Assisting Care Leavers

2. Care leavers in OECD countries

Reliable and comparative data on care leavers and child protection systems more broadly are limited. In part, this is due in part to the lack of a harmonised approach to child protection administration across countries. In addition, the way data are collected even within countries can vary, as responsibility for child protection often lies with sub-national levels of government. The most commonly available statistics are notification rates and the number of children in state care. In particular longitudinal data, such as on the number of children who enter care multiple times, are usually hard to come by and are not harmonised across countries.

Obtaining data about care leavers is particularly challenging. As young people transition out of the care system, tracking their outcomes becomes difficult. Countries completing the questionnaire were asked to provide data on the numbers of children in out-of-home care, young people in care who reach the legal leaving age and young people who remain in the care system beyond the legal leaving age. Twenty-six countries provided statistics on the number of children in out-of-home care, of which 20 distinguished different types of out-of-home care placement. Furthermore, 17 countries provided statistics on care leavers specifically.

Data on children in care and types of care arrangements

The proportion of children in care may appear modest, but tens of thousands of children are nonetheless still affected every year. There are 292 million children and young people under the age of 18 in OECD countries, representing 20% of the OECD population of 1.4 billion people. On average, children in out-of-home care across the 26 OECD countries for which data are available represent 0.8% of 0‑17 year‑olds, ranging from less than 0.1% in Greece and Turkey to more than 1.5% in Finland, Hungary and Latvia. For those 26 countries, this proportion translates to 1.1 million children in care in 2019. If the proportion of cared-for children were the same across all OECD countries as across the countries for which the numbers are known, roughly 2.3 million children would have been in some type of out-of-home care in 2019. Moreover, the share of minors who are placed in care at some point during their childhood or teenage years is still higher: estimates in the literature suggest that 3% of children in Denmark are placed in care at some point before they turn 18, a share three times as large as the share of minors in care in the country in 2019. More drastically, the 6% of children in the United States who experience out-of-home care at some point is more than seven times as large as the share who were in care in 2019 (Turney and Wildeman, 2017[5]; Ubbesen, Gilbert and Thoburn, 2015[6]).

More boys than girls and more adolescents than younger age groups are in care. The over-representation of boys is relatively small: on average, there are 6% more boys than girls in care. In many countries, the difference in the proportion between boys and girls is even smaller, non-existent or reversed. The difference in the gender ratio tends to be larger among teenagers, with the most extreme disparity occurring in Spain: in 2018, 0.6% of girls and 1.2% of boys aged 12‑17 were in care. In the Spanish case, unaccompanied minor migrants – who are by a large majority boys – contribute to the difference, but this only explains a small part. The share of children in out-of-home care increases with age: on average, 0.5% of 0‑5 year‑olds, 0.8% of 6‑11 year‑olds and 1.2% of 12‑17 year‑olds are in care. One of the reasons for the higher prevalence among older children could simply be that many entered care at a younger age but remain in out-of-home care as they grow older. For example, of the minors who entered care in England in 2018/19, nearly three‑quarters were under the age of 13 (Children’s Commissioner for England, 2021[7]). However, complementary explanations that can apply to different extents across countries are that older children and teenagers may be able and likely to advocate for their removal from a dysfunctional or abusive home, and that young people with behavioural difficulties may be placed in out-of-home care.

Figure 2.1. On average, children in out-of-home care represent less than 1% of 0‑17 year‑olds in OECD countries

Note: 2020 data for Chile, the Czech Republic, Ireland, Israel, New Zealand, Norway, Turkey, England and Scotland (UK); 2018 for Italy and Spain; 2019 for other countries.

Source: OECD Policy Questionnaire on Care Leavers (2020).

The balance between foster and institutional or residential care differs across countries. On average, two‑thirds of children in care across the 18 countries that provided statistics on the type of care placement were in foster care (Figure 2.2). These foster placements may either be with an (extended) family member (the so-called formal kinship care) or with non-family foster parents. The distinction between the two types of foster care cannot be made in all countries, but where it is possible, less than half of children in foster care were placed with a family member. Yet, the share of children in foster care overall varies from more than 90% in New Zealand, Australia, Latvia and the United States for example to about a third in Israel and Turkey, with the remainder in residential care. Likely excluded from the overall count of children in care, and in foster care specifically, are any out-of-home placements with relatives initiated outside of the regular child protection system. Such placements may occur at the behest of parents, who may leave their children with family members without informing any relevant authorities, or be initiated by child protective agencies that nonetheless bypass the formal foster system. Figures on this phenomenon of hidden or shadow foster care are naturally difficult to come by, but a recent article puts the number of such decisions in the ten to hundred thousand per year in the United States alone (Gupta-Kagan, 2020[8]).

A decreasing number of children are placed in residential care facilities. The UN Guidelines for the Alternative Care of Children call for residential care to be restricted to situations where it is “specifically appropriate, necessary and constructive” for the child in question; and call for the gradual elimination of large residential care facilities. Many countries have been pursuing deinstitutionalisation policies for several decades (Lerch and Nordenmark Severinsson, 2019[9]), and this is reflected in the statistics: Since 2010, the share of residential care decreased by 8 percentage points across the 18 countries with available data; and the decrease occurred in all but four of these countries.

Figure 2.2. On average, one‑third of children in care are in residential care in OECD countries

Note: Data on kinship and foster care cannot be split in some countries, they are put together as non-residential. For the United States, children in pre‑adoptive homes were equally shared in kinship and foster care as the current data does not allow determining if the pre‑adoptive homes setting in with a relative or non-relative.

Source: OECD Policy Questionnaire on Care Leavers (2020).

Limited evidence on care leavers

Many children who are in care return to their families, but some reach the age of majority while still in care. The exact share can be difficult to know. For 13 countries for which recent data are available, the ratio of the number of young people in care who reach the legal leaving age to the number of young people aged 12 to 17 ranged from 3 in Scotland (United Kingdom) to 59 in Portugal; with the unweighted cross-country average being 20. A particularly low ratio can indicate that many children return to their family prior to becoming legal adults; while a high ratio indicates the opposite. The latter case could also be consistent with teenagers entering the care system at a relatively older age.

An abrupt end to a care placement is vastly different from what care leavers’ peers experience. In the European Union in 2013, the average age at which young people left their parental home was 27 for boys and 25 for girls years, up by more than half a year of age since 2000 (Brady and Gilligan, 2018[10]). Across 30 OECD countries with available information for a recent year (2017‑19), an average of 43.4% of young people aged 20 to 29 were still living with their parents. In countries such as Greece, Italy, Slovenia and Spain, their share even exceeds two‑thirds within this age group. In contrast, for young people in care, a 2018 mapping exercise of policy and legislation in 36 countries (13 of which are OECD countries included in this policy report) found that in practice, the age at which support stopped was 18 and younger in 24 countries (66%) (Strahl et al., 2021[1]). A similar mapping exercise of nine European countries undertaken more than a decade earlier found the leaving age ranged from 15 to 21 (Stein, 2014[11]).

In response to this stark contrast in the age care leavers are expected to be independent and to the poor life outcomes that some face, many countries now offer additional support to young people who reach the age majority while in care, including the option of staying in some form of accompanied residence. These different options are described in more detail in the following section. Yet, even though countries provide additional supports, it is clear that they do not reach all care leavers, whether it is by the young person’s choice, a lack of available places, too high administrative hurdles or other obstacles.

It is very difficult to know exactly the share of young people who remain in care and what ‘remaining in care’ means concretely. Countries collect different statistics about care leavers, hindering cross-country (and in some cases even within-country) comparisons. In response to the OECD questionnaire on care leavers, 12 countries provided information on both the number of young people in care who reach the age of majority and the number of young people who remain in the care system beyond the legal leaving age. However, in some countries the number of young people remaining in care appears to refer to those young people who have just reached the legal leaving age, while in others it refers to all young people who remain in the care system beyond the age of majority regardless of whether they are 18, 20 or 22. The distinction as to whether a country’s figures fall in the former or the latter case is not always clear, though a ratio of in-care teenagers reaching the legal leaving age to young people who remain in the system above 100 clearly indicates that many young people remain in care after reaching majority age. The ratio exceeded 100 in the Czech Republic, Denmark, Iceland, Israel, Sweden and above all England (United Kingdom), while Hungary, Finland, Spain, Slovenia, Scotland (United Kingdom) and the United States had ratios below 100.

Though there is even less comparable and up-to-date data on the long-term outcomes of individuals who were in care during their childhood and teenage years, the data that do exist generally point towards worse life outcomes for this group of young people. They tend to leave the education system earlier than their peers (Fryar, Jordan and DeVooght, 2017[12]; Kääriälä and Hiilamo, 2017[13]) and are less likely to be employed or earn a salary equivalent to other people (Cameron, 2016[14]; Stewart et al., 2014[15]). Former youth-in-care are extremely over-represented among the homeless population (SZN, 2017[16]; MacKenzie et al., 2016[17]; Frechon and Marpsat, 2016[18]; Dworsky, Napolitano and Courtney, 2013[19]) and among teenage mothers (Dulin, 2018[20]; Vinnerljung, Franzén and Danielsson, 2007[21]). Having been in care is also associated with poorer mental health (Baidawi, Mendes and Snow, 2014[4]; Dixon, 2008[22]); higher incarceration rates (Barn and Tan, 2012[23]; Doyle Joseph J., 2007[24]) and a higher suicide rate (Vinnerljung and Ribe, 2003[25]). However, it is generally difficult to disentangle to what degree the care system itself (and the transition out of the system), as opposed to the adverse events that necessitated a placement, contributes to these negative outcomes. Moreover, it is important not to view and portray care leavers as a group ‘doomed to failure’, but rather as individuals who may have to overcome more challenges but can nonetheless thrive.

Increasing evidence on the effectiveness of supports

The lack of good quality data about care leavers is a universal issue, significantly limiting our ability to know how individuals are faring after leaving care and what supports are making the greatest positive difference for them. A 2019 study looking at extended care beyond age 18 in ten countries drew attention to the fact that in most countries, gaps in administrative data and in related longitudinal research hinder our understanding of care leavers’ transition and most particularly how effective extended care actually is (van Breda et al., 2020[26]).

Fifteen countries that are covered in this report said aftercare support services are monitored and/or evaluated. Fifteen countries also have policies or programmes in place to follow up (systematically or occasionally) with youth who have left care and track their outcomes. For example, in New Zealand, the Oranga Tamariki Act 1989 requires the Chief Executive of the Ministry for Children (Oranga Tamariki) to maintain contact with care leavers up to the age of 21 years, which is done via non-government agencies, community or iwi/Māori organisations and the Oranga Tamariki Transition Support Helpline. An annual survey ‘Just Saying’ tracks outcomes and the lived experience of tamariki (children) who receive transitional support.

While countries may have monitoring or evaluation activities in place, it is hard to say whether those activities are systematic and whether quantitative methods are being used to measure the effectiveness of supports. The literature suggests that in most cases the answer is no. However, several countries appear to be making some progress, in particular in terms of measuring the costs and benefits of extended care. For example, in their assessment of the lessons from extended care programmes in the United States and England, Mendes and Rogers (2020[27]) state that the evidence on the effectiveness of existing extended care programmes is still limited but growing and points towards positive impacts. A decade earlier, Mendes’s (2009[28]) was more cautious, stating that the evidence of whether the programmes could offset prior disadvantages was mixed. The caution was related to the fact that there were few quasi‑experimental studies that sought to compare the outcomes of care leavers receiving support with those of care leavers who did not but were otherwise similar.

As an example of in-depth studies, Norwegian researchers have used their country’s rich public registry data to compare care leavers with their peers without child welfare experience across a range of outcomes in adult life. They found poorer outcomes on a number of key indicators including health, education, and economic independence for care leavers. Comparing the outcomes of the groups of care leavers with and without aftercare support and of individuals with no child welfare experience, the researchers found that aftercare appears to have a long-term positive effect on the completion of upper secondary school (Paulsen et al., 2020[29]). It also reduces the likelihood of receiving a disability pension, and indirectly of receiving work assessment benefits and financial social assistance, as secondary education graduation reduces the likelihood of receiving this type of support. The researchers note that in the Norwegian context, the group receiving aftercare tends to be particularly vulnerable, implying that aftercare may be even more effective than it initially appears.

Courtney and colleagues have completed two separate evaluations of the benefits of extended study in the United States (USA), one on the Midwest (Courtney, 2007[30]), and the other one on California (Courtney, 2019[31]). Their study on youth transitions to adulthood in California used a variety of methods to examine the impact of extended care in California, which has the biggest population of youth in care post‑18 years in the USA. They identified specific benefits such as enhanced educational outcomes, improved earnings and less economic hardship, fewer teen pregnancies, lower levels of homelessness, reduced involvement in the criminal justice system, and greater involvement of non-custodial fathers who have been in care with their children.

The United Kingdom (UK) has also evaluated the effectiveness of extended care and demonstrated measurable social and economic benefits:

• Staying Put, an extended care programme in England, was piloted from 2008 to 2011 in 11 local authorities before being put on a statutory footing for all local authorities in 2014 (see also Box 3.4 later in the report). In 2012, the pilot was evaluated using a mixed methods approach to explore early outcomes. Young people in the pilot had more stable and supportive relationships and less housing instability, making it easier for them to remain in education, training or employment (Mendes and Rogers, 2020[27]). In May 2021, the government announced continued investment of GBP 33 million in Staying Put (Foley and Library Specialists, 2021[32]). Yet, while the Ministry of Education continues to collect data about the number of care leavers in the programme, there is no formal ongoing evaluation of the programme.

• In 2018, in response to the concern that Staying Put was not available to young people leaving residential care, the government introduced eight two‑year Staying Close pilots, where care leavers can live independently in a location close to their institutions with ongoing support from that home (Box 3.4). A 2018‑20 evaluation found improved independent living skills after 6 months as well as increased housing stability, increased participation in activities such as education or employment and increased happiness (Foley and Library Specialists, 2021[32]). A cost-benefit analysis, which the researchers acknowledged relied on strong assumptions and included limitations in the calculations, found that the programme would save the state money (Dixon, Cresswell and Ward, 2020[33]). The government signalled its commitment to a nation-wide roll-out. As with Staying Put, it is unclear whether there will be ongoing monitoring and evaluation.

In Australia, most states and territories have implemented a trial – embedded into practice or legislated (where required) – of a form of extended support. All named programmes extend support until 21 years of age. These formats range from a universal extended care programme in Victoria, to extending support to young care leavers who meet certain criteria to remain living with family-based carers in South Australia. Tasmania has embedded extended supports into their practice without the need of legislation in their Transition to Independence Program and funds family based care placements. In January 2021, Western Australia announced funding to expand the Home Stretch trial and roll out a permanent programme to support young people transitioning from care (see also Box 3.3 later in the report).

Care leaving reforms in Australia were in some cases embedded in broader care reforms, and inspired by international experiences. Reforms in Victoria commenced in 2016 with the Roadmap for Reform – Strong Families, Safe Children, which transformed the child and family system from crisis response to earlier intervention and prevention. Under these reforms, Victoria began piloting Better Futures, a new approach to supporting care leavers (see also Box 3.11 later in the report). Based on evaluations and positive outcomes from these pilot programmes, Better Futures was rolled out state‑wide in late 2019 with all eligible young people in care referred to their local Better Futures provider at 15 years and nine months. In Victoria but also elsewhere, the programmes were introduced in response to the Home Stretch campaign, which highlighted positive findings from extended care programmes in Canada, the United Kingdom and the United States, to support a social and economic case for extended care (Mendes and Rogers, 2020[27]). Victoria introduced Home Stretch in 2018, and in January 2021 it was the first Australian jurisdiction to make extended care available to all young people leaving foster, kinship and residential care to receive a more gradual and supportive transition to adulthood. This has been extended to include young people on permanent care orders. The Home Stretch programme is proposed to be embedded in Victorian legislation when the amended Children, Youth and Families Act 2005 bill is passed.

While there is still some way to go until evidence and data are used more systematically to improve care leaver policy, these examples demonstrate that measuring effectiveness and acting on the evidence is possible and that progress is being made. Longitudinal studies of care leavers well into their twenties are starting to shape our understanding of the effectiveness of extended care and other supports as early intervention strategies to improve longer-term outcomes. This progress moves us away from a sole focus on the often difficult “leaving” stage, which might perpetuate the idea that all care leavers suffer poor outcomes. Research programmes like Good Traces in Finland (see Box 2.1) will help answer critical questions about what works to improve outcomes for care leavers.

Box 2.1. Finland’s “Good Traces”

Good Traces (Hyvää jälkeä) is a Finnish research project running from 2021 to 2023, investigating transitions from care to adulthood as experienced by care leavers and the professionals working with them. The project is led by Tampere University with Savonia University of Applied Sciences and SOS Children’s Villages as consortium partners and is funded by the Finnish Ministry of Social Welfare and Health.

The project explores the complex processes and experiences associated with a young person ageing out of foster or institutional care, including: a) preparing, b) leaving/staying, and c) being in ‘after care’. The focus of the project is on positive experiences, with the aim of learning what works and what constitutes a positive leaving care experience, looking specifically at care leavers’ and professionals’ mutual and reciprocal resilience‑building experiences.

The aims of the project are to:

1. build an understanding of the leaving care process from the viewpoint of care leavers, professionals and the social service system using nationwide questionnaires created together with participants;

2. create an understanding of transitions from care as experienced by young people and professionals by employing ethnographic and other qualitative methodologies; and

3. use the results of the research, together with input from participating young people and professionals to plan a reciprocal youth-centred working platform to help develop shared multi-professional work with young care leavers.

Source: OECD Policy Questionnaire on Care Leavers (2020).