peters et al., 2020). A data extraction template was created by two authors (LL, AW), piloted, and refined in consultation with all authors (Aromataris et al., 2024).

Collating, Summarising and Reporting the Results

Results were reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines for reporting on scoping reviews. The final structure of review findings was informed by research aims and refined through discussions and mutual agreement of all authors.

Key Findings Summary

Thirty-three manuscripts reported on 15 unique communication frameworks from five countries (United States n = 19, Canada n = 5, Australia n = 3, Sweden n = 3, United Kingdom n = 3) published from 2002 to 2024. All manuscripts reported on either development, implementation and/or evaluation of a communication framework that guided professionals to have conversations and initiate responses to ACEs. Overall, the communication frameworks identified represented diverse settings, populations and evaluation measures. However, there was often scant or missing information about key elements of the framework – such as which adversities were addressed or what guidance was available for practitioners. The diversity of communication frameworks along with the level of detail provided made synthesis difficult. A full summary of key study characteristics is presented in Table 2.

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Table 2.

Summary of Included Studies.

First author, year and location	Framework name and summary	Study focus, design and methods	Adversities addressed	Professions targeted	Description of framework	Outcome measures
Abatemarco et al. 2008 USA	Practicing Safety – child abuse prevention embedded within primary care (family practice)	Implementation Quality Improvement – Multimethod Assessment Process	Maternal mental health, familial stressors, adverse childhood experiences	Physicians and other staff (not specified)	Procedures to be followed during routine family practice appointments packaged as three bundles of tools (Maternal, Infant, and Toddler) addressing common psychosocial challenges. Staff resources included questions, prompts and reminders to screen, provide anticipatory guidance and resources relating to three maternal and infant/toddler health areas	Chart audit of practice change (baseline and monthly) Physician perspectives
Abatemarco et al. 2018 USA		Implementation Quality Improvement – Interrupted time series design. PDSA cycles				Chart audit of practice changePhysician perspectives
Zachary et al. 2002USA	Adapted Verbal HITS (Hurt, Insult, Threaten, Scream) Scale – IPV screening and response embedded within primary care	Evaluation Pre/post testFocus groups	Domestic violence (DV)	Physicians and nurse practitioners	Comprehensive DV protocol informed by local and national guidelines to promote documentation, safety assessment and planning, referral and education for DV based on Verbal HITS Scale. Staff resources included coloured stickers and question prompts in client records, posters/brochures in public areas and a DV coordinator	Practitioner knowledge attitudes, skills and perceptions of curriculum via Massachusetts Medical Society Domestic Violence Seminar Series Baseline and Course Evaluation SurveyPractitioner perspectives
Dubowitz et al. 2009USA	Safe Environments for Every Kid – primary care intervention to address psychosocial risk factors for child maltreatment	Evaluation Cluster RCT	Depression, substance use, major stress, IPV and harsh punishment	Paediatricians	Parents self-complete a brief written questionnaire (PSQ) for targeted risk factors for child maltreatment while waiting for their primary care appointment. If parents screen positive, the practitioner uses a REAP approach to address concerns supported by tailored handouts, resource lists and in some instances a dedicated social worker. Staff resources included printed protocols, coloured stickers and question prompts in client records	Child abuse data from (1) child protection services, (2) client record and Parent-child conflict tactics scale (CTSPC)Pre/post survey of physician attitudes, knowledge, competence, comfort and behaviour
Dubowitz et al. 2011USA		Evaluation Cluster RCT	Depression, substance use, major stress and IPV	Paediatricians, nurse practitioners		Pre/post survey of health professional attitudes, knowledge, competence, comfort and behaviourChart audit of screening and responses to adversitiesObservation of practice
Dubowitz et al. 2012USA		Evaluation Cluster RCT	Depression, substance use, major stress and IPV	Paediatricians, nurse practitioners		Parent-Child Conflict Tactics Scale (CTSPC)Chart audit for failure to thrive, delayed immunisations, medical noncompliance, repeated injuries and child protection involvementChild abuse data from child protection servicesTime addressing on psychosocial issues during appointments
Eismann et al. 2019USA		Implementation Feasibility project	Depression, substance use, IPV, food insecurity, harsh punishment and major stress	Physicians and non-clinical staff		Physician perspectivesChart audit of families (1) attending appointment, (2) completed SEEK screening, (3) positive for a risk factor, (4) received brief intervention (REAP) and (5) accepted referral
Engstrom et al. 2023Sweden		Implementation Convergent mixed-methods	Child safety (not specified), financial worries, depression, major stress, IPV and alcohol misuse	Nurses		Nurse perspectivesNurse survey of knowledge and attitudes
Lane et al. 2021USA		Evaluation Cost-effective analysis of RCT	Substance use, IPV, depression, major stress, and harsh punishment	Physicians and nurse practitioners		Child maltreatment measured by Conflict Tactics Scale Parent-Child version (CTSPC)Costs of SEEK in staff salaries, training, time and materialsCost of child maltreatment to society (estimated)
Golsater and Andersson 2024Sweden		Implementation Exploratory mixed-methods	Depression, substance use, major stress and IPV	Nurses and social workers		Nurse and social worker perspectivesRates of SEEK screening and interventions.Nurse management meeting notes
Golsater et al. 2024Sweden		Implementation Qualitative	Depression, substance use, major stress, IPV, child safety and economic worries	Nurses and social workers		Parent perspectives
Carroll et al. 2005Canada	Antenatal Psychosocial Health Assessment – screening and response procedures embedded into routine antenatal care	Evaluation RCT	Risk factors for poor postnatal psychological health	Physicians, obstetricians, midwives	Psychological health screen procedure implemented within routine antenatal care appointments. Staff resources included a screening tool, discussion and planning prompts	Detection rates of antenatal psychosocial concernsWomen and staff satisfaction
Gershoff et al. 2018USA	NHZ – organisational policy banning physical discipline of children and requiring staff to intervene	Implementation & Evaluation Pre/post test	Physical discipline	All medical centre staff (clinical and non-clinical)	Organisational policy prohibiting physical discipline of children and requiring staff to intervene upon observing parental use of physical discipline. Staff resources included verbal scripts for intervening and signage/handouts for parents	Parent awareness of NHZParent attitudes about NHZ and physical discipline (ATSS)Staff knowledge of NHZStaff attitudes about NHZ and physical discipline (ATSS)
Bai et al. 2023USA		Evaluation Pre/post test	Physical discipline	All hospital staff (clinical and non-clinical)		Staff attitudes about physical punishment (ATSS)Staff attitudes and knowledge of NHZ
Criss et al. 2024USA		Implementation Qualitative focus groups	Physical discipline	All hospital staff (clinical and non-clinical)		Parents’ perspectives of NHZ
Szilassy et al. 2021United Kingdom	IRIS+ – expansion of routine primary care practice for identification, documentation and referral of families experiencing DVA	Implementation Mixed methods – observation, pre/post-test, interviews, survey	DVA	Clinical and non-clinical primary care staff	Enhancement to current primary care clinic practices in identification, documentation and referral of families experiencing DVA. Staff resources included communication prompts, complemented with additional specialist roles for client referrals and child advocacy	Observation of training sessionsPre/post-test of clinician preparednessChart audit (DVA identification)Referrals and contact data from partner agencyClinician, client and child perspectives
Cochrane et al. 2024United Kingdom		Evaluation Model-based cost-utility analysis (Markov model)				Costs associated with abuse (personal and health and justice systems)
Bodendorfer et al. 2020USA	ACE Conversation – guided conversation providing anticipatory guidance about ACEs in paediatric primary care	Implementation Pre-post test	Adverse childhood experiences	Primary care providers	Implementation of a protocol for a guided conversation about ACEs with parents in routine paediatric primary care – irrespective of disclosure. Staff resources included conversation prompts to raise the topic and provide anticipatory guidance, complemented by a parent handout with information/resources	Clinician and parent perspectives
Guterman et al. 2018USA	Dads Matter for Home Visiting (DM-HV) – enhancement of existing home visiting programme to positively engage fathers	Development, Implementation & Evaluation Pilot study–quasi-experimental time-lagged design	Not specifically stated – includes harsh parenting/physical abuse	Professional or paraprofessional home visitors	Implementation of a manualised intervention package aiming to positively engage fathers within an existing home visiting programme for families with a child up to 2 years. Staff resources included five modules with guidance for engaging fathers, partnering with parents to set mutual goals and resolving concerns to promote positive co-parenting	Parent–child verbal interactions–LENAMother-father relationship–PAIFather involvement–Mother and Father Involvement with Infant Scale (MFI)Parent stress–Parenting Stress IndexRisk for child abuse & neglect–Parent-Child Conflict Tactics Scale (PC-CTS)Implementation fidelity–Parent Service Log
Guterman et al. 2023USA		Evaluation Real-world pragmatic clinical trial design with stratified clustered random assignment				Father–worker relationship (Relational Health Index Mentor Scale RHI).Mother-father relationship quality & physical abuse (Relationship Quality Scale)Mother & father risk for physical child abuse (Parent-Child Conflict Tactics Scales PC-CTS)
Hooker et al. 2015Australia	Improving Maternal and Child Healthcare for Vulnerable Mothers (MOVE) – best practice domestic violence screening and support embedded into existing maternal health services	Implementation Concurrent embedded mixed method design	Family violence (FV)	Nurses	Implementation of a model of domestic violence screening (parent self-complete) and supportive care into existing maternal child and family health services. Staff resource included nurse-designed clinical tools such as checklist, clinical pathways and guidelines complemented by support from nurse mentors	Nurse attitudes and knowledge about FV (survey and interview)
Hooker et al. 2016Australia		Implementation Process evaluation in 2-year follow-up of cluster RCT	DV	Nurses		Nurse perspectives of MOVE implementation via survey and interview
Taft et al. 2015Australia		Implementation & Evaluation Cluster RCT	DV	Nurses		Rates of DV screening, disclosure, safety planning and referralsPrevalence of DV in past 12 months (Composite Abuse Scale)Women reporting harm from DV
Janssen et al. 2002Canada	Let’s Talk – postpartum assessment for IPV in tertiary hospitals	Implementation Evaluation informed by Rogers Theory of Diffusion of Innovation	IPV	Nurses	Implementation of an assessment for IPV in women who are receiving postpartum care in hospital. Staff resources included visual reminders and communication guides (i.e. pocket-sized cue cards, posters) and posters/cue-cards for women in bathrooms	Chart audit of rates of IPV screeningStaff perspectives
Mortimore et al. 2021United Kingdom	ACEs screening in maternity care – screening for ACEs at key points along women’s maternity care journey	Development & Implementation Quality Improvement – Mixed Methods	Parental adverse childhood experiences	Midwives	Implementation of an ACE screening tool (parent self-complete) into existing maternity services at specified points throughout each woman’s journey to inform care planning for these needs. Staff resources included a bespoke ACE screening tool with discussion and care-planning guides for staff and handouts for parents	Chart audit of rates and frequency of ACE disclosureStaff and parents’ perspectives
Price et al. 2017USA	Behavioural Health Risk Assessment – screening embedded into existing home visiting referral processes	Development, implementation & evaluation Service evaluation informed by Transtheoretical Model of Change	Depression, substance use and IPV	Community outreach paraprofessionals	Implementation of a brief, triaged assessment linked with further screening and referral tools based on risks identified via within antenatal home visiting referral processes. Staff resources included a structured screening tool with embedded communication, care planning and referral guidance	Chart audit of rates of disclosure and referralsStaff perspectives
Scholer et al. 2015USA	Play Nicely – multi-media programme for parents about healthy discipline followed by anticipatory guidance with primary care provider	Evaluation Qualitative component of RCT	Physical discipline	Physicians	Play Nicely involved (1) a brief multi-media educational programme for parents about health discipline followed by (2) anticipatory guidance embedded into routine child primary health care. Staff resources included discussion prompts and scripts to support education/anticipatory guidance and information about programme content	Parent perspectives of programme helpfulness
Grafton et al. 2006Canada	RUCS – screening for all women for DV embedded into postnatal home visiting	Implementation Retrospective pre/post chart audit	DV	Nurses	RUCS involved screening all women in universal and high-risk postnatal home visiting programmes for DV. Staff resources included clinical guideline with discussion prompts, safety planning guides and embedded reminders within the screening tool	Chart audit of rates of DV screening and disclosureDemographic factors associated with screening and disclosure
Vanderberg et al. 2010Canada		Implementation Retrospective pre/post chart audit	DV	Nurses		Chart audit of rates of DV screening, disclosure and whether woman was alone
Jack et al. 2012USA	IPV intervention integrated into Nurse-Family Partnership	Development Qualitative informed by Intervention Development (Van Meijel et al., 2004)	IPV	Nurses	Manualised intervention to augment standard practice of screening for IPV in socially disadvantaged mothers in the Nurse Family Partnership programme. Staff resources included a clinical pathway to inform decision-making, guidelines for reflective supervision and ongoing coaching	Nurse, client and stakeholder perspectives of responding to IPV
Jack et al. 2019USA		Evaluation Cluster-based, single-blind RCT	IPV	Nurses		Primary outcome: mothers’ quality of life (WHOQOL-BREF)Secondary outcomes: IPV recurrence (Composite Abuse Scale), Posttraumatic stress disorder (4-item SPAN), Depressive Symptoms (PRIME-MD), Alcohol Misuse (TWEAK), Global mental and physical health/wellbeing (Drug Abuse Severity Test, 12 Item Short Form 12 Health Survey)
Jack et al 2021USA		Evaluation Explanatory sequential mixed method embedded within RCT	IPV	Nurses		Nurse perspectives (focus groups) at two time pointsNurse attitudes toward addressing IPV (Public Health Nurses’ Responses to Women Who Are Abused (PHNR) Scale).
Jack et al. 2023Canada		Implementation Qualitative descriptive embedded within cluster RCT	IPV	Nurses		Supervisor and nurse perspectives of factors influencing implementation

Note. Key: ATSS = Attitudes Towards Spanking Scale; CTSPC = Parent-Child Conflict Tactics Scale; DV = Domestic Violence; HITS=Hurt, Insult, Threaten, Scream; IPV = Intimate Partner Violence; FV = Family Violence; PDSA = Plan Do Study Act; RCT = Randomised Control Trial; SEEK = Safe Environment for Every Kid; REAP = Reflect-Empathise-Assess-Plan; NHZ = No Hit Zone; DVA = Domestic Violence and Abuse; LENA = Language Environment Analysis; PAI = Parent Alliance Inventory; RUCS = Routine Universal Comprehensive Screening.

Adversities Addressed

There was significant variability in the adversities addressed across different frameworks, and in some instances within different evaluations of the same framework. A range of adversities were targeted within the 33 manuscripts, including Domestic and Family Violence (DFV; n = 22), parental mental health (n = 10), parental substance use/misuse (including alcohol; n = 9) and harsh punishment or physical discipline (n = 9). Most (n = 20) frameworks only addressed one or two adversities, while some (n = 8) covered a broad range. Some communication frameworks did not explicitly state the adversities they targeted, or they were ambiguous such as ‘parental stressors’ or ‘familial stressors’ (Abatemarco et al., 2008, 2018; Scholer et al., 2015). Furthermore, the nuances of interpersonal violence were not consistent, with multiple definitions such as ‘domestic violence/abuse’ (DVA; Cochrane et al., 2024), ‘woman abuse’ (Grafton et al., 2006) and ‘family violence’ (FV; Hooker et al., 2015).

Practice Setting

Communication frameworks were all (n = 15) embedded into healthcare settings, which varied from primary care clinics to maternal home visiting services and hospitals. None was designed for non-health-focused settings such as early childhood education or community/social care sectors. Typically, communication frameworks comprised of protocols and resources to equip practitioners to assess and respond to adversities with a parent/caregiver during a routine healthcare interaction. Routine healthcare interactions during pregnancy and early childhood occurred in antenatal care (n = 4), nurse-led primary care including clinic-based and home visiting (n = 6), physician-led primary care consultations (n = 7), and paraprofessional community outreach programmes (n = 2). These numbers include the SEEK programme, which was implemented in both nurse home visiting and physician-led primary care services (Dubowitz et al., 2009; Engström et al., 2022), and the Antenatal Psychosocial Health Assessment implemented in a primary care-based antenatal service (Carroll, 2005). One exception to communication frameworks for individual consultations was the NHZ (Bai et al., 2023; Criss et al., 2024; Gershoff et al., 2018). NHZ was an organisation-level strategy aiming to reduce child physical discipline by providing all hospital staff with practical strategies to respond to caregiver use of physical discipline.

Some communication frameworks also incorporated additional personnel who could assist practitioners identify and respond to adversities. For example, some communication frameworks for family violence included an additional family violence liaison worker (Hooker et al., 2015), an onsite family violence coordinator (Zachary et al., 2002) or an advocate/educator and children’s worker to follow-up referrals (Cochrane et al., 2024; Szilassy et al., 2021). Other additional resources supporting the communication frameworks included regular supervision meetings for staff, as in the Dads Matter intervention (Guterman et al., 2018, 2023) and a social worker available by telephone to assist staff or clients in the SEEK intervention (Dubowitz et al., 2012). Although Play Nicely did not require additional staff, it comprised of an additional resource of a short video and multi-media activity about healthy discipline which parents completed prior to their appointment (Scholer et al., 2015).

Description of Development Outcomes

Outcomes relating to the development of communication frameworks were provided by three of the four studies which aimed to develop a communication framework. These outcomes were staff, parent and/or other stakeholder perspectives (Jack et al., 2012; Mortimore et al., 2021; Price et al., 2017). One study did not report any outcomes relating to development (Guterman et al., 2018). Although there was no explicit use of co-design with service users, some communication frameworks were informed by community perspectives. For example, Szilassy et al. (2021) ‘closely engaged’ service users from study conception, while Janssen et al. (2002) engaged consumers in the design of their public-facing posters about DV.

Description of Implementation Outcomes

Implementation outcomes included objective measures such as fidelity through chart audits or observations of clinical practice (Abatemarco et al., 2008, 2018; Eismann et al., 2019; Grafton et al., 2006; Janssen et al., 2002; Mortimore et al., 2021; Price et al., 2017; Szilassy et al., 2021; Taft et al., 2015). For example, documented rates of DV screening and disclosures (Grafton et al., 2006; Vanderburg et al., 2010) or families who identified an adversity and subsequently received support (Eismann et al., 2019). Other measures of implementation included objective and subjective data of practitioner and/or parent perspectives, attitudes, knowledge or awareness of the intervention. For example, implementation of NHZ policy was assessed by measuring staff and parent awareness of the policy (Gershoff et al., 2018).

Although communication frameworks were embedded within existing health services, there was little explicit use of holistic implementation approaches. Only two interventions (n = 3 studies) used an implementation framework to inform and support sustainable translation into practice – both of which used Normalisation Process Theory (Hooker et al., 2015; Taft et al., 2015). Other studies used Roger’s Diffusion of Innovations to inform implementation (Janssen et al., 2002) and the Transtheoretical Model of Change (Price et al., 2017). Despite little explicit use of holistic implementation approaches, discrete implementation strategies were present in many studies, such as leveraging local champions (Eismann et al., 2019; Grafton et al., 2006) and Plan-Do-Study-Act cycles (Abatemarco et al., 2008).

All communication frameworks (Table 2) reported using some form of staff education or training to equip with knowledge and skills to use the communication framework. Many studies provided initial staff training, while others included ongoing follow-up sessions at varying intervals after implementation. For some frameworks, all staff inclusive of non-clinical roles received education (Bai et al., 2023; Cochrane et al., 2024; Criss et al., 2024; Gershoff et al., 2018; Szilassy et al., 2021). Some communication frameworks also incorporated client education as an implementation strategy – for example flyers informing women they would be asked about family violence (Carroll, 2005; Janssen et al., 2002), and posters about healthy child discipline in public-facing areas (Bai et al., 2023; Criss et al., 2024; Gershoff et al., 2018).

Communication frameworks incorporated a variety of resources to support practitioners, including policies, protocols and guidelines to inform practice. For example, SEEK included a brief, self-completed questionnaire (PSQ) which screened parents for experiences of adversities, while practitioners were supported with guidelines and prompts for conversations to address these adversities (Dubowitz et al., 2009, 2011, 2012; Eismann et al., 2019; Engström et al., 2022; Golsäter & Andersson, 2024; Golsäter et al., 2024; Lane et al., 2021). Guidelines were sometimes organised into clusters or bundles of resources to enable practitioners to identify and respond to specific types of parental adversities. Examples included bundles of tools tailored to specific age-related concerns including (a) infant crying, (b) maternal depression and attachment and (c) toddler toilet training (Abatemarco et al., 2008, 2018), or screening checklists incorporating discussion and question prompts to help professionals understand how to approach sensitive conversations (Bodendorfer et al., 2020; Carroll, 2005; Zachary et al., 2002). Some interventions also incorporated reminders, such as physically locating protocols in examination rooms (Zachary et al., 2002). Professionals were also provided with referral services and pathways to facilitate provision of early support for concerns outside the scope of that profession. For example, SEEK (Dubowitz et al., 2012) described a region-specific directory for staff and handouts for parents to enable professionals to effectively respond to parental adversities.

Description of Evaluation of Effectiveness Outcomes

Evaluation of communication frameworks incorporated a range of parent/caregiver and practitioner outcomes, with a smaller number exploring child outcomes or cost effectiveness. Like studies reporting implementation outcomes, many reporting evaluation outcomes used a medical record audit to determine how many families were assessed for adversities and/or subsequently disclosed (Dubowitz et al., 2009, 2011; Price et al., 2017; Taft et al., 2015). Parent outcomes included a range of validated measures relating to parents’ wellbeing or risks for child maltreatment such as the Parent Child Conflict Tactics Scales (CTSPC; n = 4), Composite Abuse Scale (CAS; n = 2), Parenting Stress Index (n = 1), World Health Organisation Quality of Life – Brief Version (WHOQOL-BREF; n = 1), TWEAK test for alcohol misuse (n = 1), and Mother-Father Involvement with Infant Scale (MFI; n = 1). Other non-validated measures of parent outcomes included parents’ satisfaction (Carroll, 2005) or perspectives of programme helpfulness (Scholer et al., 2015).

Specific practitioner measures for evaluation of communication frameworks included assessing practitioner attitudes and knowledge relating to the intervention (Bai et al., 2023; Dubowitz et al., 2009; Gershoff et al., 2018; Jack et al., 2021; Zachary et al., 2002). For example, Jack et al. (2021) explored nurses’ attitudes towards addressing IPV using the Responses to Women Who Are Abused Scale (PHNR). Other practitioner measures included practitioner perspectives of the communication framework more broadly (Carroll, 2005; Jack et al., 2021; Price et al., 2017), including satisfaction with the procedures for screening and responses to poor postnatal mental health (Carroll, 2005). Practitioner perspectives not measured through established validated surveys included written/online questionnaires, focus groups and interviews.

Only two studies measured child-related outcomes, including child health status through healthcare records (immunisations, failure to thrive, injuries; Dubowitz et al., 2012) and referrals to child protection (Dubowitz et al., 2009). There were also only two studies that explored cost-effectiveness. These were cost-effectiveness of Identification and Referral to Improve Safety plus (IRIS+) compared with usual care (Cochrane et al., 2024) and evaluation of the cost of SEEK implementation alongside costs to the health system of child maltreatment (Lane et al., 2021). Many communication frameworks were only evaluated at single sites, but IRIS+ and SEEK were more extensively evaluated across multiple sites and settings. This included two studies evaluating the SEEK framework across 18 sites (7 SEEK practices and 11 control practices; Dubowitz et al., 2011, 2012). Similarly, IRIS+ (identifying and responding to DVA) was first assessed for feasibility at three sites (Szilassy et al., 2021) and later pilot tested at seven sites (Cochrane et al., 2024).

Limitations

One limitation encountered during full-text screening was scant or missing information about core components of the intervention – such as which adversities were addressed or what guidance was provided for practitioners. In selecting the studies for inclusion in this scoping review, an inclusive approach was taken when considering what constituted communication guidance. In taking this approach, while technically each framework had communication guidance for professionals, for many frameworks, this was very minimal. Given that a key barrier to providing early support to families experiencing adversities is professionals’ skills and confidence (Lines et al., 2017; Loveday, Balgovind, Hall, Sanci, et al., 2023), more guidance is needed for professionals to engage in non-judgemental conversations early in the care pathway.

When synthesising studies, we used DFV to include related concepts of IPV, DV and FV. These concepts are often used interchangeably without standardisation (Warren et al., 2024), meaning there may be some ambiguity in how data were collected, reported and synthesised. Furthermore, all frameworks were implemented in health settings, despite aiming to also include frameworks in child education and welfare. The broad, complex and novel nature of communication frameworks spanning across child and family services presented design challenges. Some potentially relevant manuscripts implemented in education settings were screened out as these frameworks were focused on referring to child protection services rather than early communication before child protection involvement. It is possible that employing different inclusion criteria would have led to the inclusion of key frameworks for other child-focused settings. Similarly, differences in terminology across disciplines, sectors and countries may also have limited inclusion, as noted by the sample representing only the Global North. Although the search strategy was planned carefully, the generalisability of results may be limited, and further research should use broader strategies to identify communication frameworks in more diverse settings – if they exist (Table 4).

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Table 4.

Summary of Implications for Practice, Policy and Research.

Communication frameworks that guide professionals’ communication and early support for family adversities typically address only one or a small number of adversities that harm children.

Additional research is needed to develop, tailor and implement communication frameworks that are feasible and acceptable for diverse populations, especially those most impacted by family adversities.

Further research is also needed to robustly evaluate the impact of communication frameworks on outcomes for children and families.

Findings can be used to inform upscaling of these communication frameworks into a range of early childhood settings to maximise opportunities for effective engagement and early support.

Policymakers aiming to promote healthy childhoods may want to prioritise the development and implementation of communication frameworks in real-world settings.