Foster care, residential care and public care placement patterns are associated with adult life trajectories: population-based cohort study

Childhood experiences of public care may be associated with adult psychosocial outcomes. This study aimed to evaluate the
associations of four public care exposures: type of placement, length of placement, age at admission to care and number of
placements, as well as the reasons for admission to public care with emotional and behavioural traits at age 30 years.

Participants included 10,895 respondents at the age 30 survey of the 1970 British Cohort Study (BCS70) who were not adopted
and whose care history was known. Analyses were adjusted for individual, parental and family characteristics in childhood.

Cohort members with a public care experience presented lower childhood family socio-economic status compared with those in
the no public care group. After adjusting for confounding, exposure to both foster and residential care, longer placements
and multiple placements were associated with more extensive adult emotional and behavioural difficulties. Specifically, residential
care was associated with increased risk of adult criminal convictions (OR = 3.09, 95% CI: 2.10–4.55) and depression (1.81,
1.23–2.68). Multiple placements were associated with low self-efficacy in adulthood (OR = 3.57, 95% CI: 2.29, 5.56). Admission
to care after the age of 10 was associated with increased adult criminal convictions (OR = 6.03, 95% CI: 3.34–10.90) and smoking
(OR = 3.32, 95% CI: 1.97–5.58).

Adult outcomes of childhood public care reflect differences in children’s experience of public care. Older age at admission,
multiple care placements and residential care may be associated with worse outcomes.