From health assessment to service use: Do children in out-of-home care receive recommended services?

As a response to the substantial health problems and unmet needs among children in out-of-home care, a comprehensive health assessment was piloted in a Norwegian region, as the first of its kind in Norway. The current study is a follow-up of service use among children who received the assessment, designed to investigate the relationship between service recommendations and service contact with six services within the following year. Participants included children (ages 1–17 years) living in out-of-home care, who had received the health assessment ( N = 103, M age = 7.5 years). Baseline data on service recommendations were extracted from assessment reports, while data on service contact was collected through a survey to carers 12 months after the assessment. Bivariate analyses and logistic regression models tested associations between service recommendations and service contact. Results show that for low-threshold services within municipal primary health care, recommendations were associated with service contact (OR 5.0, [1.65–15.19] p = .001). For specialized mental and somatic health care and educational services, no associations between service recommendation and service contact were found. Around 40% of the children had been in contact with recommended specialized mental or physical healthcare services, and educational services at follow-up. The findings illustrate the failure of the existing service systems in meeting the severe health challenges of this high-risk child population. This has implications for assessment practices, child welfare services referral routines and interagency collaboration, and may indicate a need for specialized organizational solutions to provide necessary services to children in out-of-home care.