Fractured Systems, Compounded Trauma: A Systematic Review and Meta-Aggregation of Crisis Service Experiences After...

The immediate aftermath of child sexual assault is a critical yet understudied period where crisis interventions can mitigate or exacerbate trauma. Despite their pivotal role, no systematic review has synthesized qualitative evidence on stakeholder experiences of these services. To aggregate findings from qualitative studies examining children, young people (CYP), parents/carers, and service providers' (police, medical staff, psychosocial support, and child protection professionals) experiences of crisis responses following child sexual assault. Five databases (MEDLINE, PsycINFO, Embase, CINAHL, ProQuest Social Science) were searched using PICo (Population: Child Sexual Assault survivors/families/providers; Phenomenon: Crisis service experiences; Context: ≤72 hrs post-disclosure). Preferred Reporting Items for Systematic Reviews and Meta-Analyses guided screening ensured transparency. Included studies (n = 22) were synthesized via Joanna Briggs Institute meta-aggregation, deriving actionable themes while preserving meaning. Three stakeholder groups reported systemic challenges:• CYP (16 studies): Hesitated to disclose due to fear/blame; trauma was compounded by fragmented care but alleviated by empathetic, child-centered approaches.• Parents (6 studies): Critiqued services as disjointed and retraumatizing, urging proactive family advocacy.• Providers (6 studies): Cited interagency conflicts, resource gaps, and moral distress as barriers to trauma-informed care.This first meta-aggregation of post-child sexual assault crisis care identifies the need for systemic reforms; standardized multi-disciplinary protocols, dedicated family supports, and provider training as well as clinical and supportive supervision to mitigate secondary trauma. Findings underscore the need for trauma-informed systems to prevent compounding harm during this vulnerable period.