Comparing health outcomes for care experienced children and children in the general population in Scotland using linked administrative data

点击翻译按钮获取中文摘要

Children who are in the care of their local authority (care experienced children, CEC) are one of the most vulnerable groups of people in the society. In 2017 approximately 15,000 children in Scotland were visited by social care workers at home or placed in kinship, residential or foster care. These children often experience disadvantage compared to other young people, such as having to move homes or change schools frequently. Currently, very little is known about the health of CEC or how this compares to other children in Scotland. The small amount of evidence there is suggests that this group of children are more likely to experience poor health, such as worse mental health compared to other children. Our research aims to provide the first national level evidence on the health, pregnancy and mortality rates for CEC in Scotland.Our project links different administrative data sources, such as social care, hospitalisation, birth and death registrations data, for children who were in school and experiencing care in 2009. The care experiences (the type, length and number of placements) and health outcomes for these children will be followed over seven years up to 2016. The health of CEC will then be compared to the health of school children who did not experience care between 2009 and 2016.We will investigate the following research questions:1. Do the health, mortality and pregnancy rates of school-aged CEC differ from the general population of school-age children in Scotland?2. Do the health, mortality and pregnancy rates of school-aged CEC differ from the general population of school-aged children within deprivation categories across Scotland?3. Which care experiences (type, length and the number of social care placements) increase the risks of adverse health outcomes, mortality and pregnancy?4. How do different care experiences interact with deprivation and family socioeconomic status (SES) to affect the risks of adverse health outcomes, mortality and pregnancy?The first two questions provide an understanding of the health of CEC relative to other children. We will look at a wide range of health outcomes (hospitalization rates, the number and type of prescriptions) to identify the ones for which health disparities between the CEC and other children are the greatest. For hospitalizations, prescriptions and mortality we will first look at overall rates, followed by cause-specific analysis that groups the major causes of illness. The main causes of interest are mental-health related outcomes (hospitalization due to self-harm or anti-depressant use) and mortality due to causes that could have been prevented with effective medical treatment (e.g. asthma) or by other interventions (e.g. accidents). If possible, we will also study other major causes of illness, such as respiratory diseases. These outcomes will be analysed by small-area deprivation to see if and to what extent the health disparities are explained by socioeconomic inequalities.After getting a sense of the broad differences between the two populations, questions 3 and 4 will investigate in detail how different care paths, family SES, past health and other factors impact health, mortality and pregnancy rates. These results can say whether children who have frequent changes in care placements experience more health problems or whether children in certain types of placements are more likely to have health problems. This will help identify the location and timing for early interventions among CEC in Scotland.The research results will be published in academic journals, but we will also write a research report for non-academic audiences. This report will present the main findings and is aimed at policy makers, professionals and service providers working with CEC. We will collaborate with the Centre for Excellence for Looked After Children in Scotland to develop the report and present this at a knowledge exchange workshop at the end of the project.