Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO 80045, USA.
Child Abuse Negl. 2012 Oct;36(10):722-31. doi: 10.1016/j.chiabu.2012.09.005. Epub 2012 Oct 24.
This article reviews the available evidence regarding the efficacy, effectiveness, ethics, and sustainability of approaches to strengthen systems to care for and protect children living outside family care in low- and middle-income countries.
For trafficked children, children of and on the street, children of conflict/disaster, and institutionalized children, a systems framework approach was used to organize the topic of sustainable approaches in low- and middle-income countries and addresses the following: legislation, policies, and regulations; system structures and functions (formal and informal); and continuum of care and services. The article draws on the findings of a focal group convened by the U.S. Government Evidence Summit: Protecting Children Outside of Family Care (December 12-13, 2011, Washington, DC), tasked with reviewing the literature on systems, strategies, and interventions for sustainable long-term care and protection of children with a history of living outside of family care in low- and middle-income country contexts. The specific methodology for the review is described in the commentary paper (Higgs, Zlidar, & Balster, 2012) that accompanies these papers.
For the most part, the evidence base in support of sustainable long-term care for the populations of interest is relatively weak, with some stronger but unreplicated studies. Some populations have been studied more thoroughly than others, and there are many gaps. Most of the existing studies identify population characteristics, needs, and consequences of a lack of systemic services to promote family-like care. There is some evidence of the effectiveness of laws and policies, as well as some evidence of service effectiveness, in improving outcomes for children outside of family care.
Despite the weaknesses and gaps of the existing research, there is a foundation of research for going forward, which should focus on developing and implementing systems for these most vulnerable children. The evidence reviewed indicates that child protection systems should aim for appropriate, permanent family care (including reunification, adoption, kinship care, or kafalah) for children in order to secure the best environment for a child's developmental prospects. Evidence also suggests that the quality and duration of care, including both permanent family care and alternative care, are important regardless of setting. The diversity of political, socioeconomic, historical, regional, community, and cultural contexts in which child protection systems operate need to be taken into account during programming and research design.
本文回顾了在低中等收入国家加强家庭外儿童照护和保护系统的有效性、实用性、伦理和可持续性方面的现有证据。
对于被贩卖儿童、街头儿童、冲突/灾害儿童和机构化儿童，本文采用系统框架方法来组织低中等收入国家可持续方法的主题，并涉及以下内容：立法、政策和法规；系统结构和功能（正式和非正式）；以及连续照护和服务。本文借鉴了美国政府证据峰会组织的焦点小组会议的调查结果：保护家庭外儿童（2011 年 12 月 12 日至 13 日，华盛顿特区），负责审查有关系统、战略和干预措施的文献，以实现可持续的长期照护和保护低中等收入国家中经历过家庭外生活的儿童。这些论文所附的评论文章（Higgs、Zlidar 和 Balster，2012）描述了审查的具体方法。
在大多数情况下，支持感兴趣人群的可持续长期照护的证据基础相对薄弱，有一些更有力但未经复制的研究。一些人群比其他人群研究得更透彻，并且存在许多差距。大多数现有研究都确定了人口特征、需求以及缺乏系统服务以促进类似家庭的照护所带来的后果。有一些证据表明法律和政策的有效性，以及一些服务有效性的证据，这些证据都改善了家庭外儿童的结果。
尽管现有研究存在弱点和差距，但仍有基础继续研究，应专注于为这些最脆弱的儿童开发和实施系统。综述的证据表明，儿童保护系统应旨在为家庭外儿童提供适当、永久的家庭照顾（包括团聚、收养、亲属照顾或监护），以确保儿童发展前景的最佳环境。证据还表明，无论在何种环境下，护理的质量和持续时间，包括永久家庭照顾和替代照顾，都很重要。在方案制定和研究设计中，需要考虑到儿童保护系统运作的政治、社会经济、历史、区域、社区和文化背景的多样性。
