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Systematic Review
The main objective of this review was to answer the following research questions: What are the effects of outreach programmes on problem/high‐risk behaviour of young people between 8 and 25 years of age living in OECD countries? Are they less likely to experience an adverse outcome such as school failure or drop‐ out, runaway and homelessness, substance and/or alcohol abuse, unemployment, long‐term poverty, delinquency and more serious criminal behaviour?
Four of the five studies used for meta analysis were from the USA and one was from Canada. The timespan in which included studies were carried out was 32 years, from 1985 to 2017; on average the intervention year was 2005. The average number of participants in the analysed interventions was 116, ranging from 30 to 346 and the average number of controls was 81, ranging from 32 to 321. At most, the results from two studies could be pooled in a single meta‐analysis. It was only possible to pool the outcomes drug (other than marijuana) use, marijuana use and alcohol use each at two different time points (one and 3 months follow up). At 1 month follow up the weighted averages varied between zero and 0.05 and at 3 months follow up between −0.17 and 0.07. None of them were statistically significant. In addition, a number of other outcomes were reported in a single study only.
Overall, there were too few studies included in any of the meta‐analyses in order for us to draw any conclusion concerning the effectiveness of outreach. The vast majority of studies were undertaken in the USA. The dominance of the USA as the main country in which outreach interventions meeting our inclusion criteria have been evaluated using rigorous methods and within our specific parameters clearly limits the generalisability of the findings. None of the studies, however, was considered to be of overall high quality in our risk of bias assessment and the process of excluding studies with critical risk of bias from the meta‐analysis applied in this review left us with only five of a total of 16 possible studies to synthesise. Further, because too few studies reported results on the same type of outcome at most two studies could be combined in a particular meta‐analysis. Given the limited number of rigorous studies available from countries other than the USA, it would be natural to consider conducting a series of randomised controlled trials evaluating the effectiveness of outreach for at‐risk youth in countries outside the USA. The trial(s) should be designed, conducted and reported according to methodological criteria for rigour in respect of internal and external validity to achieve robust results and preferably reporting a larger number of outcomes.