Children´s out-of-home care across Finnish and Norwegian regions: lifetime risks, expected length, and care leaving routes for synthetic cohorts

Background Country and regional comparisons of out-of-home care illustrate the burden of care for the care systems and the individuals. We compare the regional dynamics of out-of-home care in Finland and Norway, countries with similar family service-oriented child welfare systems. Methods We followed all children in Finland in 2011–2020 and Norway in 2013–2022 with 128 million and 133 million person-months linked to complete data from social care registers. We constructed incidence-based multistate life tables to calculate the lifetime risk of experiencing out-of-home care episodes, the expected length of stay in care, and care leaving routes by NUTS3 regional units. Results The lifetime risk of experiencing any care episodes before age 18 declined in Norway from 4.5% in 2013 to 2.2% in 2022, but remained at around 6% in Finland. In both countries, the lifetime risk was twice as high in the region with the highest risk as in the region with the lowest risk. The lifetime risk of entering residential care was four times higher in Finland (5%) than in Norway (1%). The expected length of stay was higher in Norway (4.6 vs. 3.2 years), but was higher for residential care in Finland (1.4 vs. 1.1. years). In both countries, half of children who entered care once returned home without re-entry. Conclusion The risk of entering residential care is four times higher in Finland than in Norway. The time children spend in residential care in Finland may be reduced through effective early interventions and prioritisation of family-based care.