Search Results (47)

Black children and youth remain disproportionately represented within child welfare systems across Canada, yet limited research has examined how Black girls experience trauma within out-of-home placements and how these experiences shape mental health and suicidality. This qualitative study examines the experiences of Black young women who aged out of care in Ontario, Canada, and explores how cumulative and intersecting forms of trauma, affected their emotional well-being and mental health. Drawing on critical race theory, Black girlhood studies, and critical suicidology, the study conceptualizes trauma as relational, structural, and cumulative rather than as a singular event. Findings drawn from six out of 10 participants reveal five key themes: dysfunctional foster families and complex traumas; trauma of multiple placement; lack of mental health support for the initial and ongoing traumas they experienced while in care; and mental health impacts of out-of-home placements and exposure to traumas and suicide-related behaviours of other youth in care. The participants highlighted the links between their experiences in foster care and the increased risk of suicide-related thoughts and behaviours. The findings highlight the need for models of care that are racially affirming, trauma-informed, and culturally responsive for child welfare and mental health interventions for Black girls in out-of-home placements. The key limitation of the study is the small sample size. Full article

Out-of-home care and parental death are both associated with psychiatric disorders. It remains unclear whether parental death moderates the association between out-of-home care and psychiatric disorders, particularly regarding timing and duration of out-of-home placement. This cohort study included 944,138 individuals (459,712 women and 484,426 men) born in Sweden (1972–1981). Of these, 23,106 individuals (2.5%) experienced out-of-home care between ages 0 and 19. Psychiatric disorders, identified from the National Patient Register, were examined as the outcome. Information on parental death between ages 0 and 19 years and familial covariates was obtained from linked national registers. Sex-stratified Cox proportional hazard models examined the associations between out-of-home care, parental death, and psychiatric disorders from ages 20 to 47 years. Individuals with experience of out-of-home care had increased psychiatric risk across adulthood, with the highest risks observed for teenage placements. Parental death was also associated with an increased psychiatric risk. Associations between parental death and psychiatric disorders were attenuated across the teenage, long-term, and early intermediate placement groups among women and across the early intermediate, teenage, and early short-term placement groups among men compared with non-placed counterparts. Findings suggest that parental death adds limited risk within a highly vulnerable and disadvantaged population, highlighting the importance of interventions addressing multiple risks across developmental periods. Full article

Children’s cultural care is not an ancillary practice concern but a central element of governance, safeguarding, and ethical responsibility within out-of-home care systems. Across child protection systems internationally, out-of-home care services are mandated to safeguard children while upholding statutory and international care obligations. Leadership sets direction, organisational structures embed accountability, and learning cultures sustain responsiveness, forming an architecture that protects children’s cultural identities as inseparable from their safety, wellbeing, and belonging. Cultural care thus signals organisational integrity and the translation of rights-based commitments into practice. Yet many out-of-home care organisations struggle to support children from culturally and linguistically diverse backgrounds to maintain connections with family, community, and culture. Responsibility is often delegated to individual caseworkers, limiting systemic impact. Whole-of-organisation approaches are needed to embed cultural connection as a core safeguarding priority, strengthen accountability, and develop practitioner capability. Interviews with representatives from service organisations across five countries examined the organisational drivers that enable effective cultural care and the factors shaping the implementation of practice tools. Findings highlight the interconnected roles of leadership, governance, workforce development, and practitioner teams in sustaining culturally responsive practice. This paper reinforces shared responsibility across organisational levels to act with intentionality and cultural curiosity in supporting children’s rights to identity and belonging and concludes with an A–Z prompt tool offering reflective questions for leaders and practitioners to strengthen organisational approaches to cultural care. Full article

Voluntary placement agreements are a less understood avenue through which children and families receive child welfare services. This article describes a qualitative exploratory study of participants who oversee and engage with children and families utilizing voluntary placement services in two states (n = 12). Thematic analysis of interviews revealed voluntary placements are used as a strategy for strengths-based engagement with families, including creative problem-solving, to help obtain resources for youth with emotional and behavioral health needs. Participants also described challenges managing ambiguity regarding the use of voluntary placements and acknowledged limitations and varied outcomes of voluntary placement. Youth in voluntary placements are often overlooked in broader child welfare and foster care practice and policy discussions. Stronger accountability and guidance on voluntary placements are needed to ensure children and families are provided adequate supports to reduce the need for out-of-home placements when possible. Full article

Permanency planning, an approach to the placement of children in out-of-home care, is central to child and family system practice, policy and law. Using the example of legislative reforms in New South Wales (NSW), Australia, this article explores how privileging legal permanence leads to ongoing failures to account for Aboriginal worldviews and child-rearing practices. Drawing on qualitative research, including Yarning Circles and semi-structured interviews that I conducted with Aboriginal community members in NSW, the findings contribute to limited evidence on permanence from Indigenous perspectives, revealing how familial and cultural connectedness shape belonging and social and emotional wellbeing and highlighting the importance of children’s ongoing connections with extended Aboriginal family, community and culture. Aboriginal understandings of permanence align more closely with cultural, relational and physical domains than with the construct of legal permanence that predominates in permanency planning approaches. Prioritizing legally permanent care arrangements above other domains poses long-term risks to Aboriginal children’s social and emotional wellbeing, demonstrating the need for “deep-level” cultural adaptation in child welfare law, policy and practice. The findings have implications for decolonizing child protection and repositioning Aboriginal conceptualizations of permanence as the foundation for legislation, policy and practice—reforms that must be Indigenous-led, culturally grounded from the outset, and anchored in full implementation of principles embedding self-determination and Indigenous children’s fundamental rights. Full article

First Nations children remain dramatically over-represented in Australia’s Out-of-Home Care (OOHC) system, particularly in New South Wales (NSW), which continues to report the highest numbers nationally. This narrative review, grounded in a relational First Nations Standpoint Theory and decolonising research paradigms, to critically examine the systemic, structural, and historical factors contributing to these disproportionalities. Drawing on interdisciplinary evidence across law, criminology, education, health, governance studies, and public policy, the analysis centres Indigenous-authored scholarship and contemporary empirical literature, including grey literature, inquiries, and community-led reports. Findings reveal that the OOHC system reproduces the colonial logics that historically drove the Stolen Generations. Macro-level structural drivers—including systemic racism, Indigenous data injustice, entrenched poverty and deprivation, intergenerational trauma, and Westernised governance frameworks—continue to shape child protection policies and practices. Micro-level drivers such as parental supports, mental health distress, substance misuse, family violence, and the criminalisation of children in care (“crossover children”) must be understood as direct consequences of structural inequality rather than as isolated individual risk factors. Current placement and permanency orders in NSW further compound cultural disconnection, with ongoing failures to implement the Aboriginal and Torres Strait Islander Child Placement Principle (ATSICPP). Contemporary cultural rights and Indigenous Cultural and Intellectual Property (ICIP) frameworks highlight the urgency of restoring Indigenous authority in decision-making processes. The literature consistently demonstrates that cultural continuity, kinship networks, and ACCO-led models are sort to produce stronger long-term outcomes for children. The review concludes that genuine transformation requires a systemic shift toward Indigenous-led governance, community-controlled service delivery, data sovereignty, and legislative reform that embeds cultural rights and self-determination. Without acknowledging the structural drivers and redistributing genuine power and authority, the state risks perpetuating a cycle of removal that mirrors earlier assimilationist policies. Strengthening First Peoples governance and cultural authority is therefore essential to creating pathways for First Nations children to live safely, remain connected to family and kin, and thrive in culture. Full article

Background/Objectives: Respiratory syncytial virus (RSV) is the most common cause of bronchiolitis and infant hospitalization in the US. RSV prevention evolved in 2023 as nirsevimab and maternal RSV pre-fusion vaccine became available for healthy newborns and infants. This study investigates sociodemographic characteristics associated with RSV immunoprophylaxis. Methods: A cross-sectional survey was conducted from November 2023 through March 2024 among a convenience sample of parents of infants aged <8 months who received newborn care or pediatric ambulatory care at a single academic institution in Central Pennsylvania, USA. Logistic regression examined sociodemographic factors associated with RSV immunoprophylaxis uptake. Given the nirsevimab shortage during the 2023–2024 RSV season, a sensitivity analysis was completed for intended immunoprophylaxis. Results: Among 118 participants, 66.9% received RSV immunoprophylaxis while 74.5% intended to receive nirsevimab. Higher income, private insurance, out-of-home childcare, and an adult/partner working in healthcare were associated with intended nirsevimab receipt. Participation in the Women, Infants and Children program was associated with lower rates of intended nirsevimab receipt. Out-of-home childcare was associated with both RSV immunoprophylaxis uptake and intended nirsevimab receipt. Conclusions: Sociodemographic factors significantly influence the intent to receive nirsevimab and RSV immunoprophylaxis uptake. Having an adult/partner in healthcare was the most significant predictor for intent, suggesting that greater health literacy drives immunization intention. Enrollment in out-of-home childcare was the sole predictor of RSV immunoprophylaxis uptake. These findings highlight the importance of policy initiatives that promote equitable access to RSV immunoprophylaxis, including strategies to address socioeconomic barriers, improve health literacy, and ensure consistent availability of preventive agents for all infants. Full article

Young people under the care of child protection agencies are at increased risk of entering the criminal justice system. Residential youth organisations support young people who are unable to reside with their families or in foster care. Youth workers in these environments ensure the safety and wellbeing of young people in their care, consequently supporting the wellbeing of the overall community. This research explored the views and experiences of Queensland residential youth workers via a focus group interview. The data captured a thick description of service delivery practices. Constructivist Grounded Theory was used to conceptualise a theoretical framework based on the various empirical realities of participants. The findings highlight occasions where complex power dynamics had damaging consequences for youth workers and young people. Participants explored systemic constraints and structural inequalities, thus detailing the implications of top-down organisational structures on their service delivery, safety, and outcomes for young people. Participants were concerned about the implications of interrupted attachment and young people’s progression into crime. Practice recommendations centre around improving the disconnection between front-line realities and systemic hierarchies. Residential out-of-home care service delivery should focus on building community connection and belonging; mental, emotional and physical safety; collaborative care; and support. Full article

Bring them home, keep them home is research based in New South Wales (NSW) Australia, that aims to understand successful and sustainable reunification for Aboriginal families who have children in out-of-home care (OOHC). This research is led by Aboriginal researchers, and partners with Aboriginal organisations. It is informed by the experiences of 20 Aboriginal parents and family members, and more than 200 practitioners and professionals working in child protection and reunification. This paper traces the evolution of Bring them home, keep them home which is now at the forefront of influence for NSW child protection reforms. Using specific examples, it highlights the role of research advocacy and resistance in challenging and disrupting systems in ways that amplify the voices of Aboriginal families and communities and embeds these voices as the foundation for radical innovation for child reunification approaches. The paper shares lessons being learned and insights for Aboriginal-led research with communities in the pursuit of restorative justice, system change, and self-determination. Providing a framework for liberating Aboriginal families from child abduction systems, this paper seeks to offer a truth-telling and practical contribution to the international efforts of Indigenous resistance to child abduction systems. Full article

Background: Foster care alumni face increased health challenges across the domains of mental and physical health, yet there is a paucity of research examining the associations between care experiences, health, and sleep quality in alumni aged 30 and above. Objectives: Our exploratory mixed-method study examined the sleep quality of North American group care leavers aged 30+ to understand whether sleep quality in adulthood is associated with earlier child welfare system experiences during childhood and adolescence. Secondly, we examined the association between sleep quality and overall concurrent health. Methods: Using a convenience sample of 41 alumni of care aged 30–85 and 16 qualitative interviews, we explored the intricate connections between group care leavers’ developmental trauma, sleep quality, and health. Linear regression and qualitative content analysis were utilized to understand how sleep was related to well-being in aging care alumni. Results: Adult sleep was significantly associated with the perceived quality of their youth out-of-home placement experiences (β = 0.421, p < 0.01), controlling for friendship support networks and demographic variables. Adult sleep quality was a significant predictor of overall health (β = −0.328, p < 0.05). Qualitative interviews elucidated insights into the importance and linkages of child welfare system experiences, adult sleep, and well-being. Conclusions: Our research highlights the enduring association between child welfare placement experiences, and sleep functioning well into adulthood, even when accounting for contemporaneous social support and other demographic indicators. Practitioners should be inquiring directly about sleep, and future longitudinal research should delve deeper into the nature of sleep difficulties and their association with health and well-being. Full article

Interactions between First Nations and non-Indigenous Australians have long been shaped by notions of Western authority and First Nations inferiority, both culturally and biologically. From invasion to the present day, forced removals and intergenerational trauma have deeply affected First Nations Australians, particularly through the operations of interacting colonial systems, including child removals and placements. Throughout the 20th century, systematic child removals led to the Stolen Generations, a tragic example of power imbalances, paternalism, and Western ideals, perpetuating trauma across generations. This article examines the context of First Nations removals by the state under the lies of benevolence, exposing the evolution of the colonial system and the systematic dislocation of culture and identity. It highlights the social, legal, and political factors that enabled removal practices and their enduring consequences, including the legacy of forced child separations and cultural erasure. This article argues that policies of absorption and assimilation served to further isolate children from their families, communities, and kinship networks. In doing so, it contends that the systematic disruption of First Nations communities is part of an ongoing process of subjugation, continuing the colonial agenda of cultural and familial disintegration. Full article

Experiences of out-of-home care (placement in foster-family care or residential care) and parental death in childhood are known risk factors for premature all-cause mortality. However, it remains unclear whether parental death during placement moderates the association between out-of-home care and mortality, particularly when considering the timing and duration of placement. Longitudinal register data from 10 Swedish birth cohorts (n = 948,483) were analyzed. Around 2.5% (n = 23,628) had out-of-home care experience during ages 0–19. Sex-specific Cox proportional hazard regression models assessed associations between experience of out-of-home care (categorized by timing and duration), parental death, and premature all-cause mortality (ages 20–47). Both men and women with out-of-home care experience displayed increased risk of premature all-cause mortality, as did those who experienced parental death before age 20. However, statistical interaction analyses revealed no moderating effect of parental death on the association between placement and premature all-cause mortality. Compared to non-placed individuals, parental death during placement in out-of-home care did not further increase the risk of premature mortality across placement groups. Possible reasons include strong attachments within the out-of-home care setting or reduced stress towards biological parents. Further research is needed to explore the complex dynamics of parental loss within out-of-home care populations. Full article

When a child is placed in out-of-home care, parents must adapt their parenting to a unique situation governed by Child Welfare Services (CWS). Contact arrangements between parents and children are particularly important, as they provide the primary opportunity for parents to maintain a meaningful connection and participate in their children’s lives. This article explores how mothers with migration experiences navigate their motherhood when it is regulated by the CWS in Norway. Drawing on semi-structured interviews and a photo-elicitation task with eight birth mothers, the study sheds light on how they perceive and talk about staying connected with their children living in out-of-home care during contact visits. Three themes were identified through a narrative-inspired thematic analysis: (1) mothers’ active efforts to organise meaningful contact visits for their children; (2) their struggles to maintain family cohesion and belonging; and (3) the constraints they face in their emotional care work due to regulated and limited contact. These findings illustrate how contact visits function as an essential but also challenging space for motherhood. We argue that by recognising mothers’ perspectives, resources, and challenges during the limited and regulated contact visits, CWS can offer more culturally sensitive and supportive parental follow-up. Full article

Adults with a history of living in residential youth care (RYC) face elevated risks across various life domains. In this cohort profile paper, we outline the design of a comprehensive follow-up study—the VINGO study—targeting young adults (22–30 years) with a history of living in RYC (T2). We describe the recruitment strategy and present sample characteristics. Data were collected in the baseline study (T1) from 2011 to 2014. At T1, the 400 adolescent participants showed a high prevalence of mental disorders, maltreatment experiences, substance use, and self-reported suicide attempts. Data collection at T2 10 years later (2021–2023) included self-reported sociodemographic information, physical health, childhood maltreatment, dissociation, quality of life, social support, and self-esteem using standardized and validated instruments. A diagnostic psychiatric assessment and subjective evaluation of service utilization were conducted by telephone interviews. Additionally, a qualitative sub-study involved in-depth interviews of fourteen participants. We reached a 52% response rate at T2. Comparing participants (n = 157, 107 females) to non-participants (n = 243, 123 females) based on T1 data revealed that T2 participants had a higher prevalence of depression, anxiety, and conduct disorder and a lower prevalence of ADHD at T1. Furthermore, T2 participants reported more suicide attempts, experiences of maltreatment, and problematic substance use at T1. Our results show that we reached a burdened population, positioning the VINGO study as a unique opportunity to examine a vulnerable population of emerging adults. Full article

Background/Objectives: Low quality diets are a risk factor for non-communicable diseases; therefore, improving diet quality is a public health and policy priority in the UK and elsewhere. Reformulating food/beverage products to make them healthier may be an effective approach. Evidence suggests that fiscal interventions, notably taxes/levies on soft drinks, can lead to reformulation but the evidence for voluntary or mandated non-fiscal interventions is less clear. We aimed to review and synthesise contemporary evidence to determine whether non-fiscal policies/interventions result in the reformulation of food/beverage products Methods: In April 2023, we systematically searched ten international academic and nine grey literature databases. We included real-world study designs, all nutrients, in- and out-of-home sectors, and studies published from 2013, to ensure policy relevancy. We excluded modelling studies. Using the Synthesis Without Meta-Analysis method we conducted vote counting of studies based on the direction of effect and narrative synthesis by intervention type. Risk of bias was assessed using a tool developed by the EPPI-Centre and quality was assessed using GRADE. Results: We included 77 real-world studies from 19 countries, reporting 100 non-fiscal policies/interventions. Most commonly, these were reduction targets (n = 44), front-of-pack labels (n = 23), and advertising standards (n = 9). Most interventions were voluntary (n = 67), compared to mandatory (n = 33), and focused on the in-home sector (n = 63). The vote counting results showed non-fiscal policies/interventions overall led to improvements in reformulation in 60/63 studies with a valid direction of effect (95%, 95% CI 0.869, 0.984, p < 0.001). Mandatory implementations were more successful than voluntary implementations with 15/15 showing an improvement (100%, 95% CI 0.796, 1], p < 0.001), compared 40/43 showing an improvement (93%, 95% CI 0.814, 0.976, p < 0.001). Most of the studies were of low quality, due to the observational nature of the studies. Sodium was the most commonly targeted nutrient (n = 56) and was found to be reformulated in most studies. Causation is difficult to establish from real-world studies, but evidence suggests that regulatory and multi-component strategies may be effective at driving reformulation. Conclusions: Non-fiscal policies/interventions can play an important role in driving reformulation, alongside fiscal measures. This work was funded by the National Institute for Health and Care Research PRP-PRU-02-15-Healthy Weight and registered on Open Science Framework. Full article