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

2021年，大约有10.2万名儿童生活在英国地方当局的照顾下（NSPCC Learning， 2021年）。研究发现，受照料的儿童患一系列心理健康障碍的风险显著增加，包括品行障碍、自杀、重度抑郁症和反应性依恋障碍（Engler等人，2022；Ford等人，2007）。尽管下议院强调了“永久性”护理的重要性（Hiller等人，2022），但许多儿童在不同的护理地点之间反复移动；到2020年，大约5-10%的英国儿童在一年内有三个或更多的实习机会（NSPCC Learning， 2021年）。这种安置不稳定是严重焦虑和痛苦的来源，被认为是心理健康问题发展和/或复发的一个因果因素（Rahilly & Hendry, 2014; Care Inquiry, 2013）。迄今为止，安置不稳定与受照料儿童不良心理健康结果之间的复杂关系尚未得到充分探讨。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，增加对服务水平变化的影响的知识，用于支持经常更换安置的儿童，也可以为这个问题提供关键的见解。目的和目标本博士课程的总体目的是探讨那些遭受严重安置不稳定的儿童的特点和经历。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）受照料儿童的特征和人口统计学（例如，性别、种族、进入照料时的年龄、地理区域），以评估遭遇不稳定的儿童和处于稳定安置的儿童之间的差异。这将涉及结合来自英格兰成长数据集（GUIE），儿童照顾威尔士数据集和苏格兰政府：儿童照顾纵向数据集的数据。采用事件历史分析、成长曲线分析等定量方法对同一数据集进行分析，探讨安置变化与儿童心理健康服务可及性的时间关系。这将有助于探索三个假设：a)安置变化与随后心理健康服务获取的增加有关，b)心理健康服务获取预测随后的安置变化，或c)安置变化与较低的心理健康服务获取有关。从16岁以上有护理经历的个体的角度，对多次安置变化的原因（包括服务水平因素）和后果进行定性调查。这将通过对访谈数据进行专题分析（Braun & Clarke, 2006）来完成，这些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/好处尽管他们是英国最弱势的群体之一，但他们仍然“缺乏集体知识”，对受照顾儿童的需求缺乏了解（Ofsted, 2022）。本研究将确定导致安置不稳定的因素，并阐明安置不稳定与不良心理健康之间关联的潜在基础，这对接受照顾的儿童的支持具有重要意义。定性调查可能导致建议，以改善在服务水平的安置变化的管理。最终，该项目将提供关于英国经历安置不稳定的儿童的特征和经历的大量知识，安置不稳定是不良心理健康结果的主要风险因素。

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.