Objective: The aim of this systematic review was to examine which psychological and biological effects of out-of-home care (OOHC) have on maltreated children and adolescents, and whether these children experience a difference in development, compared to those children who stay at home (IH). This is examined through the following research question:
How does out-of-home placement affect the psychological and biological development of children and adolescents who have experienced child maltreatment? And is there a difference in the development of maltreated children and adolescents who are removed, compared to those who remain at the home?
Methods: The literature review was conducted following the PRISMA guidelines, and the articles used in this review, were extracted through three stages. The three stages were as follows: screening and sorting out duplicates, reading through the titles and abstract, and reading the full articles. The chosen articles was then analyzed for results, before a Risk of Bias analysis was conducted on both the chosen articles and the literature review itself.
Results: The screening process was conducted, and articles were excluded on the basis of the in- and exclusion criteria made by the authors. 15 articles met the criteria and went through to the analysis. The analysis showed that out-of-home placement improved the aspects of quality of life, adaptive functioning, and growth in height and weight. Furthermore the results were conflicting concerning the cortisol levels, though one study showed that OOHC improved more than IH in this area. The evidence was also conflicting concerning psychopathology, including the outcomes mental well-being and psychiatric diagnoses. The results showed improvement in some aspects of mental well-being but not all. Regarding psychiatric diagnoses, the evidence was limited. Furthermore no study investigated the development aspect of this area. When comparing the children who remain at home and children residing in out-of-home care, the tendency was that OOHC had poorer outcomes at baseline compared to IH in both aspect of psychopathology.
The comparison of OOHC and IH at follow-up showed that OOHC had the most improvements in the areas of quality of life and growth in height. There was no difference regarding adaptive functioning and the results were conflicting concerning mental well-being.
The Risk of Bias-analysis showed that only one article had a high intern quality with no apparent bias, while the other 14 articles had some bias in certain areas. The literature review itself had a moderate to high intern quality, with bias in only one area; obtaining the data. Though the PRISMA guidelines were followed, and the extraction of data was conducted systematically, the review did not meet the criteria for low Risk of Bias in this aspect.
Conclusion: Overall the current literature review concludes that out-of-home placement can improve certain areas of the children's biological and psychological development. Some of the outcomes reported, are supported or researched by only one study, hence no general assumption can be concluded. Though a tendency can be detected that children residing in OOHC performs better at follow-up, compared to the children staying at home in certain aspects. Therefore the current literature review’s conclusion is that out-of-home placement has a positive effect on some of maltreated children's biological and psychological developmental aspects. More research is needed to conclude the effect OOHC has on the development of psychiatric diagnoses and mental well-being.
Concerning practice implementation, the current literature review ́s recommendation is to implement a more psychological approach to the current social pedagogical work concerning maltreated and out-of-home placed children. Doing this, a psychological screening, and possible treatment, for the children can show the child's individual needs and challenges, and therefore adapt the intervention so that the children is supported in areas of need, rather than offering a one-size-fits-all model. A more holistic approach, rather than exclusively social pedagogical, is hypothesized to be more effective concerning the overall challenges a maltreated child carry. A biopsychosocial approach, with corresponding interventions, is hypothesized to improve the developmental, biological and psychological outcomes further,
compared to findings in the current literature review. More research is needed to conclude whether these hypotheses can be validated.