We look at four intervention types.
Prevention
Prevention interventions aim to decrease the likelihood or risk of child maltreatment occurring or recurring.
Interventions can be for any child / adult (‘universal populations’), or targeted at specific populations. Examples include school-based safety programmes, organisational guidelines or practices, and interventions targeted at perpetrators to reduce re-offending.
Encouraging disclosure
Disclosure: interventions aiming to encourage facilitate, support, or disclosure of child maltreatment. This includes universal interventions, such as media campaigns, child helplines, and therapeutic interventions for children that aim to promote disclosure (e.g., play therapy). It includes interventions relating to perpetrators, such as mandatory reporting, and promoting disclosure in an organisation e.g., staff training, and organisational guidelines.
Response
Response interventions include enhancing safeguarding practices, legal and policy interventions, supporting the victim and/or family, working with child protection agencies, and providing training and crisis support to staff in organisations.
Treatment
Treatment: therapeutic responses, including those provided to children who have experienced child maltreatment (whether that happened in institutions or outside), and interventions serving perpetrators. The Romania studies (Bucharest Early Intervention Project) are included here, because foster care was provided as treatment for young children who spent their early lives in terrible institutions (Communist children’s homes).
A summary of what the evidence says.
Here we summarise policies and practices, protocols, training and screening, which the research found to have positive effects. The full findings are in The Guidebook.
To understand this data in more detail, visit the Evidence and Gap Map.
Improving the organisation’s environment to protect children.
Educating teachers and childcare providers can significantly improve the environment of organisations that care for children. School-based teacher training programs such as the IRIE classroom toolbox have found to be effective in reducing teacher violence against children and fostering an emotionally supportive classroom setting. Similarly, the Second Step Child Protection Unit (CPU) intervention has effectively addressed child sexual abuse (CSA), resulting in positive changes in teachers’ knowledge, attitudes, and relationships with children. Children who participated in the program also benefited by gaining improved knowledge of CSA. These programmes are specifically designed to assist institutional staff to develop healthy relationships with children, recognise signs of mistreatment, and refrain from violent or aggressive behaviour towards the children. By improving the training and education of educators and caregivers, we can create a safer and healthier environment for children.
There are only 6 studies in this cell: 4 papers from 3 RCTs, 1 protocol for an RCT and 1 systematic review. The studies have moderate risk of bias with a high risk of bias. All 4 completed studies were rated as low risk of bias.
Training childcare providers can improve their knowledge, attitudes, and practices to prevent abuse.
Here the focus is on enhancing institutional operations by training teachers and other professionals who work with children. But it is unclear whether such training programmes protect children from abuse: though there does seem to be an increase in detection of abuse cases and a modest rise in the knowledge, attitude and behaviours of the adults trained.
The cell has 3 completed studies and protocols for 2 new studies. 2 completed studies were from the US and one from Spain. Overall, the findings had high risk of bias and hence are rather unreliable.
Training teachers and caregivers can help prevent CSA and discourage use of violence against children.
Training programmes equip teachers and other childcare professionals with knowledge and attitudes to identify and respond to any signs of child sexual abuse (CSA). In addition, trained teachers also used less harsh punishment against children. Red Flag/Green Flag is an example of a classroom-training programme for both children and teachers to recognise inappropriate touching, know about CSA and learn healthy response strategies. A sound training can raise the knowledge, awareness, and attitudes of institutional care providers towards child sexual abuse.
Evidence came from 15 primary studies – 4 from the US, 3 from Tanzania, 2 from Jamaica and the rest from Germany, the UK, South Africa, Uganda, Iran, and Ireland. 4 protocols and 2 systematic review. The studies have moderate risk of bias are also part of this intervention-outcome cell. At least half of all studies were marked as low risk of bias.
Increasing disclosure of potential abuse among children.
These programmes focused on increasing children’s knowledge about physical and sexual abuse and training them in what to do: the programmes increased their likelihood of disclosing abuse. If children can recognise, object and report situations of abuse, it creates an atmosphere where they can discuss instances of abuse. Evidence clearly shows that such programmes increase disclosures. Five of the studies are from the US. Helping children to identify unacceptable behaviours and respond in the right way(s) can create a safe environment for children to disclose abuse.
There are 11 primary studies in this cell (5 from USA, one each from Australia, Canada, Germany, Spain, UK & Uganda). Six studies were marked as moderate risk of bias and 3 had high risk of bias. Hence, the evidence was moderately reliable.
Training teachers can reduce their use of violence against children.
Teacher training can improve attitudes towards violence as punishment against children and introduce alternate methods of disciplining. All studied programmes were from Africa and Jamaica. Though multiple studies indicate that these programme reduce violence by staff, the findings need to be considered cautiously due to the high risk of bias in many studies. There is a need to build positive strategies of classroom management and disciplining children to provide them with a supportive environment to learn and engage.
Evidence came from 19 primary studies, 4 protocols and 5 systematic review. The studies have moderate risk of bias.
Early teacher training and caregiver engagement improves cognitive functioning among younger children.
Programmes like IRIE Classroom Toolbox, the Good School Toolkit and Early Head Start target training of preschool teachers in better classroom management and avoiding violent disciplining techniques. Some programmes also work with parents and caregivers to reduce use of violence. Young children who got these programmes show better overall cognitive functioning, particularly in reading, oral language skills, and scores on standardised cognitive development tests.
The cell includes 6 primary studies and 4 protocols. 4 of the primary studies are from Jamaica and the rest from Uganda, Tanzania, Haiti, Ghana, and the US. The findings are pretty reliable as 4 of the included studies are ‘low risk of bias’.
Effect of child abuse prevention programmes on children’s social-emotional functioning.
School-based programmes like ESPACE and Make a Move provide children with the knowledge and skills to identify and avoid abuse. The effects of these programmes on the social-emotional functioning of children is uncertain. Though some studies found improvements such as children having higher self-confidence and better conflict resolution skills, other studies found no such changes in self-efficacy, empathy or other similar emotions.
This cell has six primary studies, all except one based in high-income countries (The one exception is Jamaica). One systematic review. The studies have moderate risk of bias and protocols for 2 RCTs and are part of this cell. The overall evidence is marked as moderate risk of bias. Only one study had a high risk of bias.
School-based interventions have unclear effect in preventing peer violence among school students.
These programmes has no significant effect on peer violence. Research is needed to better understand and develop evidence-based interventions that effectively address and prevent peer violence and gender-based violence in schools.
This cell has three primary studies – one each from the US, South Africa and Pakistan. The study from US had a low risk of bias, the one from South Africa had a moderate risk of bias and the Pakistan one had a high risk of bias.
Sexual abuse prevention programmes raise children’s knowledge and awareness about sexual abuse.
School-based programmes to prevent sexual abuse work with children to teach them about abuse, and how to recognise and report it. Findings strongly indicate that such programmes work: children learn and retain what is taught.
Evidence comes from 63 primary studies, dominantly located in the US. The other studies are from Canada, the UK, Europe, Australia, Central America, Africa, and East Asia. Most studies are marked as ‘moderate risk of bias’, but the large number of included studies and consistency in the findings make the evidence highly reliable.
School-based sexual abuse prevention programmes do not increase anxiety in children.
Several classroom-based sexual abuse prevention programmes prepare young children to identify, avoid and report sexual abuse. Anxiety is often considered a potential side-effect of being exposed to such content. However, evidence clearly indicates no increase in anxiety among children who participated in sexual abuse prevention programmes. Evidently, such efforts need not be impeded by fears of making children anxious.
The cell has 25 primary studies and protocols for four new RCTs. Eight of the studies are from the US and the rest from Australia, Spain, Germany, the Netherlands, Malaysia, Australia, and the Republic of Ireland. The studies had ‘moderate risk of bias’.
Structured training programmes for teachers, parents, and other childcare providers can reduce the risk of violence against children.
Training teachers, parents and other childcare providers can shift their attitude towards violence against children. Programmes such as the IRIE Classroom Toolbox and Interaction Competencies with Children – for Caregivers (ICC-C) encourages caregivers to avoid violence as a disciplining technique and to be positively involved in the child’s life. There is a clear drop in violence by caregivers who take this training.
The cell has four completed primary studies and a protocol for an RCT – three studies from Jamaica and one each from Tanzania and Haiti. All four studies are low risk of bias, making the findings highly reliable.
Training teachers and parents can improve their knowledge on preventing abuse and violence against children.
School-based training programmes for parents and teachers can improve their knowledge and attitude towards abuse and use of violence against children. Initiatives like the Good School Toolkit and the Stay Safe programmes are successful in changing parents’ outlook towards abuse-prevention programmes. Significantly, parents and teachers gained knowledge about seeking help against abuse and used less violence to discipline children. The findings carry a moderate risk of bias. Implementing early parent and teacher training can enhance their knowledge and attitude towards child abuse and violence.
The cell includes eight primary studies assessing seven different programmes – 2 of the programmes were from the US, while one each was from Jamaica, Uganda, South Africa, Northern Ireland and the Republic of Ireland. The overall evidence had a moderate risk of bias.
Programmes to increase the likelihood of children self-disclosing potential abuse.
A few studies suggest that disclosure-focused programmes can increase children self-disclosing potential abuse. However, the studies are still too few to provide solid and reliable answers about the effectiveness here.
Two studies were school-based and focused on preparing students to identify dangerous situations and how to avoid them. One of these studies is specifically focused on ‘Learn to be Safe with Emmy and Friends’ and creating a safe environment for children to disclose potential abuse.
The third study is quite different: with statutory agencies. The Multi-Agency Investigation and Support Team (MIST) was in Australia, and was inspired by Child Advocacy Centers (CACs) in the US: it created teams across statutory agencies to collaborate on response to alleged abuse.
This cell has three primary studies and one systematic review. The studies have moderate risk of bias. Two primary studies are low risk of bias: the other one has a high risk of bias.
Impact of disclosure-focussed programmes on children’s knowledge and awareness.
Disclosure-focused education aims to create an environment where children can safely discuss abuse and neglect. Such programmes can help children to recognize abuse and instruct them on what to do in dangerous situations. But their effects are mixed: some programmes helped children to recognise child abuse and neglect, but others did not succeed. There is an improvement in children’s willingness and confidence to disclose.
One option for organisations might be to combine disclosure-focused programmes with prevention programmes.
Improving institutional practices to protect children.
The effect of statutory response interventions to safeguard children is mixed. Response-focused interventions such as the Multi-agency Investigation & Support Team (MIST: which worked across statutory agencies in Australia) and Differential Response (which worked with social services in the US) involve specific actions or strategies to address and mitigate risks faced by children.
These interventions are in statutory agencies and hospitals: not schools, churches, clubs etc.
These interventions take various forms, including training agency staff on child protection practices, establishing protocols for reporting and managing allegations, and improving communication systems between staff members.
Two studies assess interventions to improve criminal justice, child protection, and service outcomes. One on Multi-agency Investigation & Support Team (MIST) program in Perth, Australia. MIST is similar to the prominent Children’s Advocacy Centre in the US approach where a group of government and community support agencies provide combined support services with investigations. Another study studied the impact of Differential Response (DR) in how social services handle families at low-to-moderate risk of child maltreatment, through family engagement, diversion from formal child protective services investigations, and service provision.
Two of the RCTs evaluated interventions in hospitals to see whether intervention can improve the practices of healthcare professionals in managing child maltreatment. One of them studied how a computerised support tool can help healthcare professionals adhere to Child Abuse and Neglect guidelines. Another study evaluated the impact of the
PediBIRN (Pediatric Brain Injury Research Network) 4-variable clinical decision rule on abuse evaluations and missed abusive head trauma in pediatric intensive care settings.
Two of these studies focus on healthcare and childcare professionals, one on training frontline professionals such as social workers, paediatricians, police officers, psychologists, psychiatrists, and nurses who are involved in reporting cases of child maltreatment to Child Protective Services and others on training adults in childcare settings on how to prevent, recognise and respond to child sexual abuse.
The cell contains six completed primary studies, a systematic review. The studies have moderate risk of bias and protocols for two new RCTs. The three completed studies are from the USA, Spain, the Netherlands and Australia (the MIST study). The findings are not very reliable as only one primary study had a low risk of bias. Response-focused interventions to enhance the institutional environment to protect children
Programmes to improve knowledge, attitudes, and practices of adults working with children helped them recognise child abuse and respond effectively to it. Programmes such as the Step Child Protection Unit, which addresses child sexual abuse through school policies, procedures, staff training, student lessons, and family education, has helped teachers to understand the signs of child sexual abuse as well as respond and report to these situations. Building robust response-focused interventions can ensure a safer organisation for children in the care of schools, day-care centres, foster homes and elsewhere.
This cell includes four studies: three completed primary studies and one systematic review. The studies have moderate risk of bias, plus a protocol. Two of the completed studies are from the US and one is from Portugal. The overall findings are rated as low risk of bias.
Training programmes for those who work with children can improve their knowledge, attitudes, and readiness to respond to signs of child abuse.
These programmes often target healthcare providers, early childhood educators, residential care providers, school teachers and administrators. Such training was found to succeed at increasing caregiver knowledge on child abuse and teaching them how to respond to abuse cases.
This cell has nine primary studies, a protocol for a primary study, and 1 systematic review. The studies have moderate risk of bias. Five studies are from the US, two from Turkey, and one each from Germany, Portugal, and Iran. The evidence is moderately reliable because most of the studies have only a moderate risk of bias.
Impact of response-focused interventions on child mistreatment.
The interventions here look at statutory agencies: local authorities, social services, and education authorities.
not things that individual schools / churches / clubs can implement on their own.
The programmes aim to enable a safer environment where children can disclose instances of potential abuse.
The programmes studied have mixed results, so there is no definitive answer as to whether these programmes succeed.
MIST (Multi-Agency Investigation & Support Team) worked with agencies in Australia to improve collaborative responses to child abuse allegations, by convening multiple agencies in one location. A case involves detectives, social workers, child family advocates, and therapists working together.
Another policy approach is Differential Response (DR), for social services. This provides responses based on the needs and risks of each individual case, as opposed to a one-size-fits-all approach. It aims to provide early intervention and support to low- to moderate-risk families to prevent occurrence or recurrence of child maltreatment. Families receive engagement, access to various services, and diversion from child protection investigations.
This cell has two primary studies and one review. The primary studies are from the US and Australia (MIST). The evidence is not very reliable: just two studies, both only quasi-experimental studies. One study has a low risk of bias, while the other has a moderate risk of bias.
Effect of response-focused programmes on children’s mental health.
There are no completed primary studies here, so we do not know the effects.
However, there are three systematic review. The studies have moderate risk of bias in this cell (though they do not contain primary studies which meet the criteria to the on the map). Two of the systematic reviews look at institutional care settings that reported mental health outcomes (two studies were included in both reviews). These studies had no control group. Results on mental health outcomes were mixed. One study reported a moderate reduction in Post-Traumatic Stress Disorder (PTSD) symptoms but no effect on depressive symptoms, internalising (“being withdrawn”) and externalising (“acting out”) behaviours. The second study found a significant drop in depressive symptoms, a moderate drop in internalising and externalising behaviours and a large drop in aggressive behaviours at three months. The third study from Portugal compared outcomes for children who lived at home vs in institutions after a Child Protective Services (CPS) investigation (they also compared both groups to a third group which did not receive any intervention). More than half of children in institutional care reported a suicide attempt.
The cell has no completed primary studies here. It has just three systematic reviews and one protocol for a new RCT.
Response-focused intervention can raise children’s knowledge and awareness about abuse.
There is only one completed study on this. It found that the interventions to improve response to abuse did increase child knowledge and awareness about abuse.
The Second Step Child Protection Unit (CPU) curriculum aims to empower pupils to address false assumptions about child sexual abuse. The programme provides teachers with tools so that they can identify and respond to abuse situations and teaches children about personal safety, not keeping secrets, and good/bad touches. School staff are trained online using simulated scenarios. Teachers also receive support to teach this material. The CPU program improved child sexual abuse prevention knowledge and self-efficacy among elementary school students. It was more effective for younger students (lower grades) than for older students (higher grades). Girls gained more knowledge and self-efficacy than did boys.
This cell has only one completed primary study and four systematic review. The studies have moderate risk of bias. The sole primary study is from the US and has a low risk of bias. Generally, the findings carry a moderate risk of bias.
Treatment programmes for children who have faced abuse can help their cognitive development.
A foster care programme for children who had been in terrible institutional care in Bucharest, Romania; they were permanently removed from the homes when less than three years old. This improved cognitive development in early childhood.
The Bucharest Early Intervention Project (BEIP) examined foster care for children who had spent their early years in terrible Communist orphanage with significant neglect. Foster parents were trained to establish strong relationship with the children. Although the foster care improved cognitive development in early childhood, there was no significant impact by adolescence.
This cell has five papers based on one RCT conducted in Romania. There is also one systematic review. The studies have moderate risk of bias.
Early intervention treatment can benefit children’s social and emotional functioning.
The Bucharest Early Intervention Project examines children who have experienced extreme neglect by putting them with foster families, aiming to improve their social and emotional growth. Foster care reversed the harms done to these children by Romania’s terrible orphanages and facilitated strong emotional bonds with the parent: fostered children had more friends and better relationships. This structured foster care greatly improved the overall development of the children’s social communication and relationships.
The cell has 4 primary papers based on one RCT conducted in Romania. Two systematic review. The studies have moderate risk of bias are in the cell. The findings, in general, have a moderate risk of bias.
Treatment programmes can improve the mental health of abused children.
There are two studies here. High-quality foster care helps children who have previously experienced neglect under institutional care.
Interventions to improve mental health in children who have experienced extremely adverse conditions such as living in dreadful institutions or being sexually abused and exploited are effective but based on only two primary studies.
Six papers come from the Bucharest Early Intervention Project (BEIP). Here, children who were in terrible orphanages before their third birthday were randomly assigned to either move to foster homes or to remain in the orphanages. Mental health outcomes were measured for both groups, and for children who had always lived with their birth families. The latter had consistently better mental health than children who were ever in the orphanages. Early entry into foster care and longer stable foster care improved mental health.
The other primary study in this cell examined psychotherapy for children who had suffered sexual abuse. A year after receiving therapy, many mental health outcomes improved but other outcomes saw no change.
This cell includes 3 systematic review. The studies have moderate risk of bias and 7 papers based on two primary studies, from the US and Romania. The cell also contains one protocol for a new RCT. The findings have a moderate risk of bias.
10 pointers for designing or requesting new monitoring or evaluation.
There are many gaps in the existing evidence about institutional responses to child abuse. So practitioners, funders and policy-makers may need to commission new rigorous research. It’s easy to waste time and money there! This guide explains what to do and what to avoid.