Health, Experienced Support and School Performance among Children in Out-of-home care

Rikard Tordön - Linköping University Medical Dissertations


Children in out-of-home care (OHC) have a higher risk for developing poorer health and school achievement, being subjected to more abuse experiences, as well as negative long-term outcomes related to occupational performance, socio-economic status, addiction, and criminality. Research related to children in OHC is fragmented and the effects of interventions are under-studied.

This thesis aimed to explore health, abuse, support, and preconditions for school among children in OHC and to assess changes after an intervention targeting foster children’s school performance.

Paper I compared pupils in OHC in last year high school to non-OHC peers in a national survey with 5 839 pupils. The study showed that risks of abuse and poor mental health are evident for adolescents in out-of-home care. Also, results indicated a lower disclosure rate of sexual abuse, particularly to police or social services.

Paper II compared pupils in OHC to peers in birth parent care by analyzing responses in four consecutive year surveys in a regional sample comprising 23 798 pupils in 8th -year compulsory and 2nd -year high school. Responses from the 311 pupils in OHC showed poorer outcomes than did birth-parent care peers in perceived satisfaction with social life and relations, trust to other persons in different relations, abuse experiences online, and sense of security in the school and at home. These results also applied when compared to a subset of pupils living with a single birth parent.

Paper III analyzed prospective test and questionnaire data of intelligence, adaptive behavior, mathematics, literacy skills, and psychosocial wellbeing from 856 children in foster care. Results revealed poorer preconditions for school performance of between 0.5 and 1.0 standard deviations below age-standardized norms. The analysis also provided results regarding different intelligence domains, where working memory showed the lowest scores while perceptual functioning was close to norms. Boys generally scored poorer than girls except in mathematics.

Paper IV explored the effects of a school-based intervention, Skolfam, on a subset of Paper III cohort (n = 475). Results showed improved skills in higher-order cognitive executive functions such as reading comprehension, sentence chains, mathematics, and intelligence. For less complex cognitive functions, affective functioning or psychosocial symptoms, no improvements were seen, except for reduced hyperactivity.

Conclusion: The studies confirm that children in OHC have poorer mental health, are less satisfied with social life, have more adverse experiences both online and in real life and have poorer preconditions for school performance than do non-OHC peers. Importantly, Skolfam intervention can partially enhance preconditions for school performance. Further studies on longitudinal risk, with a design to identify specific protective factors, development of school-related competencies and ways to support school for children in OHC are needed.