Coren Esther, Hossain Rosa, Pardo Jordi Pardo, Veras Mirella M S, Chakraborty Kabita, Harris Holly, Martin Anne J
Research Centre for Children, Families and Communities, Canterbury Christ Church University, Canterbury, UK.
Evid Based Child Health. 2013 Jul;8(4):1140-272. doi: 10.1002/ebch.1923.
Numbers of street-connected children and young people run into many millions worldwide and include children and young people who live or work in street environments. Whether or not they remain connected to their families of origin, and despite many strengths and resiliencies, they are vulnerable to a range of risks and are excluded from mainstream social structures and opportunities.
To summarise the effectiveness of interventions for street-connected children and young people that promote inclusion and reintegration and reduce harms. To explore the processes of successful intervention and models of change in this area, and to understand how intervention effectiveness may vary in different contexts.
We searched the following bibliographic databases, from inception to 2012, and various relevant non-governmental and organisational websites: Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE and PreMEDLINE; EMBASE and EMBASE Classic; CINAHL; PsycINFO; ERIC; Sociological Abstracts; Social Services Abstracts; Social Work Abstracts; Healthstar; LILACS; System for Grey literature in Europe (OpenGrey); ProQuest Dissertations and Theses; EconLit; IDEAS Economics and Finance Research; JOLIS Library Catalog of the holdings of the World Bank Group and IMF Libraries; BLDS (British Library for Development Studies); Google, Google Scholar.
The review included data from harm reduction or reintegration promotion intervention studies that used a comparison group study design and were all randomised or quasi-randomised studies. Studies were included if they evaluated interventions aimed to benefit street-connected children and young people, aged 0 to 24 years, in all contexts.
Two review authors independently extracted data and assessed the risk of bias of included studies. Data were extracted on intervention delivery, context, process factors, equity and outcomes. Outcome measures were grouped according to whether they measured psychosocial outcomes, risky sexual behaviours or substance use. A meta-analysis was conducted for some outcomes though it was not possible for all due to differences in measurements between studies. Other outcomes were evaluated narratively.
We included 11 studies evaluating 12 interventions from high income countries. We did not find any sufficiently robust evaluations conducted in low and middle income countries (LMICs) despite the existence of many relevant programmes. Study quality overall was low to moderate and there was great variation in the measurement used by studies, making comparison difficult. Participants were drop-in and shelter based. We found no consistent results on a range of relevant outcomes within domains of psychosocial health, substance misuse and sexual risky behaviours despite the many measurements collected in the studies. The interventions being evaluated consisted of time limited therapeutically based programmes which did not prove more effective than standard shelter or drop-in services for most outcomes and in most studies. There were favourable changes from baseline in outcomes for most particpants in therapy interventions and also in standard services. There was considerable heterogeneity between studies and equity data were inconsistently reported. No study measured the primary outcome of reintegration or reported on adverse effects. The review discussion section included consideration of the relevance of the findings for LMIC settings.
AUTHORS' CONCLUSIONS: Analysis across the included studies found no consistently significant benefit for the 'new' interventions compared to standard services for street-connected children and young people. These latter interventions, however, have not been rigorously evaluated, especially in the context of LMICs. Robustly evaluating the interventions would enable better recommendations to be made for service delivery. There is a need for future research in LMICs that includes children who are on the streets due to urbanisation, war or migration and who may be vulnerable to risks such as trafficking.
全球与街头有联系的儿童和年轻人达数百万之多，包括在街头环境中生活或工作的儿童和年轻人。无论他们是否仍与原生家庭保持联系，尽管他们有许多优势和适应能力，但他们易受一系列风险影响，被排除在主流社会结构和机会之外。
总结促进与街头有联系的儿童和年轻人融入社会并减少伤害的干预措施的有效性。探讨该领域成功干预的过程和变革模式，并了解干预效果在不同背景下可能如何变化。
我们检索了以下书目数据库，从建库至2012年，以及各种相关的非政府组织和机构网站：Cochrane对照试验中心注册库（CENTRAL）；医学索引（MEDLINE）和医学预印本数据库（PreMEDLINE）；荷兰医学文摘数据库（EMBASE）及其经典版；护理学与健康领域数据库（CINAHL）；心理学文摘数据库（PsycINFO）；教育资源信息中心数据库（ERIC）；社会学文摘数据库；社会服务文摘数据库；社会工作文摘数据库；健康之星数据库；拉丁美洲及加勒比地区健康科学数据库（LILACS）；欧洲灰色文献系统（OpenGrey）；ProQuest学位论文数据库；经济文献数据库（EconLit）；IDEAS经济学与金融研究数据库；世界银行集团和国际货币基金组织图书馆馆藏目录（JOLIS）；英国发展研究图书馆（BLDS）；谷歌、谷歌学术。
本综述纳入了来自减少伤害或促进重新融入社会干预研究的数据，这些研究采用比较组研究设计，均为随机或准随机研究。如果研究评估的干预措施旨在使0至24岁的与街头有联系的儿童和年轻人在所有背景下受益，则纳入该研究。
两位综述作者独立提取数据并评估纳入研究的偏倚风险。提取了关于干预实施、背景、过程因素、公平性和结果的数据。结果测量指标根据其是否测量心理社会结果、危险性行为或物质使用进行分组。对一些结果进行了荟萃分析，但由于研究之间测量方法的差异，并非所有结果都能进行荟萃分析。其他结果则进行叙述性评估。
我们纳入了11项评估来自高收入国家的12项干预措施的研究。尽管存在许多相关项目，但我们未在低收入和中等收入国家（LMICs）找到任何足够有力的评估。总体研究质量为低到中等，研究使用的测量方法差异很大，难以进行比较。参与者为临时收容所和庇护所的儿童。尽管研究中收集了许多测量数据，但我们在心理社会健康、物质滥用和危险性行为等领域的一系列相关结果上未发现一致的结果。所评估的干预措施包括限时治疗性项目，在大多数结果和大多数研究中，这些项目并不比标准的庇护所或临时收容所服务更有效。治疗性干预措施和标准服务中大多数参与者的结果与基线相比都有有利变化。研究之间存在相当大的异质性，公平性数据报告不一致。没有研究测量重新融入社会的主要结果或报告不良反应。综述讨论部分考虑了研究结果对低收入和中等收入国家背景的相关性。
对纳入研究的分析发现，与针对与街头有联系的儿童和年轻人的标准服务相比，“新”干预措施没有始终显示出显著益处。然而，这些标准服务尚未得到严格评估，尤其是在低收入和中等收入国家的背景下。对干预措施进行严格评估将有助于为服务提供提出更好的建议。未来需要在低收入和中等收入国家进行研究，纳入因城市化、战争或移民而流落街头且可能易受人口贩运等风险影响的儿童。
