Comparative International data on patterns of inequality in child welfare interventions, for example, the proportion of children about whom there are substantiated child protection (CP) concerns or who are in out-of-home care (CLA), are far less developed than data about inequalities in health. Few countries collect reliable, comprehensive information and definitions, methods of data collection and analysis are rarely consistent. The four UK countries (England, Northern Ireland, Scotland and Wales) provide a potential 'natural experiment' for comparing intervention patterns. This study reports on a large quantitative, descriptive study focusing on children in contact with children's services on a single date in 2015. It found that children's chances of receiving a child protection intervention was primarily related to family socio-economic circumstances, measured by neighbourhood deprivation, within all four countries and in every local area. There was a strong social gradient which was significantly steeper in some countries than others. Ethnicity was another important factor underlying inequalities. While inequalities in patterns of intervention between the four countries were considerable, they did not mirror relative levels of deprivation in the child population. Inequalities in intervention rates result from a combination of demand and supply factors. The level and extent of inequity raise profound ethical, economic and practical challenges to those involved in child protection, the wider society and the state.

Child maltreatment is a global problem affecting millions of children and is associated with an array of cumulative negative outcomes later in life, including unemployment and financial difficulties. Although establishing child maltreatment as a causal mechanism for adult economic outcomes is fraught with difficulty, understanding the relationship between the two is essential to reducing such inequality. This paper presents findings from a systematic review of longitudinal research examining experiences of child maltreatment and economic outcomes in adulthood. A systematic search of seven databases found twelve eligible retrospective and prospective cohort studies. From the available evidence, there was a relatively clear relationship between 'child maltreatment' and poorer economic outcomes such as reduced income, unemployment, lower level of job skill and fewer assets, over and above the influence of family of origin socio-economic status. Despite an extremely limited evidence base, neglect had a consistent relationship with a number of long-term economic outcomes, while physical abuse has a more consistent relationship with income and employment. Studies examining sexual abuse found less of an association with income and employment, although they did find a relationship other outcomes such as sickness absence, assets, welfare receipt and financial insecurity. Nonetheless, all twelve studies showed some association between at least one maltreatment type and at least one economic measure. The task for future research is to clarify the relationship between specific maltreatment types and specific economic outcomes, taking account of how this may be influenced by gender and life course stage.

As Northern Ireland transitions to a post‐conflict society the nature of violent victimization and its influence on adolescents following the “Troubles” becomes an even more important area of interest. Adolescents are particularly at risk of victimization and associated social, emotional, and psychological health problems. In this analysis of the fifth year of the Belfast Youth Development Study (BYDS), the prevalence and implications of exposure to violence is examined for a sample of 3,828 young people (aged 15–16 years). Knowledge of violent events was particularly prevalent suggesting that the social and psychological legacy of the “Troubles” may pass onto post‐conflict generations. Over three quarters of young people had experienced violence within their community. Exposure was associated with higher levels of depression, psychotic symptoms, and substance misuse. The findings suggest that adolescents in Northern Ireland are vulnerable to both direct and vicarious victimization, and, subsequently, to significant risks to psychological well‐being. © 2009 Wiley Periodicals, Inc.

BackgroundChild maltreatment is a substantial social problem that affects large numbers of children and young people in the UK, resulting in a range of significant short- and long-term psychosocial problems.ObjectivesTo synthesise evidence of the effectiveness, cost-effectiveness and acceptability of interventions addressing the adverse consequences of child maltreatment.Study designFor effectiveness, we included any controlled study. Other study designs were considered for economic decision modelling. For acceptability, we included any study that asked participants for their views.ParticipantsChildren and young people up to 24 years 11 months, who had experienced maltreatment before the age of 17 years 11 months.InterventionsAny psychosocial intervention provided in any setting aiming to address the consequences of maltreatment.Main outcome measuresPsychological distress [particularly post-traumatic stress disorder (PTSD), depression and anxiety, and self-harm], behaviour, social functioning, quality of life and acceptability.MethodsYoung Persons and Professional Advisory Groups guided the project, which was conducted in accordance with Cochrane Collaboration and NHS Centre for Reviews and Dissemination guidance. Departures from the published protocol were recorded and explained. Meta-analyses and cost-effectiveness analyses of available data were undertaken where possible.ResultsWe identified 198 effectiveness studies (including 62 randomised trials); six economic evaluations (five using trial data and one decision-analytic model); and 73 studies investigating treatment acceptability. Pooled data on cognitive–behavioural therapy (CBT) for sexual abuse suggested post-treatment reductions in PTSD [standardised mean difference (SMD) –0.44 (95% CI –4.43 to –1.53)], depression [mean difference –2.83 (95% CI –4.53 to –1.13)] and anxiety [SMD –0.23 (95% CI –0.03 to –0.42)]. No differences were observed for post-treatment sexualised behaviour, externalising behaviour, behaviour management skills of parents, or parental support to the child. Findings from attachment-focused interventions suggested improvements in secure attachment [odds ratio 0.14 (95% CI 0.03 to 0.70)] and reductions in disorganised behaviour [SMD 0.23 (95% CI 0.13 to 0.42)], but no differences in avoidant attachment or externalising behaviour. Few studies addressed the role of caregivers, or the impact of the therapist–child relationship. Economic evaluations suffered methodological limitations and provided conflicting results. As a result, decision-analytic modelling was not possible, but cost-effectiveness analysis using effectiveness data from meta-analyses was undertaken for the most promising intervention: CBT for sexual abuse. Analyses of the cost-effectiveness of CBT were limited by the lack of cost data beyond the cost of CBT itself.ConclusionsIt is not possible to draw firm conclusions about which interventions are effective for children with different maltreatment profiles, which are of no benefit or are harmful, and which factors encourage people to seek therapy, accept the offer of therapy and actively engage with therapy. Little is known about the cost-effectiveness of alternative interventions.LimitationsStudies were largely conducted outside the UK. The heterogeneity of outcomes and measures seriously impacted on the ability to conduct meta-analyses.Future workStudies are needed that assess the effectiveness of interventions within a UK context, which address the wider effects of maltreatment, as well as specific clinical outcomes.Study registrationThis study is registered as PROSPERO CRD42013003889.FundingThe National Institute for Health Research Health Technology Assessment programme.