PROTOCOL: Evidence and gap map protocol: Institutional responses to child maltreatment

Child maltreatment, that is, ‘various types of violence such as sexual, emotional and physical, abuse and/or emotional and physical neglect’ (Lueger-Schuster et al., 2018), is a widespread phenomenon affecting millions of children, adults and communities around the globe. Measuring the prevalence of child maltreatment in institutional contexts is challenging, and these data are not readily available. Moreover, studies do not generally deal solely with maltreatment occurring specifically in these settings, and disentangling the effects of maltreatment occurring in institutional settings versus other maltreatment settings is not routine. That said, the overall rates of any type of child maltreatment may provide some indication, and these have recently been estimated to be between 3 per 1,000 children for physical and emotional abuse and 4 per 1,000 children for sexual abuse (Stoltenborgh, Bakermans-Kranenburg, Alink & van IJzendoorn, 2015). The World report on violence and health launched in 2002 reported a prevalence for abandonment and neglect at 21.9% in Kenya and 12–19% of physical neglect and abandonment in Canada (Krug, 2002). A series of meta-analyses estimated an overall prevalence rate of 16.3% for physical neglect and 18.4% for emotional neglect (Stoltenborgh et al., 2015). However, prevalence rates are sensitive to a number of factors. There are both geographical and gender differences. Rates also vary depending on whether incidences of maltreatment are self-reported or based on informants (Greger, Myhre, Lydersen & Jozefiak, 2015; Moody, Cannings-John, Hood, Kemp & Robling, 2018), and can vary with the identity of the perpetrator/s. How widely or narrowly different subtypes of maltreatment are defined and operationalised in studies or how many items are used to measure prevalence, can also impact on rate estimates. They should therefore be interpreted with caution. Even less is known about the prevalence of various forms of child maltreatment taking place within institutional settings such as kindergartens and schools, religious institutions, out-of-home care and other comparable contexts in which children spend their time (Blakemore, Herbert, Arney & Parkinson, 2017; Proeve, Malvaso & DelFabbro, 2016). Maltreatment in these contexts, can encompass adults abusing children, children abusing other children, institutions enabling child maltreatment and child characteristics enhancing their vulnerability to maltreatment. The dearth of research is due to the comparably young age of institutional child maltreatment as a field of empirical research (Timmerman & Schreuder, 2014), in which the focus has been on sexual abuse within especially religious and out-of-home care institutions, whereas other types of maltreatment and settings have been less examined (Proeve et al., 2016). Recent studies conducted in Germany (Allroggen, Ohlert, Rau & Fegert, 2018) and Norway (Greger et al., 2015) confirm that children placed in institutional care are at significantly higher risk of experiencing maltreatment but less is known about maltreatment taking place in areas such as sports and exercise (Bjørnseth & Szabo, 2018). However, it is clear that child maltreatment taking place in these settings affects the lives of both victims, their families and their communities—at times for generations. Child maltreatment has a negative impact on the physical, mental, spiritual, educational and economic wellbeing of those experiencing and surviving it—both in the short term and in the form of long-term consequences that reduce the quality of life during adulthood (Lueger-Schuster et al., 2018). In recent years, child maltreatment occurring in institutional settings has received substantial attention both at the policy level, amongst practitioners and service agencies working with children in different capacities and roles, and as part of the public debate. Law Commission of Canada (2012). Restoring Dignity—Responding to Child Abuse in Canadian Institutions. The Scottish Government (2012). Review of Child Neglect in Scotland. New Zealand House of Representatives (2014). Inquiry into Improving Child Health Outcomes and preventing child abuse with a focus from preconception until three years of age. Royal Commission into Institutional Responses to Child Sexual Abuse (Australia, 2014–2017). Northern Ireland Historical Institutional Abuse Inquiry 1922–1995 (2017). Pennsylvania Attorney General (2018). Pennsylvania Diocese Victims Report. Unabhängige Kommission zur Aufarbeitung sexuellen Kindesmissbrauchs (Germany, 2016–2023). Indepedent Inquiry Child Sexual Abuse (U.K., 2019). Sexual Abuse of Children in Custodial Institutions (U.K., 2009–2017). These inquiries have led to the production of many research reports—among them a number of rapid or full systematic reviews examining the impact of institutional child maltreatment (Blakemore et al., 2017), how it can be prevented (South, Shlonsky & Mildon, 2014, 2015; Pitts, 2015), victims supported (Shlonsky, Albers & Paterson, 2017), and suitable responses be implemented and maintained over time (Parenting Research Centre, 2015; Albers & Mildon, 2016). However, this and other evidence on the effectiveness of interventions aimed at identifying, preventing or responding to institutional child maltreatment is spread across multiple sources and often exists in the form of academic or grey literature that can be difficult to access for institutions that wish to improve their practices and services in this area. Therefore, there is still considerable confusion amongst sector stakeholders about what evidence exists for safeguarding interventions developed for use in institutional settings. The objective of the evidence and gap map (EGM) described in this protocol is to reduce this confusion and to provide a ‘go to’ knowledge base for stakeholders wanting to access high-quality evidence on interventions addressing institutional child maltreatment. The guiding research question for this evidence and gap map is: Prevent the occurrence of maltreatment of children (including preventing peer to peer abuse) Prevent the recurrence of maltreatment of children (preventing offenders from re-offending) Reduce harm to the health and wellbeing of children exposed to child maltreatment Enhance the disclosure of child maltreatment; and Improve organisational practice and standards for addressing issues related to child maltreatment. Guided by this research question, the EGM will be structured into interventions aimed at institutional child maltreatment identification/disclosure, prevention, treatment and other responses (vertical structure). The EGM's horizontal structure will be formed by outcomes that relate to the institutional setting, the child's physical, mental, spiritual, educational and economic wellbeing, and the perpetrators of child maltreatment. These dimensions of the EGM are outlined in greater detail below—under ‘EGM Framework’. The EGM will contain effectiveness studies of different designs, including overviews of systematic reviews, systematic reviews, (cluster) randomised controlled trials and studies using quasi-experimental designs. It will be a global EGM covering low-, middle- and high-income countries. In the following, these and other characteristics are described in greater detail. Child maltreatment in institutional settings is a complex problem consisting of four potential factors influencing the occurrence of child maltreatment (Royal Commission into Institutional Responses to Child Sexual Abuse, 2017): Adults abusing children, Children abusing other children, Institutions enabling child maltreatment, and Child characteristics enhancing their vulnerability to maltreatment Preventing occurrence and reoccurrence of child maltreatment. This may be based on either Universal services available to an entire target population and aimed at promoting positive behaviours and functioning and/or at decreasing risk factors and the likelihood of problems and challenges in a person's life. Targeted services available to selected members of a target population who are at risk of developing or experiencing particular problems—with the intervention aimed at reducing these risks. Disclosing child maltreatment. A key factor in ending, responding to and treating the consequences of child maltreatment is its disclosure—especially in cases of child sexual abuse (Paine & Hansen, 2002; Lemaigre, Taylor & Gittoes, 2017). Recent inquiries have documented the substantial barriers existing in institutional settings to facilitate such disclosure (Royal Commission into Institutional Responses to Child Sexual Abuse, https://www.childabuseroyalcommission.gov.au/; Lemaigre et al., 2017), pointing to the importance of including disclosure interventions in this EGM. Responding to the occurrence of child maltreatment. Institutions have strong legal and ethical obligations to respond appropriately when child maltreatment has been detected or disclosed. This includes reporting the maltreatment, supporting the victim and/or family, working with child protection agencies and providing training and crisis support to staff. Treating the consequences of child maltreatment. Providing services or referring children and families to agencies that provide therapeutic care for one or more of the many known problems associated with experiencing child abuse and neglect (e.g., PTSD). Based on this understanding, the EGM will cover studies examining interventions aimed at preventing occurrence and reoccurrence of child maltreatment, disclosing child maltreatment, responding to the occurrence of child maltreatment and/or treating its consequences. These interventions may be placed at all levels of the service spectrum and target either children, child offenders, perpetrators or the institutional setting. Cultural factors (e.g., leadership, organisational culture), Operational factors (e.g., governance, day-to-day work routines and practices), and Environmental factors (e.g., physical spaces). Studies examining interventions addressing any of these organisational factors will therefore be included in this EGM. A more detailed outline of how this overarching framework will be operationalised in developing the full EGM is presented in Section 3 of this protocol. Given the lack of a ‘go to’ global knowledge base presenting high quality evidence on the effectiveness of safeguarding (actions taken to protect vulnerable groups from harm; Cambridge University Press, 2019) interventions tested in institutional settings, the production of this EGM is highly overdue. The identification of areas with potentially sufficient studies to conduct a meta-analysis within a systematic review - if none currently exists. Service providers (institutions) in identifying potentially effective interventions and/or key characteristics of potentially effective interventions. This knowledge can be used to inform the selection or design of safeguarding interventions to be applied locally. Funders and policymakers to inform funding and/or policy decisions related to the safeguarding of children in institutional settings. These can be decisions about the selection of potentially effective interventions or the funding of research—for example, research that can fill existing gaps in the knowledge base. Research organisations in assessing the current evidence on child maltreatment in institutional settings. This knowledge can inform the development of research agendas and priorities. Kornør, John, Axelsdottir, Biedilæ and Albers (2018) is in development still. 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