title: Fostering Child Development by Improving Care Quality: A Systematic Review of the Effectiveness of Structural Interventions and Caregiver Trainings in Institutional Care.
abstract: 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.
authors.affiliation: 1 Department of Psychology, University of Konstanz, Konstanz, Germany.|2 vivo international, Konstanz, Germany.
authors.forename: Katharin
authors.initials: K
authors.lastname: Hermenau
authors.affiliation: 1 Department of Psychology, University of Konstanz, Konstanz, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Goessmann
authors.affiliation: 3 FairstartGlobal, Denmark.
authors.forename: Niels Peter
authors.initials: NP
authors.lastname: Rygaard
authors.affiliation: 2 vivo international, Konstanz, Germany.|4 University Children's Hospital Zurich, Zurich, Switzerland.|5 Department of Child and Adolescent Health Psychology, Institute of Psychology, University of Zurich, Zurich, Switzerland.
authors.forename: Markus A
authors.initials: MA
authors.lastname: Landolt
authors.affiliation: 1 Department of Psychology, University of Konstanz, Konstanz, Germany.|2 vivo international, Konstanz, Germany.|6 Division of Psychopathology & Clinical Intervention, Institute of Psychology, University of Zurich, Zurich, Switzerland.
authors.forename: Tobias
authors.initials: T
authors.lastname: Hecker
mesh_terms: D000293:Adolescent; D017028:Caregivers / Q000193:education*; D002648:Child; D002649:Child Abuse / Q000517:prevention & control; D002654:Child Care / Q000592:standards*; D002657:Child Development; D002674:Child, Institutionalized / Q000706:statistics & numerical data*; D054540:Child, Orphaned / Q000706:statistics & numerical data*; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019372:Orphanages
keywords: attachment; care quality; child maltreatment; institutional care; interventions; orphans; prevention