PROTOCOL: Evidence and gap map protocol: Institutional responses to child maltreatment
2019; The Campbell Collaboration; Volume: 15; Issue: 3 Linguagem: Inglês
10.1002/cl2.1039
ISSN1891-1803
AutoresBianca Albers, Caroline Fiennes, Aron Shlonsky, Meghan Finch, Ludvig Daae Bjørndal, James J. Hennessy, Joachim Krapels, Rebecca Featherston, Robyn Mildon,
Tópico(s)Migration, Health and Trauma
ResumoCampbell Systematic ReviewsVolume 15, Issue 3 e1039 PROTOCOLOpen Access PROTOCOL: Evidence and gap map protocol: Institutional responses to child maltreatment Bianca Albers, Bianca Albers Centre for Evidence and Implementation, London, UKSearch for more papers by this authorCaroline Fiennes, Caroline Fiennes Giving Evidence, Cornwall, UKSearch for more papers by this authorAron Shlonsky, Aron Shlonsky School of Primary and Allied Health Care, Monash University Peninsula Campus, Frankston, Victoria, AustraliaSearch for more papers by this authorMeghan Finch, Corresponding Author Meghan Finch meghan.finch@ceiglobal.org Centre for Evidence and Implementation, Carlton, Victoria, Australia Correspondence Meghan Finch, Senior Advisor, Centre for Evidence and Implementation, 33 Lincoln Square South, Carlton, Victoria 3053, Australia. Email: meghan.finch@ceiglobal.orgSearch for more papers by this authorLudvig Bjørndal, Ludvig Bjørndal Centre for Evidence and Implementation, London, UKSearch for more papers by this authorJames Hennessy, James Hennessy Centre for Evidence and Implementation, London, UKSearch for more papers by this authorJoachim Krapels, Joachim Krapels Porticus, Amsterdam, The NetherlandsSearch for more papers by this authorRebecca Featherston, Rebecca Featherston Department of Social Work School of Primary and Allied Health Care, Faculty of Medicine Nursing & Health Sciences, Monash University Peninsula Campus, Frankston, Victoria, AustraliaSearch for more papers by this authorRobyn Mildon, Robyn Mildon Centre for Evidence and Implementation, Carlton, Victoria, AustraliaSearch for more papers by this author Bianca Albers, Bianca Albers Centre for Evidence and Implementation, London, UKSearch for more papers by this authorCaroline Fiennes, Caroline Fiennes Giving Evidence, Cornwall, UKSearch for more papers by this authorAron Shlonsky, Aron Shlonsky School of Primary and Allied Health Care, Monash University Peninsula Campus, Frankston, Victoria, AustraliaSearch for more papers by this authorMeghan Finch, Corresponding Author Meghan Finch meghan.finch@ceiglobal.org Centre for Evidence and Implementation, Carlton, Victoria, Australia Correspondence Meghan Finch, Senior Advisor, Centre for Evidence and Implementation, 33 Lincoln Square South, Carlton, Victoria 3053, Australia. Email: meghan.finch@ceiglobal.orgSearch for more papers by this authorLudvig Bjørndal, Ludvig Bjørndal Centre for Evidence and Implementation, London, UKSearch for more papers by this authorJames Hennessy, James Hennessy Centre for Evidence and Implementation, London, UKSearch for more papers by this authorJoachim Krapels, Joachim Krapels Porticus, Amsterdam, The NetherlandsSearch for more papers by this authorRebecca Featherston, Rebecca Featherston Department of Social Work School of Primary and Allied Health Care, Faculty of Medicine Nursing & Health Sciences, Monash University Peninsula Campus, Frankston, Victoria, AustraliaSearch for more papers by this authorRobyn Mildon, Robyn Mildon Centre for Evidence and Implementation, Carlton, Victoria, AustraliaSearch for more papers by this author First published: 13 September 2019 https://doi.org/10.1002/cl2.1039Citations: 5 Linked Article: Evidence and gap map AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat 1 BACKGROUND 1.1 The problem, condition or issue Child maltreatment, that is, 'various types of violence such as sexual, emotional and physical, abuse and/or emotional and physical neglect' (Lueger-Schuster et al., 2018), is a widespread phenomenon affecting millions of children, adults and communities around the globe. Measuring the prevalence of child maltreatment in institutional contexts is challenging, and these data are not readily available. Moreover, studies do not generally deal solely with maltreatment occurring specifically in these settings, and disentangling the effects of maltreatment occurring in institutional settings versus other maltreatment settings is not routine. That said, the overall rates of any type of child maltreatment may provide some indication, and these have recently been estimated to be between 3 per 1,000 children for physical and emotional abuse and 4 per 1,000 children for sexual abuse (Stoltenborgh, Bakermans-Kranenburg, Alink & van IJzendoorn, 2015). The World report on violence and health launched in 2002 reported a prevalence for abandonment and neglect at 21.9% in Kenya and 12–19% of physical neglect and abandonment in Canada (Krug, 2002). A series of meta-analyses estimated an overall prevalence rate of 16.3% for physical neglect and 18.4% for emotional neglect (Stoltenborgh et al., 2015). However, prevalence rates are sensitive to a number of factors. There are both geographical and gender differences. Rates also vary depending on whether incidences of maltreatment are self-reported or based on informants (Greger, Myhre, Lydersen & Jozefiak, 2015; Moody, Cannings-John, Hood, Kemp & Robling, 2018), and can vary with the identity of the perpetrator/s. How widely or narrowly different subtypes of maltreatment are defined and operationalised in studies or how many items are used to measure prevalence, can also impact on rate estimates. They should therefore be interpreted with caution. Even less is known about the prevalence of various forms of child maltreatment taking place within institutional settings such as kindergartens and schools, religious institutions, out-of-home care and other comparable contexts in which children spend their time (Blakemore, Herbert, Arney & Parkinson, 2017; Proeve, Malvaso & DelFabbro, 2016). Maltreatment in these contexts, can encompass adults abusing children, children abusing other children, institutions enabling child maltreatment and child characteristics enhancing their vulnerability to maltreatment. The dearth of research is due to the comparably young age of institutional child maltreatment as a field of empirical research (Timmerman & Schreuder, 2014), in which the focus has been on sexual abuse within especially religious and out-of-home care institutions, whereas other types of maltreatment and settings have been less examined (Proeve et al., 2016). Recent studies conducted in Germany (Allroggen, Ohlert, Rau & Fegert, 2018) and Norway (Greger et al., 2015) confirm that children placed in institutional care are at significantly higher risk of experiencing maltreatment but less is known about maltreatment taking place in areas such as sports and exercise (Bjørnseth & Szabo, 2018). However, it is clear that child maltreatment taking place in these settings affects the lives of both victims, their families and their communities—at times for generations. Child maltreatment has a negative impact on the physical, mental, spiritual, educational and economic wellbeing of those experiencing and surviving it—both in the short term and in the form of long-term consequences that reduce the quality of life during adulthood (Lueger-Schuster et al., 2018). In recent years, child maltreatment occurring in institutional settings has received substantial attention both at the policy level, amongst practitioners and service agencies working with children in different capacities and roles, and as part of the public debate. The shift in attention and prioritisation of child maltreatment as a key concern of society is reflected in a broad range of official inquiries and key reports conducted in recent years in especially high-income countries—of which the following is a selected sample: Law Commission of Canada (2012). Restoring Dignity—Responding to Child Abuse in Canadian Institutions. The Scottish Government (2012). Review of Child Neglect in Scotland. New Zealand House of Representatives (2014). Inquiry into Improving Child Health Outcomes and preventing child abuse with a focus from preconception until three years of age. Royal Commission into Institutional Responses to Child Sexual Abuse (Australia, 2014–2017). Northern Ireland Historical Institutional Abuse Inquiry 1922–1995 (2017). Pennsylvania Attorney General (2018). Pennsylvania Diocese Victims Report. Unabhängige Kommission zur Aufarbeitung sexuellen Kindesmissbrauchs (Germany, 2016–2023). Indepedent Inquiry Child Sexual Abuse (U.K., 2019). Sexual Abuse of Children in Custodial Institutions (U.K., 2009–2017). These inquiries have led to the production of many research reports—among them a number of rapid or full systematic reviews examining the impact of institutional child maltreatment (Blakemore et al., 2017), how it can be prevented (South, Shlonsky & Mildon, 2014, 2015; Pitts, 2015), victims supported (Shlonsky, Albers & Paterson, 2017), and suitable responses be implemented and maintained over time (Parenting Research Centre, 2015; Albers & Mildon, 2016). However, this and other evidence on the effectiveness of interventions aimed at identifying, preventing or responding to institutional child maltreatment is spread across multiple sources and often exists in the form of academic or grey literature that can be difficult to access for institutions that wish to improve their practices and services in this area. Therefore, there is still considerable confusion amongst sector stakeholders about what evidence exists for safeguarding interventions developed for use in institutional settings. The objective of the evidence and gap map (EGM) described in this protocol is to reduce this confusion and to provide a 'go to' knowledge base for stakeholders wanting to access high-quality evidence on interventions addressing institutional child maltreatment. 1.2 Scope of the EGM The guiding research question for this evidence and gap map is: What is the prevalence of evidence on the effectiveness of interventions that—within institutional settings—are aiming to Prevent the occurrence of maltreatment of children (including preventing peer to peer abuse) Prevent the recurrence of maltreatment of children (preventing offenders from re-offending) Reduce harm to the health and wellbeing of children exposed to child maltreatment Enhance the disclosure of child maltreatment; and Improve organisational practice and standards for addressing issues related to child maltreatment. Guided by this research question, the EGM will be structured into interventions aimed at institutional child maltreatment identification/disclosure, prevention, treatment and other responses (vertical structure). The EGM's horizontal structure will be formed by outcomes that relate to the institutional setting, the child's physical, mental, spiritual, educational and economic wellbeing, and the perpetrators of child maltreatment. These dimensions of the EGM are outlined in greater detail below—under 'EGM Framework'. The EGM will contain effectiveness studies of different designs, including overviews of systematic reviews, systematic reviews, (cluster) randomised controlled trials and studies using quasi-experimental designs. It will be a global EGM covering low-, middle- and high-income countries. In the following, these and other characteristics are described in greater detail. 1.3 Conceptual framework of the EGM Child maltreatment in institutional settings is a complex problem consisting of four potential factors influencing the occurrence of child maltreatment (Royal Commission into Institutional Responses to Child Sexual Abuse, 2017): Adults abusing children, Children abusing other children, Institutions enabling child maltreatment, and Child characteristics enhancing their vulnerability to maltreatment In targeting child maltreatment, interventions may have a different scope and be aimed at: Preventing occurrence and reoccurrence of child maltreatment. This may be based on either – Universal services available to an entire target population and aimed at promoting positive behaviours and functioning and/or at decreasing risk factors and the likelihood of problems and challenges in a person's life. – Targeted services available to selected members of a target population who are at risk of developing or experiencing particular problems—with the intervention aimed at reducing these risks. Disclosing child maltreatment. A key factor in ending, responding to and treating the consequences of child maltreatment is its disclosure—especially in cases of child sexual abuse (Paine & Hansen, 2002; Lemaigre, Taylor & Gittoes, 2017). Recent inquiries have documented the substantial barriers existing in institutional settings to facilitate such disclosure (Royal Commission into Institutional Responses to Child Sexual Abuse, https://www.childabuseroyalcommission.gov.au/; Lemaigre et al., 2017), pointing to the importance of including disclosure interventions in this EGM. Responding to the occurrence of child maltreatment. Institutions have strong legal and ethical obligations to respond appropriately when child maltreatment has been detected or disclosed. This includes reporting the maltreatment, supporting the victim and/or family, working with child protection agencies and providing training and crisis support to staff. Treating the consequences of child maltreatment. Providing services or referring children and families to agencies that provide therapeutic care for one or more of the many known problems associated with experiencing child abuse and neglect (e.g., PTSD). Based on this understanding, the EGM will cover studies examining interventions aimed at preventing occurrence and reoccurrence of child maltreatment, disclosing child maltreatment, responding to the occurrence of child maltreatment and/or treating its consequences. These interventions may be placed at all levels of the service spectrum and target either children, child offenders, perpetrators or the institutional setting. Different organisational factors have been identified that purportedly increase or decrease the likelihood of institutional child abuse (Royal Commission into Institutional Responses to Child Sexual Abuse, 2017), including institutional: Cultural factors (e.g., leadership, organisational culture), Operational factors (e.g., governance, day-to-day work routines and practices), and Environmental factors (e.g., physical spaces). Studies examining interventions addressing any of these organisational factors will therefore be included in this EGM. A more detailed outline of how this overarching framework will be operationalised in developing the full EGM is presented in Section 3 of this protocol. 1.4 Why it is important to develop the EGM Given the lack of a 'go to' global knowledge base presenting high quality evidence on the effectiveness of safeguarding (actions taken to protect vulnerable groups from harm; Cambridge University Press, 2019) interventions tested in institutional settings, the production of this EGM is highly overdue. The knowledge it will generate will have the potential to support: The identification of areas with potentially sufficient studies to conduct a meta-analysis within a systematic review - if none currently exists. Service providers (institutions) in identifying potentially effective interventions and/or key characteristics of potentially effective interventions. This knowledge can be used to inform the selection or design of safeguarding interventions to be applied locally. Funders and policymakers to inform funding and/or policy decisions related to the safeguarding of children in institutional settings. These can be decisions about the selection of potentially effective interventions or the funding of research—for example, research that can fill existing gaps in the knowledge base. Research organisations in assessing the current evidence on child maltreatment in institutional settings. This knowledge can inform the development of research agendas and priorities. 1.5 Existing EGMs and/or relevant systematic reviews To our knowledge, there are only three other evidence and gap maps that—in different ways—relate to issues of child maltreatment—all of which are registered with the Campbell Collaboration: 1. Kornør, John, Axelsdottir, Biedilæ and Albers (2018) is in development still. It will focus on a. Child maltreatment b. Children aged prenatal-12 years c. Studies conducted in high-income countries only. The focus of this EGM is child abuse and neglect in general, with a focus on clinical interventions and hence does not keep a focus on institutional settings where the evidence on the effectiveness of non-clinical interventions aimed at enhancing, for example, organisational standards or disclosure rates, is of particular interest. 2. Saran, Albright, Adona & White (2018) has been developed in full and is available in the public domain. It focuses on a. Child welfare b. Children aged under 18 c. Studies conducted in low- and middle-income countries (LMICs) only. This EGM includes 302 systematic reviews on a broad range of child welfare interventions and outcomes with a focus on evidence relating to LMICs. Interventions addressing child abuse are a minor element of this EGM, no particular focus on institutional settings is described, and studies conducted in high-income countries are not included. 3. Pundir, Saran, White, Adona, and Subrahmanian (2019) is in development. It will focus on: a. Violence against children b. Children under 18 years c. Studies conducted in LMICs only This EGM will provide an overview of the evidence on the effectiveness of interventions aimed at reducing violence against children in LMICs. As for Saran et al. (2018) described above, no particular focus on institutional settings is described, and studies conducted in high-income countries are not included Taken together, this means that the EGM described here will be a genuine and much needed contribution to the evidence base on child maltreatment because it: focuses on institutional settings—which are not the key focus of any of the other evidence and gap maps and therefore may be at risk of 'disappearing' in large amounts of other evidence regarding child maltreatment occurring in other contexts; and keeps a global focus and combines the evidence existing for high- with that from low- and middle-income countries. As such, this EGM will be a substantial resource for a broad range of stakeholders operating in child health, welfare and education sectors. This includes kindergartens, schools, charities, churches, sports clubs, scouting associations, out-of-home-care providers and the many other organisations that have children in their care on a daily basis—and their funders. 2 OBJECTIVES The objectives of this EGM are twofold. It will a) Provide a structured and accessible collection of existing evidence from finalised and ongoing overviews of systematic reviews, systematic reviews and effectiveness studies of institutional responses to child maltreatment - for those who work to fund, develop, implement, and evaluate interventions aimed at ensuring children's safety in institutional settings. b) Identify gaps in the available evidence on institutional responses to child maltreatment - thereby helping to inform the research agendas of funders and other organisations. 3 METHODOLOGY 3.1 Defining evidence and gap maps Mapping the evidence in an existing area is a relatively new approach that has been used since the early 2000s (Saran & White, 2018). EGMs are 'evidence collections' (Snilstveit, Vojtkova, Bhavsar & Gaarder, 2013, pp. 3) that provide a visual overview of the availability of evidence for a particular sector—in this case, institutional responses to child maltreatment. They belong to a group of evidence synthesis products that aim to 'configure information' (Littell, 2018, pp.10). They help to consolidate what we know and do not know about studies that evaluate the effectiveness of interventions in a given area - by mapping out existing and ongoing systematic reviews and impact evaluations in this field, and by providing a graphical display of areas with strong, weak or non-existent evidence on the effect of such interventions. Studies included in an EGM are identified through a comprehensive search of published and unpublished literature, which targets both completed and ongoing studies—the latter to help identify research in development, which might help fill existing evidence gaps. The methods for conducting EGMs draw on the principles and methodologies adopted in existing evidence mapping and synthesis products. Typically, six steps are taken when conducting an EGM: Step 1. Defining scope The first step in producing an EGM is to set the scope by developing a framework, which represents the universe of interventions and outcomes in the field to be covered. The rows of the framework cover all interventions relevant to the sector covered, while columns include all relevant outcomes, from intermediate outcomes to final outcomes. Step 2. Setting study inclusion criteria As part of this step, the types of evidence to be included in the EGM are determined. EGMs often rely on two types of studies: (a) systematic reviews that critically appraise and synthesise all available evidence in a particular area; (b) and impact evaluations that rigorously test effectiveness using rigorous experimental and quasi-experimental designs. Step 3. Searching for studies and assessing inclusion Next, a strategy for populating the EGM framework with studies meeting the study inclusion criteria is developed. The methods for doing so draw on methods of systematic searching commonly used for systematic reviews and overviews of reviews. Step 4. Coding and critical appraisal This step involves the systematic coding and extraction of data using a structured format. Studies are coded according to relevant intervention and outcome categories. The quality of the included systematic reviews and impact evaluations is also appraised. Depending on the purpose of the EGM and the needs of stakeholders, other coding categories may also be relevant, including, for example, geographical scope of the evidence, demographic characteristics of target populations, study settings etc. Step 5. Producing user-friendly summaries, presentations and analysis A key feature of an EGM is to provide direct access to user-friendly summaries. The method for this—and the final functionality of the map—will often depend on the resources available to produce the EGM. Step 6. Further disseminating knowledge derived from the EGM Finally, the map itself, together with information about its key findings and use, will be disseminated to its key users and other stakeholders, for example, through presentations, webinars, research briefs and other means. In the following, we outline how these steps will be taken for the EGM on child maltreatment in institutional settings. 3.2 EGM framework 3.2.1 Population This EGM will focus on the universe of interventions and outcomes for children aged under 18 years at the point of baseline measurement, living in and/or engaging in activities in institutional settings. Whilst children are the key target population, study participants may still be adults in that this EGM aims to include evidence on interventions that improve the professional practice of staff and organisational standards of agencies providing services to children and families. This EGM will be based on the framework visually outlined below. In the following we will first define intervention categories, followed by outcome categories. 3.2.2 Intervention categories This EGM will focus on four different intervention categories. Within each of these, the subcategories remain the same, as interventions are classified by their primary target—the child (victim), the offender/perpetrator or the institutional/organisational context in which child maltreatment takes place. The following table provides definitions for each intervention category and examples of how these may relate to each subcategory of key targets: Intervention category Subcategory Examples Prevention Victim − Universal/primary interventions (e.g. Educational interventions used in school settings, maternal-child health screening) − Tertiary interventions (e.g. Advocacy, social supports) Perpetrator − Universal/primary interventions (e.g. Traditional or social media campaigns) − Targeted therapeutic interventions (e.g. CBT group therapy, education interventions) − Tertiary interventions (e.g. criminal justice, pre-employment screening/criminal background checks) Organizational context − Staff training / professional development (e.g. Education programs) − Organisational guidelines and/or practices − Legal/policy interventions aimed at introducing new procedures for institutions to follow (e.g. Response framework) − Particular institutions aimed at enhancing safeguarding practice and outcomes in institutional settings (e.g. Child Advocacy Centres) Disclosure Victim − Universal/primary interventions (e.g. Traditional or social media campaigns, abuse helplines) − Targeted therapeutic interventions (e.g. Play therapy) Perpetrator − Legal interventions (e.g. Mandatory reporting) Organizational context − Staff training / professional development − Organisational guidelines and/or practices (e.g. Guidelines for reporting abuse) − Legal/policy interventions aimed at introducing new procedures for institutions to follow (e.g. Response framework) − Particular institutions aimed at enhancing safeguarding practice and outcomes in institutional settings (e.g. Child Advocacy Centres) Response Victim − Tertiary interventions (e.g. Legal avenues for criminal redress, advocacy, social supports) Perpetrator − Tertiary interventions (e.g. Criminal justice, arrest, removal of credentials) Organizational context − Staff training / professional development − Organisational guidelines and/or practices (e.g. Response framework, perpetrator accountability) − Legal/policy interventions aimed at introducing new procedures for institutions to follow − Particular institutions aimed at enhancing safeguarding practice and outcomes in institutional settings (e.g. Child Advocacy Centres) Treatment Victim − Targeted therapeutic interventions (e.g. Trauma-focussed interventions) Perpetrator − Targeted therapeutic interventions (e.g. CBT group therapy, behaviour change programs, narrative therapy) Organizational context − Staff support (e.g. Staff counselling) Studies in which only a subset of the interventions covered are eligible for inclusion in the map will be included, provided that the outcomes reported for these interventions are of relevance to this EGM. 3.2.3 Outcome categories This EGM will focus on six different outcome domains Outcome category Subcategory Examples Institutional safeguarding practice Cultural changes − Leadership behaviour (e.g. role modelling of safeguarding behaviour) − Staff perceptions of the importance of safeguarding / risk-aware / risk-targeting behaviour Operational changes − Staff recruitment procedures to enhance safeguarding practices − Staff training to increase knowledge and awareness − Implementation of child safeguarding policies Environmental changes − Changes in the institution's physical environment Child maltreatment disclosure Disclosure rates − The disclosure of different types of maltreatment through the victim, caregivers, institutional staff or others involved in the child's life Child maltreatment occurrence or reoccurrence (child safety) Neglect − The occurrence or re-occurrence of different types of child maltreatment within the institutional setting, for study participants – measured e.g. through self- or informant-reports Emotional and Psychological Abuse − Feelings of personal safety and security Physical Abuse − Presence of relationships that facilitate disclosure and / or harm Sexual Abuse Child knowledge / awareness − Knowledge about child maltreatment and potential responses to offending behaviour − Risk-aware / risk-targeting behaviour Child health and wellbeing Physical Health & Development − Normative standards for growth and development − Gross motor and fine motor skills − Overall health − BMI − Risk-avoidance behaviour related to health Mental health − Self-control, emotional management and expression − Internalizing and externalizing behaviours − Trauma symptoms − Self-esteem − Emotional intelligence − Self-efficacy − Motivation − Prosocial behaviour − Positive outlook − Coping Social-emotional functioning − Social competencies and skills − Attachment and caregiver relationships − Adaptive behaviour − Social connections and relationships Cognitive functioning − Language development − Pre-academic skills (e.g., literacy / numeracy) − Approaches to learning − Problem-solving skills − Academic achievement − School engagement / school attachment Adult perpetrator / child or youth offender outcomes Desistance − The degree of cessation of the maltreating behaviour Recidivism − The occurrence of relapse into maltreating behaviour Maltreatment behaviours − Harmful coercive behaviours − Bullying behaviours − Proble
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