What are the most effective early response strategies and interventions to assess and address the immediate needs of children outside of family care?
OBJECTIVE
Children outside of family care face increased risk of threats to their well-being, have lower educational achievement, and experience adverse developmental outcomes. While it is generally accepted that early response and intervention is critical to reducing the risk of harm for children who have been separated from their families, it is not always clear what the most effective early response strategies are for assessing and addressing their immediate needs. The purpose of this review was to identify evidence-based early response strategies and interventions for improving the outcomes of children outside of family care, including children of and on the street, institutionalized children, trafficked children, children affected by conflict and disaster, and who are exploited for their labor.


METHODS
A multi-phased, systematic evidence review was conducted on peer-reviewed and gray literature, which yielded a total of 101 documents that met the inclusion criteria and were reviewed.


RESULTS
Overall there is a weak evidence base regarding assessment and early response interventions for children living outside of family care. Few studies included careful outcome measures or comparison groups. Although few proven interventions emerged, the review identified several promising early interventions and approaches. In emergency settings, family tracing and reunification is a highly effective response in regard to separated children, whereas placing children in institutional care is problematic, with the possible exception of time-limited placements of formerly recruited children in interim care centers. Livelihood supports are promising in regard to preventing and responding to children living outside family care. Other promising interventions include psychosocial support, including the use of traditional cleansing rituals as appropriate, educational supports such as Child Friendly Spaces, the maintenance of family connectedness for children of or on the streets, the use of community-based approaches that aid social integration, and approaches that enable meaningful child participation. A recurrent theme was that to be effective, all assessments and interventions must fit the context.


CONCLUSIONS
A strong need exists for strengthening the evidence base regarding the effectiveness of early assessments and responses to children living outside family care and for using the evidence to guide operational policy and practice. Recommendations regarding policy, practices, and research emerged from the review process.
Columbia University, Mailman School of Public Health, 722 West 168th Street, New York, NY 10032, USA.
Neil
N
Boothby
Mike
M
Wessells
John
J
Williamson
Gillian
G
Huebner
Kelly
K
Canter
Eduardo Garcia
EG
Rolland
Vesna
V
Kutlesic
Farah
F
Bader
Lena
L
Diaw
Maya
M
Levine
Anita
A
Malley
Kathleen
K
Michels
Sonali
S
Patel
Tanya
T
Rasa
Fred
F
Ssewamala
Vicki
V
Walker
D002648:Child; D002649:Child Abuse / Q000534:rehabilitation*; D002669:Child Welfare; D004632:Emergency Medical Services / Q000379:methods; D055317:Evidence-Based Practice / Q000379:methods*; D006801:Humans; D020380:Needs Assessment / Q000458:organization & administration; D015397:Program Evaluation; D035862:Vulnerable Populations