In Search of Evidence for Impact on De-Institutionalization: A Systematic Review of the Current Status, Gaps and Future Directions of Translatable Mental Health Research on Alternative Care

ABSTRACT: The transition from institutionalized care to alternative family-based care arrangements for children and youth without available parents is an important policy aim around the world. To document evidence on de-institutionalization (DI) and identify gaps that are stalling the translation of DI findings into policy or practice, we conducted a systematic scoping review of studies on de-institutionalization published in the last five years. Our systematic search identified 221 pertinent studies covering 67 countries across most continents. The majority of the studies were qualitative, used some type of ‘convenience’ sampling, and had a modest number of participants (but with a broad range, 1–5351). Remarkably few studies included children under 6 years of age. Despite small samples and relatively weak designs, the majority of the studies suggested policy implications of their results. We discuss the gaps in DI research, stressing the need for transparency and replicability, paying attention to the specific circumstances of performing DI research. To overcome these gaps, we suggt that DI studies create more replicable evidence with translatable impact for governments, policymakers, sponsors, and practitioners. Vulnerable children and their (alternative) parents deserve family-based DI reform that is sustainable and successful in improving their lives.