A UK Investigation into the Characteristics and Experiences of Children in Care who Have Experienced Significant Placement Instability

背景于二零二一年，约有102，000名儿童由英国地方当局照顾（NSPCC Learning，二零二一年）。已经发现，受照料的儿童患有一系列精神健康障碍的风险显著升高，包括行为障碍、自杀倾向、重度抑郁症和反应性依恋障碍（Engler等人，2022;福特等人，2007).尽管下议院强调护理“持久性”的重要性（Hiller等人，2022年），许多儿童在不同的安置之间反复移动;在2020年，大约5-10%的儿童在英国照顾有三个或更多的安置在一年（NSPCC学习，2021年）。这种安置不稳定性是严重焦虑和痛苦的来源，被认为是心理健康问题发展和/或复发的因果因素（Rahilly & Hendry，2014; Care Inquiry，2013）迄今为止，安置不稳定性与儿童心理健康状况不良之间的复杂关系尚未得到充分研究。了解经历显著安置不稳定的儿童的定义特征以及安置不稳定与心理健康之间的时间关系至关重要。此外，越来越多的知识周围的服务水平变化的影响，用于支持儿童的方法，频繁的位置变化也可以提供关键的洞察到这个问题。Aims and ObjectivesThe的总体目标，这个博士学位是探索的特点和经验的儿童在照顾谁遭受了显着的安置不稳定。提出了三个主要目标：定量探索（使用线性回归和增长曲线分析）的特点和人口统计（例如，性别、种族、进入照料机构时的年龄、地理区域），以评估处境不稳定的儿童与安置稳定的儿童之间的差异。这将涉及结合来自英格兰成长（GUIE）数据集、威尔士儿童照料数据集和苏格兰政府：儿童照料纵向数据集的数据。事件历史分析和生长曲线分析），以探讨安置变化与儿童获得心理健康服务之间的时间关系。这将有助于探讨三个假设：a）安置变化与后续心理健康服务访问的增加相关，B）心理健康服务访问预测后续安置变化，或c）安置变动与较低的精神健康服务可及性有关。（包括服务水平因素）和从16岁以上有护理经验的个人的角度来看多次安置变化的后果。这将通过进行专题分析来实现（Braun & Clarke，2006）的访谈数据，探讨了安置变化的主观体验，对影响这些变化的因素的看法，减轻或加剧任何相关痛苦的因素，以及对心理健康服务参与的影响。潜在的应用/好处尽管是英国最脆弱的个人之一，围绕受照料儿童的需求，仍然“缺乏集体知识”（英国教育标准局，2022年）。这项研究将确定因素造成的安置不稳定性和阐明安置不稳定性和心理健康状况差之间的关联的潜在基础，具有重要意义的支持儿童在护理接收。定性调查可能会导致建议，以改善管理的位置变化在服务水平。最终，该项目将提供大量的知识，围绕儿童的特点和经验，在英国经历安置不稳定，不良心理健康结果的一个主要风险因素。

ContextIn 2021, approximately 102,000 children were living in the care of UK local authorities (NSPCC Learning, 2021). Children in care have been found to be at a significantly elevated risk for a range of mental health disorders including conduct disorder, suicidality, major depressive disorder, and reactive attachment disorder (Engler et al., 2022; Ford et al., 2007).Despite the House of Commons stressing the importance of 'permanence' in care (Hiller et al., 2022), many children in care repeatedly move between different placements; in 2020, around 5-10% of children in UK care had three or more placements in a single year (NSPCC Learning, 2021). This placement instability is a source of significant anxiety and distress that is assumed to be a causal factor in the development and/or recurrence of mental health problems (Rahilly & Hendry, 2014; Care Inquiry, 2013).To date, the complex relationship between placement instability and poor mental health outcomes for children in care has been underexplored. Understanding the defining characteristics of children who experience significant placement instability and the temporal relationship between placement instability and mental health is crucial. Additionally, increasing knowledge around the impact of service-level variations in the approaches used to support children with frequent placement changes could also provide critical insight into this issue.Aims and ObjectivesThe overall aim of this PhD is to explore the characteristics and experiences of children in care who have suffered from significant placement instability. Three main objectives are proposed:To quantitatively explore (using linear regression and growth curve analysis) the characteristics and demographics (e.g., sex, ethnicity, age at entering care, geographical region) of children in care to assess for differences between those encountering instability and those in stable placements. This will involve combining data from the Growing Up in England (GUIE) Dataset, the Children Looked After Wales Dataset, and the Scottish Government: Looked After Children Longitudinal Dataset.To employ quantitative methods (e.g., event history analysis and growth curve analysis) on the same datasets to explore the temporal relationship between placement changes and children's access to mental health services. This will enable exploration of three hypotheses: a) placement changes are associated with elevated subsequent mental health service access, b) mental health service access predicts subsequent placement changes, or c) placement changes are associated with lower mental health service access.To conduct a qualitative investigation into the causes (including service level factors) and consequences of multiple placement changes from the perspective of care-experienced individuals aged 16+. This will be done through conducting thematic analysis (Braun & Clarke, 2006) on interview data which explores subjective experiences of placement changes, perceptions of factors influencing these changes, factors that mitigate or exacerbate any associated distress, and the implications for mental health service engagement.Potential Applications/BenefitsDespite being among the most vulnerable individuals in the UK, there remains a 'lack of collective knowledge' around the needs of children in care (Ofsted, 2022). This research will identify factors contributing to placement instability and elucidate the potential underpinnings of associations between placement instability and poor mental health, with important implications for the support children in care receive. The qualitative investigation may lead to recommendations for improved management of placement changes at a service level. Ultimately, this project will provide substantial knowledge around the characteristics and experiences of children in the UK experiencing placement instability, a major risk factor for adverse mental health outcomes.