Centring the child's experience: A synthesis of evidence for measuring outcomes in Barnahus.

BACKGROUND

Multi-agency responses to child abuse, such as the Barnahus and Children's Advocacy Center models aim to provide holistic, child-friendly interventions. However, evaluation of these services tends to rely on procedural metrics (e.g., conviction rates), overlooking the experiences of primary service users.

OBJECTIVE

This review aimed to synthesize qualitative evidence regarding children's experiences of child protection, criminal justice, medical, and therapeutic responses to identify child-centered outcome domains.

PARTICIPANTS AND

SETTING

The review included 51 peer-reviewed studies and reports published between 2015 and 2025. Participants included cohorts of children (n = 33), adult survivors reflecting on childhood experiences (n = 8), and mixed groups (n = 10) from Europe, North America, Africa, Asia, and Oceania.

METHODS

A systematic search was conducted across five databases (PsycINFO, Medline, CINAHL, Scopus, and Proquest Social Sciences). Data were analyzed using a thematic synthesis approach to identify cross-cutting domains of service quality from the perspective of children and young people.

RESULTS

Five primary outcome domains were identified: (1) The Professional Relationship (trust, kindness, and being believed); (2) Empowerment and Participation (agency and clear information); (3) Safety and Security (emotional, physical, and procedural safety); (4) Holistic Wellbeing (trauma-informed, timely support); and (5) Systemic Efficacy (coordination to minimize re-telling). Children currently in the system prioritized immediate information and safety, while adult survivors emphasized the long-term impact of respectful professional relationships.

CONCLUSIONS

For children, the process of intervention is as significant as the formal outcome. High-quality responses are defined by relational safety and empowering children's participation. Evaluation frameworks for multi-agency models should incorporate these experiential domains to ensure accountability to children.