托儿质量对儿童的发展和心理调整有着至关重要的影响,特别是对于有虐待和创伤史的孤儿。然而,对孤儿的充分照顾往往受到不利的照顾者-儿童比例和训练不足的影响,人员负担过重,特别是在资源有限和大量孤儿的国家的机构护理中。本系统综述调查了机构环境中结构性干预和护理人员培训对儿童发育的影响。本系统综述中包含的24项干预研究报告了对儿童情绪的有益影响,社会,和认知发展。然而,很少有研究关注干预措施对儿童-照顾者关系或一般机构环境的影响。此外,我们的审查显示,旨在改善机构护理环境的干预措施在很大程度上忽视了暴力和虐待预防.不幸的是,我们的研究结果部分受到研究设计和方法的限制.总之,本系统综述阐明了改善机构护理的障碍和可能性。必须作出更大的努力防止暴力,滥用,忽视住在机构照料中的儿童。因此,我们主张将基于依恋理论的模型与虐待预防方法相结合,然后使用严格的科学标准进行测试。通过使用基于证据的方法,有可能使更多的孩子在支持性和非暴力的环境中成长。
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.