a Department of Infection & Population Health , University College London , London , UK.
Psychol Health Med. 2017 Mar;22(sup1):31-57. doi: 10.1080/13548506.2016.1271951. Epub 2017 Jan 9.
Institutions are not necessarily good environments for children. In the face of challenges such as HIV, Ebola, poverty, conflict and disaster the numbers have grown rather than reduced. Some countries have closed institutions down -driven by findings that cognitive developmental delay is associated with institutional care. Yet insight into abuse and violence within institutionalised settings is neglected. Maltreatment -violence and abuse -may be an issue. This systematic review series addresses violence and abuse experiences in institutionalised care, exploring firstly the frequency of abuse/violence in institutions, secondly any interventions to reduce such violence or abuse and thirdly the perpetrators of such violence or abuse. The final systematic review updates the findings on cognitive delay associated with institutionalised care. With a violence lens, cognitive delay may well be considered under the umbrella of neglect. Maltreatment and abuse may be a driver of cognitive delay. The keyword search covered several electronic databases and studies were included for data abstraction if they met adequacy criteria. Eight studies were identified on the prevalence of abuse in institutions and a further three studies reported on interventions. Only one study was identified documenting peer on peer violence in institutions. Sixty-six studies were identified examining cognitive development for institutionalised children. All but two of these record cognitive deficits associated with institutionalisation. Only two asked about violence or abuse which was found to be higher in institutionalised children. Overall the abuse experiences of children in institutions are poorly recorded, and in one study violence was associated with high suicidal attempts. The major intervention pathway for ameliorating cognitive challenge seems to be placement out of the institutions which shows benefits and redresses some cognitive outcomes - yet not a total panacea. The single study providing training and monitoring of harsh punishment and maltreatment showed immediate and decided reductions. This data suggest, despite the paucity of studies, violence and abuse, by commission or omission is prevalent in institutions, has an effect on child well-being and is amenable to intervention. Simple training or more complex structures to place children within conducive alternative environments (or to avoid institutionalised placements in the first place) seem to be the main pathway of intervention.
机构对于儿童来说并不一定是良好的环境。面对艾滋病、埃博拉、贫困、冲突和灾难等挑战，儿童数量不仅没有减少，反而有所增加。一些国家已经关闭了机构，这是因为研究发现认知发育迟缓与机构照料有关。然而，人们忽视了机构环境中虐待和暴力的问题。虐待——暴力和虐待——可能是一个问题。本系列系统评价探讨了机构照料中的虐待和暴力经历，首先探讨了机构中虐待/暴力的频率，其次探讨了任何减少这种暴力或虐待的干预措施，最后探讨了这种暴力或虐待的实施者。最后一项系统评价更新了与机构照料相关的认知发育迟缓的发现。从暴力的角度来看，认知发育迟缓很可能被视为忽视的一部分。虐待和虐待可能是认知发育迟缓的驱动因素。关键词搜索涵盖了几个电子数据库，如果研究符合充分性标准，就会纳入数据摘要。确定了八项关于机构中虐待流行率的研究，另有三项研究报告了干预措施。只有一项研究记录了机构中同伴间的暴力行为。有 66 项研究审查了机构中儿童的认知发展。除了两项记录与机构化相关的认知缺陷外，其余的都记录了认知缺陷。只有两项研究询问了暴力或虐待问题，结果发现机构化儿童的暴力或虐待发生率更高。总的来说，机构中儿童的虐待经历记录不佳，在一项研究中，暴力与高自杀企图有关。改善认知挑战的主要干预途径似乎是将儿童从机构中安置出来，这显示出了益处，并纠正了一些认知结果——但并非完全有效。唯一一项提供关于严厉惩罚和虐待培训和监测的研究显示，这种培训和监测立即产生了显著的效果。这些数据表明，尽管研究很少，但机构中普遍存在着暴力和虐待行为，这种行为对儿童的福祉有影响，而且可以进行干预。简单的培训或更复杂的结构，将儿童安置在有利的替代环境中（或首先避免机构化安置），似乎是干预的主要途径。
