PLAIN LANGUAGE SUMMARY

Few studies but promising results on employment outcomes for individuals with autism spectrum disorders (ASD)

Few studies evaluate interventions to improve employment outcomes for individuals with autism spectrum disorders (ASD). The available studies – which all have small sample sizes – suggest large effects.

What is this review about?

The incidence of ASD is on the rise, yet individuals with ASD are gainfully employed at disproportionately lower rates than individuals without a disability. Employment interventions are vocational programs that provide training associated with access and maintenance of employment such as interviewing or vocational/social skills training.

This review looked at whether employment interventions and business-as-usual have different effects on the rates of employment.

What is the aim of this review?

This Campbell systematic review update examines the effects of employment interventions for people with autism spectrum disorders. The review summarizes evidence from three randomized controlled trials.

What studies are included?

This review uncovered three randomized studies from the USA that evaluate the effects of employment interventions for individuals with ASD. The studies spanned the period from 2014 to 2016.

Do interventions improve employment rates for individuals with ASD?

Yes. There is an overall improvement in employment rates for individuals with ASD that participate in vocational-related interventions.

What do the findings of the review mean?

The main policy-relevant findings include further consideration for how vocational rehabilitation is conducted among individuals with developmental disabilities such as ASD. Moreover, the relative paucity of empirical studies meeting inclusion criteria for this review points to an urgent need for greater funding for high-quality research and technical assistance to support the employment of individuals with ASD.

How up-to-date is this review?

The review authors searched for studies up to 2017.

PLAIN LANGUAGE SUMMARY

Micronutrient and vitamin supplementation during pregnancy improves some maternal and child health outcomes

Micronutrients and vitamins are important for the body’s normal functioning, growth and development, but many women and children get too few from their diets.

What is this review about?

Micronutrient deficiencies, the lack of essential vitamins and minerals, are especially a concern during pregnancy, when energy and nutrient demands are greater for both mother and foetus, and can lead to adverse health and development outcomes for the mother and child, such as being born too soon or too small.

A cost-effective strategy that has been implemented worldwide is to provide micronutrient and vitamin supplementation during pregnancy to achieve better health outcomes in the mother and child. There are different types of supplementation, including provision of a single micronutrient/vitamin (e.g. vitamin D), two micronutrients/vitamins (e.g. iron-folic acid supplementation), or several micronutrients/vitamins, which can be in the form of tablets, powders, or fat-based products.

Multiple micronutrient supplementation will help women and children who have more than one type of deficiency. However, it is understood that some micronutrients and vitamins can compete for absorption in the body and, as such, intake of several micronutrients at the same time may not be as effective as one would hope.

It is important to evaluate the various types of supplementation in pregnancy and their effects on maternal and child health outcomes to determine the best strategy for reducing poor outcomes.

What is the aim of this review?

This Campbell systematic review evaluates the various types of supplementation in pregnancy and their effects on maternal and child health outcomes to determine the best strategy for reducing poor outcomes.

What studies are included?

We searched for papers published between 1995 and 31 October 2019 in a variety of relevant databases and within grey literature. This systematic review included 314 papers across 72 studies (involving 451,723 women), of which 64 studies (involving 439,649 women) contributed to meta-analysis.

The included studies used the following comparisons: iron-folic acid supplementation versus folic-acid only; multiple-micronutrient supplementation versus iron-folic acid or iron alone; lipid nutrient-based supplementation versus multiple micronutrients; and iron, zinc, vitamin A, vitamin D or calcium supplementations, each compared to placebo.

What are the main findings of the review?

Across all comparisons, micronutrient and vitamin supplementation had little to no effect on the number of deaths among mothers and infants. Overall, women who received multiple micronutrient supplementation had fewer babies that were born early (< 37 weeks of gestation), fewer babies born too small (< 2500 g) and fewer babies who were smaller in size than normal for their gestational age, compared to women who received iron-folic acid supplementation. Iron or iron-folic acid supplementation was very good at improving maternal anaemia.

Mothers who received calcium supplementation may have had a decreased risk of pre-eclampsia and eclampsia during pregnancy, and mothers who received vitamin D compared to mothers who received placebo may have had fewer babies that were born early (< 37 weeks of gestation).

Women supplemented with vitamin A compared to mothers given placebo had higher amounts of serum/plasma retinol, while zinc supplementation had no effect on all maternal and child outcomes reported.

Lipid nutrient-based supplementation showed little to no effect compared to multiple micronutrients; however, there were very few studies included and further research should be conducted.

What do the findings of this review mean?

The findings of this review support the use of micronutrient and vitamin supplementation during pregnancy to improve certain maternal and child health outcomes, which is especially important for populations living in low- and middle-income settings. Supplementation with multiple micronutrients was particularly good at improving several outcomes.

Further research should be done to establish the effects of supplementation on pregnant adolescents, who may have specific needs. Also, more data is needed to understand supplementation effects on long-term health and development outcomes for mother and child.

How up-to-date is this review?

The review authors searched for studies published up to October 2019.

PLAIN LANGUAGE SUMMARY

Housing, income assistance, and case management improve housing outcomes for persons with lived experience of homelessness

Permanent supportive housing interventions appear to improve short- and long-term housing stability for persons with lived experience of homelessness. Income assistance and intensive mental health interventions show moderate benefits in housing outcomes, and evidence on standardised case management suggests potential to improve housing stability. Peer support alone does not impact housing stability. Inconsistent results on mental health, substance use and other social outcomes require additional research.

What is this review about?

Homelessness greatly magnifies morbidity and mortality and worsens preventable health and social inequities. We present evidence on a wide range of interventions targeting homelessness: permanent supportive housing (PSH); income assistance; standard case management and peer support; mental health interventions such as assertive community treatment (ACT), intensive case management (ICM), critical time intervention (CTI), and injectable antipsychotics; and substance use interventions such as supervised consumption facilities, managed alcohol programmes and pharmacological interventions for opioid use disorders.

What is the aim of this review?

This systematic review and meta-analysis examines the effects of a broad range of interventions on housing stability, mental health, quality of life, substance use, hospitalisations and health service utilisation, as well as employment and income among individuals with lived experience of homelessness.

What studies are included?

We included 86 studies across 128 publications among individuals with lived experience of homelessness. The vast majority of studies followed a randomised controlled design. Most took place in the USA (73). The rest were undertaken in Canada (8), the UK (2), The Netherlands (2) and Australia (1).

What are the main findings of this review?

Studies on housing interventions showed significant improvements in housing stability, with potential sustained benefit for up to 5.4 years.

Income assistance interventions also appeared to be effective in improving housing outcomes. Standard case management carried the potential to improve housing, with mixed evidence suggesting its added benefit, whereas peer support programmes demonstrated no impact on housing relative to usual care.

Intensive mental health interventions demonstrated moderate improvements in housing stability and often worked in synergy with permanent housing.

Cost-analysis studies of housing interventions reported mixed economic results. Income assistance was associated with increased costs that were offset by its added benefits. Intensive mental health interventions, such as ACT, ICM, and CTI, were found to be economically beneficial. In contrast, standard case management did not offer good value for money compared to other interventions.

No economic evidence was found for peer support, injectable antipsychotics or substance use interventions.

What do the findings of the review mean?

Permanent supportive housing may improve and maintain housing stability. Further examination of implementation barriers of housing programmes is needed to inform decisionmakers.

Income assistance, standard case management and intensive mental health interventions carry the potential to improve housing outcomes, but more research is needed to examine their mechanisms. Our results on mental health and other social outcomes were mixed and inconclusive. This could be attributed to the significant proportion of study participants who were suffering from chronic mental health or substance use conditions.

What are the implications for research and policy?

More longitudinal research is needed to better examine non-housing outcomes. Furthermore, poor reporting, lack of blinding and allocation bias reduced the certainty and precision of our results.

There are other ongoing gaps that warrant more investigation, including peer support programmes, community substance use interventions, and programmes targeted towards special populations. Further examination of implementation barriers of housing programmes is also needed.

The absence of evidence on substance use interventions for people living with homelessness represents an important research and policy gap.

How up-to-date is this review?

The review authors searched for studies that had been published up to 10 February 2020.

PLAIN LANGUAGE SUMMARY

Nutrition interventions for pregnant women may improve some maternal and infant health and nutrition outcomes, but more studies are needed

Poor maternal nutrition and maternal obesity are risk factors for maternal and infant health and nutrition outcomes. Balanced energy protein supplementation and food distribution programmes improve some of these outcomes.

Dietary interventions to prevent maternal obesity during pregnancy can reduce birth weight with no effect on other outcomes.

What is this review about?

Optimal nutrition plays a crucial role before, during and after pregnancy. Poor maternal nutrition and maternal obesity has risk factors for fetal complications and neonatal outcomes. Looking at birth, infant health, and developmental outcomes, this review aims to assess the effectiveness of balanced energy protein (BEP) supplementation, food distribution programmes (FDP), and dietary interventions to prevent maternal obesity during pregnancy.

What is the aim of this review?

This Campbell systematic review summarises the evidence from 15 studies of the effect of nutritional interventions for pregnant women on maternal and infant health outcomes.

What studies are included?

Eligible studies had to be randomised control trials or quasi-experimental trials to evaluate the impact of nutritional interventions (BEP, FDP and dietary interventions to prevent maternal obesity) compared to control or standard care, among healthy pregnant women of any age living in low- and middle-income countries.

Fifteen studies are included in the review. Of these, eight were on BEP supplementation, five on FDP, and two on interventions for obesity prevention. The included studies are mainly from Asia (7 studies) and Africa (6 studies).

Do the interventions work?

Overall, BEP and FDP have a positive effect on selected maternal and infant outcomes, but not on others. Obesity prevention programmes may beneficially reduce birth weight, with no effect on other outcomes. In all cases, the evidence is of low to moderate quality.

Balanced energy protein supplementation

BEP supplementation may show a reduction in the rate of stillbirths, perinatal mortality, low birth weight, babies who are small for gestational age, and an increase in birth weight of 107.3 g which is clinically significant in the countries where the intervention was provided.

BEP supplementation had no effect on miscarriage, neonatal mortality, infant mortality, pre-term birth, birth length and head circumference.

Food distribution programmes

FDP may reduce stunting and wasting and improve mean birth weight by 46 g as well as birth length by 0.20 cm.

There was no effect of FDP on perinatal mortality, miscarriage, maternal mortality, neonatal mortality, infant mortality, pre-term birth, low birth weight, small for genstational age, head circumference or underweight babies.

Obesity prevention

Obesity prevention was associated with a 195.6 g reduction in mean birth weight but not macrosomia (the proportion of babies much larger than average for their gestational age) or birth length.

Studies on interventions for obesity prevention among pregnant women did not report other outcomes such as miscarriages and mortality.

What do the findings of this review mean?

Our review highlights improvement in selected maternal, birth, and infant outcomes through BEP supplementation and FDP during pregnancy, though not on others. However, due to the small number of included studies and low quality of evidence, we are uncertain of the effect of BEP supplementation, FDP and dietary interventions for prevention of obesity on maternal, and infant outcomes. Thus, further good quality research is recommended to assess the effect of these interventions on maternal, infant and developmental outcomes.

How up-to-date is this review?

The review authors searched for studies published up to April 2019.

Limited evidence on agroforestry interventions shows positive impacts on agricultural yield and income

Agroforestry interventions may lead to a large, positive impact on yield, though there is high variations in findings. Agroforestry interventions may also lead to a small, positive impact on income. There is insufficient evidence on nutrition, food security and environmental outcomes. Equity concerns of agroforestry interventions appeared in many of the studies, with mixed results, indicating that additional consideration of equity in agroforestry interventions is needed.

What is this review about?

Agroforestry is defined as the integration of trees and woody shrubs in crop and livestock production systems. It is widely promoted as a conservation and development tool to sequester carbon, improve soil fertility, and conserve biodiversity on agricultural lands while generating economic benefits for farmers. Agroforestry is promoted through a range of interventions, including farmer capacity development, provision of tree germplasm, and financial or tenure security provision.

This review examines the evidence on the impacts of any type of agroforestry intervention in low- and middle-income countries (LMICs) on three broad outcomes: agricultural productivity, ecosystem services, and human well-being.

What is the aim of this review?

This Campbell systematic review synthesizes the evidence from 11 quasi-experimental impact evaluations of the impacts of agroforestry interventions in LMICs on agricultural productivity, ecosystem services, and human well-being. The review also identifies key pathways through which agroforestry interventions led to these outcomes, and how the interventions affected different sub-groups of the population.

What studies are included?

This review includes studies that evaluate the effect of agroforestry interventions on agricultural productivity, ecosystem services, and human well-being in LMICs. All the studies had methodological weaknesses and high risk of bias. No evaluations using randomised controlled trials for agroforestry interventions were identified.

The review summarises the findings from 11 impact evaluations covering 15 programmes in Brazil, China, Colombia, Indonesia, Kenya, Malawi, Mozambique, Nicaragua, and Zambia.

Eight of the studies evaluated farmer capacity development programmes, which provided extension services and technical training, and five incorporated tree germplasm provision. Four studies evaluated incentive programmes, including payments for ecosystem services, certification schemes, and tenure security.

The practices that were promoted by the interventions included improved fallow systems, incorporating trees in crop fields, silvopasture, coffee agroforestry, and agrosilvopastoral systems.

What are the main findings of this review?

There is a large, positive overall effect of agroforestry interventions on agricultural yields, although there is large variation in the results. The largest positive impacts of agroforestry on yields are associated with less fertile lands, and negative impacts are associated with highly productive lands.

There is a very small, positive overall effect of agroforestry interventions on income. Increased or neutral income effects are associated with either increased yields providing additional income, or incentive payments offsetting the costs associated with decreased yields.

Few impact evaluations considered the impacts of agroforestry interventions on nutrition and food security. Qualitative assessment suggests that agroforestry interventions may lead to positive or neutral nutrition and dietary diversity outcomes and may lead to positive food security outcomes.

Few studies considered the impacts of agroforestry interventions on ecosystem services. However, the effects of agroforestry practices on ecosystem services are well-documented in the broader agroforestry literature.

In areas with limited soil fertility, agroforestry interventions provided technical support through extension and training programmes, and in some cases provided access to tree germplasm, to support farmers to adopt agroforestry practices intended to increase yields and incomes. In higher productivity areas, agroforestry interventions provided incentives – such as payments for ecosystem services, certification schemes, and tenure security – to adopt agroforestry practices intended for conservation that may reduce overall yields.

What do the findings of the review mean?

The existing evidence suggests that there may be positive impacts on agricultural yields and incomes as well as food security and ecosystem services, but appropriate intervention design is dependent on local biophysical and socio-economic characteristics.

How up-to-date is this review?

The review authors searched for studies up to October 2017.

Public sector corruption: control and deterrence is more effective than organizational and cultural reform

Control and deterrence interventions are more effective than organizational and cultural reforms in curbing corruption in the public sector, at least in the short term. The combination of different types of interventions is more effective than single interventions.

What is this review about?

This review addresses corruption in public administration. This includes corrupt acts involving civil servants in their dealings with their superiors, during the implementation of public policies, or while interacting with the public for service delivery. Administrative corruption is distinct from political corruption, and from private-to-private corruption.

This review covers any type of intervention developed in the public sector with the aim of deterring or preventing administrative corruption. Two main groups of interventions to curb administrative corruption are considered: 1) control and deterrence, and 2) organizational and cultural reforms.

What is the aim of this review?

This Campbell systematic review evaluates the impact on administrative corruption of public sector interventions based on control and deterrence, and on organizational and cultural change. The review synthetizes evidence from 29 high-quality studies based on randomized controlled trials.

What studies are included?

Twenty-nine studies match the inclusion criteria. They span the period 2007 to 2018 and cover 16 different countries. All studies are randomized controlled trials, with 25 conducted in a laboratory, while four are field experiments.

What are the findings of this review?

Do anti-corruption interventions work in the public sector? Yes. Administrative corruption is reduced by control and deterrence interventions. But the reduction in corruption brought about by organizational and cultural interventions is not statistically significant. Anti-corruption interventions can be more effective in reducing misappropriation of public resources than discouraging bribery.

The simultaneous combination of more than one intervention is more effective than single interventions. For example, policies guaranteeing impunity to officials or citizens who report corrupt practices (leniency treatment) are more effective if associated with a high probability of audit (detection), than leniency alone. A low probability of detection can be compensated by the threat of high fines in reducing both the amount and the likelihood of bribe demands. Conversely, a high probability of detection and low fines have no effect on either.

What do the findings of the review mean?

This review provides an in-depth synthesis of the available evidence over 11 years and 16 countries. The findings suggest that policies based on control and deterrence are more effective in curbing corruption in the public sector than interventions based on organizational and cultural change.

The impact of the intervention may be affected by the likelihood of continued interactions between bribe takers and givers, and the prevalence of corruption. Measures tending to increase social blame of corrupt practices work in low-corruption countries. In environments where corruption is the exception rather than the rule, adding punishments where actors’ behavior is tightly monitored increases compliance.

The fact that control and deterrence turn out to be more effective than organizational and cultural interventions in curbing administrative corruption confirms the importance of economic theories. However, combining different types of interventions works better than single measures. This is true not only when combining policies reinforcing control and deterrence, but also when policies based on organizational and cultural change are added.

In particular, the role of moral levers in preventing corruption emerges, and especially the importance of strengthening professional identity and values to avoid conflicts between an individual’s private interests and public role. Moreover, bonuses and penalties may backfire because they lower the moral cost of corruption by diverting officials away from their sense of duty and their ethical responsibilities. Sensitization messages stressing public officials’ professional identity and position increase the moral cost of bribery.

These results highlight the importance of going beyond economic models for explaining corruption. Moral and cultural mechanisms remain important to understand how different forms of corruption emerge at macro (cross-country), meso (country/nation-state), and micro (individual) levels. In particular, individual-level factors, such as the drive for power, low self-control, loss aversion and risk acceptance need to be addressed.

How up-to-date is this review?

The review authors searched for studies up to 2018.

Accommodation-based approaches help people remain healthy and stably housed

Accommodation-based approaches are mostly effective for increasing housing stability and health outcomes, except for those which offer low support housing without behavioural conditions. These approaches led to worse outcomes related to housing stability and health than receiving nothing at all. Agencies working together and sharing resources such as time and staff creates a commitment to ending homelessness.

What is this review about?

Globally, almost 1.6 billion individuals lack adequate housing. Many accommodation-based approaches have evolved to incorporate support and services beyond delivery of housing. This review looked at whether these approaches are effective on outcomes including housing stability, health, employment, crime, wellbeing, and cost for individuals experiencing or at risk of experiencing homelessness.

What is the aim of this review?

This Campbell systematic review of qualitative and quantitative evidence examines how useful accommodation-based approaches are for people experiencing homelessness. The quantitative data summarises evidence from 28 studies, reported in 51 articles, mainly from North America. The qualitative data summarises evidence from 10 articles from high-income countries.

What studies are included?

The quantitative research provides an overview of effectiveness findings from 28 intervention studies reported in 51 articles of accommodation-based interventions. Twenty five out of the 28 studies are from the USA, two from Canada and one from the UK. The quality of the research is generally low and represents important weaknesses in the evidence base.

The qualitative data presents one evaluation based on an intervention conducted in the UK, two in Ireland, one in Australia, one across Europe and the remaining five carried out in North America; three in the USA and two in Canada. The quality of the evaluations was average and did not directly evaluate the effectiveness interventions discussed in this review.

Do accommodation-based approaches help people experiencing homelessness?

Interventions which provide the highest levels of support and do not place rules on the person receiving the intervention are best at improving housing stability and health outcomes.

Interventions which offer the lowest levels of support and do not place rules on the person might harm those individuals. For those individuals, housing stability and health outcomes were worse than for all other interventions, including individuals who are not receiving any intervention at all.

What implementation factors affect how well accommodation-based approaches work?

Staff, resources and time often impacted the delivery of accommodation programmes most. Programme managers knew that members of staff working on the ground took initiative and were capable in their roles. However, they need adequate training and time to build good relations with service users.

There is a tension in funding allocated between new and established services, which can cause issues when services collaborate. It can also impact upon the shared commitment to ending homelessness. Buy-in at all levels of influence can impact how successful a programme is and how many people experiencing homelessness it can engage with.

What do the findings of the review mean?

Those interventions which are described as Basic/Unconditional (i.e., those that only satisfy very basic human needs such as a bed and food) harm people: meaning they had worse health and housing stability outcomes even when compared to receiving nothing at all. This invites questions on whether these types of accommodation-based interventions should be discontinued so that other more suitable and effective offers of support can be made available.

Too few studies assess the cost, or important participant characteristics like age and gender. There are also gaps related to where the research is conducted. Most of the studies included are from the USA and Canada which have very different social welfare systems to those of the UK. The process evaluations were conducted in high-income countries with different housing contexts and social welfare systems.

The studies were of average quality and not connected to the effectiveness studies, which presented issues when drawing connections between the available data. Researchers conducting studies into accommodation-based interventions should consider evaluating and publishing the factors impacting upon the trial, reflecting on why the intervention did or did not work, and for whom.

How up-to-date is this review?

Quantitative studies were downloaded from the Effectiveness Evidence and Gap Map on 12 April 2019. Qualitative reports were downloaded from the Process and Implementation Evidence and Gap Map on 10 May 2019.