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[182] 15 maart 2021: Interventions that address institutional child maltreatment: Evidence and gap map

Inleiding en context

Allemaal een hele fijne werkweek toegewenst op deze maandagmorgen 15 maart 2021. Vandaag een onderwerp dat niet vrolijk stemt, daarom eerst een popklassieker om de week toch op een fijne manier te beginnen: https://www.youtube.com/watch?v=yj5WvpkYHz0 Inderdaad, het voorjaar komt er aan. Het wachten op de zomerzon kan beginnen. Jim Morrison, één van mijn (dode) helden. Maar nu naar de bijgesloten systematische review van vanochtend.

Kindermishandeling, dat wil zeggen verschillende soorten geweld zoals seksueel, emotioneel en fysiek, misbruik en / of emotionele en fysieke verwaarlozing’ is een wijdverbreid fenomeen dat miljoenen kinderen en gemeenschappen over de hele wereld treft. Het meten van de prevalentie van kindermishandeling in institutionele contexten en settings is een hele uitdaging omdat deze gegevens zijn niet direct beschikbaar zijn. Er is weinig bekend over de prevalentie van verschillende vormen van kindermishandeling die plaatsvinden in institutionele omgevingen zoals kleuterscholen en scholen, religieuze instellingen, instellingen voor uithuisgeplaatste kinderen en andere vergelijkbare contexten waarin kinderen hun tijd doorbrengen. Mishandeling in deze contexten kan betrekking hebben op volwassenen die kinderen misbruiken, kinderen die andere kinderen misbruiken, instellingen die kindermishandeling risicovolle mogelijkheden bieden en kenmerken van kinderen die hun kwetsbaarheid voor het risico op mishandeling vergroten. Het gebrek aan onderzoek is te wijten aan de relatief jonge onderzoektraditie van institutionele kindermishandeling als een veld van empirisch onderzoek. Hierbij lag de focus vooral op seksueel misbruik binnen met name religieuze settings en zorginstellingen voor uithuisgeplaatste kinderen. Andere institutionele vormen waar kindermishandeling plaats vindt zijn veel minder zijn onderzocht.

Kindermishandeling in institutionele omgevingen is een complex probleem dat bestaat uit vier mogelijke factoren die het ontstaan en de prevalentie van kindermishandeling beïnvloeden:

  • Volwassenen die kinderen mishandelen / misbruiken,
  • Kinderen die andere kinderen misbruiken,
  • Instellingen die kindermishandeling mogelijk maken, en
  • Kenmerken van kinderen die hun kwetsbaarheid voor mishandeling vergroten.

Bijgesloten systematische review biedt een overzicht waarin een gestructureerde en toegankelijke verzameling van bestaande evaluaties uit afgeronde en lopende projecten en interventies, een overzicht van systematische reviews en effectiviteitsstudies van kindermishandeling in institutionele contexten wordt gepresenteerd. Binnen deze review wordt een ‘institutionele setting’ gedefinieerd als een instelling of organisatie die wordt gebruikt om kind gerelateerde activiteiten en / of zorg te promoten. Op basis van deze definitie komen onderzoeken die in de volgende instellingen zijn uitgevoerd in aanmerking:

  • Kleuterschool  / centrum voor voor- en vroegschoolse educatie en opvang,
  • Scholen / instellingen voor voor- en naschoolse opvang,
  • Sportclubs, sport- en recreatie-instellingen,
  • Dans-, toneel- en muziekstudio’s / scholen,
  • Kerken / religieuze instellingen,
  • Zomer- / vakantiekampen,
  • Instellingen voor out-of-home care (OOHC) / pleegzorg,
  • Weeshuizen,
  • Detentiecentra / jeugdstrafrechtsinstellingen,
  • Reddingswezen,
  • Ziekenhuizen / gezondheidsklinieken / spoedeisende hulp,
  • Elk ander type organisatie / institutionele omgeving waarin kinderen hun tijd kunnen doorbrengen.

Bron

Finch Meghan, Rebecca Featherston, Sangita Chakraborty, Ludvig Bjørndal, Robyn Mildon, Bianca Albers, Caroline Fiennes, David J. A. Taylor, Rebecca Schachtman, Taoran Yang & Aron Shlonsky (March 2021). Interventions that address institutional child maltreatment: Evidence and gap map. Campbell Systematic Reviews, vol. 17, no. 1, March, pp. 1-104. https://onlinelibrary.wiley.com/doi/full/10.1002/cl2.1139

Samenvatting

Child maltreatment has serious short and long‐term negative impacts for those experiencing it. Child maltreatment occurring in institutional settings has recently received substantial attention. However, evidence about the effectiveness of interventions that prevent, disclose, respond to, or treat maltreatment that has occurred in these environments is fragmented and can be difficult to access. This evidence and gap map (EGM) collates this research evidence. It was developed as a resource for stakeholders operating in the child health, welfare and protection sectors, including practitioners, organisational leaders, policy developers and researchers, wanting to access high quality evidence on interventions addressing institutional child maltreatment.

Child maltreatment affects millions of children, adults and communities globally. Research on institutional maltreatment is spread across multiple sources and can be difficult for stakeholders to locate. This EGM provides a “go to” resource that presents existing evidence evaluating the effectiveness of interventions targeting the prevention, disclosure, response to and treatment of institutional child maltreatment. The map indicates that evidence supporting interventions addressing institutional child maltreatment is limited. Child maltreatment, including sexual, physical or emotional abuse and neglect, negatively impacts the physical, mental, spiritual and interpersonal wellbeing of those experiencing and surviving it, in both the short term and the long term. Child maltreatment occurring in institutional settings has recently gained substantial public and policy recognition through government inquiries. Institutional settings can include places of education, foster care, residential care or juvenile justice or health care settings. The relevant research can be difficult for stakeholders, such as policy makers, researchers, practitioners and others, to access and use because it is spread out across multiple sources.

Eligible studies were systematic reviews and primary studies that reported on the effectiveness of interventions addressing child maltreatment within institutional settings. Seventy‐three eligible studies met the selection criteria, including: 11 systematic reviews, 59 primary studies and three protocols. The studies were conducted across 18 countries, with over half within the United States. Most studies evaluated curriculum‐based interventions delivered in educational settings, aimed at preventing sexual abuse. Fewer studies examined other organisational settings, such as out‐of‐home care settings (including, foster care, residential care and orphanages). No studies explicitly assessed sports clubs, religious organisations, juvenile justice or health care settings.

Most interventions targeted children, rather than adults. Few studies included populations known to be at risk, or those already exposed to maltreatment. Prevention interventions were most studied, with few studies evaluating disclosure, institutional responses or treatment interventions. The majority of studies assessed interventions addressing sexual abuse, and far fewer addressed physical and emotional abuse, or neglect. The reported outcomes reflected the bias toward child‐targeted interventions, and primarily captured child wellbeing and protective skills/knowledge outcomes. Measures of maltreatment disclosure or maltreatment occurrence/reoccurrence were less common, and all other outcome categories included in the EGM were minimally represented. Only a third of studies reported measures of implementation. These included measures representing the feasibility, adoption, fidelity, acceptability and penetration of the interventions being evaluated.

This EGM indicates that evidence supporting interventions addressing institutional child maltreatment is limited. The map highlights a substantial need for more high‐quality studies that evaluate interventions across a broader range of institutional contexts and maltreatment types. The evidence does not currently cover countries with large populations and those with the greatest incidence of child maltreatment. Few studies focussed on perpetrators or the organisational environment. There are evidence gaps for disclosure, organisational responses and treatment interventions, and few studies assessed interventions targeting perpetrators’ behaviours, recidivism or desistence. More research is needed to address the gaps described above. Furthermore, future studies should include measures of programme implementation.

Afsluitend

Afsluitend geef ik in dit geval maar een opsomming van de door de auteurs van deze bijgesloten systematische review geformuleerde implicaties voor onderzoek, beleid en praktijk:

Overall, the evidence included in the EGM is sparse and of low to moderate quality. There is much need for further high‐quality research, specifically:

  • Evaluating interventions in a broader range of institutions;
  • In countries with the largest populations, in which the greatest prevalence of child maltreatment in institutions is likely to occur;
  • Assessing interventions that focus on perpetrators and the organisational environment (as well as children);
  • Studies of gender‐specific interventions or studies that disaggregate the results by gender, particularly those evaluating group‐based delivery approaches, to ascertain whether gender‐specific approaches to prevention or treatment have merit;
  • Assessing interventions addressing a broader range of maltreatment types, in particular those relating to neglect and emotional abuse (i.e., not only sexual abuse);
  • Assessing interventions focussed on disclosure, organisational responses and treatment (both victim/survivor and offender);
  • Assessing interventions targeting perpetrators, maltreatment behaviours, recidivism and desistence and
  • Assessment and reporting of implementation outcomes.

The current evidence base for interventions specifically addressing institutional child maltreatment is sparse. It is therefore difficult to assess whether an intervention which achieved some result in one location or setting will achieve that same result elsewhere. For instance:

  • Could school‐based education and skills training interventions be appropriately translated to other institutions and/or other populations? For example, could the kind of child trainings which have been studied schools be delivered at Scouts? Could training for teachers be delivered to clergy?
  • Could effective institutional safeguarding practices or policies be adapted to other organisational contexts and/or personnel?
  • Are treatment principles for children who experienced maltreatment in other settings appropriate and effective for children who experienced maltreatment in an institutional environment? Or, are interventions for perpetrators as effective with populations of perpetrators who abused within an institutional setting?
  • Given the potential for boys to respond differently to programmes than girls, should non gendered approaches be adapted into gender‐specific interventions?

Clearly, interventions that are moved from one type of setting to another may not work as well there. This highlights the importance of continuing to evaluate an intervention when it is delivered somewhere other than the setting it has been shown to be effective in. For example, if an education and training intervention which has been effective when delivered in schools, is used in a sports or recreational setting, it should be further evaluated there. Similarly, an education and training intervention for school staff to prevent child physical and emotional abuse may be transferrable to coaches and mentors in sport and recreation contexts, but would need to be evaluated with those personnel in their contexts.