Childhood interactions with social services and risk of poor health and social outcomes in adulthood: a population wide data linkage study

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In 2015 around 5.5% of young people (aged 0-18 years) in Northern Ireland were known to social services as a child in need (n=23,834), with 2,875 in the care of the Health and Social Care Trusts (a "looked after" child). The "looked after" population in Northern Ireland is increasing, with a 31% increase between 2002 and 2014, despite a total population decrease of young people of 2.9%. In addition, Northern Ireland is experiencing a mental health crisis with the highest ever recorded prevalence of poor mental health in the population and the highest suicide rate in the UK. Mental health is a major concern, and half of children "looked after" by social services report some form of mental health difficulty compared to just 10% not in care. But very little is known as to what happens these children after they leave the care of social services. This is important as poor mental health in childhood can not only lead to poor mental health in adulthood but to physical health problems, employment problems, economic problems and relationship breakdown. It is vital to understand who is most at risk, so policy makers can target interventions to reduce childhood mental health difficulties and thus reduce poor adult health and social outcomes. However, research involving children known to social services (which includes "looked after" children, children in need and children on the child protection register) is difficult due to their high mobility and difficulties surrounding gaining parental or informed consent. To study adult outcomes would involve long-term follow up which takes a lot of time and money. Some existing longitudinal studies have tried to study adult outcomes of children known to social services but only have very small samples within their study with limited information on why the individual entered care. Other survey based studies have asked adults to recall their experiences of social services as children but these are subject to a range of possible errors. Large scale longitudinal studies with detailed information on the circumstances surrounding entry to care, placement type and duration, and health and social outcomes after leaving care are critical to understanding which individuals are at an elevated risk of poor mental health outcomes and which individuals show resilience and prosper in difficult circumstances. Northern Ireland is unique within the UK in that it has an integrated health and social care system, and therefore holds data centrally on all individuals known to social services since 1985, providing an optimal environment for the study of long-term outcomes. This project will utilise 30 years of de-identified social services data linked to Census returns, medication data and death records to create the UKs first historical, population-wide cohort studying the long-term social and mental health outcomes of children known to social services. The research will be in partnership with the Administrative Data Research Centre - Northern Ireland, one of four such centres across the UK, who will make the data anonymous and hold it in their secure data environment. This project represents one of the most ambitious record linkage studies undertaken in the UK and therefore I will be collaborating with a world renowned Scandinavian team from the University of Helsinki who have extensive experience in large scale register based studies and can provide help and advice on data complexity and analytical methods. The project will also provide a significant training opportunity, developing my skills in large scale data analysis.Basically, this study will use already existing administrative data and link it to better understand the long-term mental health and social trajectories of children known to social services. The research will indicate potential predictors of both poor and good adult mental health and social outcomes which could be used to target resources and interventions toward those most in need.