New research has shed light on the many different factors that lead to children entering out-of-home care in high-income countries.
Published in the Children and Youth Services Review Journal, the collaborative review is funded by the National Institute for Health and Care Research (NIHR).
Children who enter out-of-home care, such as foster care or residential care, often face lasting challenges, including lower school achievement, limited job opportunities, and a higher risk of behavioural difficulties.
Research suggests that while care placements can offer some stability, they do not fully counteract the effects of early adversity. The impact extends beyond the child, affecting families and communities, particularly in disadvantaged areas where care placements are more common.
Researchers from CARELINK Wales conducted a systematic examination of reviews to identify key factors influencing children's initial entry and re-entry into out-of-home care systems before the age of 18.
Led by HDR UK Wales, CARELINK Wales brings together leading researchers from Swansea University, Bangor University, Public Health Wales, Cardiff University, and the University of Manchester. The partnership is supported by ADR Wales and the Centre for Population Health.
The team’s review combined findings from seven peer-reviewed studies from 2013 to 2024 and identified key factors influencing childhood out-of-home care, showing how child, family, community, and system-level elements interact in complex ways.
Risk factors:
- Child-related factors - health needs, emotional and behavioural challenges, and experiences linked to ethnicity;
- Family factors - financial hardship and difficulties related to substance use;
- Community factors - living in areas with limited resources, such as fewer support services; and,
- System-related factors - previous involvement with child welfare services and frequent changes in care placements.
Protective factors:
- Child-related factors - being in primary school (ages 6–12) and, in some cases, ethnicity;
- Family factors - greater access to education and financial stability;
- Community factors - supportive communities with essential services like healthcare and education; and,
- System-related factors - increased funding for child welfare services to provide families with more support.
Richmond Opoku, a PhD Student for ADR Wales and lead author of the review, said: "With the significant emotional and financial costs involved in out-of-home care, there is a clear need for better-targeted policies and early support to help at-risk families and reduce unnecessary care placements.
“Our review highlights the need for holistic approaches that extend beyond reactive measures within the social care system. Policymakers and practitioners must prioritise early intervention strategies that address broader factors like poverty, education, and community support."
Tash Kennedy, CARELINK Wales lead, said: “By synthesising evidence across multiple levels including child, family, community, and systemic, it highlights the structural inequalities that place certain children at a heightened risk of out-of-home care entry.
“The findings reinforce the importance of early targeted support and cross sector collaboration to address the root causes, including poverty, housing instability, and parental mental health challenges.”
Professor Sinead Brophy, HDR UK Wales Co-Lead, said: “This comprehensive review identifies gaps for future research and policy development. It highlights the urgent need for improved collaboration across sector and integrated, evidence-based interventions that promote child welfare and family resilience.”