Citation

Almquist YB, Straatmann VS. Int. J. Environ. Res. Public Health 2022; 19(13): e7881.

Copyright

(Copyright © 2022, MDPI: Multidisciplinary Digital Publishing Institute)

DOI

10.3390/ijerph19137881

PMID

35805537

Abstract

When parents are unable to raise their children or to meet the minimum acceptable standards for their care, this can lead to involvement with child welfare services. In some cases, children are separated from their families and taken into out-of-home care (OHC). For good reason, prior research has primarily focused on the lifelong development of these children, and there is now extensive evidence showing that the experience of placement in OHC is predictive of worse outcomes in almost every dimension of adult life [1,2,3,4,5,6]. It is nonetheless likely that the treatment of OHC as a risk factor at the level of the individual child greatly underestimates the scope of the issue from a public health perspective. Here, we argue that gaining more knowledge about the familial circumstances under which the child welfare services enter--and, in many cases, later on exit--the scene would not only facilitate the understanding of why experiences of OHC tend to leave such long-lasting marks on children, but also how they reflect and contribute to inequalities at the population level.

Primary reasons for children being placed in OHC include problems that can be said to broadly reflect poor mental health (e.g., affective disorders, substance misuse, and self-harm) among the biological parents [7]. Importantly, however, the families that come to the attention of the child welfare services also diverge in other systematic ways from the general population. For example, the biological parents are much more likely to live under disadvantaged socioeconomic conditions (as often indicated by single parenthood, belonging to minority groups, poverty, low education, and poor labor market attachment) [7,8,9]. Past inquiries have commonly studied these types of socioeconomic disadvantage without discerning the weight and contribution of each factor [10]. The extent to which they actually drive the selection of children into OHC is thus still uncertain. There is furthermore a complex interplay between socioeconomic disadvantages and mental health problems; for example, parental substance use accompanied by poverty is more likely to lead to involvement with child welfare services than substance use in a position of affluence [8]. Disentangling how these processes at the familial level may--or may not--lead to the placement of a child in OHC would make important contributions to our understanding of the drivers of inequalities among families involved with child welfare services. This could in turn help us to find actionable entry points and assist the development of effective policies to reduce such inequalities.

Language: en