Children’s experiences with Child Protection Services: A synthesis of qualitative evidence

https://doi.org/10.1016/j.childyouth.2020.104974 Received 31 October 2019; Received in revised form 27 March 2020; Accepted 29 March 2020 ⁎ Corresponding author. E-mail addresses: samita.wilson@uis.no (S. Wilson), sarah.hean@uis.no (S. Hean), tatek.abebe@ntnu.no (T. Abebe), vheaslip@bournemouth.ac.uk (V. Heaslip). Children and Youth Services Review 113 (2020) 104974 Available online 06 April 2020 0190-7409/ © 2020 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/BY/4.0/). T social workers and families, and providing supportive services to parents. In this literature review, the term CPS will encapsulate both models (Pösö, Skivenes, & Hestbæk, 2014), viewing children’s right to protection not just as safeguarding but also ensuring their overall wellbeing. Using Child Protection Services can be challenging for children. First, although children have a right to access CPS services directly, most children access these through adults (e.g., parents, teachers, and social workers), putting children in a potentially vulnerable position, and limiting their ability to act as independent citizens and service users (Lorenz, 2015). A recent systematic review of empirical evidence into the outcomes of children who had been in contact with the CPS concluded that persons who have been involved with CPS often experience reduced educational outcomes, fewer employment opportunities, lower annual income, and poorer mental health compared to the general population (Gypen, Vanderfaeillie, De Maeyer, Belenger, & Van Holen, 2017). These findings were confirmed by a quantitative research (Vinnerljung & Hjern, 2011), which concluded that the dire outcomes were the same regardless of whether the child in contact with the CPS had received a home-based service or had been placed in out-of-home care. Improvements in including the child’s perspectives in CPS can ameliorate these challenges (Alexanderson, Hyvönen, Karlsson, & Larsson, 2014). Listening to children’s views and striving to understand their lived experiences is key to fully realizing their right to protection, support, and participation (UN, 1989; Cossar, Brandon, & Jordan, 2011). While there is an increasing focus on research with children in CPS, no literature review has been conducted to present an overview of children’s generic lived experiences across different services provided by CPS, starting from their first contact to the end of intervention and how it affects their view of themselves and others around them. Being with CPS significantly affect a child’s life and inter-personal world, thus, it is pertinent to explore their subject perception and appraisal of their time with the services. Direct exploration and description of children’s lived experiences (emic perspective) would develop a richer, deeper and more accurate understanding of issues concerning children in CPS (Mitchell & Kuczynski, 2010; Heaslip, Hean, & Parker, 2018). Hence, a literature review to synthesize current evidence of children’s experiences of Child Protection Services has potential to reveal common challenges and disruptions that children experience in CPS, which can inform future practices, research and policies related to child protection. The aim of this article is to synthesize current research with children about their perspectives on and experiences with CPS to gain better insight. The research question was: What are the children’s experiences with Child Protection Services? 2. Methods Qualitative research approaches are well suited to capture the lived experience of participants and to allow their voices to be heard. These approaches can uncover how participants make sense of their lives, their subjective or lived experiences, and the world around them (O'Day & Killeen, 2002). Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) is an evidence-based minimum set of items for reporting in systematic reviews and meta-analyses (Liberati et al., 2009). This systematic review was conducted in accordance with the PRISMA flow chart to provide the reader with a better understanding of the selection process (see Fig. 1). Furthermore, the qualitative metasynthesis approach was adopted to integrate and present new interpretations of data (Sandelowski, Barroso, & Voils, 2007). 2.1. Search strategy A systematic search of the literature was conducted using databases most relevant to social work practice: Academic Search Premier, CINAHL, SocIndex, Scopus, Web of Science, and Psychological & Behavioural Science Collection. The search strategy also involved screening reference lists of included papers, forward citation tracking of studies in Google Scholar and manual selection of articles. This method of ‘ancestry search’ (looking through reference lists) and ‘forward citation’ approach (looking for publications that cite the selected paper) has been found to increase the recovery of relevant articles by almost 50% (Fegran, Hall, Uhrenfeldt, Aagaard, & Ludvigsen, 2014, p. 125). Population, Context, Outcome (PCO) framework is a modified form of PICO (Population, Intervention, Comparison, Outcome) for qualitative methodologies (Stern, Jordan, & McArthur, 2014). PCO was used to identify the key words in the review question, which provided the basis for the search strategy. An overview of these terms is provided in Table 1. To keep the search volume manageable, the function ‘NOT’ was used for terms such as: ‘practitioners’, ‘social workers’, ‘parents’, ‘education’, ‘health’, ‘mental health’ and ‘sexual health’. These terms were selected after going through the initial 200 titles and abstracts and listing the keywords for studies that showed up in the initial search results but were later found not relevant. The search was carried out between May 2018 and July 2018. Other studies were added until November 2018 by the first author through manual selection of articles from previous search and/or recommendation from colleagues, in addition to the chaining process. 2.1.1. Inclusion and exclusion criteria Child Protection Services were defined as those structures and interventions that have a state mandate to intervene in families and children’s lives, when children’s well-being and protection is in jeopardy (Waterhouse and McGhee, 2015). The inclusion and exclusion criteria for the review are presented in Table 2. All articles focus on children’s lived experiences of services and interventions provided by the CPS. Studies related to, for example, educational attainment of children in foster care or foster children’s perspectives of biological parents were excluded. There were no restrictions placed on geographical location of the studies. The time limit (1990 and onwards) was applied to capture research done after the ratification and adoption of UNCRC in state polices. 2.2. Search outcome The initial search yielded 875 articles. The titles and abstracts of these articles were screened by the first author based on the predefined inclusion and exclusion criteria and 44 articles were shortlisted for full text reading. After a careful examination of the full-texts, 28 articles were excluded. Two of the team members (SW & SH) applied an interrater check on 33% of the retrieved papers and a third team member was brought in when there was a lack of agreement between the review pair. The reference list of the 16 included studies were reviewed and forward citation tracking conducted. Twenty-three more studies were included through this process. A total of 39 papers formed the final sample for further analysis. Fig. 1 illustrates the PRISMA flowchart to represent the search process. 2.3. Quality appraisal The quality of the 39 articles was appraised using the Critical Appraisal Programme (CASP) assessment tool for qualitative studies (CASP, 2018). Two team members (SW & VH) individually appraised the quality of 10% of the articles. Where there were discrepancies, we discussed the paper until consensus was reached. First author appraised the remaining articles in line with the discussed criteria. The main purpose of CASP was to become familiar with the included studies and assess the methodological rigour of the studies. As recommended by Sandelowski et al. (2007), no articles were excluded due to lack of methodological rigour. S. Wilson, et al. Children and Youth Services Review 113 (2020) 104974


Introduction
The United Nations Convention on the Rights of the Child (UNCRC) defines the child as a right-bearing citizen of the state, and asserts that the 'best interest of the child', and her or his right to protection, should be taken into consideration in all actions concerning them (UN, 1989). Children have a right to state services that ensure their well-being and protection from neglect and abuse (Parton, 2014;Tisdall, 2015). Child Protection Services (CPS) are responsible for investigating reports of maltreatment, determining whether child abuse/neglect has occurred, and collaborating with families/care providers through in-home services and out-of-home care to ensure a safe environment for the child (Featherstone, White, & Morris, 2014;Jones, La Liberte, & Piescher, 2015;Munro, 2001).
Child Protection Services is sometimes used synonymously with Child Welfare Services but in theory there are differences between the two (Gilbert, Parton, & Skivenes, 2011;Fargion, 2014). Gilbert et al. (2011) note that the child protection model is more remedial than preventive, focusing on deficiencies and risk factors for the child and family, whereas child welfare models focus on partnership between social workers and families, and providing supportive services to parents. In this literature review, the term CPS will encapsulate both models (Pösö, Skivenes, & Hestbaek, 2014), viewing children's right to protection not just as safeguarding but also ensuring their overall wellbeing.
Using Child Protection Services can be challenging for children. First, although children have a right to access CPS services directly, most children access these through adults (e.g., parents, teachers, and social workers), putting children in a potentially vulnerable position, and limiting their ability to act as independent citizens and service users (Lorenz, 2015). A recent systematic review of empirical evidence into the outcomes of children who had been in contact with the CPS concluded that persons who have been involved with CPS often experience reduced educational outcomes, fewer employment opportunities, lower annual income, and poorer mental health compared to the general population (Gypen, Vanderfaeillie, De Maeyer, Belenger, & Van Holen, 2017). These findings were confirmed by a quantitative research (Vinnerljung & Hjern, 2011), which concluded that the dire outcomes were the same regardless of whether the child in contact with the CPS had received a home-based service or had been placed in out-of-home care. Improvements in including the child's perspectives in CPS can ameliorate these challenges (Alexanderson, Hyvönen, Karlsson, & Larsson, 2014).
Listening to children's views and striving to understand their lived experiences is key to fully realizing their right to protection, support, and participation (UN, 1989;Cossar, Brandon, & Jordan, 2011). While there is an increasing focus on research with children in CPS, no literature review has been conducted to present an overview of children's generic lived experiences across different services provided by CPS, starting from their first contact to the end of intervention and how it affects their view of themselves and others around them. Being with CPS significantly affect a child's life and inter-personal world, thus, it is pertinent to explore their subject perception and appraisal of their time with the services. Direct exploration and description of children's lived experiences (emic perspective) would develop a richer, deeper and more accurate understanding of issues concerning children in CPS (Mitchell & Kuczynski, 2010;Heaslip, Hean, & Parker, 2018).
Hence, a literature review to synthesize current evidence of children's experiences of Child Protection Services has potential to reveal common challenges and disruptions that children experience in CPS, which can inform future practices, research and policies related to child protection. The aim of this article is to synthesize current research with children about their perspectives on and experiences with CPS to gain better insight. The research question was: What are the children's experiences with Child Protection Services?

Methods
Qualitative research approaches are well suited to capture the lived experience of participants and to allow their voices to be heard. These approaches can uncover how participants make sense of their lives, their subjective or lived experiences, and the world around them (O'Day & Killeen, 2002). Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) is an evidence-based minimum set of items for reporting in systematic reviews and meta-analyses (Liberati et al., 2009). This systematic review was conducted in accordance with the PRISMA flow chart to provide the reader with a better understanding of the selection process (see Fig. 1). Furthermore, the qualitative metasynthesis approach was adopted to integrate and present new interpretations of data (Sandelowski, Barroso, & Voils, 2007).

Search strategy
A systematic search of the literature was conducted using databases most relevant to social work practice: Academic Search Premier, CINAHL, SocIndex, Scopus, Web of Science, and Psychological & Behavioural Science Collection. The search strategy also involved screening reference lists of included papers, forward citation tracking of studies in Google Scholar and manual selection of articles. This method of 'ancestry search' (looking through reference lists) and 'forward citation' approach (looking for publications that cite the selected paper) has been found to increase the recovery of relevant articles by almost 50% (Fegran, Hall, Uhrenfeldt, Aagaard, & Ludvigsen, 2014, p. 125).
Population, Context, Outcome (PCO) framework is a modified form of PICO (Population, Intervention, Comparison, Outcome) for qualitative methodologies (Stern, Jordan, & McArthur, 2014). PCO was used to identify the key words in the review question, which provided the basis for the search strategy. An overview of these terms is provided in Table 1.
To keep the search volume manageable, the function 'NOT' was used for terms such as: 'practitioners', 'social workers', 'parents', 'education', 'health', 'mental health' and 'sexual health'. These terms were selected after going through the initial 200 titles and abstracts and listing the keywords for studies that showed up in the initial search results but were later found not relevant.
The search was carried out between May 2018 and July 2018. Other studies were added until November 2018 by the first author through manual selection of articles from previous search and/or recommendation from colleagues, in addition to the chaining process.

Inclusion and exclusion criteria
Child Protection Services were defined as those structures and interventions that have a state mandate to intervene in families and children's lives, when children's well-being and protection is in jeopardy (Waterhouse and McGhee, 2015). The inclusion and exclusion criteria for the review are presented in Table 2. All articles focus on children's lived experiences of services and interventions provided by the CPS. Studies related to, for example, educational attainment of children in foster care or foster children's perspectives of biological parents were excluded. There were no restrictions placed on geographical location of the studies. The time limit (1990 and onwards) was applied to capture research done after the ratification and adoption of UNCRC in state polices.

Search outcome
The initial search yielded 875 articles. The titles and abstracts of these articles were screened by the first author based on the predefined inclusion and exclusion criteria and 44 articles were shortlisted for full text reading. After a careful examination of the full-texts, 28 articles were excluded. Two of the team members (SW & SH) applied an interrater check on 33% of the retrieved papers and a third team member was brought in when there was a lack of agreement between the review pair.
The reference list of the 16 included studies were reviewed and forward citation tracking conducted. Twenty-three more studies were included through this process. A total of 39 papers formed the final sample for further analysis. Fig. 1 illustrates the PRISMA flowchart to represent the search process.

Quality appraisal
The quality of the 39 articles was appraised using the Critical Appraisal Programme (CASP) assessment tool for qualitative studies (CASP, 2018). Two team members (SW & VH) individually appraised the quality of 10% of the articles. Where there were discrepancies, we discussed the paper until consensus was reached. First author appraised the remaining articles in line with the discussed criteria.
The main purpose of CASP was to become familiar with the included studies and assess the methodological rigour of the studies. As recommended by Sandelowski et al. (2007), no articles were excluded due to lack of methodological rigour.

Table 1
Search terms (with *truncation notation) used in the PCO framework.

Population
Context Outcome Children or adolescent* or "young people" or "youth" or "child in care" or "look after child*" "Child Protection Service*" or "Child Welfare Service*" or "social services" or "social care" "Lived experience*" or experience* or view* or attitude* or perspective* or perception*

Data extraction & analysis
The first author used an excel spreadsheet to document information pertaining to the following domains: bibliographic details, geographical location, research focus, research design, data-collection and analysis methods, sample, and study context (see Table 3).
For the purpose of synthesis, findings related to experiences of children with the CPS from the child's own perspective were extracted from each article. Target findings included both direct quotations of the children presented in the article as well as the primary researcher's interpretations of children's experiences. These two data sources were imported into NViVo for coding (Britten et al., 2002;Edhlund, 2011).
The findings were first read and re-read in their entirety by the first author to obtain an initial and holistic overview of experiences (Lindseth & Norberg, 2004). The direct quotations and the interpretations were merged and a thematic analysis of all data as a single entity was conducted using three stages as proposed by Thomas and Harden (2008). The resulting text was initially coded and constructed into descriptive themes, which eventually generated analytical themes. Themes and sub-themes were discussed with the research team to explore the confirmability of the analysis and achieve critical interpretation and understanding of the experiences.
Although we tried to include only children's voices in this review, this was at times challenging. A few studies reported on interviews with both children and adult, and it was not always clear who was quoted; the child or the adult, which was the case, for example, in the studies of Johansson (2013) and that of Burnside and Fuchs (2013). However, as both studies included the children views -it was agreed across the research team to include them.
Of 39 articles reviewed, 36 were qualitative and three were mixed method studies (Table 3). Studies were conducted in the US (n = 3), Sweden (n = 3), UK (n = 15), Norway (n = 5), Japan (n = 2), Canada (n = 3), Serbia (n = 1), Portugal (n = 1), Finland (n = 1), Spain (n = 1), New Zealand (n = 1), Australia (n = 1), Netherlands (n = 1), and Estonia (n = 1). Twenty-two studies were of children living in outof-home care, two studies had children living both in out-of-home care and at home, two studies were done with children living at home, while others did not provide a clear context. Overall, the CASP results showed that most of the included articles had good quality (scoring 15 points and above), with only a few lacking clarity in the type of methodology and analysis that was used, while a few did not clearly present the findings (see Table 3).

The first point of contact
Children talked of friends and family usually being the first point of contact when seeking help. They disclosed abuse to peers, especially when they were afraid to ask adults. Family members were mostly helpful when the perpetrator was someone outside the family. However, when the perpetrator was an insider, children felt not believed or dissuaded to seek help (Pölkki et al., 2012;Jobe & Gorin, 2013). Teachers were usually the first professional to whom children disclosed abuse. Children reported mixed experiences of the teachers' responses: While some believed children and actively tried to help them, others were caught up in bureaucracy and lost view of the child (Bell, 2002;Jobe & Gorin, 2013;Fylkesnes et al., 2018).

Disclosure to CPS
Children described the first contact with CPS as particularly frightening (Bell, 2002). This occurred by either them reporting abuse and actively seeking help or the CPS contacting them. The later contact was sometimes considered unsolicited by children.
Children varied in their understandings of the reasons why CPS contacted them if this was unsolicited. Most children were surprised and neither knew nor had a clear understanding why they were contacted, even in cases where their social worker from CPS tried to explain it to them (Woolfson et al., 2009;Larsen, 2011;Jobe & Gorin, 2013;Fylkesnes et al., 2018). In general, children's greatest fear was being taken away from their home and family. They were confused, not knowing what was going to happen during the safeguarding process, with a limited understanding of the professional's 'role' (Van Bijleveld et al., 2014;Jobe & Gorin, 2013;Bell, 2002). In a few cases, the involvement of CPS was seen by children as a positive; an opportunity to share and receive help (Winter, 2010;Woolfson et al., 2009).

Going through the investigation process
Children described the investigation stage of CPS process stressful, describing feeling fearful, especially of being removed from the home, anxiety, confusion, and concern for family (Bell, 2002;Woolfson et al., 2009;Pölkki et al., 2012;Cossar, Brandon, & Jordan, 2016;Sanders et al., 2017). They reported feeling pressured by personal questions from the social worker, often a stranger to them, which felt invasive. This was especially the case when they were being treated as the sole source of evidence (Cossar et al., 2016). For example, a child described this as: "The lady who came asked me a lot of questions. She put me under pressure" (Bell, 2002: 5). Children talked about finding it hard to focus on and understand what was happening and the information provided to them, due to the emotional pressure (Woolfson et al., 2009;Buckley, Carr, & Whelan, 2011;Jobe & Gorin, 2013;Lindhal et al., 2017). Children reported a need for clear and understandable information during the investigation process with time to absorb this information. Well-informed children were more positive about the investigation even if they did not agree with the intervention (Woolfson et al., 2009;Jobe & Gorin, 2013;Van Bijleveld et al., 2014).
Children, during the investigative process, reported not being listened to, not being asked for their opinion, and that the adult's perspective was given priority over theirs. They also feared that social workers would not keep their information confidential (Bell, 2002;Woolfson et al., 2009;Pölkki et al., 2012;Jobe & Gorin, 2013;Cossar et al., 2016;Sanders et al., 2017;Fylkesnes et al., 2018;Lindahl and Bruhn, 2017). A child complained that: "No, it all felt like what ever I told them they would go and tell my mum…" (Jobe & Gorin, 2013: 435). Some children also reported social workers not following through after a disclosure, leaving the child frustrated or worse off (Woolfson et al., 2009;Sanders et al., 2017;Johannson, 2013;Fylkesnes et al., 2018).
In some cases, children felt surprised when social workers were not able to observe things that were right in front of them during the investigation. This meant that parents succeeded in creating a false picture of their situation at home (Pölkki et al., 2012). Sometimes children felt judged and disbelieved due to their appearance or circumstances. For example, a child commented that social workers did not believe that she was being abused at home, as she belonged to a white middle class family (Sanders et al., 2017). This highlights the vulnerable position of children in relation to the adults on whom they are dependent for information, participation and making appropriate assessment of their situation.

Conflicting emotions and self-blame
Children were hindered from seeking help for fear of being placed in care, concern for and loyalty towards family members (even if they were the abusers), or fear that the abuse might escalate (Jobe & Gorin, 2013). They reported generally not feeling safe enough to disclose abuse and lacking the self-esteem to report it. The most important factor for children when disclosing abuse was to have space to express themselves, feeling genuinely listened to and having time to develop trust with the person(s) (e.g., the social worker) from whom they were asking help (Jobe & Gorin, 2013). Some children blamed themselves and felt responsible for CPS being involved in their lives, considering themselves as troublemakers or not having proper clothes to wear at school, etc. (Winter, 2010;Jones, 2015;Mitchell & Kuczynski, 2010). Even if children understood that their parents did not treat them well, they still loved them and wanted to take care of them (Mitchell & Kuczynski, 2010;Winter, 2010;Pölkki et al., 2012;Jones, 2015;Burgund and Zegarac, 2016;Sanders et al., 2017). For example, a child mentioned that: "They may have asked something but because my own mother was near me, I did not start ex-plaining… yes, she always drinks. I only said that it was going well" (Pölkki et al., 2012: 118). These findings highlight the emotional and psychological stress that children experience at the start of their contact with CPS, even when they were in clear need of these services. The following section shows children's subjective experiences of the interventions and services received from CPS.

Being transferred to foster care
In case of removal from home, most of the children showed little to no understanding of the reasons for this. In some cases, they were taken by surprise and did not see the necessity for the intervention (Mitchell & Kuczynski, 2010;Pölkki et al., 2012;Burgund and Zegarac, 2016). However, knowing the reason for removal did not necessarily mean that children agreed with it (Mitchell & Kuczynski, 2010;Pölkki et al., 2012;Burgund and Zegarac, 2016;Jones, 2015;Sanders et al., 2017;Lindahl and Bruhn, 2017).
Removal from home left children distressed and shocked, and they could not remember what information they had been given by social workers at that point (Burgund and Zegarac, 2016): "They just came suddenly. The police came. Took me, my (siblings), then went away" (Fylkesnes et al., 2018: 345). While most children were notified by their social worker that they were going to be placed in foster care, a few mentioned receiving this information via a parent or even strangers, such as taxi drivers (Mitchell & Kuczynski, 2010;Pölkki et al., 2012;Jones, 2015;Burgund and Zegarac, 2016;Sanders et al., 2017). They often did not know what foster care meant and when they would return home. They reported fear, anxiety, sadness, anger and confusion (Mitchell & Kuczynski, 2010, Johannson, 2012Burgund and Zegarac, 2016). Younger children felt kidnapped as nobody provided them with any information about placement in foster care (Mitchell & Kuczynski, 2010). They worried whether their basic needs (play, sleep, food, and companionship) would be met. They were traumatized by thoughts such as fearing pets in the foster home, fear that they or their siblings might get hurt or that they would never see their friends and family again (Mitchell & Kuczynski, 2010). One child told that "I was afraid that they might hit me or my little (siblings)… Like I didn't mind if they hurt me, but like my siblings, they are too important to get to me. So it was sort of scary for that" (Mitchell & Kuczynski, 2010: 441).

Feelings and attitudes towards institutional care
Children in institutional or residential care were usually older (13-18 years). Children stated that it was difficult to find foster homes for adolescents as people consider fostering them difficult (Hyde & Kammerer, 2009). Some children who had experienced foster care preferred residential care as they did not feel that they were invading someone else's space there and needed to make a new family. For example, one child commented: "Woah!… who are these people? I don't even know these people. I don't even know them and I'm moving in with them… Holy! Bring me somewhere else. I don't care where I'll have to go. I'll get locked up as long as I am not with just some family I don't know" (Mitchell & Kuczynski, 2010: 441) Some children considered their room to be their safe haven, even when there was chaos in the institution (Bamba & Haight, 2009;Moore, McArthur, Death, Tilbury, & Roche, 2017).
While it was children's own choice to be in an institution in most cases, they had entered the institution not knowing enough to make an informed choice (Burgund and Zegarac, 2016). Children highlighted that they are not a homogenous group. Thus, they desired better planning when placing children together in a residential care, instead of randomly putting them together (Moore et al., 2017). They felt that residential care should not be an option for younger children due to peer-to-peer violence, bullying, sexual harassment, and lack of supervision from staff (Moore et al., 2017). Children who never understood the reason for their placement found it difficult to come to terms with these experiences (Van Bijleveld et al., 2014). Children reported using difficult behaviour to negotiate their needs with professionals, as in their experience, staff did not prioritize 'good children' (Bell, 2002;Hyde & Kammerer, 2009;Ellis, 2015;Ellis, 2018). As one child explains: "I show them I'm being good and tell them and that I am being good, but they're not bothered. When I'm naughty they're always on the phone and always coming, but when I'm being good, they're never really bothered (Ellis, 2015(Ellis, : 1563. They discussed the short-term benefits of such behaviours, but that this behaviour was documented and had longer-term repercussions was not considered by them (Ellis, 2015;Husby et al., 2018).

Failed expectations, deceptions & disappointments
While some children were satisfied with their foster care and appreciated the quality of relationships with people in their foster homes, developing trustful relationships with foster parents and pets over time (Mitchell & Kuczynski, 2010;Johannson, 2012;Burgund and Zegarac, 2016;Fylkesnes et al., 2018), others found it hard to adapt to the rules and routines of the new home (Mitchell & Kuczynski, 2010;Rauktis, Fusco, Cahalane, Bennett, & Reinhart, 2011;Fylkesnes et al., 2018). It was especially confusing for children who moved to various foster homes, and who experienced different and contrasting norms and rules within each household (Mitchell & Kuczynski, 2010;Rauktis et al., 2011). For example, in some foster-homes children could stay out late, have mobile phones and have contact with family and friends, while other households had stricter rules (Rauktis et al., 2011).
Sometimes there were different expectations of foster care from children and adults, which left children confused and sad (Mitchell & Kuczynski, 2010). Children, especially young adolescents, felt mismatched with their foster family in some cases. A few of the factors that children attributed this to included: different religious beliefs and practices, limited tolerance of different sexual orientations, generational gaps, and lack of knowledge/skills on how to care for adolescents (Hyde & Kammerer, 2009;Rauktis et al., 2011;Fylkesnes et al., 2018). Children found it hard to disclose unfair treatment at a foster home, especially if they had to continue living there. A few who did report the mistreatment found themselves in a worse situation than before (Hyde & Kammerer, 2009).
Young people who expected to return home soon from institutional care, and who saw institutional care as a temporary intervention, felt deceived by professionals when that did not happen. This resulted in anger and frustration and desire for honesty from adults about the time they would spend in out-of-home care (Hyde & Kammerer, 2009;Magalhães et al., 2018). It was painful for children to realize they had false expectations (Hyde & Kammerer, 2009). Those who perceived themselves to be the reason for ending up in out-of-home care felt trapped and did not know what they could do to return home. They felt that information received from different staff members about what they needed to do to return home, and what happened in practice, to be contradictory. Inconsistencies and delays led to some children making poor decisions, such as running away or fighting (Hyde & Kammerer, 2009).
In addition, institutional care did not always live up to children's expectations of safety. They expected it to be less violent and abusive than their homes, but this was not always the case (Moore et al., 2017;Hyde & Kammerer, 2009). Some found institutional care worse, as they had to fight for survival, both with the staff and peers (Hyde & Kammerer, 2009). These situations made them to choose to run away to deal with their problems and get away from this unsafe environment (Ellis, 2015;Moore et al., 2017).
Children who considered CPS to be the worst experience of their life reported feeling misunderstood. They felt that their opinions had not influenced decision-making processes. Sometimes they felt interventions to be sporadic and that new referrals did not draw on information/plans from previous referral (Sanders et al., 2017).

Disrupted personal and social lives
Children asserted their need for an explanation for the reasons of their removal and what did it entail. The lack of information left them sad and stressed by the worry that they might not see their parents again (Mitchell & Kuczynski, 2010). Many children discussed how moving into out-of-home care resulted in feelings of isolation and loneliness due to displacement from family and friends (Mitchell & Kuczynski, 2010;Fylkesnes et al., 2018).
Being moved between placements or being sent back home abruptly, in general, took a toll on young people emotionally, physically, and psychologically (Mateos et al., 2017;Moore et al., 2017). Uncertainty about their future was a great source of anxiety and frustration. It entailed children losing their community, adjusting to new living situations, finding new schools, establishing relationships with new staff or new family members, peers etc. These difficulties increased when the changes were sudden, unpredictable, and without explanation. It made children believe that nothing they did matters, thus becoming emotionally distanced with each placement move (Mateos et al., 2017;Hyde & Kammerer, 2009). Children wanted to know about the changes that occur in their situation, as they needed to prepare for those changes, for example, saying good-byes, and getting used to the idea of moving to a new place (Hyde & Kammerer, 2009;Van Bijleveld et al., 2014). The lack of stability and permanence in their placement affected their relationships with social workers and peers.

Sense of gain
Some children considered removal from the home to be the best solution for them. This was especially the case when they were informed about the process i.e., about what and why something was happening, and had a trusting relationship with their social worker (Winter, 2010;Jones, 2015;Bell, 2002;Van Bijleveld et al., 2014). While most of the children found the initial process confusing and stressful, at the same time there were some who found the interventions helpful and appreciated when social workers believed and helped them (Woolfson et al., 2009;Jobe & Gorin, 2013;Johannson, 2013;Fylkesnes et al., 2018). Thus, children's dissatisfaction with the investigation process did not necessarily mean that they were disappointed with the outcomes (Woolfson et al., 2009;Johansson, 2013;Arbeiter & Toros, 2017). Some children reported that things had improved for them as a result of CPS interventions: changes in their own behaviour, material gain, and improved parenting (Bell, 2002;Woolfson et al., 2009;Dunn, Culhane, & Taussig, 2010;Larsen, 2011). A child commented, "There was too much abuse in my home. I would not be where I am today had I stayed with my parents, I got a lot of help that I probably would have not gotten otherwise. The system allowed me to do much better than my cousins who have not even finished college. Besides the system is rich. My parents are poor" (Jones, 2015: 112). Even when children did not think that their situation had improved, they acknowledged CPS efforts. There was a general sense of gain. Children experienced positive life changes and felt that the intervention had made them a better person (Jones, 2015). It was important for them that their basic needs had been met (e.g., a safe place to stay, enough food, clean clothes) (McLeod, 2008;Winter, 2010;Jones, 2015). They valued having a regular household, a 'normal' family, and an overall good environment (McLeod, 2008;Sanders et al., 2017). Survival was another gain mentioned by children; they felt safe in foster care and reflected that without it, they might have been killed, become pregnant, get sexually transmitted diseases, or suffered homelessness. They appreciated the safe, stable environment, as it provided freedom from abuse and time to recover psychologically from abuse (Jones, 2015;Winter, 2010). The relationships (e.g., with foster-family, pets, friends, professionals and community) developed as a result of CPS intervention were also vital (Jones, 2015;Fylkesnes et al., 2018;Sanders et al., 2017). It was helpful when they had the same people, whether foster parents or social workers, throughout the whole process of CPS (McLeod, 2007;Lindahl and Bruhn, 2017;Sanders et al., 2017). Some children reported that institutional care gave them learning opportunities, space to plan a future and improved life conditions that they would not have had within their family (Magalhães et al., 2018). They stressed that the 'system is rich'; hence CPS was able to provide them with opportunities and experiences that their parents could not offer (McLeod, 2008;Jones, 2015:111). One such opportunity was to attend post-secondary education, which offered them a sense of optimism for the future (Bell, 2002;Woolfson et al., 2009;Dunn et al., 2010;Fylkesnes et al., 2018;Magalhães et al., 2018;Sanders et al., 2017;Bamba & Haight, 2007;Burgund and Zegarac, 2016;McLeod, 2008;Jones, 2015).
While some children welcomed opportunities to be a child again, to play, draw, and be in a drug free environment (Dunn et al., 2010;Ellis, 2018), others were resentful towards CPS and found the case closure to be the most helpful (Bell, 2002;Sanders et al., 2017).

Sense of loss
Children also felt a sense of loss because of CPS intervention. They were particularly unhappy with out-of-home care. Many missed their parents and siblings, and it made them sad thinking that they might never see them again. They reported a loss of the familiar and found it hard to adapt to new routines and ways of living. The foster home felt like a prison to some of them due to all the routines and regulations (Jones, 2015;Bell, 2002;Mitchell & Kuczynski, 2010;Dunn et al., 2010). One child commented, "I'm used to having siblings and stuff, so, I'll want to hang out with my friends and stuff because I'm the only kid there and it's really boring" (Mitchell & Kuczynski, 2010: 442).
Some children mentioned that they would have liked contact with their biological family, siblings, friends and community; however, they did not receive any support or advice for doing so. This entailed children feeling isolated, lonely and helpless (Burgund and Zegarac, 2016;Mitchell & Kuczynski, 2010). Similarly, discontinuity of social workers left children feeling deprived, forgotten and confused (Bell, 2002). They complained about people not keeping their promises/commitments, thus making them lose trust in people and authorities (Bell, 2002;Dunn et al., 2010). A child complained, "I told them I'd like to be off the care order. I think they said they'd try …but I don't think they did try" (Bell, 2002: 4).
Children placed in out-of-home care from an early age had huge gaps in their life story (Pölkki et al., 2012). Those experiencing multiple foster homes and institutional care felt that they did not have a place to call home (Fylkesnes et al., 2018;Dunn et al., 2010). Children in institutional care felt that they had lost their childhood in comparison to peers in their home community who were living a normal life (going to school, hanging out with friends, sleepovers, dating, engaging in new experiences etc.). Lack of permanence and stability in children's life due to multiple placements, uncertainty about their future and social relations were some of the challenges that hindered them from having what they considered a normal life. Their circle of friends grew smaller as the years passed by, as did the number of trustworthy adults (Hyde & Kammerer, 2009). They lacked control of their lives, privacy and independence. Children complained that CPS were trying to turn them into someone they were not (Rauktis et al., 2011;Ellis, 2015;Dunn et al., 2010;Fylkesnes et al., 2018).

Negotiating 'vulnerability' and 'childhood'
Some institutionalized young people disliked being treated as 'children' by social workers. This was not only because of the activities they were expected to participate in, such as playing board games, but also because children generally have an unequal status in society. They felt that social workers treated them as incapable (Ellis, 2018;McLeod, 2008;Moore et al., 2017) and resented the different rules for adults and themselves. As one child complained "I think children are treated very much in this society, but particularly by Social Services, as incapable, the same way mentally ill or elderly people are treated" (McLeod, 2008: 777). They demanded equal respect and a right to have say in determining their own future (McLeod, 2008;Van Bijleveld et al., 2014;Bolin, 2016).
Children described themselves as good, strong, adaptable, and communicative. However, they did not think that other people perceived them in the same way (Burgund and Zegarac, 2016;Magalhães et al., 2018;Lindahl and Bruhn, 2017;Ellis, 2018). Furthermore, young people did not agree with the notion of 'vulnerability' ascribed to them and insisted that they could take care of themselves. Rather than seeing their life experiences as making them vulnerable, they focused on their image as strong, independent people who survived their experiences (Ellis, 2015(Ellis, , 2018. Children insisted that: "I can actually look after myself […] I don't think I'm vulnerable" and "I know I ain't vulnerable […] I know about me and nobody can tell me what I am" (Ellis, 2015: 161).
Nevertheless, some children felt vulnerable to exploitation, as they were not always able to distinguish between appropriate and inappropriate relationships, the latter often being formed as compensation for the attention, care and material resources they lacked when in institutional care and the absence of good adult role models (Moore et al., 2017;Rabley, Preyde, & Gharabaghi, 2014).

Seeking recognition
Most children in institutional care perceived themselves labelled as 'nothing' or 'bad' by adults. They had lived with that label for so long that they internalized it and sometimes acted it out, thus confirming adult opinion about them (Hyde & Kammerer, 2009). One child explained, "They drug tested me before and it came back negative, I never did anything, but she (caseworker) always just treated me as if I did something wrong… they assumed I was doing drugs… even if it comes out negative, you are still making them feel like you are assuming they are a bad kid" (Hyde & Kammerer, 2009: 270). However, children were worried about what other people think about them and were frustrated that their reputation followed them because of information recorded in their case files, which was shared across services. They felt that adults in their lives focus more on their negative than positive behaviours, which fed their negative self-perception (Ellis, 2015).
Moreover, children perceived themselves as a 'job', because social workers mostly treated them in a detached manner -just another person to help (Husby et al., 2018). It helped boost children's perception of themselves as equal and strengthened their well-being when they could help social workers or had someone to speak up for them (Bamba & Haight, 2009;Bell, 2002). Children believed that if adults focused on their positive behaviours that would develop their self-esteem (Hyde & Kammerer, 2009;McLeod, 2008;Husby et al., 2018;Ellis, 2015;Rabley et al., 2014;Pölkki et al., 2012;Burgund and Zegarac, 2016).
Consequently, children constructed the idea of a 'good' child and tried to behave accordingly. Being 'good' for them meant that one did not get in trouble or cause trouble, did not do drugs or drink, did not start fights and followed rules. They suppressed difficult emotions and did not show it to adults around them to up-keep their image of 'good child' (Ellis, 2015;Burgund and Zegarac, 2016). However, this did not always result in positive feelings. For example, children found it unfair that they were in secure settings with 'bad' kids, even though they themselves were 'good'.
According to children, they were perceived as good, helpful, as a good friend, and strong by people who knew them (Burgund and Zegarac, 2016). Nevertheless, they also mentioned that sometimes they were tired of being strong and just wanted to feel happy (Mateos et al., 2017).

Feeling of stigma
Children felt stigma and shame due to their association with CPS and believed that, because they are in the system or in care, people looked at them as troublemakers or vulnerable -at risk of potential harm and in need of being looked-after (McLeod, 2008;Buckley et al., 2011;Ellis, 2015). For them, CPS is associated with lower status and with being on the margins of society (Buckley et al., 2011). A few children reported that professionals disrespected them and their families (e.g., name-calling) (Magalhães et al., 2018). In addition, they felt that professionals used language as a tool of power, which made them feel even more vulnerable as they could not understand the information provided to them about their case or fully participate in meetings (Bolin, 2016;Magalhães et al., 2018).
Children's perceptions of negative social image/stigma associated with being in institutional care resulted in emotional difficulties. Children expressed that "… Because we are in the system, why should we feel like we are not normal? We have all these restrictions and stuff. …like it makes us feel as though we have foster care stamped on our head…" (Rauktis et al., 2011(Rauktis et al., : 1229. Some considered it being their 'biggest secret' and concealed their residential placement from their peers. Their self-esteem was even lower if they were bullied (Magalhães et al., 2018;Bamba & Haight, 2009;Rauktis et al., 2011). However, it helped when they felt understood by teachers and accepted by other children in school (Burgund and Zegarac, 2016).

Discussion
This paper synthesized current documentation of children's lived experience of CPS, following the introduction of the UNCRC in 1990. The literature demonstrates an increasing acknowledgment of children as knowledgeable agents (James, Jenks, & Prout, 1998) as this research field has developed over the past three decades.
Children and young people expressed emotional and psychosocial impacts of being involved with CPS on their lives while highlighting their struggle with conflicting emotions and loyalty towards their parents, failed expectations and feeling deceived by the services, isolation, uncertainty about future due to lack of stability and permanence and desire for recognition. They constantly seek ways to survive, which might result in them using bad behaviour to achieve ends or living up to their construct of 'good child' and not showing their emotions at all or running away from the situation. The material resources and educational opportunities provided by CPS were also important in ensuring their positive self-esteem and better future.
In this meta-synthesis, children found the initial contact with CPS and investigation process to be the most stressful and frightening experience. This psychological and emotional stress, as well lack of information and mistrust on the social workers, hinders children to make full disclosure to CPS. In Ungar, Tutty, McConnell, Barter, and Fairholm (2009) study, disclosure of abuse is described as a pattern from less direct disclosure (e.g., talking with peers, family etc.) to those mandated to intervene (e.g., teachers, CPS etc.). While children in this review somewhat follow this pattern, however, none of them reported any benefit from the non-direct disclosure. Children's disclosure of abuse and neglect is crucial if public services are to provide them support and protection, especially when there are no third-party witnesses (Linell, 2017). This highlights the need for training professionals as teachers, and peers in recognizing signs of indirect disclosure so that they can help children in need. While CPS need to understand that children need emotional and psychological safety in addition to the physical safety to make a disclosure.
The findings highlight the importance of children's right to information and participation in decision-making process in CPS. The sentiments of children and young people towards CPS intervention and services varied at different phases. Children who were removed from home at a young age did not remember much about their life and felt a hole, while others felt trapped and kidnapped. This happened especially in cases where children were not well informed about what is happening and the reason behind it. While those who received information from CPS were more acceptable and satisfied by its intervention. The UNCRC promotes child-centered, participatory social work practice (Alderson, 2000). However, actual children's participation is often ambiguous due to lack of clear guidelines and different perspectives of social workers on what 'listening to a child' entails in CPS (Van Bijleveld et al., 2014;McLeod, 2007). Studies with social workers show that they find children's participation in decision making challenging due to perceived communication difficulties or unnecessary and even inappropriate because it might be harmful for the children (Vis, Holtan, & Thomas, 2012). This suggests that even though there is a shift in CPS policies towards child rights discourse, in practice the protectionist discourse is still dominant. CPS, in practice, must treat children as service users with rights, providing them with complete and understandable information. This would support children's meaningful participation in the CPS process as well as decrease their stress and improve their self-esteem (Schofield & Beek, 2005;Gilligan, 2000).
Our results revealed that children expected the out-of-home care to be better and safer than home, however, that was not always the case. The social environment in out-of-home care, especially institutions compromised children's safety through violence, bullying, stealing, etc. These concerns are echoed elsewhere by former youth in out-of-home care (Freundlich, Avery, Gerstenzang, & Munson, 2006). This environment is considered a risk factor for child development and has an adverse impact on their emotional, physical and psychological wellbeing (Mazzone, Nocentini, & Menesini, 2018). This emphasizes the importance of timely follow-up for children, both during and after the CPS intervention (Davidson-Arad & Kaznelson, 2010). This can be achieved by actively involving citizens and community groups in CPS (Jones, Litzelfelner, & Ford, 2003). An example of this are Citizen Review Panels (CRP) in the USA. While research shows some benefits of CRP, for example, more stability in children's foster placements and adoption, there is a need for improved sharing of information and collaboration between CRP and CPS (Bryan, Jones, & Lawson, 2010). In addition, CRP members would benefit from specific trainings about policies, practice and ongoing challenges faced by CPS to work effectively (Jones, 2004;Miller & Vaughn, 2018) Nevertheless, children appreciate the material support provided by CPS; as children from low income households are more likely to end up in CPS (Featherstone, White, & Morris, 2014). Children describe the 'system as rich' and that there was more material support for them in foster or residential care than there had been at home. However, at the same time, they suffer from a sense of loss as well; loss of family and friends, lack of social relations due to instability and loss of privacy and independence. A study by Braxton and Krajewski-Jaime (2011) criticized CPS for focusing too heavily on the deficiency needs of safety and permanency, and not enough on 'being needs'. This highlights the need for CPS to focus on children's 'being needs', such as love and belongingness, self-esteem, and self-actualization, in addition to fulfilling their 'basic needs', i.e., food, shelter, safety, etc. (Maslow, 1943). Thus, challenging CPS to think beyond the conventional rights of provision, protection and participation to include other rights that relate to a wider definition of well-being. Children's right to develop and to reach their full potential is a complex process, which cannot be reduced to three Ps -provision, protection, and participation (UN, 1989).
Children and young people in CPS are often seen by adults around them as 'problematic', 'vulnerable' and are 'stigmatised' due to their CPS status. Internalisation of stigma can result in feeling of guilt and shame (Goffman, 1963), which has long-term consequences such as negative emotional, psychological, behavioural and educational outcomes (Kang & Inzlicht, 2012). Children in care want to be seen as 'normal' (Martin & Jackson, 2002) and are concerned about what other people think of them and their family situation (Dansey, Shbero, & John, 2019). They wish to be seen as resilient, strong and treated with respect. Their desire for acknowledgement adheres to Honneth's theory of recognition, which postulates that recognition is a fundamental element in human interaction and for individual identity (Honneth, 1995). He considered all three forms of recognitions (love, rights and solidarity) to be foundations for development of one's self-confidence, self-respect and self-esteem, respectively. Thus, all needs for recognition (love, rights and solidarity) must be satisfied for an individual to develop a positive relation to oneself successfully. This entails CPS providing supportive adults for children, who would take interest in their lives and invest time; treat children as right-bearing individuals and recognize their strengths and talents when working with them.
This review highlighted that children have varied experiences of the CPS and that they are a heterogeneous group; each child and her or his context should be considered individually. It also presented an overview of children's perspectives described in the literature but bearing in mind the heterogeneity of these views there is a need for future research to explore the perspectives of particular population groups, children with special needs, gender, national, socio economic and ethnic differences, for example. Furthermore, research on children's emotional experiences of being with CPS is needed. Although only a few children talked about culture and importance of their cultural and ethnic roots, it would be a useful topic to explore, especially within the present context of increased migration due to globalization. The reviewed studies also show that there is a dearth of comparative, cross-cultural and longitudinal research that can shed light on how children who come of age in CPS from different 'welfare regimes' fare in their lives.

Strengths and limitations
This review brings out the voice of children in research by encapsulating their subjective experiences and perceptions of CPS, highlighting their emotional, psychological and social struggles to receive help and the importance of treating children as right bearing individuals whose 'being' needs are as important as their 'basic' needs. By using a broader and non-categorical question (such as experience of participation in CPS, etc.), this meta-synthesis was able to contribute useful insights for practice and further research.
The limitations of this review are that relevant qualitative studies may have been left out due to unclear titles or abstracts, issues with indexing, and the inclusion of English language studies only. Also, even though CPS provides a wide range of the services, most of the studies (about 77%) included in this review focused on children in out-of-home care, which may have caused a biased perspective.

Conclusion
This review explored and synthesized 39 qualitative articles regarding the experience of children with CPS. This has shown that although research capturing the child's experiences is growing, it remains small. Even though children reported varied experiences of CPS processes, however everyone finds initial contact and investigation particularly stressful. Children demand more and understandable information about CPS process and transparency in decision-making. Timely follow-up of CPS interventions is crucial to ensure the latter.
Overall, the review suggests that CPS have a strong focus on children's right to provision, which can obscure their other rights, such as the right to clear and understandable information, to participate and to be protected. Children's right to protection entails more than physical safety; it encompasses their emotional and psychological safety, and overall well-being. Lastly, children feel that there is a stigma attached to being involved in CPS, which negatively affects their self-perception and self-esteem.
This highlights that children need emotional support and a safe space for disclosure at this stage instead of bureaucratic investigation. Information about CPS and its work should be made readily available for children to facilitate easy access to the services when needed. Children's right to information is important, as is their participation. Information provided to them should be detailed, clear, and understandable. Children must be given respect as CPS users who can provide useful insights regarding their situation and recommend suitable interventions for them. Lastly, interventions must be tailored to the child's needs.

Declaration of Competing Interest
None of the authors have any conflict of interest.

Appendix A. Supplementary material
Supplementary data to this article can be found online at https:// doi.org/10.1016/j.childyouth.2020.104974.