TABLE 1.
Barriers across the stigma action framework
| Study included | ||
|---|---|---|
| Individual level of stigma—person who experiences individual stigma (i.e., unfair treatment, internalized stigma and anticipated stigma that inhibits accessing support) | Fear or mistrust of the child welfare system | Baskin et al. (2015); Blakey and Hatcher (2013); Carlson et al. (2006); Elms et al. (2018); Falletta et al. (2018); Howell and Chasnoff (1999); Jessup et al. (2003); Kruk and Banga (2011); Radcliffe (2009); Roberts and Nuru‐Jeter (2012); Rockhill et al. (2008); Taylor and Kroll (2004) |
| Internalized stigma (limiting self‐esteem/capacity to seek support) | Blakey and Hatcher (2013); Carlson et al. (2006); Elms et al. (2018); Feder et al. (2018); Radcliffe (2009); Rockhill et al. (2008); Salmon et al. (2000); Smith (2006); Stringer and Baker (2018) | |
| Fear of failing to reduce substance use | Elms et al. (2018); Jessup et al. (2003); Kruk and Banga (2011); Radcliffe (2009); Rockhill et al. (2008); Salmon et al. (2000) | |
| Trauma history | Carlson et al. (2008); Kenny and Barrington (2018) | |
| Previous substance use treatment attempts | Green et al. (2006) | |
| Fear of prenatal care | Jessup et al. (2003) | |
| Fear of prosecution due to substance use | Bessant (2003); Jessup et al. (2003) | |
| Interpersonal level of stigma—from friends, family, service providers, social/work networks (i.e., derogatory language, intrusive questions and hate crimes) | Partner's/family influence on treatment access | Bessant (2003); Carlson et al. (2006); Comfort and Kaltenbach (2000); Howell and Chasnoff (1999); Jessup et al. (2003); Rockhill et al. (2008); Tuten et al. (2003) |
| Stigma (substance use, mothering, pregnancy) | Bessant (2003); Carlson et al. (2006); Elms et al. (2018); Feder et al. (2018); Kenny and Barrington (2018); Radcliffe (2009); Rockhill et al. (2008); Stringer and Baker (2018) | |
| Having to restore trust and rebuilding relationships with children | Carlson et al. (2008); Kenny and Barrington (2018) | |
| Belief from providers that substance use results in an inability to parent | Drabble (2007); He et al. (2014) | |
| Lack of trusting and respectful relationships with service providers | Grosenick and Hatmaker (2000); Salmon et al. (2000) | |
| External expressions of trauma | Blakey and Hatcher (2013) | |
| Institutional level of stigma—organizational (i.e., being made to feel less than, longer wait times, non‐inclusive physical environment and institutional policies that cause harm) | Lack of coordination across service providers | Drabble (2007); Falletta et al. (2018); Haller et al. (2003); Henry et al. (2018); Howell and Chasnoff (1999); Kovalesky (2001); Lussier et al. (2010); Marcenko et al. (2011); Roberts and Nuru‐Jeter (2012); Robertson and Haight (2012); Smith and Testa (2002); Smith (2006); Taylor and Kroll (2004) |
| High expectations placed on women who use substances to meet an unrealistic number of tasks (including administrative tasks) | Baskin et al. (2015); Carlson et al. (2006, 2008); Elms et al. (2018); Falletta et al. (2018); He et al. (2014); Jessup et al. (2003); Lewis (2004); Radcliffe (2009); Roberts and Nuru‐Jeter (2012); Rockhill et al. (2008); Smith (2002) | |
| Institutional stigma due to low socioeconomic status or interpersonal resources (i.e., housing and food) | Bessant (2003); Carlson et al. (2008); Comfort and Kaltenbach (2000); Henry et al. (2018); Lean et al. (2013); Lussier et al. (2010); Marcenko et al. (2011); Rockhill et al. (2008); Tuten et al. (2003) | |
| Institutional stigma due to pregnancy or mothering status | Bessant (2003); Falletta et al. (2018); Howell and Chasnoff (1999); Jessup et al. (2003); Kruk and Banga (2011); Radcliffe (2009); Smith (2002, 2006) | |
| Lack of outreach/ability to access harm reduction and treatment programs | Bessant (2003); Elms et al. (2018); Green et al. (2006); Howell and Chasnoff (1999); Kruk and Banga (2011); Rockhill et al. (2008) | |
| Lack of gender‐ and trauma‐informed programming | Bessant (2003); Grosenick and Hatmaker (2000); Kruk and Banga (2011); Lewis (2004); Tuten et al. (2003) | |
| Geographic and transportation barriers to visitation (particularly in relation to substance use treatment programs) | Kovalesky (2001); Letourneau et al. (2013); Marcenko et al. (2011); Smith and Testa (2002) | |
| Impact of child welfare system (e.g. distracting mothers from reducing their substance use or increased substance use after apprehension) | Carlson et al. (2008); Jessup et al. (2003); Rockhill et al. (2015, 2008); Smith and Testa (2002); Smith (2002) | |
| Proof of treatment completion and abstinence from substances | Carlson et al. (2006); He et al. (2014); Robertson and Haight (2012); Taplin and Mattick (2015) | |
| Reunification timelines (mothers' readiness for reunification in relation to how long a child can be in foster care before parental rates are terminated) | Carlson (2006); Carlson et al. (2008); Kenny and Barrington (2018) | |
| Lack of financial support for programs (including allied services) | Carlson et al. (2006); Robertson and Haight (2012); Taylor and Kroll (2004) | |
| Wait times to access substance use services | Green et al. (2006); Kruk and Banga (2011); Rockhill et al. (2008) | |
| Lack of family‐centred programming | Carlson (2006); Kruk and Banga (2011) | |
| Lack of control over visitation rights and schedule | Kovalesky (2001); Smith and Testa (2002); Smith (2002) | |
| Lack of information sharing (with women and across staff) | Letourneau et al. (2013); Salmon et al. (2000) | |
| Staff turnover | Kruk and Banga (2011); Taylor and Kroll (2004) | |
| Insurance acceptability | Angelotta et al. (2016) | |
| Different perceptions of the impact of substance use across fields | Drabble (2007) | |
| Institutional barriers due to use of methadone maintenance | Lean et al. (2013) | |
| Population level of stigma—mass media, policies, law (i.e., stereotypes, negative portrayals in media, discriminatory policies and laws and inadequate legal protections) | Discrimination due to mental health status | Brown et al. (2016); Carlson et al. (2008); Henry et al. (2018); Lean et al. (2013); Marcenko et al. (2011); Marshall et al. (2011); Smith and Testa (2002) |
| Discrimination due to substance use | Baskin et al. (2015); Carlson et al. (2006); Kenny and Barrington (2018); Smith (2002); Taylor and Kroll (2004) | |
| Punitive approaches, including prenatal child welfare laws and apprehensions at birth | Angelotta et al. (2016); He et al. (2014); Roberts and Nuru‐Jeter (2012); Robertson and Haight (2012) | |
| Discrimination due to intergenerational involvement with child welfare | Blakey and Hatcher (2013); Marshall et al. (2011) | |
| Racism | Blakey and Hatcher (2013) | |
| Historical trauma | Baskin et al. (2015) | |