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

2015年，北方爱尔兰约有5.5%的年轻人（0-18岁）被社会服务机构称为有需要的儿童（n= 23，834），其中2，875人由健康和社会护理信托基金（“照顾”儿童）照顾。北方爱尔兰“被照顾”的人口正在增加，2002年至2014年期间增加了31%，尽管年轻人的总人口减少了2.9%。此外，北方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患病率是有史以来最高的，自杀率也是英国最高的。心理健康是一个主要问题，一半的儿童“照顾”的社会服务报告某种形式的心理健康困难相比，只有10%没有照顾。但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，因为儿童时期的心理健康状况不佳不仅会导致成年后的心理健康状况不佳，还会导致身体健康问题、就业问题、经济问题和关系破裂。了解谁的风险最大至关重要，因此政策制定者可以有针对性地采取干预措施，减少儿童心理健康问题，从而减少不良的成人健康和社会后果。然而，涉及社会服务机构所了解的儿童（包括“被照顾”的儿童、需要帮助的儿童和儿童保护登记册上的儿童）的研究很困难，因为他们流动性很大，而且难以获得父母或知情同意。研究成人的结果将涉及长期的随访，这需要大量的时间和金钱。一些现有的纵向研究试图研究社会服务机构所知的儿童的成人结局，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，但这些经历可能会出现一系列错误。大规模的纵向研究，详细信息的情况下进入护理，安置类型和持续时间，以及离开护理后的健康和社会成果是至关重要的，以了解哪些人是在一个高风险的不良心理健康结果，哪些人表现出弹性和繁荣在困难的情况。北方爱尔兰在联合王国内是独一无二的，因为它有一个综合的卫生和社会保健系统，因此集中保存自1985年以来所有社会服务已知的个人的数据，为长期结果的研究提供了最佳环境。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性的人口队列，研究社会服务已知儿童的长期社会和心理健康结果。该研究将与北方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，他们将使数据匿名并将其保存在安全的数据环境中。该项目代表了在英国进行的最雄心勃勃的记录关联研究之一，因此我将与来自赫尔辛基大学的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的研究方面拥有丰富的经验，可以提供数据复杂性和分析方法方面的帮助和建议。该项目还将提供一个重要的培训机会，培养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所知儿童的长期心理健康和社会轨迹。该研究将指出不良和良好的成人心理健康和社会结果的潜在预测因素，这些因素可用于将资源和干预措施用于最需要的人。

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.