A new review published in the Children and Youth Services Review Journal examines the factors that influence why children enter out-of-home care, such as foster or residential placements. The study was funded by the National Institute for Health and Care Research (NIHR) and conducted by CARELINK Wales, a partnership of researchers from Swansea University, Bangor University, Public Health Wales, Cardiff University, and the University of Manchester. ADR Wales and the Centre for Population Health supported the collaboration.
The review analyzed seven peer-reviewed studies from 2013 to 2024 to identify key risk and protective factors that affect children's initial entry and re-entry into out-of-home care before age 18. The research found that children who enter these systems often face long-term challenges like lower academic achievement, limited job prospects, and increased behavioral difficulties. While placements can offer some stability, they do not fully address early adversity. These issues also impact families and communities—especially in disadvantaged areas where care placements are more frequent.
The review identified several risk factors for entering out-of-home care: child-related health needs or behavioral challenges; family financial hardship or substance use problems; community-level resource limitations; and system-related issues such as prior involvement with child welfare services or frequent placement changes.
Protective factors included being in primary school (ages 6–12), greater access to education within families, financial stability at home, supportive communities with essential services like healthcare and education, and increased funding for child welfare services to support families.
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 added: “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.”