A Systematic Review of Reviews of the Outcome of Severe Neglect in Underresourced Childcare Institutions

Abstract

The aim of the systematic review described in this article was to determine the outcomes for individuals exposed to severe neglect in congregate care institutions such as orphanages. In this context, severe neglect refers to failure to meet children’s basic physical, developmental, and emotional needs due to inadequate resources. In this systematic review of previous systematic reviews and meta-analyses, searches of 10 databases were conducted, 18 papers that met inclusion and exclusion criteria were selected for review, their quality was assessed, and data were extracted and synthesized. The 550 primary studies included in the 18 systematic reviews and meta-analyses were relatively well designed, allowing confidence to be placed in their results. Severe neglect was associated with a wide range of problems in the domains of physical development, cognitive development, attachment, and mental health. The severity of adverse outcomes was partly influenced by the duration and severity of deprivation and a constellation of risk and protective factors. Prevention policies should aim to eliminate large underresourced congregate care institutions for infants. In taking steps toward this, policies should aim to adequately resource congregate care institutions to meet children’s developmental needs for nutrition, stimulation, and attachment to a stable primary caregiver with adequate parenting skills and training. Early placement in adoptive or foster families, with access to routine physical and mental health-care service available in developed countries, is the most viable effective intervention for child survivors of severe neglect.

Is the deinstitutionalisation of alternative care a ‘wicked problem’? A qualitative study exploring the perceptions of child welfare practitioners and policy actors in Thailand

“…Alongside the belief that institutions were necessary for economic reasons, several participants had faith in the state-run orphanages and believed that they were providing a good standard of care that provided safety, shelter and met basic needs. However, these beliefs about quality of care were contradicted in other participants’ accounts that highlighted low staffing ratios which they felt resulted in limited care and nurturing, which – as we know from the existing literature – can compromise the social, behavioural and developmental needs of children, particularly infants (Carr et al, 2020; Dumais et al, 2014). These two perceptions of institutional care that centre on its necessity and its perceived quality could serve as barriers to implementing deinstitutionalisation.…”

“…The existing research evidence that examines the outcomes of children growing up within institutions shows the negative impact this form of care can have, particularly on the developmental needs of infants (Carr et al, 2020; Dumais et al, 2014). We know from Bowlby’s (1951) and Ainsworth’s (1964) seminal work on attachment in the United Kingdom about the benefits of consistent care, and the importance of developing nurturing bonds between an infant and a caregiver.…”

A Systematic Review of Reviews of the Outcome of Noninstitutional Child Maltreatment

“…It is the first in a series of three on the outcome of child maltreatment. The second paper is a review of review papers on the outcome of severe neglect in orphanages which care for large groups of children, with inadequate and unstable staffing, and limited physical resources (Carr et al, 2020a). The third paper is a review of studies of outcomes for survivors of child maltreatment which occurred in long-term residential care (Carr et al, 2020b).…”

A Systematic Review of the Outcome of Child Abuse in Long-Term Care

“…The first paper in the series is a review of review papers on the outcome of child abuse in noninstitutional contexts (Carr, Duff, & Craddock, 2020a). The second paper is a review of review papers on the outcome of severe structural neglect in underresourced institutions (Carr, Duff, & Craddock, 2020b).…”