Mental health and psychosocial interventions for children and adolescents in street situations in low- and middle-income countries: A systematic review

This article reviews the available quantitative literature on mental health and psychosocial interventions among children and adolescents in street situations (CASS) in low- and middle-income countries (LAMIC). PRISMA standards for systematic reviews were used to search five databases as well as grey literature. There were four inclusion criteria; studies had to involve a description of an external (i.e. outside of the home) mental health or psychosocial intervention/treatment, must be focused in LAMIC, must be focused on CASS, and must empirically evaluate the effectiveness of the intervention described. A quality assessment tool was used to assess the risk of bias in included articles. Five studies were included. A multidisciplinary care approach was significant in reducing psychological distress, substance use and improving sleeping arrangements (p<0.001, n=400). Residency step programmes were on average 52% successful in reintegrating children back into communities (n=863). Resilience training significantly increased psychological well-being components (p<0.001, n=60). Emotional regulation training had a beneficial improvement in emotional regulation. FORNET (Forensic Offender Rehabilitation Narrative Exposure Therapy) (n=32) reduced the number of self-reported offenses committed [t(19.26)=1.81, p=0.043]. There are not enough credible studies available to develop a firm conclusion on the effectiveness of mental health and psychosocial interventions delivered to CASS in LAMIC. The limited amount of studies, inconsistent outcome measures, interventions and imperfect study designs maintain that this is an area in need of greater attention and research focus.