Children's out-of-home care in Finland, 1993-2020: lifetime risks, expectancies, exit routes, and number of placements for synthetic cohorts.

BACKGROUND

Population level studies rarely include multiple dimensions of the out-of-home care (OHC) experience, which are important for understanding the nuanced experiences of children and families. Multiple dimensions of OHC journeys can be measured without birth cohort data using the synthetic cohort approach, which summarizes contemporary risks of OHC for a synthetic cohort.

METHODS

We use register data on all children born in Finland in 1980-2020 (n = 2,747,803) and link them with the Register of Child Welfare (OHC episodes n = 305,045). We fit discrete-time multistate models to estimate the lifetime risks, expected duration, exit routes, and number of home-to-OHC transitions for synthetic cohorts, that is, cohorts experiencing risks observed in a given calendar year across their childhood. We use these metrics to describe OHC development in Finland from 1993 to 2020.

RESULTS

The lifetime risk from birth to age 18 of any OHC entry increased from 2.6 % in 1993 to 5.7 % in 2020, with the largest increases occurring in residential care (from 1.7 % in 1993 to 4.8 % in 2020). Among children who entered care, the expected duration decreased from 4.2 to 3.5 years and the chances of returning from OHC to home by age 18 increased from 32 % to 44 % over this period. In 2020, there were 1.8 home-to-OHC transitions per person ever in OHC.

CONCLUSION

For the synthetic cohorts of 1993-2020, the lifetime risk of entry into OHC increased two-fold and the lifetime risk of entry into residential care three-fold. Despite international declarations of intent to prioritise family-based care, increasing numbers of children are being placed in residential care in Finland.