A systematic review examining outcomes of children following permanency placements

Abstract

Children in care have experienced adversities, including maltreatment prior to contact with the system, negatively impacting on their mental health outcomes. The type of placement and length of time in care are thought to be important and the child welfare system aim is to achieve a permanent decision for children that best supports their needs by establishing a stable familial network. Permanency decisions can include reunification, foster care, kinship care, adoption, and residential placements. This review aims to establish to what extent permanent placement type, maltreatment experienced, length of time in care and age at which permanency is achieved impacts child mental health outcomes. Following PRISMA guidelines, five databases (ASSIA, CINAHL, PsycINFO, Scopus and SocINDEX) and two registers (CENTRAL and TRoPHI) were systematically searched yielding six articles for inclusion in the study. Data were extracted and articles critically appraised utilising the Crowe Critical Appraisal Tool (CCAT). Papers reported mixed findings for permanent placement type and child mental health outcomes with little or no significant overall differences reported. Type of maltreatment experienced moderated the type of mental health symptomology reported. Difficulties in attachment and social relationships were reported for children placed older than two years, although confounding factors such as type of maltreatment likely reduce the strength of the association. Typically, children in permanent placements had better outcomes compared with peers in short-term or unstable placements. A lack of suitable validated and age-appropriate outcome measures and the existence of confounding factors impair our understanding of the interaction between pre-care adversities, the child welfare system itself and permanent placement outcomes.