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

2015年，北爱尔兰约5.5%的年轻人（0-18岁）作为有需要的儿童接受社会服务（n=23,834），其中2,875人由卫生和社会保健信托基金照顾（“被照顾”的儿童）。北爱尔兰的“被照顾”人口正在增加，2002年至2014年期间增加了31%，尽管年轻人总人口减少了2.9%。此外，北爱尔兰正在经历一场心理健康危机，人口中心理健康状况不佳的发生率达到有史以来最高水平，自杀率也达到英国最高水平。心理健康是一个主要问题，一半由社会服务机构“照顾”的儿童报告有某种形式的心理健康问题，而没有得到照顾的儿童只有10%。但是很少有人知道这些孩子离开社会服务机构后会发生什么。这一点很重要，因为儿童时期的精神健康状况不佳不仅会导致成年后的精神健康状况不佳，还会导致身体健康问题、就业问题、经济问题和关系破裂。至关重要的是要了解谁面临的风险最大，以便决策者能够有针对性地采取干预措施，减少儿童心理健康困难，从而减少不良的成人健康和社会后果。然而，涉及社会服务机构认识的儿童（包括“照顾”儿童、有需要的儿童和儿童保护登记册上的儿童）的研究是困难的，因为他们流动性高，难以获得父母或知情同意。研究成人的结果需要长期的随访，这需要花费大量的时间和金钱。一些现有的纵向研究试图研究社会服务机构已知的儿童的成年结果，但在他们的研究中只有非常小的样本，关于个人为什么进入护理的信息有限。其他基于调查的研究要求成年人回忆他们小时候的社会服务经历，但这些可能存在一系列错误。大规模的纵向研究，详细了解进入护理的情况，安置类型和持续时间，以及离开护理后的健康和社会结果，对于了解哪些人心理健康状况不佳的风险较高，哪些人在困难的环境中表现出适应力和繁荣至关重要。北爱尔兰在联合王国是独一无二的，因为它有一个综合的卫生和社会保健系统，因此集中保存了1985年以来社会服务部门已知的所有个人的数据，为研究长期结果提供了最佳环境。该项目将利用30年来与人口普查报表、药物数据和死亡记录相关的去识别社会服务数据，创建英国第一个历史的、全人口的队列，研究社会服务机构已知的儿童的长期社会和心理健康结果。该研究将与北爱尔兰行政数据研究中心合作，该中心是英国四个此类中心之一，将使数据匿名并将其保存在安全的数据环境中。这个项目代表了在英国进行的最雄心勃勃的记录链接研究之一，因此我将与赫尔辛基大学的一个世界知名的斯堪的纳维亚团队合作，他们在大规模基于登记册的研究方面拥有丰富的经验，可以提供有关数据复杂性和分析方法的帮助和建议。该项目也将提供一个重要的培训机会，发展我在大规模数据分析方面的技能。基本上，这项研究将使用现有的行政数据，并将其联系起来，以更好地了解社会服务机构已知的儿童的长期心理健康和社会轨迹。这项研究将指出成人心理健康和社会结果好坏的潜在预测因素，可用于将资源和干预措施定向到最需要帮助的人身上。

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.