Preventing children's care entry: an umbrella review of the risks, protective factors, and interventions

Existing reviews have documented a range of factors associated with care entry or re-entry for children, with much less attention given to the intervention literature. In addition, there has been no systematic attempt to bring these two bodies of evidence together. In this overview of systematic reviews we aimed to identify and synthesise evidence on both risk/protective factors and interventions for preventing care entry/re-entry and to identify potential entry points for policy intervention.

We identified systematic reviews related to children's care entry/re-entry, in high-income countries, published since 2013. Selection and data extraction were performed in duplicate, and AMSTAR-2 was used to appraise review quality. We combined findings using narrative synthesis, categorising factors into non-modifiable or modifiable (using the Dahlgren-Whitehead model of health determinants), and linking interventions with these factors where appropriate.

Of the 33 systematic reviews included, 15 focused on risk/protective factors and 18 on interventions. Modifiable factors and related interventions were categorised into individual and lifestyle factors (maternal mental ill-health/substance misuse, child health), social and community factors (social support, child maltreatment), and living and working conditions (socioeconomic and service-level factors). This overview highlighted the multifaceted risk and protective factors associated with children's entry and re-entry into care, and the interacting and cumulative effect of risk factors. Reviews on the effectiveness of interventions reported limited or inconsistent evidence, often due to different study designs (experimental vs observational), small numbers of included primary studies, or the heterogeneity of interventions. Individual programmes rather than structural policies tended to be the focus in reviews, and most programmes were conducted in the US.

Factors associated with care entry/re-entry are multifaceted and involve complex interactions between upstream and downstream drivers. A range of interventions have been evaluated, but robust evaluations of interventions focusing on context-specific policies are needed to better understand and improve outcomes for children and families.