When support loses meaning or becomes rigid: A cybernetic interpretation of cyclical barriers to occupational therapy in child maltreatment prevention in Japan

Introduction: Child maltreatment prevention requires coordinated support across institutional, organisational, and family contexts. Evidence on how occupational therapists in Japan contribute to maltreatment-prevention work remains limited. This study explored multi-layered mechanisms that impede paediatric and developmental occupational therapy with children and families at risk of maltreatment. Method: An exploratory qualitative study was conducted in Japan. Eight occupational therapists participated in individual semi-structured online interviews (October 2024–March 2025). Data were analysed using reflexive thematic analysis, and Bateson-informed cybernetic concepts informed integrative interpretation. Findings: Five themes captured barriers across institutional, relational, and environmental levels: institutional logics misaligned with support realities; fragile relational foundations and discontinuity across support stages; post-initiation mismatch driven by rigid parenting beliefs and standardised service delivery; delayed interprofessional coordination that fragmented support; and isolation shaped by environmental vulnerability and distrust of public services. Integrative interpretation suggested two interacting processes: hollowing out of constraints (loss of contextual meaning and continuity) and rigidification of constraints (procedural inflexibility that limits adaptation and therapeutic depth). Conclusion: Barriers reflect interacting system constraints rather than isolated practitioner or case factors. System-sensitive occupational therapy may require occupation-anchored goals and documentation, delivery formats that support carry-over, and re-evaluation practices that help meaningful change travel across services.