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Abstract Background Children in care and care leavers have worse health outcomes than their peers without care experience. This study addresses an evidence gap in exploring care-experienced young people’s views and experiences of accessing general practice and dental services and attending health reviews in England. Methods We conducted a qualitative study using podcasting as a creative medium. We recruited young people from two sites: one in South England (A) and one in greater London (B). We held two paired discussions in site A and two focus groups in site B, with 14 participants in total. Participants were aged between 13 and 22 years and were diverse in gender, ethnicity, and care experiences. Data were analysed thematically using candidacy theory as a theoretical framework. Results Mental health was a prevailing concern for participants, but general practice was not considered a place to discuss it. Most participants reported distant relationships with primary healthcare professionals and considered opening-up to a professional to be risky, for example, it could result in an unknown/unwanted outcome. A lack of time and personal connection in appointments, and experiences of feeling judged, dismissed, or misunderstood, hindered young people’s ability to disclose mental health or relationship concerns. Participants reported variation in the timeliness and location of services, with salient examples of extensive waiting periods for braces. Participants perceived annual health reviews to be largely inconsequential. Conclusions Any primary care presentation by a care-experienced young person should trigger additional professional curiosity. To build rapport and trust, professionals should not underestimate the power of active listening, being reliable and honest, and small acts of thoughtfulness, for example, ensuring medical letters are provided promptly. Carers and other trusted professionals should help care-experienced young people to understand the role of primary care and support them with access. Health reviews may not be of value to all young people in care. Further research is needed to examine primary healthcare access for care-experienced young people with significant safeguarding and healthcare needs.

Abstract Research has demonstrated children in out-of-home care have experienced trauma and a significant proportion are in need of behavioral health services (e.g. Casaneuva et al., NSCAW II baseline report: Child well-being, US Department of Health and Human Services, Washington, DC, 2011). Accessing services requires interagency coordination between child welfare and behavioral health professionals; however, challenges to coordination and collaboration may result in lack of service utilization for many youth (Hanson et al. 2016). Utilizing a mixed methodological approach, this paper describes the results of a study conducted five years after full state-wide implementation of processes designed to promote the use of evidence-based practices to inform decision-making for youth dually served by the child welfare and behavioral health systems. Outcomes from the study were used to develop strategies to address programmatic concerns and reinforce implementation supports. Study findings may aid organizations seeking to reinforce data-informed practices and employ strategies for addressing barriers at the worker and agency level.

Summary: Background: While individuals who were separated from their biological family and placed into the care of the state during childhood (out-of-home care) are more prone to developing selected adverse health problems in adulthood, their risk of cardiovascular disease is uncertain. Our aim was to explore this association by pooling published and unpublished results from prospective cohort studies. Methods: We used two approaches to identifying relevant data on childhood care and adult cardiovascular disease (PROSPERO registration CRD42021254665). First, to locate published studies, we searched PubMed (Medline) until November 2023. Second, with the objective of identifying unpublished studies with the potential to address the present research question, we scrutinised retrieved reviews on childhood out-of-home care and other adult health outcomes. Included studies were required to satisfy three criteria: a cohort study in which the assessment of care was made prospectively pre-adulthood (in the avoidance of recall bias); data on an unexposed comparator group were available (for the computation of relative risk); and a diagnosis of adult cardiovascular disease events (coronary heart disease, stroke, or their combination) had been made (as opposed to risk factors only). Collaborating investigators provided study-specific estimates which were aggregated using random-effects meta-analysis. The Newcastle-Ottawa Scale was used to assess individual study quality. Findings: Twelve studies (2 published, 10 unpublished) met the inclusion criteria, and investigators from nine provided viable results, including updated analyses of the published studies. Studies comprised 611,601 individuals (301,129 women) from the US, UK, Sweden, Finland, and Australia. Five of the nine studies were judged to be of higher methodological quality. Relative to the unexposed, individuals with a care placement during childhood had a 51% greater risk of cardiovascular disease in adulthood (summary rate ratio after age- and sex-adjustment [95% confidence interval]: 1.51 [1.22, 1.86]; range of study-specific estimates: 1.07 to 2.06; I2 = 69%, p = 0.001). This association was attenuated but persisted after adjustment for socioeconomic status in childhood (8 studies; 1.41 [1.15, 1.72]) and adulthood (9 studies, 1.29 [1.11, 1.51]). Interpretation: Our findings show that individuals with experience of out-of-home care in childhood have a moderately raised risk of cardiovascular disease in adulthood. Funding: Medical Research Council; National Institute on Aging; Wellcome Trust.

IntroductionWestern Australia has one of the highest rates of Aboriginal children entering out-of-home care in Australia. Kinship care is the preferred culturally safe out-of-home care option for Aboriginal children, yet all jurisdictions, including Western Australia, are far from meeting best-practice national standards. Intersectoral collaboration is a key primary healthcare principle and internationally recognized for improving health systems and outcomes. This paper presents findings from a qualitative research project investigating Aboriginal primary healthcare workers’ experiences of intersectoral collaboration challenges and strengthening opportunities.MethodsConstructivist grounded theory guided this research involving 55 semi-structured interviews and four focus group discussions with Aboriginal primary healthcare workers. The research was guided by Indigenous methodologies and led by Indigenous researchers Participants were recruited from seven Aboriginal Community Controlled Health Organisations located across Perth metro, Pilbara, Midwest/Gascoyne and Southwest regions in Western Australia.ResultsKey themes identified around intersectoral collaboration challenges were communication, including information sharing and interagency meetings, and the relationship with the government sector, including trust and the importance of the perception of Aboriginal health service independence. Key themes around strengthening areas to improve intersectoral collaboration included strengthening service resourcing and coverage, including the availability of services, and addressing high program turnover. The need for a shift in approach, including more emphasis on Aboriginal-led care and aligning approaches between sectors, was another area for strengthening.DiscussionThis study addresses a significant research gap concerning out-of-home care, kinship care, and intersectoral collaboration in an Australian Aboriginal context. Findings highlighted the need to review the out-of-home and kinship models of care to strengthen the system, including creating more formal and structured modes of collaborating and better resourcing family support and kinship care.

This article explores the increasing prevalence of for-profit residential care, with a particular focus on Great Britain, while also drawing on the international evidence from the Global North. Comprising a critical review of the published evidence (both academic and grey literature), the article seeks to examine what might explain the rising prevalence of and the possible associated impacts of the increase in for-profit provision. The findings indicate that the rise of for profit-companies among residential child care providers appears to have occurred by default, rather than explicit policy design. Our analysis also highlights gaps in the knowledge base about the quality of care and whether better quality is associated with the type of provider. Furthermore, the relationships between provider, quality, cost and outcomes are unclear. There are inconsistencies in the evidence base, with different conclusions being reached. However, available evidence tends to suggest the increased prevalence of for-profit residential child care providers has had an overall negative, rather than positive, effect. The best case in favour of the continued use of for-profit residential care is currently a non-moral pragmatic one: that in countries with medium and high prevalence of the use of residential child care, it would be hard to sustain care systems if for-profit providers were to suddenly withdraw or be withdrawn.

One of the long-term consequences related to migration due to wars, violence, and ecological and climate crises is the additional challenges to the health and child welfare systems in the host country. Previous research has shown that the need for the help of migrant children and children of migrants differs from the help needs of the main population of the host country. In the current scoping review, our objective is to describe how the mental health and child protection services needs and use of child and youth refugees and migrants differ from those of the natives in the host country, and also to identify the main obstacles in receiving suitable mental health or child protective services. Implications for healthcare and child protective services are discussed.

“Vulnerability” is now a widely used term in different settings—from politics and academia to everyday life. In response, a growing body of research has emerged critiquing and challenging the use of the concept in the social sciences. In this paper, we explore the use of the term vulnerability in research on children in out-of-home care and discuss the possible negative consequences of this—for the people involved and for the knowledge produced. Showing some of the problems involved in classifying these children as “particularly vulnerable”, we argue that there is a need for more nuanced understandings of children growing up in out-of-home care.

Growing numbers of children of all ages grow up in out-of-home care institutions due to personal and socioecological risk variables that destabilized their families of origin. In the aftermath of the COVID-19 pandemic which disrupted lives and development, there is particular interest in how children who grow up in out-of-home care institutions cope and develop. This paper reports the findings of a study that sought to document anchors of resilience in children who resided in a care institution run by a non-governmental, church-based welfare organization in one of the central provinces of South Africa. In line with recent developments in childcare, the organization mainly functions via smaller child and youth group homes across the province (compared to bigger children’s homes in the past). In our qualitative, phenomenological study, we used the participatory, child-friendly, and less intrusive draw-and-write technique to generate data. We asked the 20 participating children of one of these group homes to make drawings that mirror their lives, and to write paragraphs in which they described their drawings. All were school-going children in care, aged from 12 to 19. There were 11 girls and 9 boys in the study, and one of these identified as “other.” The grades ranged from 7 to 12 and they spoke African languages, namely Afrikaans, Sesotho, Setswana and IsiXhosa. We used inductive content analysis to process the data, and the findings indicate that, notwithstanding personal and socioecological risks during and after the COVID-19 pandemic, the resilience of the participants was anchored by a number of universal personal strengths as well as socioecological resources.

Treatment Foster Care Oregon (TFCO) is a comprehensive and evidence-based program focusing on youths with serious problem behaviors and their families. The program was developed in the US, and studies indicate that TFCO is an effective treatment program for youths with serious behavioral and emotional problems. The present study aimed to examine treatment changes in behavioral and emotional problems in a sample of 76 Norwegian youths (57.9% boys, mean age = 14.93) who were assigned to TFCO. Data were retrieved from the Routine Outcome Monitoring (ROM) system, used to ensure the program’s national quality, and included measures of risk factors (YLS/CMI), internalizing and externalizing behaviors (ASEBA), in addition to five nationally defined outcome goals. The study included data from intake and the end of treatment. The results showed significant reductions in risk factors and externalizing and internalizing problems. The number of youths who completed all five outcome goals increased over the course of therapy. The results suggest that TFCO might be an effective treatment program for Norwegian youths with severe problem behaviors.

Research Framework: Inequalities in access to childcare for young children are particularly strong in France. We analyze them through the question of the non-recourse to rights and services (Warin, 2016) in order to think about families’ childcare arrangements in relation to a local public offer. Objectives: The objective is to research the different ways in which working-class mothers choose to care for their children when faced with a very inadequate public supply of early childhood care and an allocation criteria that are not favourable to them. Methodology: The empirical survey is based on comprehensive interviews that were carried out with mothers (N = 27) in three working-class neighbourhoods in a city with very few childcare facilities. Results: The analysis shows different forms of non-use that mothers have of childcare facilities. These forms are linked to the social and professional situations they are confronted with, that is in connection with an inadequate local supply: an assumed or asserted non-demand; a lack of information and knowledge of the supply and administrative procedures; a failure to offer and receive alternative proposals to the crèche, informal childcare by relatives or under the table. As their children grow older, mothers express increasing needs for care that are specifically at their development and socialization, and not only the needs related to their professional activity. Conclusions: The difficulties encountered by mothers raise questions about the quantity and quality of municipal childcare provision, as well as the cobbling together of formal and informal childcare solutions. Contribution: To understand whether or not mothers have recourse to extra-familial childcare, we emphasize the importance of simultaneously taking into account the situation of the local supply with which they are directly confronted and their own social and professional situation.

Licensing is a public instrument used to control welfare services. One such service is residential care for children, which is targeted at children who experience maltreatment in their home environment and/or have behavioural problems and have been separated from their parents by the authorities. In Sweden, Finland, Norway and Denmark, residential care may be provided by public or private (not-for-profit or for-profit) providers. The aim of this article is to explore and compare how public authorities in Sweden, Finland, Norway, and Denmark, license residential care for children. The data consist of application forms and instructions for how to apply for a licence as well as interviews with key staff responsible for licensing. The findings show differences in how national agencies license residential care providers. Licensing models may be centralised/general (Sweden, Finland) or regionalised/specialised towards residential care (Norway, Denmark). The process can be more investigative (Sweden, Norway) or consultative (Finland, Denmark), and the review of standards formality-oriented (Sweden, Finland, Norway) or content-oriented (Denmark). Finally, the models of supervision post-licence vary in terms of being non-intervening (Finland), semi-intervening (Sweden, Norway) or intervening (Denmark). The discussion centres on the possible contribution of the different models to the regulation of the residential care markets.

Between 2012 and 2017, N = 2814 youth between the ages of 4 and 20 were in child protective services (CPS) custody in Hamilton County, Ohio, and placed in out-of-home care. Child welfare administrative records were extracted and linked to electronic health records for all encounters at Cincinnati Children's Hospital Medical Center, with n = 2787 (99.1%) of records successfully linked prior to de-identifying the data for research purposes. Child welfare administrative data fields in the dataset include demographics, dates of entry into and exit from protective custody and out-of-home care, reasons for entry into custody, dates of placement changes, reasons for placement changes, and types of placement (e.g., foster home, kinship home, group home, residential treatment, independent living). Electronic health records (EHR) data fields include demographics, all inpatient and outpatient encounters with medications, diagnoses, screening results, laboratory test results, flowsheet data, and problem list entries. Data have been coded to capture broader categories of health needs and encounter details, medications, and other health concerns. Due to the high representation of children in CPS custody and out-of-home care who are also represented in the EHR data, this dataset provides a comprehensive view of the medical needs and health concerns for school-aged children in CPS custody in an entire county. As a result, these data can be useful for understanding the emergence of global and specific health concerns, frequency of healthcare use, and placement stability for all youth in CPS custody in this community, accounting for variation due to other health and child welfare factors. These data are likely generalizable to other mid-sized urban communities where academic medical centers provide healthcare for children in CPS custody. De-identified data may be made available to other researchers with approved data transfer agreements between academic institutions in place.

Abstract Background Relative to their counterparts in the general population, young people who leave, or transition out of, out-of-home (OOHC) arrangements commonly experience poorer outcomes across a range of indicators, including higher rates of homelessness, unemployment, reliance on public assistance, physical and mental health problems and contact with the criminal justice system. The age at which young people transition from OOHC varies between and within some countries, but for most, formal support ceases between the ages of 18 and 21. Programs designed to support transitions are generally available to young people toward the end of their OOHC placement, although some can extend beyond. They often encourage the development of skills required for continued engagement in education, obtaining employment, maintaining housing and general life skills. Little is known about the effectiveness of these programs or of extended care policies that raise the age at which support remains available to young people after leaving OOHC. This systematic review will seek to identify programs and/or interventions that improve outcomes for youth transitioning from the OOHC system into adult living arrangements. Methods This review will identify programs, interventions and policies that seek to improve health and wellbeing of this population that have been tested using robust controlled methods. Primary outcomes of interest are homelessness, health, education, employment, exposure to violence and risky behaviour. Secondary outcomes are relationships and life skills. We will search, from January 1990 onwards, MEDLINE, EMBASE, PsycINFO, ERIC, CINAHL, Cochrane CENTRAL, SocINDEX, Sociological Abstracts, Social Services Abstracts, NHS Economic Evaluation Database and Health Technology Assessment. Grey literature will be identified through searching websites and databases, e.g. clearing houses, government agencies and organisations known to be undertaking or consolidating research on this topic area. Two reviewers will independently screen all title and abstracts and full text articles with conflicts to be resolved by a third reviewer. Data extraction will be undertaken by pairs of review authors, with one reviewer checking the results of the other. If more than one study with suitable data can be identified, we plan to undertake both fixed-effects and random-effects meta-analyses and intend to present the random-effects result if there is no indication of funnel plot asymmetry. Risk of bias will be assessed using tools appropriate to the study methodology. Quality of evidence across studies will be assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. Discussion Previous reviews were unable to identify any programs or interventions, backed by methodologically rigorous research, that improve outcomes for this population. This review seeks to update this previous work, taking into account changes in the provision of extended care, which is now available in some jurisdictions. Systematic review registration PROSPERO CRD42020146999

Previous studies have shown that mental health disorders (MHD) among parents might be an important mechanism in the intergenerational transmission of out-of-home care (OHC). The current study aimed to further study this interplay by investigating the associations between OHC and MHD within and across generations. We used prospective data from the Stockholm Birth Cohort Multigenerational Study (SBC Multigen) on 9033 cohort members (Generation 1; G1) and their 15,305 sons and daughters (Generation 2; G2). By odds ratios of generalised structural equation modelling, we investigated the intergenerational transmission of OHC and MHD, respectively, as well as the association between OHC and MHD within each generation. Second, we examined the associations between OHC and MHD across the two generations. In order to explore possible sex differences, we performed the analyses stratified by the sex of G2. The results showed an intergenerational transmission of OHC, irrespective of sex. Regarding the intergenerational transmission of MHD, it was shown for both sexes although only statistically significant among G2 males. OHC was associated with MHD within both generations; in G2, this association was stronger among the males. While we found no direct association between OHC in G1 and MHD in G2, there was a significant association between MHD in G1 and OHC in G2. The latter was more evident among G2 females than G2 males. We conclude that OHC and MHD seem to be processes intertwined both within and across generations, with some variation according to sex. Although there did not seem to be any direct influences of OHC in one generation on MHD in the next generation, there was some indication of indirect paths going via parental MHD and child OHC.

Abstract Background Randomised controlled trials (RCTs) are comparatively rare in UK social work, but can offer distinct advantages. Confidence in Care (CiC) is an RCT with embedded process evaluation evaluating Fostering Changes (FC), a 12-week training programme for foster and kinship carers to increase skills and coping strategies. In order to mitigate challenges in participant recruitment, an engagement strategy was designed to maximise this. Our aim is to explore experiences of key study stakeholders towards trial recruitment and identify broader messages about recruitment to social care trials. Methods Three focus groups were conducted, two with field-based recruiting staff (n = 7) and one with carers who attended the FC programme (n = 8). Five interviews were conducted with trainers who delivered FC, eight with foster carers who attended the programme, 18 with Foster Carers who elected not to take part in the programme, and 12 with social workers from participating trial sites. In addition, an away day for FC trainers was observed and discussions related to recruitment were noted. Transcribed audio-recorded data were inductively coded, double-coded by a second researcher, and thematically analysed. Results Six themes were identified. The first addressed pragmatic aspects of the intervention affecting recruitment (e.g. committing to a 12-week programme). A second focussed on accuracy of communication about the trial between provider agencies and carers. A third concerned the ability of recruiting staff to contact carers, a particular challenge in group-based recruitment. A fourth addressed trial methods and their communication (e.g. relationship between trial team and recruiting staff). A fifth explored lack of differentiation by carers between the roles of the various professionals (e.g. FC facilitators and provider agencies). The sixth addressed perceived differences between recruitment into social care and health studies. Conclusions Recruitment challenges in this social care setting were similar to those in healthcare. Some (e.g. gatekeeping by professional staff) may be rooted in randomisation anxiety, or unfamiliarity with research methods. Researchers more familiar with healthcare recruitment were however encouraged about the experience of working in this care setting. The original recruitment strategy and adaptations form the basis of further recommendations for research practice. Trial registration ISRCTN19090228 . Registered on 11 January 2017.

The research protocol described aims to examine and establish the health outcomes of children and young people living in Out-of-Home Care (OOHC) in Perth, Western Australia (WA) from the perspective of the care recipients and service providers. A Study Advisory Panel (SAP) will be established comprised of Aboriginal Elders (because of the over-representation of Aboriginal children in OOHC), health professionals and other relevant stakeholders to help co-design all phases of the study. Mixed methods will be used in data collection and analysis. In the quantitative phase, it is proposed to collect retrospective data from three WA Department of Communities (DOC) districts. The data proposed to be collected includes: the number of children who received initial and annual health assessments, the health needs identified, and interventions put in place to address these needs. The qualitative phase will consist of interviews with service recipients (young people who have exited OOHC and Carers), health service providers (Community Health Nurses, School Nurses, General Practitioners and Paediatricians) and OOHC Case Workers. The research will provide an overview of the current health needs of children and young people in OOHC in WA and the perspectives of these young people, their Carers and service providers on current processes for accessing healthcare. It is anticipated that the study will provide valuable evidence for quality improvement in health service delivery to better meet the health needs of children and young people in OOHC.

Young people living in out-of-home care (OoHC) are widely considered to be one of the most vulnerable groups in the community. This article describes the evaluation and implementation study protocol of a healthy lifestyle programme developed to improve the eating and physical activity habits of young people living in residential OoHC. The study will employ a longitudinal multi-group pre-post process evaluation to assess our implementation strategy in the dissemination of HEALing Matters at the: 1) system-level; 2) organizational-level; 3) residential home-level; and 4) individual-level (N = approximately 60 residential homes [approximately 400–500 staff and 240 young people]). Implementation- and program-related outcomes will be assessed using self-report surveys, semi-structured interviews and focus groups, house audits and website usage data collected prior, during and after implementation. Results are expected to inform and help guide the further development and training of residential care staff’s understanding and application of health literacy.

Whilst advancing outcomes for young people transitioning from out-of-home care is a national priority, no synthesis of Australian interventions that support their transition from care and into independence currently exists. The aim of this systematic scoping review was to examine the characteristics of such interventions delivered in Australia and to evaluate their impact. Papers were included if they assessed the extent to which transitional support interventions, delivered in Australia, improved housing, employment, education, financial, health, or social functioning outcomes. Eleven studies were included. Interventions primarily adopted a case management approach to support care-leavers’ transition. Interventions facilitated improvements in care-leavers’ independent living outcomes (e.g., housing, education, and financial stability), but less so in health outcomes. This synthesis provides guidance for how research organizations in partnership with community service organizations and statutory services should develop and deliver interventions to support young Australians transitioning from care.

Children in care (CiC) experience poorer health outcomes than their same-aged peers without an experience of care. Despite growing recognition of the importance of listening to the voices of children and young people (YP), to date, the voices of CiC are not well represented in research examining their health. This study aimed to explore the experiences and perceptions of health among YP who have previously lived in care. A co-design approach was used to inform the research methodology by engaging YP with a lived experience in cooperative discussions. Ten YP participated in one-on-one semi-structured interviews and thematic analysis was used to analyse the data. The current findings highlight that YP consistently felt their health needs were not adequately met while in care, nor did they feel listened to, understood, or educated about health-related matters. This unique insight into the challenges they experienced in care offers realistic guidance for change.

Abstract Background Italian laws allow the protection of a child who is suspected to be a victim of abuse through a procedure that can be put in motion by the attending physician in any Emergency Department (article nr. 403 Civil Code) with a temporarily suspension of parental authority. This study aims at evaluating both the appropriateness of the activation of the protection procedure by ED doctors in cases of suspected child abuse in terms of judicial confirmation and how it impacts children in the long-term. Methods We selected cases in which the procedure was activated due to suspected child abuse. The children were admitted to the ED of a tertiary children hospital from 2006 to 2018. We then reviewed the medical charts and collected data from the social services through a questionnaire concerning the long-term outcomes . Results Twenty-eight patients were included (75% females, mean age 13.8 years). In 90% of cases the activation of the procedure in the ED was followed by a Court confirmation. Evaluation of long term outcome was possible in 22 cases. Among them, a positive social outcome was achieved in 15 cases (68.2%). The remaining abandoned the program or had critical reintegration in the family. Eighteen percent of patients developed major issues such as aberrant behaviours, substance abuse or psychiatric disorders. Conclusions This report identifies a good ability of ED doctors in the activation of an emergency procedure to protect the child. Overall, the social outcome was good for nearly 70% of the patients, highlighting the importance of activation of social support programs for child abuse.

Abstract Background The terms affective dysregulation (AD) and irritability describe transdiagnostic dimensions and are characterized by an excessive reactivity to negative emotional stimuli with an affective (anger) and a behavioral component (aggression). Due to early onset, high prevalence and persistence, as well as developmental comorbidity, AD in childhood is one of the most psychosocially impairing and cost-intensive mental health conditions. AD is especially prevalent in children in the youth welfare service. Despite continuous research, there remains a substantial need for diagnostic approaches and optimization of individualized treatment strategies in order to improve outcomes and reduce the subjective and economic burden. Methods The ADOPT (Affective Dysregulation – Optimizing Prevention and Treatment) Consortium integrates internationally established, highly experienced and interdisciplinary research groups. The work program encompasses (a) epidemiology, including prevalence of symptoms and disorders, (b) development and evaluation of screening and assessment tools, (c) stepped care approaches for clinically useful personalized medicine, (d) evaluation of an easily accessible and cost-effective online intervention as indicated prevention (treatment effects, moderation/mediation analysis), and (e) evaluation of an intensive personalized modular outpatient treatment in a cohort of children with AD who live with their parents and in a cohort of children with AD who live in out-of-home care (treatment effects, moderation/mediation analysis). Discussion The results will lead to significant recommendations for improving treatment within routine clinical care in two cohorts of children with AD and coexisting conditions, especially oppositional-defiant disorder, conduct disorder and disruptive mood dysregulation disorder. Trial registration Trial registration ADOPT Online: German Clinical Trials Register (DRKS) DRKS00014963. Registered 27 June 2018. Trial registration ADOPT Treatment: German Clinical Trials Register (DRKS) DRKS00013317. Registered 27 September 2018. Trial registration ADOPT Institution: German Clinical Trials Register (DRKS) DRKS00014581. Registered 04 July 2018.

Abstract Background Past research has shown that individuals who have had experiences of out-of-home care (OHC) in childhood have increased risks of premature mortality. Prior studies also suggest that these individuals are more likely to follow long-term trajectories that are characterised by economic, work-, and health-related disadvantages, compared to majority population peers. Yet, we do not know the extent to which such trajectories may explain their elevated mortality risks. The aim of this study is therefore to examine whether trajectories of economic, work-, and health-related disadvantages in midlife mediate the association between OHC experience in childhood and subsequent all-cause mortality. Methods Utilising longitudinal Swedish data from a 1953 cohort (n = 14,294), followed from birth up until 2008 (age 55), this study applies gender-specific logistic regression analysis to analyse the association between OHC experience in childhood (ages 0–19; 1953–1972) and all-cause mortality (ages 47–55; 2000–2008). A decomposition method developed for non-linear regression models is used to estimate mediation by trajectories of economic, work-, and health-related disadvantages (ages 39–46; 1992–1999), as indicated by social welfare receipt, unemployment, and mental health problems. To account for selection processes underlying placement in OHC, an alternative comparison group of children who were investigated by the child welfare committee but not placed, is included. Results The results confirm that individuals with experience of OHC have more than a two-fold increased risk of all-cause mortality, for men (OR: 2.10, 95% CI: 1.42–3.11) and women (OR: 2.23, 95% CI: 1.39–3.59) alike. Approximately one-third (31.1%) of the association among men, and one-fourth (27.4%) of the association among women, is mediated by the long-term trajectories of economic, work-, and health-related disadvantages. The group who were investigated but not placed shows similar, yet overall weaker, associations. Conclusions Individuals who come to the attention of the child welfare services, regardless of whether they are placed in out-of-home care or not, continue to be at risk of adverse outcomes across the life course. Preventing them from following trajectories of economic, work-, and health-related disadvantages could potentially reduce their risk of premature death.

In recent decades, Swedish out-of-home care has been criticised for a number of reasons. In this article, based on research and public debate, we discuss this criticism as well as the institutional responses that have been evoked. We use the concepts of risk, control and trust to structure the analysis, which outlines three core issues portrayed as problematic: a) certain principles of the Swedish child welfare system with relevance for the placement of children and adolescence, b) the quality of out-of-home care and c) the privatisation of out-of-home care and the possibility of generating profits on such services. The institutional response to the criticism has mainly been increased control measures, but the development is not uniform - trust and control-oriented responses are often combined. We conclude the article by relating Swedish out-of-home care to international child welfare trends, discussing the institutional responses and the implications for social work practice.

All Breaks and instability is the reality for many children and young people placed outside their homes. For some of these children and young people this might results in a wide range of negative outcomes in relation to education, occupation and psychological wellbeing. The purpose of this article is to discuss the concept of continuity for Danish children and young people placed outside their homes through a policy analysis, a theoretical perspective and through looking at empirical research. The discussion starts with a review of the developments in legislation and social policy followed by an encirclement of the concept of continuity based on the perspectives of young people who had been placed outside their homes as children and relevant theory. Finally, an assessment of how these developments has affected the experience of continuity for children and young people placed outside their homes is carried out by a review of our own and other researchers empirical studies about placement stability and breakdowns, contact with family during placements, and continuity in schooling and education. The discussions in this article indicates that despite of the increasing focus on stability in legislation and social policy during the three last decade’s discontinuity is still the reality for many children and young people placed outside their homes in Denmark.

The article examines how the future is anticipated and integrated in the statutory decision-making of care orders, and how disagreements between the social worker and the parents and/or child are portrayed when decisions about the future of the child are at stake. Despite the rights given to children (aged 12 or older) and parents to express their view and to have a say in the decision-making process in Finland, the analysis, based on care order documents, highlights only the scarce recording of substitute care, disagreement, and anticipation of the future. Future substitute care is indeed a difficult landscape for formal disputes in organisational settings when the ‘future’ is unknown. The term ‘disillusioned compromise’ is suggested to capture the problematic weak nature of the anticipation of the future.

This special issue addresses the field of international research on out-of-home care, as there are tremendous problems regarding the quality of life of young people living in out-of-home care, their transition from care to independent life as well as fundamental research gaps within this field.

Interventions aimed at improving school performance for children in foster care are few and are generally not implemented. By preventing failure in school, the prospect of reducing the risk for future poor health, substance abuse, unemployment, and other detrimental social conditions are met. This paper focuses on the change of preconditions for compulsory school performance in out-of-home care children, following an intervention called “Skolfam” that aims to improve school performance by individual assessments and school-based interventions. In this study, data were compiled from prospective repeated tests of 475 children in foster care in Sweden. Educational preconditions were analysed for compulsory school performance, such as intelligence (WISC-IV), psychosocial (SDQ) and adaptive behavior (ABAS-II), literacy (Reading Chains) and mathematical skills (Magne Mathematic Diagnoses) before and after the first 2 years of the “Skolfam” intervention. All tests were age-standardized and performed by experienced professionals. The results showed improved skills in complex aspects of literacy, mathematics, and cognitive performance, but no improvement in less complex literacy skills, adaptive behavior or mental health symptoms. In conclusion, higher-order cognitive functions can develop positively when appropriate school support is provided. Affective function, adaptive behavior, and psychosocial well-being present a more pervasive challenge for children in foster care. Implications for future research, practice in social services, and school is that further development of methods to aid future prospects for children in out-of-home care should aim to improve both cognitive higher-order executive-, and affective functions.

Abstract Background and aims Identification of child abuse involves a medical investigation and assessment of problems related to social environment and upbringing and might necessitate out‐of‐home care. The objective of this study was to analyse infants placed in out‐of‐home care in Sweden by incidence, medical diagnoses, and perinatal factors. Methods This was a population‐based register study of infants born in Sweden 1997 to 2014. Data were retrieved from registers at the Swedish National Board of Health and Welfare and Statistics Sweden. Outcome measures were out‐of‐home care categories: (a) “Problems Related to Social Environment/Upbringing”, (b) “Abuse diagnoses without SDH (subdural haemorrhage), RH (retinal haemorrhage), rib fracture, or long bone fracture”, and (c) “SDH, RH, rib fracture, or long bone fracture.” As a reference population, we randomly selected infants without medical diagnoses born the same year. Results Overall incidence of out‐of‐home care was 402 per 100 000. For subcategories (a), (b), and (c), the incidences were 14.8 (n = 273), 3.77 (n = 70), and 9.83 (n = 182) per 100 000, respectively. During the study period, the first remained unchanged; the latter two have been increasing. Compared with other reasons for out‐of‐home care, children in category (c), “SDH, RH, rib fracture, or long bone fracture”, had increased odds of being boys (adjusted odds ratio [aOR] 1.60; 95% confidence interval [CI], 1.08‐2.38) and decreased odds of having a mother being single (aOR 0.49; 95% CI, 0.32‐0.75) and a smoker (aOR 0.60; 95% CI, 0.37‐0.96). Compared with the reference population, children in this category were more often twin born (7.7% versus 2.8%), preterm (18.5% versus 5.5%), and small‐for‐gestational age (5.2% versus 2.1%). Conclusion SDH, RH, rib fracture, or long bone fracture constitute a minor part of medical diagnoses for infants entered in out‐of‐home care, but have been increasing, both in numbers and proportion. Overdiagnosis of abuse might be a possible reason but cannot be ascertained by this study design.

Abstract Objective: Given the high prevalence of overweight/obesity among young people in residential out‐of‐home care (OOHC), and as their carers are in loco parentis, this research aimed: 1) to examine the healthy lifestyle cognitions and behaviours of residential carers; and 2) to describe resources needed to improve diet and/or physical activity outcomes for residents. Methods: Cross‐sectional data were collected from 243 residential carers. Measures included: demographics; knowledge of dietary/physical activity recommendations; self‐reported encouragement/importance of health behaviours; physical activity/screen time (at work); unit ‘healthiness’; and necessary resources for creating a healthy environment. Results: Staff placed importance on the residents eating well and being physically active. However, examination of carer knowledge found significant gaps in staff education. Three key priority areas were identified to help build a healthy food and activity environment in residential OOHC: funding, professional development and policy. Conclusion: Carer knowledge of healthy lifestyles can be improved and they need to be well resourced to ensure children in public care settings live in a healthy environment. Implications: These findings may inform the development of ongoing professional development to improve carers' health literacy, as well as policy to support dietary/activity guidelines for the OOHC sector.

Gender-based violence is a social scourge with an increasing incidence at younger ages. Many studies have focused on finding effective solutions for overcoming this problem; however, few studies have analyzed the contribution of interactive learning environments to gender-based violence prevention. This article attempts to fill this gap by showing the impact of Dialogic Feminist Gatherings on the preventive socialization against gender-based violence toward adolescent girls (aged 15–18) who are in out-of-home care and living in shelters—part of the institutional protection system—for different reasons that are primarily associated with violence and a lack of family protection. This qualitative study was conducted using the communicative methodology involving fifteen daily life stories that analyze the dialogues and reflections produced among the girls during Dialogic Feminist Gatherings. The results show the acquisition of competencies in aspects such as attraction, election, and equality in sexual-affective relationships. These dimensions, when developed through Dialogic Feminist Gatherings, are consistent with the scientific literature that characterized them as protective factors against gender-based violence. This study concludes by contrasting participants’ daily life reality with scientific evidence, which makes possible new methods of the preventive socialization against gender-based violence for adolescent girls in out-of-home care.

Indigenous children and young people are overrepresented in the Australian out-of-home care (OOHC) system. To date, specific research has not been undertaken on workers' perspectives regarding the Indigenous-specific and non-Indigenous supports and services available to Indigenous young people exiting the system. This exploratory research involved focus group consultations with workers from seven child and family welfare agencies to examine the current support services available to Indigenous young people who are in or will be leaving out-of-home care in the State of Victoria. Findings suggest that Aboriginal Community Controlled Organisations (ACCOs) play a positive role in working with non-Indigenous agencies to assist Indigenous care leavers. Participants identified some key strategies to improve outcomes, such as facilitating stronger relationships between Indigenous and non-Indigenous services, and improving the resourcing of ACCOs.

Children who experience maltreatment in their families may be placed in out-of-home care. A large, and increasing, number of children are being raised in these settings in Australia. The history of maltreatment that children in out-of-home care have experienced results in a variety of educational challenges. It is generally believed that schools are best placed to serve the educational needs of these children. However, there is extensive evidence that schools are unable to facilitate learning success for many children in out-of-home care. This paper argues that because home education can provide a low- stress environment and individually tailored learning, it can be an effective method of education for children and young people in out-of-home care. A case study of a home-educated child in out-of-home care is presented.

In this paper we draw on in-depth interviews with 59 young people (aged between 18-24) who had experienced a volatile transition from out-of-home care. As a group they had a high number of placements in care, many had experienced physical and/or sexual abuse prior to, or while they were in care, most had histories of substance misuse, and all had experienced homelessness at some point since leaving care. However, we found that the circumstances of just over half (n=32) had significantly improved and they appeared to be successfully navigating a route to independence. We argue that a notable feature of those who were ‘moving on’ was the agency and, more specifically, the positive focus and direction of their agency. Those who were ‘moving on’ expressed a strong sense of the need to take control and of wanting something better and we identified five pivotal moments or experiences that encouraged young people to actively seize control over their lives and their circumstances —stable housing; addressing substance abuse; improved family relationships; meaningful relationships with professional support; and finding work. These five factors are often interlinked, but whatever the catalyst(s), the resulting turnaround in the young people’s lives was pronounced. We draw a connection between these positive turning points, and the importance of policy and legislation that enables ongoing support for care leavers beyond the initial transition from care.

Several studies have shown that there are gaps in academic achievement between youth in care and those who have never had a placement experience. Differences are also noted in relation to the number and type of placement experienced by these youths. In fact, youths in rehabilitation centres or group homes represent a subgroup at risk of experiencing a negative experience in school. The purpose of this article is to understand how placement in a rehabilitation centre or group home influences the school experience of this population. To answer this question, life course theory was used as a paradigm to understand how the historical, spatiotemporal, social, experiential and transitional dimensions associated with placement influence their school experience. Based on biographical interviews with 35 young people aged between 14 and 18 years old, about half of whom were living at the time in residential care and the other half in a group home, results of the study show how youths’ placement histories, the conditions of their placement and the support they receive in the context of their placement influence their school experience. We finally identify avenues to improve the educational experience of young people in residential care.