Mapping the evidence on outcomes of childhood out-of-home care: A scoping review of reviews

Background: Children placed in out-of-home care in high-income countries face complex challenges due to exposure to adverse childhood experiences and systemic disadvantages. While research on their outcomes has grown, the evidence base remains fragmented. An overview of review-level evidence was conducted to identify patterns, gaps, and priorities for future research and practice. Methods: A scoping review of reviews was conducted. Peer-reviewed review articles published between January 2013 and July 2024 were identified through searches in databases including EBSCOhost, ProQuest, Cochrane Database of Systematic Reviews, and Epistemonikos. Eligible reviews focused on childhood out-of-home care experience and reported outcomes for care-experienced individuals (assessed either in childhood or adulthood) and/or associated factors. Outcomes were categorised under the following domains: Health and Emotional Wellbeing (HEW), Physical and Legal Security (PLS), Education and Learning (EL), Living Standards and Social Wellness (LSSW), and Identity and Civic Participation (ICP). Factors were classified across multiple levels, including individual child-level, socio-relational-level, community-level, system-level, and other factors. Results: A total of 77 reviews were included, spanning diverse methodologies and contexts. Research was concentrated in domains such as HEW and LSSW, with indicators such as mental and emotional health and attachment and behaviour functioning receiving substantial attention. Conversely, key gaps were identified, including the limited reporting of ICP outcomes (e.g., identity and self-respect). System-level factors, such as care quality and placement type, were most frequently reported across outcome domains and indicators. Individual child level and socio-relational-level factors were consistently highlighted, while community-level factors were largely underrepresented. Conclusion: Future research should target gaps in underexplored outcome domains like ICP and indicators such as bullying, mortality, and educational readiness. Community-level factors warrant more attention as they play a significant role in supporting transitions to independence and social integration.