Health of children in out‐of‐home care: Can we do better?

Children in out-of-home care are a vulnerable and at-risk group. The majority has been subject to abuse or neglect necessitating removal from family and placement in a system not always responsive to their needs. It is known that children experiencing abuse and neglect, particularly in their early years when attachment is disordered, have a high incidence of subsequent emotional and behavioural disorders and mental health problems.1–3 These include oppositional defiant disorder, post-traumatic stress disorder and depression. They may progress to have significant problems in adulthood including substance abuse and criminality.4 When these factors are often combined with a lowered developmental trajectory and learning impairment and educational disruption, children in the out-of-home care are often severely disadvantaged for life. Breaking this cycle requires intervention at the earliest possible age. However, for many children access toassistancemaynotoccuruntil a timewhenthere is statutory intervention and entry into care andprotection. It is the responsibility of all government agencies that their ‘care’ is not a euphemism, but the best that can be provided.