Changes in first entry to out-of-home care from 1992 to 2012 among children in England: analysis of administrative data

Abstract

BackgroundPlacement of children in out-of-home care indicates serious childhood adversity and is associated with poor social, educational, and health outcomes, including high rates of mental health issues and premature death. Each year 0·5% of children in England are living in out-of-home care but little is known about the cumulative proportion entering during childhood and how this varies over time and by ethnicity. We aimed to address this lack of information about out-of-home care in England using routinely gathered, administrative data. MethodsWe measured the proportion of children entering out-of-home care from administrative data—namely, the Department for Education's one-third sample of looked-after children. Children born between Jan 1, 1992, and Dec 31, 2011, who entered out-of-home care by Dec 31, 2012, were included. We explored variation in rates of entry to care and the determinants of changes over time using decomposition methods. We also described changes in type, duration, and stability of first placement. Findings84 674 children were included. By age 18 years, 19 751 children (3·3%) born in 1992–94 entered out-of-home care. This proportion varied by ethnicity: fewer white children born in 2001–03 than black children entered care by the age of 9 years (1·6% [7586/470 634], 95% CI 1·5–1·7 vs 4·5 [835/18 778], 4·4–4·6; p<0·0001). Increases over time were also evident with 5151 (0·8%) of 649 928 children born in 2009–11 (95% CI 0·7–0·9) entering out-of-home care by age 1 compared with 2886 (0·5%) of 639 541 born in 1992–94 (0·4–0·6, p<0·0001). Overall increases were driven primarily by increased rates of entry among white children, and not by concurrent increases in the proportional non-white population (eg, which accounted for 0·15 vs 0·03 percentage points, respectively, among infants). Over time children stayed longer and had fewer placement changes. For example, infants born in 2008 spent 70 weeks in out-of-home care and 456 (31·0%) of 1482 had more than one placement change in the 2 years after first care entry compared with 66 weeks (p=0·01) and 431 (37·6%) of 1145 infants born in 2000 (p=0·0003). InterpretationThe proportion of children entering out-of-home care in England is increasing and the care they receive is changing—ie, earlier intervention and longer, more stable placements. Further research is required to understand the reasons for these changes in practice and whether they are cost-effective, sustainable, and improve outcomes for children and society. FundingThis research is funded by the Economic and Social Research Council (grant reference number ES/L007517/1), to establish the Administrative Data Research Centre for England (ADRC-E).