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Systematic Review and Meta-analysis of Policies, Programmes and Interventions that Improve Outcomes for Young People Leaving the Out-of-Home Care System

This systematic review and meta-analysis aims to assess the effectiveness of policies, programmes and interventions which improve outcomes for care leavers transitioning into adult living arrangements.

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Professionals

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Summary

Young people who ‘age-out’ of out-of-home care face increased risks of poor outcomes, including homelessness, unemployment and substance abuse. This systematic review and meta-analysis aims to assess the effectiveness of policies, programmes and interventions which improve outcomes for care leavers transitioning into adult living arrangements. Findings suggest that the evidence base for almost all of the approaches was of poor quality. There is some emerging evidence that extended care policies could be beneficial, however it is too early to recommend a particular approach and more evidence is needed.

Objectives

The primary aim of this review was to assess the available evidence to understand the effects of policies, programmes and interventions that seek to improve outcomes for young people leaving out-of-home care and transitioning into independent living arrangements.

How we went about it

Searches looked for studies that evaluated the effect of any policy, programme or intervention if it targeted, and was provided to, young people (aged 16 – 25) who had been in out-of-home care due to concerns about child maltreatment and who were leaving care and entering independent living arrangements. Study designs needed to be either randomised controlled trials or quasi-experimental designs. 

Searches were carried out using eleven databases as well as expert contacts, websites and tracing citations from previously identified documents.

Key findings

Sixteen studies (reported in 25 papers) were eligible for inclusion in the review. Of these, eight were randomised controlled trials (RCTs) and eight were quasi-experimental design (QED) studies with parallel cohorts. Fifteen studies were conducted in the United States, and one study in Australia.

Study quality
A review of the quality of included studies concluded that for all studies there were significant concerns over the ways in which they were carried out. Therefore, there is low certainty of evidence for the included studies in this review. This suggests caution should be used when interpreting findings.

Transition support programmes
Coaching and peer support programmes were found to have a medium sized (some positive) impact on educational attainment. However, there are some concerns about the risk of bias in both of the included studies in this analysis, and the certainty we have in this evidence is therefore very low.

Independent living services, on their own, are unlikely to improve outcomes for care leavers. It may be the case that they are beneficial when combined with other support services, but they appear to be insufficient on their own.

Extended care policies
There is limited but emerging evidence that extending care can improve outcomes across a number of domains. However, more research is required to increase certainty and to better describe which aspects of extending care and its implementation work for which young people. Therefore, it is too early to recommend a particular approach. 

Cost effectiveness
One study of extended care policies included a cost-benefit analysis which suggested that the benefits significantly outweigh the costs of providing additional care.

Implications

The review concludes that the effectiveness of policies, programmes and interventions for young people leaving care remain insufficient to draw conclusions about the effectiveness of any approach. 

There were suggestions that decision-makers in policy and practice need to work towards improving the quality of policies, programmes and interventions targeting young people leaving care and services as usual. There were suggestions for research to test the feasibility and effectiveness of different implementation strategies to support the use of transition interventions.

Next steps / What next?

Research in this area is reaching a tipping point in terms of the number of rigorous studies available to do more complex synthesis. More rigorous effectiveness research is required, particularly with populations of care leavers in countries other than the United States. 

Rigorous exploration of different combinations of services, delivered in different ways, may go a long way toward meeting the complex needs of young people as they transition from state care.