Interventions to prevent, reduce, and respond to violence against children and adolescents: a systematic review of systematic reviews to update the INSPIRE Framework.

Each year, one billion children globally experience violence, which carries lifelong detrimental effects. In 2016, WHO and partners launched the INSPIRE Framework: seven strategies to end violence against children. A decade after INSPIRE's development, this systematic review updates its evidence base and assesses which interventions could be prioritised for implementation. This systematic review of systematic reviews searched 152 information sources from Jan 1, 2010, to May 15, 2023, to identify systematic reviews evaluating the effectiveness of policies or interventions in addressing violence against children. Reviews were narratively synthesised and interventions were ranked using a decision matrix based on the amount and quality of evidence and the consistency of effectiveness. From 22 117 initial articles screened, 216 unique systematic reviews were included, of which 149 focused on interventions that do not have WHO implementation guidelines. Of these 149 reviews, 47 (32%) were assessed to be high or moderate confidence using the AMSTAR2 tool. Across outcome domains and countries, the strongest evidence of effectiveness includes parenting programmes for reducing child maltreatment, safe and enabling school environments (whole-school approaches) for preventing youth violence, healthy romantic relationships education for reducing adolescent intimate partner violence, cash-plus life-skills training among adolescents in low-income and middle-income countries for reducing youth violence (including sexual violence), and cognitive behavioural therapy for children exposed to violence. Parenting programmes might also reduce maternal intimate partner violence, although few studies have directly examined this outcome. Scaling up these evidence-based approaches is essential to ending violence against children. This study was registered with PROSPERO (CRD42023427487).