Out of care and into care again: A Danish register‐based study of children placed in out-of‐home care before their third birthday

https://doi.org/10.1016/j.childyouth.2012.07.014Get rights and content

Abstract

Objective

When children are reunited with their families of origin and the reasons for placing them in out-of-home care no longer exist, it is usually considered a good outcome. Unfortunately, some children are later returned to care. The objective of this register-based study is to describe in terms of rates the processes of reunification and re-entry, involving children placed in out-of-home care before their third birthday. Furthermore, the objective is to study whether individual and parental characteristics predict reunifications and re-entries.

Method

Data were obtained by using personal identification numbers to link several registration systems. The study population was defined as all children from entry cohorts in 1991–2001 who entered the Danish out-of-home care system before their third birthday (n = 3928). Graphs of cumulative incidences are used to describe the processes of reunification and re-entry. Cox regression is used to estimate the covariates associated with reunification and re-entry.

Results

39% (n = 1525) of all children who enter care for the first time reunify with their families within five years of care. 22% of these children re-enter care within two years. Results further point to complex patterns of risk factors. Single parenthood is associated with a lower rate of reunification when combined with unemployment or psychiatric diagnoses, but it is associated with a higher rate of reunification when parents are employed or when none of the parents have psychiatric histories. A psychiatric history is associated with re-entry only when the family structure consists of two parents. An immigration background is associated with a higher likelihood of reunification and with a lower likelihood of re-entry.

Highlights

► Investigation of reunification and re-entry on a national population. ► Use of individual level data describing child's and parents' characteristics. ► Estimation of covariates associated with reunification and re-entry. ► Results reveal complex patterns of movements out of and into the system.

Introduction

In recent decades, numerous studies on children in out-of-home care have emerged. A central theme in these studies is stability. Stability in the sense of stable and lasting relations during childhood development is a fundamental aspect of sound human development (Baumeister & Leary, 1995). The trajectories of children in out-of-home care systems are characterized by varying degrees of stability. Some children are placed in out-of-home care for a very short period of time followed by reunification with their parents. Other children are placed in out-of-home care for many years — maybe for their entire childhood. Still other children are subject to placement patterns that are influenced by discontinuity, e.g. repeated transfers within the system or entries into/exits from the system. Such different types of contact with the system reflect how the degree of stability may vary, resulting in different long-term implications.

The importance of stability is widely recognized; nevertheless, child welfare practices differ. For many years permanency has been a guiding principle for many child welfare agencies (Fein & Maluccio, 1992). The concept of permanency is unclear in the sense that the definitions used differ slightly, e.g. permanency may refer to the process of making long-term care arrangements, ensuring lifetime relationships and a sense of belonging (Tilbury & Osmond, 2006). This perspective corresponds very well to the idea of stability in childhood. Thus, working toward permanency constitutes an attempt to secure the child's stable relations with significant adults as it grows up, and permanency is then based on stability in childhood, no matter where this stability is established.

At other times permanency refers to guiding principles and performance standard measures concerning successful adoptions or reunifications between child and family (Barth, 1997). In this sense of permanency, family relations and the necessity of returning the child to its home are seen as very important aspects of the child's need for stability. These two perspectives are not necessarily inconsistent with the importance of stability in childhood. However, some perspectives on permanency mainly focus on achieving stability by reuniting the child and its family or on facilitating adoption. Other perspectives do not reject that stability can also be achieved by placing the child in long-term placement settings. These differences may reflect differences in practice, legislation, and tradition within child welfare systems. In some countries (e.g. the USA, the U.K., Canada, and, to a lesser degree, Australia, New Zealand), entering care is something that should be avoided, whereas in other countries (e.g. Denmark, France, Germany, Ireland, Italy, Norway, Spain, and Sweden) entering the system of care – by being placed out of home – is rather a necessary part of family support and of child's mental health systems (Thoburn, 2007). As a result of the differences in practice, caution should be taken when comparing international results from studies on child welfare systems. Results should always be interpreted by taking into account the context they reflect.

The importance of stable and long-lasting relations and the ability of child protection systems to facilitate such stability in children's lives make studies on reunification and re-entry relevant. Often administrative data are used to take snapshots of children placed in a child protection system at a specific time. The snapshot is used to calculate frequencies of children in care, the mean length of stays, etc. The snapshot approach has well-defined weaknesses, in the sense that they tend to over-represent long-term placements and under-represent children with unstable placement patterns (Webster, Usher, Needell, & Wildfire, 2009). In short this approach does not describe stability and it does not describe children's care trajectories. Organizing longitudinal data will enable one to control methodology weaknesses and to produce precise descriptions of the stages children experience in their care trajectory.

When a child is removed from its parents, it constitutes a break with the child's stable relations, though the quality of these relations can be questioned, as a removal is necessary. One way to secure stability is to prevent out-of-home placements by intervening with different types of in-home services. The number of children who enter care and the probability hereof describe this event. Thus, entry rates are an important measure of the ability to secure stability, as they describe child protection systems' ability to either prevent placements or to detect and protect the children who are in need of out-of-home care.

When a child has entered care, stability becomes important as a measure of the quality of the child's relations with the significant others that constitute its social reality. In larger studies using administrative data, information about subjective entities such as forms of attachment and well-being mostly remains unobserved. In such studies stability can be understood as placement stability — e.g. the number of moves between care settings from the time of entering the out-of-home care system to the time of exit. Such moves may result in experiences of exclusion and rejection and might undermine future placement stability (Webster, Barth, & Needell, 2000).

The present study focuses on reunification and re-entry. When children reunify with their families of origin and the reasons for placing them in out-of-home care no longer exist, it is usually considered a good outcome. It enables the child to develop long-lasting and stable relationships with its parents. Unfortunately, some children are later returned to care. When a child is removed from its parents several times it seriously violates the child's need for stability and sense of belonging. Therefore, any study of reunifications is incomplete if re-entries are not taken into account (Shaw, 2006). In this study stability is defined as no change in the child's status as in-care or out-of-care. In methodological terms this is measured by long-term placement or reunification without subsequent re-entry.

Section snippets

Previous research

Previous research in child welfare varies with regard to focus and methodology. The following selective review is solely based on research using administrative data. Studying processes of stability in the out-of-home care system, several outcomes are relevant (Section 1.2). Many exit types are associated with stability, e.g. reunification is the exit type most frequently studied, whereas adoption, leaving guardianship, and relative custody are the most rarely studied outcomes (Akin, 2011).

Sources of data

Since 1968 all persons living in Denmark have been assigned an individual identification number (CPR). CPR is used across several registration systems, which can be linked via CPR; hence, it becomes possible to make very reliable descriptions and analyses of the population. In the present study the CPR system is used to combine data from four different sources. The Register of Support for Children and Adolescents, maintained by Statistics Denmark, contains information on all placements made in

Descriptive characteristics

This section presents the results of the study. The descriptive characteristics of the study population are described in Table 1; some of the characteristics are, however, not shown in the table because further differentiation will result in too small cells in the statistical models. 96% (n = 324) of children with an immigrant background are descendants of immigrants, not actual immigrants. 37% (n = 134) are associated with countries in Europe, including Greenland, 35% (n = 128) with countries in

Overall rates on reunification and re-entry

A focal concern of this article is to unravel the processes of moving into and out of the Danish system of care for children placed in out-of-home care for the first time before their third birthday. Focusing on ten entry cohorts from 1991 to 2001, the overall finding shows that 38.8% of the children are reunited with their families within five years after their first day in care. 21.6% of these re-enter care within two years after they have left care. Moreover, the overall findings indicate

Conclusion

The aim of the study was to describe rates of reunification and re-entry of children entering the Danish out-of-home care system before their third birthday. This was done using cumulated incidences and by calculating hazard ratios. 39% (n = 1525) are reunited with their families within five years in care, 22% hereof (n = 329) re-enter care within two years. The aim of the study was also to describe how these processes can be explained using variables that describe individual and parental

References (45)

  • E. Putnam-Hornstein et al.

    Predictors of child protective service contact between birth and age five: An examination of California's 2002 birth cohort

    Children and Youth Services Review

    (2011)
  • T.V. Shaw

    Reentry into the foster care system after reunification

    Children and Youth Services Review

    (2006)
  • T. Terling

    The efficacy of family reunification practices: Reentry rates and correlates of reentry for abused and neglected children reunited with their families

    Child Abuse & Neglect

    (1999)
  • E. van Santen

    Predictors of exit type and length of stay in non-kinship family foster care—The German experience

    Children and Youth Services Review

    (2010)
  • K. Wells et al.

    Reunification and reentry of foster children

    Children and Youth Services Review

    (1999)
  • S. Yampolskaya et al.

    Factors associated with exiting and reentry into out-of-home care under community-based care in Florida

    Children and Youth Services Review

    (2007)
  • K.M. Abel et al.

    Birth weight, schizophrenia, and adult mental disorder: Is risk confined to the smallest babies?

    (2010)
  • K. Appleyard et al.

    When more is not better: The role of cumulative risk in child behavior outcomes

    Journal of Child Psychology and Psychiatry

    (2005)
  • R.P. Barth et al.

    Placement into foster care and the interplay of urbanicity, child behavior problems, and poverty

    (2006)
  • R.F. Baumeister et al.

    The need to belong: Desire for interpersonal attachments as a fundamental human motivation

    Psychological Bulletin

    (1995)
  • H.L. Behrens

    5230 børn på krisecenter: En diskreptiv undersøgelse

    (2002)
  • Cited by (20)

    • Reunification trajectories in Quebec: Acknowledging chronic family challenges to support stability

      2022, Child Abuse and Neglect
      Citation Excerpt :

      To date, no Canada-based studies have analyzed how and why reunification following placement may be stable or result in a child re-entering care. While stable reunification is the goal following a child's placement in out-of-home care, research demonstrates that family reunifications break down anywhere between 13% of the time after one year reunited (Shaw, 2006; Wells & Guo, 1999) and over 50% of the time after four or five years (Hélie et al., 2020; Ubbesen et al., 2012; Wade, Biehal, Farrelly, & Sinclair, 2011). Numerous reasons may explain the instability of certain family reunifications.

    • Children in care: Where do children entering care at different ages end up? An analysis of local authority administrative data

      2019, Children and Youth Services Review
      Citation Excerpt :

      Consequently in countries other than the USA and UK longer stays in foster care or residential care are more usual. Examples of the non US/UK research include studies from Norway (Christiansen & Anderssen, 2010), Australia (Delfabbro, Fernandez, McCormick, & Ketter, 2015), Quebec (Esposito et al., 2014), Denmark (Ubbesen, Petersen, Mortensen, & Kristensen, 2012) and Sweden (Vinnerljung & Sallnas, 2008). Turning to research in England, several studies have used the SSDA903 dataset to explore the characteristics of children in care and to look at their different pathways.

    • Reunifying abused or neglected children: Decision-making and outcomes

      2015, Child Abuse and Neglect
      Citation Excerpt :

      Studies from the USA have reported rates of re-entry ranging from 13 to 28% (Barth, Weigensberg, Fisher, Fetrow, & Green, 2008; Courtney, 1995; Festinger, 1996; Goodman, 1997; Shaw, 2006; Wells & Guo, 1999; Wulczyn, 1991, 2004). In Scandinavia, a Danish study found a re-entry rate of 22% within two years of reunification and cited a rate of 25% in Sweden over the same period (Ubbesen, Petersen, Mortensen, & Kristensen, 2012; Vinnerlung, Oman, & Gunnarson, 2004). The few available English studies of reunification have typically reported higher rates, ranging from 37% over three years (Sinclair, Baker, Wilson, & Gibbs, 2005) to 47% over two years (Farmer & Wijedasa, 2013).

    • Cumulative incidence of entry into out-of-home care: Changes over time in Denmark and England

      2015, Child Abuse and Neglect
      Citation Excerpt :

      The English data were provided from the Office for National Statistics (Statistics, 2013) and the Danish data was provided by Statistics Denmark (Statistics Denmark, 2013). We did not analyse cumulative incidence by ethnic or national origin because classifications for ethnicity (England) or nationality (Denmark) were not comparable in the OHC data (Thoburn, Chand, & Procter, 2005; Ubbesen, Petersen, Mortensen, & Kristensen, 2012), and appropriate denominators are not available by local authority in England We calculated the cumulative incidence of being placed in OHC for the first time by year of age and calendar period of birth.

    View all citing articles on Scopus
    View full text