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Table 1 Summary of findings (grouped by intervention type)

From: Interventions to support people exposed to adverse childhood experiences: systematic review of systematic reviews

ReferenceAges inclIntervention typePopulationOutcome typeSummary findingPooled effect size if reportedN primary studies
1. CBT
 Altena [15]NRCognitive-behavioural interventionsHomelessMHMixed2
 Beresford [16]NRCBTP depressionMHMixed2
BehaviourNot eff3
 Fraser [17]0–17CBT, EMDRAbuse/neglectMHMixed5
BehaviourMixed5
 Howarth [18]< 18CBTP IPVMHNot effSMD − 0.43 (−1.24 to 0.50)
 Macdonald [19]< 18 (at ACE) < 25 (at study)CBTSexual abusePTSDEffAfter intervention SMD − 0.44 (−4.43 to − 1.53)
At 3–6 mo SMD − 0.39 (− 0.74 to − 0.04))
At ≥1 y SMD − 0.38 (− 0.65 to − 0.11)
6
AnxietyEffAfter intervention SMD − 0.23 (− 0.42 to − 0.03)
At 3–67 mo SMD − 0.38 (95% CI − 0.61 to − 0.14)
At ≥1 y SMD − 0.28 (− 0.52 to − 0.04)
5
Sexualised behaviourNot effAfter intervention MD − 0.65 (−3.53 to 2.24)
At 3–6 mo MD − 0.46 (−5.68 to 4.76)
At ≥1 y MD − 1.61 (− 5.72 to 2.49)
5
Externalising behaviourNot effAfter intervention SMD − 0.12 (− 0.40 to 0.17)
At 3–6 mo SMD − 0.11 (− 0.42 to 0.21)
At ≥1y SMD 0.05 (− 0.16 to 0.27)
7
DepressionMixedAfter intervention MD −2.83 (−4.53 to −1.13)
At 3–6 mo MD − 1.76 (−3.33 to −0.20)
At ≥1 y MD − 1.42 (− 2.91 to 0.06)
5
Other abuse/neglectMHEff5
BehaviourMixed5
 Wethington [20]≤21CBTSexual abuseAnxietyNot effSMD −0.23 (−0.48 to 0.01)4
DepressionNot effSMD −0.03 (−0.28 to 0.21)4
PTSDNot effSMD −0.29 (−0.69 to 0.11)4
 Wilen [21]NR (at ACE)
> 18 (at study)
CBTSexual abusePTSDNot effSMD − 0.06 (− 0.49 to 0.37)2
2. Other psychological therapies
 Altena [15]NRBrief motivational interviewingHomelessDrug/alcohol useNot eff2
 BC Centre [22]NRMother-child psychotherapyP IPVBehaviourEff2
MHEff2
 Howarth [18]< 18PsychotherapyP IPVMHNot effSMD −0.51 (−1.13 to 0.10)
 Kinsey [23]NRRelational psychological interventionsLACYPBehaviourMixed2
 Macdonald [19]< 18 (at ACE)
< 25 (at study)
Group activity-based therapiesAbuse/neglectMHMixed3
Multisystemic family therapyMHEff3
Family-based systemic interventionsBehaviourMixed3
Group therapyMHEff2
BehaviourMixed3
Psychotherapy and counsellingMHMixed1
BehaviourMixed4
 Wilen [21]NR (at ACE)
> 18 (at study)
Humanistic therapySexual abusePTSDNot effSMD −0.14 (− 0.53 to 0.26)3
3. Psychoeducation
 Howarth [18]< 18Psychoeducation (child + parent)P IPVMHNot effSMD 0.05 (− 0.43 to 0.50)
BehaviourNot effSMD −0.18 (− 0.57 to 0.23)
Psychoeducation (child only)MHNot effSMD −0.39 (− 0.80 to 0.02)
BehaviourNot effSMD 0.27 (−0.21 to 0.77)
 Loechner [24]≤18Group psychoeducationP depressionDepression (incidence)EffAt 6–15 mo RR 0.56 (0.40 to 0.77)4
Depressive symptomsMixedAt 0–4 mo SMD −0.20 (− 0.34 to − 0.06))
At 5–12 mo SMD − 0.11 (− 0.25 to 0.03)
At 15–72 mo SMD − 0.05 (− 0.18 to 0.08)
6
 Macdonald [19]< 18 (at ACE)
< 25 (at study)
Group psychoeducationAbuse/neglectMHMixed7
BehaviourNot eff2
4. Parent / foster carer training
 BC Centre [22]NRParent training + child therapyP IPVBehaviourEff4
MHMixed2
 Everson-Hock b [25]AnyFoster carer trainingLACYPBehaviourMixed3
 Fraser [17]0–14Foster carer trainingLACYPBehaviourMixed4
 Howarth [18]< 18Parent training + advocacyP IPVBehaviourEffSMD −0.46 (− 0.85 to −0.06)
MHNot effSMD −0.31 (−1.04 to 0.46)
 Kemmis-Riggs [26]NRFoster carer trainingLACYPBehaviourMixed12
SocialMixed3
 Kinsey [23]NRFoster carer trainingLACYPBehaviourMixed5
 Macdonald [19]< 18 (at ACE)
< 25 (at study)
Parent-child interaction therapyAbuse/neglectBehaviourMixed2
 Montgomery [27]0–18Parent-child interaction therapyPhysical abuseBehaviourMixed2
 Troy [28]3–18Parent trainingP in criminal justice systemBehaviourNot eff4
MHMixed2
 Turner [29]≤18Group cognitive-behavioural foster carer trainingLACYPMHNot effSMD 0.13 (− 0.71 to 0.96)2
BehaviourNot effSMD 0.23 (−0.06 to 0.52)2
 Ziviani [30]0–18Foster carer trainingLACYPBehaviourNot eff2
5. Cross-sector support
 Howarth [18]< 18AdvocacyP IPVMHNot effSMD 0.07 (−0.23 to 0.38)
BehaviourNot effSMD 0.18 (− 0.11 to 0.47)
 Jones [31]NRCase managementLACYPService receiptNot eff3
 Kinsey [23]NR‘Wraparound’ supportLACYPMHEff3
BehaviourMixed2
 Macdonald [19]< 18 (at ACE)
< 25 (at study)
Treatment foster careAbuse/neglectBehaviourMixed4
MHMixed2
SocialNot eff2
 Ziviani [30]0–18Case managementLACYPBehaviourEff2
SocialEff2
Criminal behaviourMixed2
6. Educational interventions
 Evans [32]≤18Educational interventionsLACYPAcademic skillsMixed 9
School attendanceMixed 3
Macdonald [19]< 18 (at ACE)
< 25 (at study)
Therapeutic day careAbuse/neglectMHEff 2
 Montgomery [27]0–18Therapeutic day carePhysical abuseSocialEff 2
7. Housing / life skills
 Coren [33]0–24Various interventionsHomelessAlcohol or drug useNot effDays alcohol use at 3 mo MD −0.56 (−1.13 to 0.01)
Days alcohol use at 6 mo MD 1.05 (−1.76 to 3.86)
Days alcohol use at 12 mo MD 0.63 (−2.23 to 3.48)
Drinking index score at 3 mo MD 1.08 (−4.42 to 6.57)
% days drug/alcohol use at 3 mo MD − 0.70 (−9.09 to 7.70)
% days drug/alcohol use at 6 mo MD − 2.15 (−9.82 to 5.53)
% days drug/alcohol use at 12 mo MD 5.87 (=5.06 to 16.79)
% days drug use at 3 mo MD 0.67 (−6.82 to 8.15)
% days drug use at 6 mo MD − 2.28 (− 11.53 to 6.96)
% days drug use at 12 mo MD −5.28 (− 13.79 to 3.23)
11
Sexual behaviourNot effN times had sex at 3 mo MD −0.51 (−1.13 to 0.10)
N times had sex at 6 mo MD − 0.04 (− 0.22 to 0.13)
N partners at 3 mo MD − 0.56 (− 1.13 to 0.01)
N partners at 6 mo − 0.56 (− 1.13 to 0.01)
5
MHNot effSelf−esteem SMD 0.11 (−0.22 to 0.44)
Depression at 3 mo SMD − 0.03 (− 0.22 to 0.17)
Depression at 6 mo SMD 0.83 (− 0.88 to 2.55)
Depression at 12 mo SMD 1.28 (− 0.36 to 2.92)
7
DelinquencyMixedAt 3 mo SMD −0.29 (− 0.54 to − 0.03)
At 6 mo SMD − 0.07 (− 0.52 to 0.37)
At 12 mo 0.31 (−1.58 to 2.20)
2
 Everson-Hock a [34]NRSupport for transition from careLACYPHousing / independent livingEff6
EducationalNot eff5
EmploymentNot eff6
CrimeNot eff6
HomelessnessNot eff4
MHNot eff3
  1. Abbreviations: CBT Cognitive behavioural therapy, Eff Effective, EMDR Eye movement desensitation and reprocessing, IPV Intimate partner violence, LACYP Looked-after children and young people, MD Mean difference, MH Mental health, P parent(al), PTSD Post-traumatic stress disorder, RR Risk ratio, SMD Standardised mean difference