What is this?

The systematic review examined whether placement outcomes are different between disabled and non-disabled children. It also considered the factors that influence placement outcomes for children with disabilities. The factors considered include child characteristics.

Note: The systematic review adopts a social model of disability that included children with physical or sensory impairments, intellectual disabilities, challenging behaviours, mental distress and children on the autistic spectrum.

How is it meant to work?

The review did not report any mechanisms.

What are the evaluated outcomes?

• Reunification
• Placement disruption

How effective is it?

Outcome 1: Reunification – Overall the review found that disabled children were less likely to be successfully reunified than non-disabled children. This is based on very low strength evidence, because the review did not include information about the methods or quality of the research involved. Caution should therefore be used when interpreting this finding.

Outcome 2: Placement disruption – Overall, the review found a mixed effect on placement disruption. This means that studies show a mixture of effects and the criteria for negative or tends to positive effect is not met. This is based on very low strength evidence, because the review did not include information about the methods or quality of the research involved. Caution should therefore be used when interpreting this finding.

Strength of evidence:

• The review does not specify the methods used in each of the included studies. Therefore, conclusions cannot be drawn about the overall quality of the research, and  caution should be applied when interpreting the findings.
• The evidence is based on international literature published between 1998-2003.

Where has it been studied?

The evidence originates from a total of 90 sources, with 54 from the US, 20 from the UK, 10 from Canada, and with one paper each from both China and the Netherlands.

Who does it work for?

• It was suggested that compared to girls, boys are more likely to experience longer delays in waiting for adoption, with an average wait for adoption amongst disabled boys of 11.8 years.
• Looked-after disabled children are more likely to enter care at an older age than non-disabled children.
• Younger disabled children appeared more likely to be adopted than older disabled children. Moreover, older disabled children appeared more likely to have experienced placement disruption than their younger counterparts.
• It was suggested that a correlation exists between adoptions at a young age with better outcomes.
• Black disabled children were more likely to be placed with white adopters than children who were black but not disabled. However, findings suggest that children adjust well to their white families.

When, where and how does it work?

• Children with behaviour challenges, alongside other impairments, are more likely to experience disruption and/or have more placements.  However, ‘other impairments’ are not clearly specified or defined in the review.
• Children with behaviour disabilities or mental health needs appeared to be less likely to reunify with their parents, and more likely to experience poorer outcomes in adoptions.
• Mixed findings emerged in relation to sensory and/or physical impairments. One study concluded that these children were more likely to be adopted, while two studies suggested they were no less likely to be adopted than non-disabled children.
• In relation to parental substance misuse, children were more likely to be placed in kinship care than foster care.
• Children on the autism spectrum appeared to experience high levels of placement instability.
• The review identified that access to, and the provision of specialist services is crucial in ensuring the successful placing of looked after disabled children. However, there is also evidence to suggest that accessing these services can be problematic and does not necessarily meet their needs.
• Placement success may be associated with access to looked-after disabled children’s background information. Although the review reported that this is a critical factor for adopters, no information is presented on how this directly impacts placement success or failure.

What are the costs and benefits?

No economic analysis is included in the study.

In summary...

• Disabled children are less likely to be reunited home compared to non-disabled children, and they are more likely to remain in out-of-home care placements than others
• There is mixed evidence around whether disabled children experience more placement disruption than non-disabled children who are looked after
• The evidence that exists is limited, and not much is known about disabled children’s personal accounts of their experiences in out-of-home care
• Of the very few studies that exist, it is suggested that disabled children are more likely to find their care environment more restrictive than other children
• There appears to be a correlation between adoptions at a young age and better outcomes
• Children with mental health needs or behaviour disabilities are less likely to be reunited with their parents and are more likely to experience poorer outcomes in adoptions.