1 Department of Psychology, University of Konstanz, Konstanz, Germany.
2 vivo international, Konstanz, Germany.
Trauma Violence Abuse. 2017 Dec;18(5):544-561. doi: 10.1177/1524838016641918. Epub 2016 Apr 12.
Quality of child care has been shown to have a crucial impact on children's development and psychological adjustment, particularly for orphans with a history of maltreatment and trauma. However, adequate care for orphans is often impacted by unfavorable caregiver-child ratios and poorly trained, overburdened personnel, especially in institutional care in countries with limited resources and large numbers of orphans. This systematic review investigated the effects of structural interventions and caregiver trainings on child development in institutional environments. The 24 intervention studies included in this systematic review reported beneficial effects on the children's emotional, social, and cognitive development. Yet, few studies focused on effects of interventions on the child-caregiver relationship or the general institutional environment. Moreover, our review revealed that interventions aimed at improving institutional care settings have largely neglected violence and abuse prevention. Unfortunately, our findings are partially limited by constraints of study design and methodology. In sum, this systematic review sheds light on obstacles and possibilities for the improvement in institutional care. There must be greater efforts at preventing violence, abuse, and neglect of children living in institutional care. Therefore, we advocate for combining attachment theory-based models with maltreatment prevention approaches and then testing them using rigorous scientific standards. By using approaches grounded in the evidence, it could be possible to enable more children to grow up in supportive and nonviolent environments.
儿童保健质量对儿童的发展和心理适应有至关重要的影响，尤其是对有虐待和创伤史的孤儿。然而，孤儿的适当照顾往往受到不利的照顾者与儿童比例以及训练不足、负担过重的人员的影响，尤其是在资源有限、孤儿众多的国家的机构护理中。本系统评价调查了结构性干预和照顾者培训对机构环境中儿童发展的影响。本系统评价中包括的 24 项干预研究报告了对儿童情绪、社会和认知发展的有益影响。然而，很少有研究关注干预对儿童-照顾者关系或一般机构环境的影响。此外，我们的综述还表明，旨在改善机构照顾环境的干预措施在很大程度上忽视了暴力和虐待预防。不幸的是，我们的研究结果部分受到研究设计和方法的限制。总之，本系统评价揭示了改善机构照顾的障碍和可能性。必须加大力度防止生活在机构照顾中的儿童遭受暴力、虐待和忽视。因此，我们提倡将基于依恋理论的模式与虐待预防方法相结合，然后用严格的科学标准对其进行测试。通过使用基于证据的方法，有可能使更多的儿童在支持性和非暴力的环境中成长。
