Factors associated with childhood out-of-home care entry and re-entry in high income countries: A systematic review of reviews

Background

Out-of-home care entry can have profound effects on families, society, and a child’s development and wellbeing. This review synthesised evidence on the factors contributing to initial entry and re-entry into out-of-home care during childhood (<18 years), as well as those that protect against these outcomes.

Methods

A systematic review of published reviews was conducted. EBSCOhost, ProQuest, the Cochrane Database of Systematic Reviews, and Epistemonikos were searched. Eligible reviews were peer-reviewed, published in English from 2013 to 2024, focused on childhood out-of-home care placement (<18 years), and were conducted primarily in high-income countries. Framework synthesis approach was used to identify key factors associated with care entry.

Results

Of the 711 records identified, seven reviews were included. Key child-level risks included ethnicity, health, and behavioural challenges; family-level risks encompassed parental socioeconomic adversities and substance use; community-level risks involved poor neighbourhood conditions; and system-level risks included prior child welfare involvement and placement characteristics (e.g., placement instability for re-entry into care). Protective factors included child-level factors such as being elementary school-aged (6–12 years) and ethnicity; family-level factors such as high parental income and education; community-level factors, including access to essential services; and system-level factors, such as increased funding for child welfare.

Conclusions

The evidence highlights that the factors contributing to care entry extend beyond the children’s social care system, encompassing child, family, and community-level influences. There is potential for policymakers and practitioners to move beyond reactive child welfare measures by adopting preventative, holistic solutions across various public services.