Feature Review: Promoting reintegration and reducing harmful behaviours and lifestyles in street-connected children

What services are effective to support street-connected children?

Millions of children and young people are estimated to be living and working on streets around the world. ‘Street-connected children and young people’ refers to children who work or sleep, or both, on the streets, often without conventional adult care or supervision. Important risks faced by street-connected children include physical, psychological, and sexual exploitation; violence; no skills-based employment; substance misuse and addiction; and health issues. Many demonstrate considerable resilience and coping skills but continue to be vulnerable to risks. To provide best chances for them in life, services are needed to reduce risks and prevent marginalisation from mainstream society.

A team of Cochrane authors based in Canada and the United Kingdom worked with Cochrane Public Health  to investigate which services aimed at street-connected children were effective in a variety of areas including reducing harms, increasing literacy, and promotion of mental health, including self-esteem. Thirteen studies were rigorously evaluated and included were nineteen interventions based in high-income countries. There were no robust evaluations from low- and middle-income countries. Most studies compared therapy-based services versus usual shelter and drop-in services, or versus other therapeutic/health interventions. Overall, the quality of the evidence included in this review was assessed as low/moderate.

The review found mixed results among these studies but overall findings suggested that participants receiving focused personalized therapy and those provided usual services, such as drop-in centres or case management, benefitted to a similar level.

“Given the findings of this Cochrane Review, decisions on preferred mode of practice should rest on other considerations, such as feasibility, economic effectiveness, service user preference, long-term sustainability, and so forth. The finding that in most cases the therapeutic intervention did not produce better results than service as usual might assist planning and development of policy and service delivery,” said Esther Coren, the lead author of the review. “It should be noted that none of the studies evaluated interventions based in low-income countries that include participants who may be on the street primarily to earn a living, or as a result of war, migration or urbanisation. This is one specific area where more research is needed.  Considerable work with street connected children takes place in those countries but it needs to be rigorously evaluated to assess how effective it is.”

Read the full Cochrane Review

Visit the Cochrane Public Health website

Thursday, February 11, 2016