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.