A Data-Linked Approach to Revealing out-of-Home Placement Policy: Analyzing out-of-Home Placements and Adverse Childhood Experiences

Objectives

Out-of-home placement (OHP) policies in Israel mirror those of Eastern European nations, where congregate residential care predominates, a stark contrast to the family-based foster care model favoured in English-speaking countries such as the United States, the United Kingdom, and Australia. Paradoxically, Israel's broader social welfare infrastructure closely parallels these Western liberal democracies, yet its child welfare system persists in privileging institutional over family-based care. This divergence raises fundamental questions about whose interests placement systems serve and whether current practices align with children's developmental needs and rights. This study presents a comprehensive, population-level analysis of nearly one million children who experienced OHP in Israel over a twenty-year period, examining placement type distributions, Adverse Childhood Experiences (ACEs) profiles, and the demographic and adversity-related factors associated with child protection decision-making.

Methods

Using administrative data linkage, we analyzed a dataset of N = 1,234,899 individuals spanning all ethnic and religious groups in Israel. The integrated dataset draws from birth and civil registration records, welfare services, tax authority data, educational system records, and civil service files. Features were engineered at the child, family, and service levels, including ACEs derived directly from welfare records and inferred from registry and other authorities’ data. OHP types were comprehensively categorized: residential care facilities, foster families, group homes, and juvenile correctional hostels, and associations between placement type, child age, and adversity profiles were examined using descriptive and inferential methods.

Findings

Findings reveal a system overwhelmingly reliant on residential care (86.22%), with only 8.68% of children placed in foster families. Placement decisions are strongly age-patterned: younger children (mean age 10.6 years) are more likely to enter foster care, adolescents (mean age 14.2) are predominantly placed in residential settings, and older youth (mean age 16) are concentrated in juvenile hostels. Children in foster care carry the highest average ACE burden (1.66 ACEs), compared to hostel residents (1.55) and those in residential care (1.46). Paradoxically, children with higher ACE counts are progressively less likely to be placed in foster care, the setting with the greatest evidence of effectiveness for high-need youth. Poverty is the most prevalent ACE (24.11%), frequently co-occurring with maternal violence exposure and parental loss. A substantial proportion of children across all placement types have no recorded ACEs, suggesting that factors beyond measurable adversity, including systemic bias, resource constraints, and institutional inertia, shape removal and placement decisions.

Conclusions

Israel's child welfare system reflects a historically entrenched reliance on institutional care that operates in tension with international evidence and children's rights frameworks. Age and ACE profiles significantly predict placement type, yet the inverse relationship between adversity burden and foster care placement raises pressing equity concerns. The concentration of poverty-affected children in residential care rather than family-based settings underscores the need to disentangle economic hardship from child maltreatment in policy and practice. These findings call for evidence-informed reform that prioritizes family-based care, strengthens placement-matching processes, and advances social justice for vulnerable children, all imperatives at the heart of transformative social work science.