A scoping review of system-level mechanisms to prevent children being in out-of-home care.

Lorna Stabler,Rhiannon Evans,Ulugbek Nurmatov,Simone Willis,Lydia Searchfield,Sophie Wood,Donald Forrester,Jonathan Scourfield,Mel Meindl,Sarah L Brand,Alison Kemp,Alison Weightman,Fiona Morgan

doi:10.1093/bjsw/bcab213

Abstract

Identifying which approaches can effectively reduce the need for out-of-home care for children is critically important. Despite the proliferation of different interventions and approaches globally, evidence summaries on this topic are limited. This study is a scoping review using a realist framework to explore what research evidence exists about reducing the number of children and young people in care. Searches of databases and websites were used to identify studies evaluating intervention effect on at least one of the following outcomes: reduction in initial entry to care; increase in family reunification post care. Data extracted from papers included type of study, outcome, type and level of intervention, effect, mechanism and moderator, implementation issues and economic (EMMIE) considerations. Data were coded by: primary outcome; level of intervention (community, policy, organisation, family or child); and type of evidence, using the realist EMMIE framework. This is the first example of a scoping review on any topic using this framework. Evaluated interventions were grouped and analysed according to system-level mechanism. We present the spread of evidence across system-level mechanisms and an overview of how each system-level mechanism might reduce the number of children in care. Implications and gaps are identified.

Highlights

Increasing numbers of children are in the English care system, rising from 50,900 in 1997 to 80,080 in 2020 (Department for Education, 2020)
We present the spread of evidence across system-level mechanisms and an overview of how each system-level mechanism might reduce the number of children in care
Most studies provided at least some evidence about how an intervention works (Mechanism/Moderator (MM) 1⁄4 161), describing mechanisms through which it is thought to affect change and the contexts that moderate their effect, in the form of narrative descriptions (164), mediator/moderator analysis (67) or logic models (8)

Summary

Introduction

Increasing numbers of children are in the English care system, rising from 50,900 in 1997 to 80,080 in 2020 (Department for Education, 2020). This trend is similar in Australia (Australian Institute of Health and Welfare, 2020), Germany and the Netherlands (Harder et al, 2013), a reversal of this trend seems to have been seen in the USA (Children’s Bureau, 2019). There is some consensus around the need to prevent the risk factors for care entry (Department for Education, 2016; Family Rights Group, 2018). It must be acknowledged that part of the reason for rising out-of-home care rates over time must be practice decisions and professionals’ changing responses to risk, so child welfare organisations are implicated in the rising rates as well as change in how social problems manifest (Thomas, 2018)

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Discussion

Conclusion