3. What are the short, medium and long term outcomes of children going into care?
In this section, we seek to deepen our understanding of the problem by exploring the outcomes for infants who enter care. However, measuring the direct causal impacts of services designed to prevent parent-baby separation presents significant challenges. We therefore focus on identifying outcomes associated with having been in care and use these as proxy indicators of what can potentially be prevented when a child is able to safely remain with their birth family.
While not extensively examined in the literature, outcomes can vary depending on the arrangements put in place for looked after children. When an infant is removed from their birth family, they can be placed in a variety of care settings. These can include kinship care, foster care, residential care or adoption. Notably, the majority of infants entering care in Wales do not enter residential care, with foster care with an unrelated carer the most common placement type (Cowley et al., 2023). One study using administrative data in England found that for children entering care under the age of two, 41% were adopted, 32% returned to a parent, and 17% had a Special Guardianship Order or Residency Order, with 6% remaining in care (Neil, Gitsels and Thoburn, 2019).
Residential care is associated with the least favourable outcomes (Sacker et al., 2021). Children in permanent options, including adoption, may experience less negative outcomes than those in other forms of care, with one study highlighting that children receiving kinship care or foster care had fewer ongoing difficulties than those receiving other forms of care (Li, Chng, and Chu, 2017; Coram BAAF, 2024). Other factors that are associated with better outcomes include long term stable placements in nurturing settings where children’s behaviour is recognised and responded to (Burch et al., 2018). These differences in outcomes may reflect both the nature of the placements and the experiences of the individual involved.
Comparing outcomes for children in care is problematic. Children enter care at different ages, and their stability and experiences vary significantly. The diverse outcomes can reflect pre-existing issues and are not always attributed to care (McSherry et al. 2016). This complexity should be considered when assessing the different outcomes presented below. However, the literature evaluating outcomes does not always discern between placement type. The outcomes below should therefore be interpreted as a range of outcomes that could be prevented depending on placement type and individual circumstance.
To identify outcomes, we searched for academic evidence on the impacts of infants going into care. We reviewed 33 articles, including a mix of systematic reviews, single studies and grey literature, drawing on national and international evidence, and found outcomes across three different life stages:
- Short term outcomes – outcomes experienced during infancy
- Medium term outcomes –outcomes emerging during childhood
- Long term outcomes – outcomes impacting adulthood
Short-term outcomes
Due to the importance of early development in infancy, entering care at this stage can lead to a variety of short term developmental and health outcomes for the infant, as well as implications for the wider family.
Infant development
Infants entering care face immediate developmental risks, particularly when early maternal-infant interactions are disrupted. Evidence from a systematic review links early relational experiences to key areas of development such as language, cognition, motor skills and social-emotional development (Rocha et al., 2019). Interruption of breastfeeding following infant removal may also contribute to poorer health outcomes, by increasing the vulnerability of an infant to risks of infectious disease, obesity, diabetes, leukaemia and sudden infant death syndrome (Stuebe, 2009). The care system may not always respond to developmentally vulnerability. A study in Australia showed only 17.5% of infants in care received services for developmental delay, suggesting a potential gap in early identification and intervention (Lima et al., 2024).
Wider family outcomes
Professionals and experts in the field noted significant implications of the removal of a child for the wider family. This includes a feeling of having been left to deal with stigma and navigate legal and social care systems (Wilkins and Farmer 2015). The evidence in literature for wider family outcomes is limited as funding has generally been focused on identifying child outcomes.
Medium-term outcomes
Children who have experienced the care system face a range of challenges that can significantly shape their development and wellbeing as they grow into young adults. These medium-term outcomes reflect how early care experiences influence social, educational and behavioural trajectories.
Educational attainment
Children in care are more likely to reach lower levels of academic attainment in comparison to children who are not care-experienced. An achievement gap begins early in schooling and widens throughout the school years, with fewer children in care meeting expected educational levels at each key stage (Mannay et al., 2015). This contributes to long-term barriers in accessing further education and employment opportunities.
Employment prospects
Care leavers are more likely to not be in employment, education or training (NEET). Research using administrative datasets in England highlights that care leavers are ten times more likely to be NEET by the age of 21 (Harrison et al., 2023). Not finding employment, education or training can be attributed to lower qualification levels, compared to children who are not care experienced. Between 1971 and 2001, children raised by their parents had a 27% chance of achieving a level 3 NVQ by the age of 29. This compares to 21% for those raised in kinship care, 14% for those in foster care and 11% for those in residential care (Sacker et al., 2021). A significant proportion of these NEET individuals are classified as economically inactive due to disability, including mental health conditions, or caring responsibilities (Harrison et al., 2023).
Housing stability and homelessness
Young people leaving care are at an increased risk of homelessness: 33% of care leavers become homeless in the first two years after leaving care and 25% of all single homeless people have been in care at some point in their lives (All-Party Parliamentary Group for Ending Homelessness, 2017).
Welsh Government (2024b) statistics also show that 7% of care leavers aged over 16 were placed in unsuitable accommodation. Placement in unsuitable accommodation can have negative effects on health and wellbeing and increase the likeliness of experiencing homelessness. One study found that being care experienced was associated with an increased likelihood to live in substandard housing and expressing dissatisfaction with their local area (Parsons et al., 2024). In 2016, Ofsted rated 64% of English local authorities’ services for care leavers as inadequate or requiring improvement (All-Party Parliamentary Group for Ending Homelessness 2017). This demonstrates the reduced housing security and stability experienced by care leavers across the UK.
Increased risk of a criminal conviction
Care-experienced young people are significantly more likely to encounter the criminal justice system. The vulnerability of young people with care experience to involvement in the criminal justice system can be understood through three key themes. First, many have faced a range of adversities that increase the risk of offending. Secondly, the experience of being in care itself can be criminogenic (causing or contributing to criminal behaviour). Finally, the often-compressed transition to adulthood for those in care can increase an individual’s vulnerability (Carr and McAlister, 2016). One large-scale study found 33% had received a caution or conviction by age 17, compared to 4% of their non-care-experienced peers (National Centre for Social Research, 2023).
Young parenthood
Young people with care experience are also at greater risk of becoming parents at a young age. They are two and a half times more likely to become pregnant during adolescence than their peers (Barnardo’s, 2022). A Public Health Wales audit assessing pregnancy rates amongst teenagers aged 14 to 17 years old over a 14-month period, recorded a rate of 5.8% amongst looked after teenagers compared to 0.8% amid to those who are not care-experienced. (Craine et al., 2014). Qualitative research with care-experienced parents in England revealed that many felt judged rather than supported by professionals and struggled to access timely mental health and practical support (Phillips, et al., 2024).
Long-term outcomes
Having spent time in care has been shown to bring lasting outcomes, with many individuals continuing to face challenges into adulthood.
Physical and Mental Health
Adults with a history of care are significantly more likely to report poor physical health. Data from the ONS Longitudinal Study show they are three to four times more likely to describe their health as ‘not good’ (Sacker et al., 2021).
Almost half of all mental health problems begin before age 15 (excluding dementia) and 75% emerge before age 18. Children in care are four times more likely to develop a mental health disorder and up to five times more likely to attempt suicide than their peers (Brady and Gilligan, 2019). There is also growing evidence of intergenerational trauma, particularly among parents who were themselves in care (Parsons et al., 2024).
While premature mortality rates have declined in the general population, the trend has not been observed among care leavers. Adults who spent time in care between 1971 and 2001 were found to be 70% more likely to die early than those who were not in care (Murray et al., 2020). The risk of premature death for care leavers has increased more recently, rising from 40% in 1971 to 360% in 2011 (Sacker et al., 2021). Additionally care leavers face a greater likelihood of dying from unnatural causes, such as violence, suicide or accidents.
Differing educational pathways
While intermediate educational outcomes for care leavers are often poor; longer-term trajectories show more diverse outcomes. For example, higher education attendance among care-experienced individuals increases from 6% at age 21 to 12% by age 23 (Brady and Gilligan, 2019). This highlights potential for individuals to overcome early educational barriers and pursue education later in life.
Identity and Wellbeing
Living in care can significantly shape a young person’s identity and sense of security. A large-scale survey of children and young people in out-of-home care across 23 English and Welsh local authorities found that 18% reported very low wellbeing which was higher than in the general population (Staines and Selwyn, 2020). Analysis found that worse outcomes were linked with certain factors such as not receiving clear explanations, being placed in multiple care placements, and being female.
Overall, there is a consensus within the academic research that spending care in care is linked to a variety of predominantly negative outcomes. These outcomes are experienced throughout the course of a lifetime and can have significant implications for those who have been in care. Preventing parent-baby separating and safely preventing the child from entering care could significantly reduce the likelihood of the child experiencing at least some of these outcomes.
Key Points
Entering care is associated with an increased risk of experiencing a range of negative outcomes throughout the course of an individual’s life.
The type of placement influences outcomes, with residential care having the worst outcomes. Many infants entering care are adopted, fostered, or in kinship care.
There is a lack of evidence surrounding the wider family impacts of a child being removed. Research has focused on outcomes experienced by the child.
Read the next section: What is the lived experience of involvement with statutory care proceedings?