04 February 2015

Effective interventions for children in out-of-home care: Explaining the impact of decisions and types of treatment

Effective interventions for children in out-of-home care: Explaining the impact of decisions and types of treatment

Out-of-home care is one of the most intrusive interventions by the welfare state with large consequences for both the family and the child. In Denmark, about 1 percent of all children are placed in out-of-home care at any time (approx. 12.400 children in 2011), and about 5 percent of a cohort will during their childhood experience an out-of-home placement. Compared to the other Scandinavian countries, out-of-home care is more frequently used in Denmark. Furthermore, out-of-home placement is a very costly intervention. In 2011, the total expenses amounted to 9.7 billion DDK, or more than 70 percent of all public spending on children and young people in need.

In recent years, studies have demonstrated that long-term outcomes for children in out-of-home care are considerably poorer than for other Danish children in terms of e.g. education, health and criminal record (Andersen & Fallesen 2010, Olsen, Egelund & Lausten 2011, Gupta & Frederiksen, 2012). Thus for the average child in care, the interventions currently in use do not appear to fully succeed in compensating the child for its disadvantageous background. However, poor outcomes cannot be interpreted unequivocally as a causal effect of the intervention. To make more firm conclusions on these matters, we need to know more about the outcomes of children with similar difficulties who are not being placed in care.

Safeguarding the most vulnerable children in society constitutes a key function of modern welfare states. Not surprisingly, therefore, the discouraging results for children in care have led to a renewed interest in the types of placements that are in use and the contents of interventions. In policy terms, the most significant recent development has been the promotion of foster care (including kinship care and network care) as the ”first choice” for children entering out-of-home care (cf. Barnets Reform, 2010-2011). To some degree, this reform constitutes a break with a traditional Danish practice where institutional care has played a very central role for decades (Egelund & Jakobsen, 2009a, 2011).

The shift in political focus reflects a growing disbelief in the ability of institutions to provide qualified long-term care for disadvantaged children, along with a renewed focus on the importance of integrating these children into mainstream society. In this context, ”ordinary family life” is considered to provide the most expedient platform for societal integration for children with special needs and different psychosocial difficulties.

This political reorientation is partly informed by research, with a growing number of studies documenting the poor outcomes of institutional care (cf. Andreassen, 2003, Lee, Bright, Svoboda, Fakunmoju & Barth, 2011). In general terms, however, we only know little about the effects of out-of-home care, both in terms of the absolute effects (placement vs. no placement) as well as the relative effects of different interventions (foster care vs. institutional care). This study aims at improving our knowledge base significantly, not only by measuring the absolute and relative effects of out-of-home care interventions, but also by offering an explanatory framework for understanding the estimated effects.

Principal investigator: Mette Ejrnæs
Grant provider: The TRYG Foundation
Project period: January 2014 – December 2019