Educational and health outcomes of schoolchildren in local authority care in Scotland: A retrospective record linkage study.
Educational and health outcomes of schoolchildren in local authority care in Scotland: A retrospective record linkage study.
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DOI：
10.1371/journal.pmed.1003832
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发表时间：
2021-11
期刊：
影响因子：
15.8
通讯作者：
Pell JP
中科院分区：
文献类型：
--
作者：
Fleming M;McLay JS;Clark D;King A;Mackay DF;Minnis H;Pell JP
被照顾的儿童被定义为由当地政府照顾的儿童。先前的研究报告称，与同龄人相比，被照顾的孩子心理和身体健康状况较差，行为问题更多，自残和死亡率更高。他们也经历了较差的教育成果，但缺乏对后者的全民研究，特别是在英国。教育和卫生具有双向关系；因此，对这两种结果进行双重调查是很重要的。我们的研究旨在比较被照顾儿童与同伴的教育和健康结果，调整了社会人口统计学、母性和合并症混杂因素。9个覆盖苏格兰的数据库，包括处方、住院、分娩记录、死亡证明、年度学生普查、考试、缺课/退学、失业和照顾儿童，提供了2009年至2012年期间715,111名苏格兰学校儿童的回顾性数据（照顾13,898名[1.9%]）。与同龄人相比，13,898名（1.9%）照看的儿童更有可能缺勤（调整发病率比[AIRR] 1.27, 95%可信区间[CI] 1.24至1.30）和被排除（AIRR 4.09, 95%可信区间[CI] 3.86至4.33），有特殊教育需要(SEN；调整优势比[AOR] 3.48, 95% CI 3.35 ~ 3.62)和神经发育多病（AOR 2.45, 95% CI 2.34 ~ 2.57），达到最低水平的学业成就（AOR 5.92, 95% CI 5.17 ~ 6.78），以及毕业后失业（AOR 2.12, 95% CI 1.96 ~ 2.29）。他们更有可能因癫痫（AOR 1.50, 95% CI 1.27至1.78）、注意缺陷多动障碍（ADHD; AOR 3.01, 95% CI 2.76至3.27）和抑郁症（AOR 1.90, 95% CI 1.62至2.22）而需要治疗，因损伤（AHR 1.80, 95% CI 1.69至1.91）和自残（AHR 5.19, 95% CI 4.66至5.78）和过早死亡（AHR 3.21, 95% CI 2.16至4.77）而住院（调整后的风险比[AHR] 1.23, 95% CI 1.62至1.28）。与在家照看的儿童相比，离家照看的儿童旷工率更低（比值比0.35,95% CI 0.33 ~ 0.36），被排斥率更低（比值比0.63,95% CI 0.56 ~ 0.71），失业率更低（比值比0.53,95% CI 0.46 ~ 0.62），学习成绩更好（比值比0.31,95% CI 0.23 ~ 0.40）。因此，在那些被照顾的人中，离家照顾似乎是一个保护性因素，导致更好的教育成果。本研究的主要局限是缺乏关于学龄前或2009年以前的地方当局照料、照料总时间和首次接触社会照料的年龄的数据。与神经发育状况和sen的增加无关，被照顾儿童的健康和教育结果比同龄人差，需要进一步的工作来了解较差的结果是否与进入护理的原因有关，包括虐待和不良儿童事件、神经发育脆弱性或护理系统的特征。在苏格兰的这项记录关联研究中，迈克尔·弗莱明（Michael Fleming）和他的同事们将当地政府照顾的儿童的教育和健康结果与同龄人的结果进行了比较。被照顾的儿童，定义为由地方当局照料的儿童，是一个弱势群体，与同龄人相比，其教育和健康结果较差。在英国只进行了几项小样本研究，最近的一项系统审查报告称，迫切需要对接受社会照顾服务的儿童的教育成果进行更多的全民研究。据我们所知，之前没有英国研究使用未经选择的全国队列对被照顾儿童的教育和健康结果进行双重调查。我们将9个苏格兰范围内的数据库连接起来，比较被照顾儿童与同龄人的教育和健康结果，调整社会人口统计学、母性和合并症混杂因素。照看儿童的儿童旷课和被排斥的风险增加；特殊教育需要（SEN）；学习成绩差；失业;住院和死亡率；以及癫痫、注意缺陷多动障碍（ADHD）、抑郁症和神经发育多病的治疗。在接受照顾的儿童中，离家照顾的儿童缺勤率较低，受排斥程度较低，失业率较低，学习成绩较好。与神经发育状况和sen的增加无关，被照顾的儿童的健康和教育结果比同龄人差。在被照顾的儿童中，离家照顾似乎是一个保护性因素，导致更好的教育结果。需要进一步的工作来了解较差的结果是否与进入护理的原因有关，包括虐待和不良儿童事件、神经发育脆弱性或护理系统的特征。
Looked after children are defined as children who are in the care of their local authority. Previous studies have reported that looked after children have poorer mental and physical health, increased behavioural problems, and increased self-harm and mortality compared to peers. They also experience poorer educational outcomes, yet population-wide research into the latter is lacking, particularly in the United Kingdom. Education and health share a bidirectional relationship; therefore, it is important to dually investigate both outcomes. Our study aimed to compare educational and health outcomes for looked after children with peers, adjusting for sociodemographic, maternity, and comorbidity confounders. Linkage of 9 Scotland-wide databases, covering dispensed prescriptions, hospital admissions, maternity records, death certificates, annual pupil census, examinations, school absences/exclusions, unemployment, and looked after children provided retrospective data on 715,111 children attending Scottish schools between 2009 and 2012 (13,898 [1.9%] looked after). Compared to peers, 13,898 (1.9%) looked after children were more likely to be absent (adjusted incidence rate ratio [AIRR] 1.27, 95% confidence interval [CI] 1.24 to 1.30) and excluded (AIRR 4.09, 95% CI 3.86 to 4.33) from school, have special educational need (SEN; adjusted odds ratio [AOR] 3.48, 95% CI 3.35 to 3.62) and neurodevelopmental multimorbidity (AOR 2.45, 95% CI 2.34 to 2.57), achieve the lowest level of academic attainment (AOR 5.92, 95% CI 5.17 to 6.78), and be unemployed after leaving school (AOR 2.12, 95% CI 1.96 to 2.29). They were more likely to require treatment for epilepsy (AOR 1.50, 95% CI 1.27 to 1.78), attention deficit hyperactivity disorder (ADHD; AOR 3.01, 95% CI 2.76 to 3.27), and depression (AOR 1.90, 95% CI 1.62 to 2.22), be hospitalised overall (adjusted hazard ratio [AHR] 1.23, 95% CI 1.19 to 1.28) for injury (AHR 1.80, 95% CI 1.69 to 1.91) and self-harm (AHR 5.19, 95% CI 4.66 to 5.78), and die prematurely (AHR 3.21, 95% CI 2.16 to 4.77). Compared to children looked after at home, children looked after away from home had less absenteeism (AIRR 0.35, 95% CI 0.33 to 0.36), less exclusion (AIRR 0.63, 95% CI 0.56 to 0.71), less unemployment (AOR 0.53, 95% CI 0.46 to 0.62), and better attainment (AIRR 0.31, 95% CI 0.23 to 0.40). Therefore, among those in care, being cared for away from home appeared to be a protective factor resulting in better educational outcomes. The main limitations of this study were lack of data on local authority care preschool or before 2009, total time spent in care, and age of first contact with social care. Looked after children had poorer health and educational outcomes than peers independent of increased neurodevelopmental conditions and SEN. Further work is required to understand whether poorer outcomes relate to reasons for entering care, including maltreatment and adverse childhood events, neurodevelopmental vulnerabilities, or characteristics of the care system. In this record-linkage study in Scotland, Michael Fleming and colleagues compare educational and health outcomes for children who are in the care of their local authority with the outcomes of their peers. Looked after children, defined as children placed in the care of their local authority, comprise a vulnerable cohort exhibiting poorer educational and health outcomes compared to peers. Only a few small sample studies have been conducted in the UK, and a recent systematic review reported an urgent need for more population-wide research into the educational outcomes of children placed in social care services. To our knowledge, no previous UK studies have dually investigated educational and health outcomes of looked after children compared to peers using an unselected, nationwide cohort. We linked together 9 Scotland-wide databases to compare educational and health outcomes of looked after children against peers, adjusting for sociodemographic, maternity, and comorbidity confounders. Looked after children had increased risk of school absenteeism and exclusion; special educational need (SEN); poor academic attainment; unemployment; hospitalisation and mortality; and treatment for epilepsy, attention deficit hyperactivity disorder (ADHD), depression, and neurodevelopmental multimorbidity. Among children in care, those looked after away from home had less absenteeism, less exclusion, less unemployment, and better attainment. Looked after children had poorer health and educational outcomes than peers independent of increased neurodevelopmental conditions and SEN. Among those in care, being cared for away from home appeared to be a protective factor resulting in better educational outcomes. Further work is required to understand whether poorer outcomes relate to reasons for entering care, including maltreatment and adverse childhood events, neurodevelopmental vulnerabilities, or characteristics of the care system.
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影响因子：
7.7
作者：
Fleming M;Fitton CA;Steiner MFC;McLay JS;Clark D;King A;Mackay DF;Pell JP
通讯作者：
Pell JP
影响因子：
3.3
作者：
Benbenishty, Rami;Siegel, Alana;Astor, Ron Avi
通讯作者：
Astor, Ron Avi
影响因子：
--
作者：
Kalland, M;Pensola, TH;Sinkkonen, J
通讯作者：
Sinkkonen, J
影响因子：
10.5
作者：
Ford, Tamsin;Vostanis, Panos;Goodman, Robert
通讯作者：
Goodman, Robert
影响因子：
5.2
作者：
Martin, Alice;Ford, Tamsin;Logan, Stuart
通讯作者：
Logan, Stuart