Abstract
PurposeThis is the first comprehensive review of empirical research that investigated the association between receipt of child welfare services and adult mental health outcomes. The review summarised the results of studies about mental health outcomes of adults with a history of child welfare involvement.MethodsA scoping review methodology was used to search five electronic databases (MEDLINE, EMBASE, PsychINFO, IBSS, Social Policy and Practice). Studies were included if they examined any child welfare exposure (including receipt of services while remaining at home/being placed in care) and adult mental health status.ResultsIn total 4591 records were retrieved, of which 55 met the eligibility criteria. Overall, receipt of child welfare services was associated with an increased risk of adult mental ill-health, suicide attempt and completed suicide. Results regarding potential moderating factors, such as gender and care-related experiences, were mixed. Relatively few studies investigated the reasons for requiring child welfare services, the experience of abuse or neglect or the adult outcomes of child welfare service users who remained in their own homes. Mental ill-health was defined and measured heterogeneously and details about the nature and type of welfare service utilisation were lacking.ConclusionThere is a need for detailed, longitudinal studies to better understand the relative contribution of pre-existing adversity versus experiences during and after exposure to child welfare services on adult mental health outcomes. More standardised measures of mental ill-health and greater detail from authors on specific care exposure are also needed.
Highlights
It is the statutory responsibility of child welfare systems to protect the safety and wellbeing of children in need of help or protection
Previous research has focused predominately on children in out-of-home care (OHC), suggesting they are at an increased risk of a range of mental health disorders and suicide attempt compared with their general population peers whilst in care [4–8]
The two systematic reviews of OHC and adult outcomes mentioned above and eight literature reviews were excluded as any eligible individual studies they reported were already captured in the search strategy [20, 21, 30–37]
Summary
It is the statutory responsibility of child welfare systems to protect the safety and wellbeing of children in need of help or protection. These social care systems have differing names and orientations across countries and responsibilities include both family support and child protection measures [1]. As the number of children in the child welfare system has increased in many countries, it is of key policy and practice importance to examine the nature and extent to which these mental health risks persist into adulthood and to explore variation in outcomes based on the type of child welfare service received [14–19]
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