What are the most effective early response strategies and interventions to assess and address the immediate needs of children outside of family care?

A Trauma-informed Consultation Model for Treating Survivors of Child Labour

Child labour is a global problem that affects children's lives. Children engage in work that is physically, mentally, and emotionally harmful. Previous studies have found that exposure to work as a child is associated with adverse mental health outcomes, and severity is related to the intensity and type of work. India is ranked highest in terms of children in labour in South Asia, according to ILO estimates. The Kailash Satyarthi Children's Foundation (KSCF) is a non-profit organization focused on addressing the problem of child labour in India. It works to rescue children from bonded labour and return them to their families or place them in rehabilitation centres. KSCF partnered with the Harvard T. H. Chan School of Public Health and Medical Aid Films to create a consultation program that aims to support the children and the caregivers at the rehabilitation centres. The program includes a series of short animated films, a trauma training curriculum, and ongoing case consultation with the caregivers.

Community-based surveillance to monitor trends in unaccompanied and separated children in eastern DRC

Children who are separated from their families and usual caregivers in emergencies face a multitude of risks. The humanitarian community lacks methods to systematically capture changes in the frequency and nature of such separations over time. A mobile phone-based community surveillance system was piloted in the Democratic Republic of the Congo. The goal was to identify new cases of unaccompanied and separated children on a weekly basis. Over an 11-week period, community focal points reported 62 cases of separation across 10 communities. The majority of children had been under the care of their parents prior to separation. More than half of the children were unaccompanied, meaning that they were living without an adult relative or customary caregiver. The pilot results suggest that implementing a mobile phone-based surveillance system in a humanitarian setting may be feasible and cost-effective and fills a critical gap in the measurement of separated and unaccompanied children in emergencies. A longer pilot to better understand how the system performs over time is recommended.

Mental Health, Behavioral and Developmental Issues for Youth in Foster Care

Youth in foster care represent a unique population with complex mental and behavioral health, social-emotional, and developmental needs. For this population with special healthcare needs, the risk for adverse long-term outcomes great if needs go unaddressed or inadequately addressed while in placement. Although outcomes are malleable and effective interventions exist, there are barriers to optimal healthcare delivery. The general pediatrician as advocate is paramount to improve long-term outcomes.

The science of early adversity: is there a role for large institutions in the care of vulnerable children?

It has been more than 80 years since researchers in child psychiatry first documented developmental delays among children separated from family environments and placed in orphanages or other institutions. Informed by such findings, global conventions, including the 1989 UN Convention on the Rights of the Child, assert a child's right to care within a family-like environment that offers individualised support. Nevertheless, an estimated 8 million children are presently growing up in congregate care institutions. Common reasons for institutionalisation include orphaning, abandonment due to poverty, abuse in families of origin, disability, and mental illness. Although the practice remains widespread, a robust body of scientific work suggests that institutionalisation in early childhood can incur developmental damage across diverse domains. Specific deficits have been documented in areas including physical growth, cognitive function, neurodevelopment, and social-psychological health. Effects seem most pronounced when children have least access to individualised caregiving, and when deprivation coincides with early developmental sensitive periods. Offering hope, early interventions that place institutionalised children into families have afforded substantial recovery. The strength of scientific evidence imparts urgency to efforts to achieve deinstitutionalisation in global child protection sectors, and to intervene early for individual children experiencing deprivation.

Commentary on 'interventions for promoting re-integration and reducing harmful behaviour and lifestyles in street-connected children and young people' with a response from the review authors

This is a commentary on a Cochrane review, published in the issue of EBCH, first published as: Coren E, Hossain R, Pardo Pardo J, Veras MMS, Chakraborty K, Harris H, Martin AJ. Interventions for promoting re-integration and reducing harmful behaviour and lifestyles in street-connected children and young people. Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No.: CD009823. DOI: 10.1002/14651858.CD009823.pub2.

Evidence acquisition and evaluation for a U.S. Government Evidence Summit on Protecting Children Outside Family Care

Recognizing the need for evidence to inform policies, strategies, and programs to care for vulnerable children, the U.S. Government convened an Evidence Summit on Protecting Children Outside of Family Care on December 12-13, 2011, in Washington, DC, USA. This paper summarizes the background and methods for the acquisition and evaluation of the evidence used to achieve the goals of the Summit. A multistep process was undertaken to identify the appropriate evidence for review. It began by identifying crucial focal questions intended to inform low and middle income governments and the U.S. Government about effective systems for protecting children outside family care. This was followed by a systematic attempt to gather relevant peer reviewed and gray literature that would inform these focal questions. The search processes, methods used for screening and quality reviews are described. In addition, members of the Evidence Review Teams were invited to add relevant papers not identified in the initial literature review to complete the bibliographies. These teams were asked to comply with a specific evaluation framework for recommendations on practice and policy based on both expert opinion and the quality of the data. This was the first U.S. Government Evidence Summit originating in the U.S. Agency for International Development Global Health Bureau and valuable lessons were learned on the identification and assessment of evidence informing complex development challenges.