The outcome of institutional youth care compared to non-institutional youth care for children of primary school age and early adolescence A multi-level meta-analysis

Objective: The outcome of institutional youth care for children is heavily debated. This multilevel meta-analysis aims to address the outcome of institutional youth care compared to non-institutional youth care for children of primary school age and early adolescence in economically developed countries. A gain of knowledge in this area may help the decision for referral of children to institutional youth care or other types of care (e.g., foster care or community-based care), and improve outcomes for children in youth care.
Methods: Of 19 controlled studies (15.526 participants), 63 effect sizes of behaviour problems (externalizing, internalizing, and total), skills (social and cognitive) and delinquency were computed based on comparisons between institutional Evidence-Based Treatment (EBT), institutional Care As Usual (CAU), non-institutional EBT, and non-institutional CAU.
Results: Institutional CAU showed a small-to-medium negative significant effect compared to non-institutional CAU (d = −0.342). Furthermore, children in institutional care showed slightly more delinquent behaviour compared to children in non-institutional care (d = −0.329). Significant moderating effects were also found for study design, year of publication and sex of the child.
Conclusions: Children receiving non-institutional CAU (mostly foster care) had slightly better outcomes than children in institutional CAU (regular group care). No differences were found between institutional and noninstitutional care when institutional treatment was evidence-based. More research is needed on the conditions that make established treatment methods work in institutional care for (young) children.