Longitudinal mental health trajectories of children growing up in State care in England: An exploration of patterns and influencing factors

Lead Research Organisation: University of Bristol
Department Name: Sch for Policy Studies

Abstract

Children in care constitute a most vulnerable group of children in the society. The aim of this study is to contribute to our understanding of how mental health of children in care varies over time and to explore how these patterns of mental health are influenced by care experiences, individual factors and school related factors over time.

At any given time in England, there are around 70,000 children being looked after by the State (also referred to as 'children in care'). More than 60% of these children are taken into State care due to experiences of severe maltreatment such as abuse or neglect. Consequently, being taken into care is an 'intervention' for this vulnerable group of children, with the expectation that State care will then ameliorate or at least stabilise their mental health. Despite this, numerous research studies indicate that mental concerns in this vulnerable child population is high, with 50% of children in State care having a diagnosable mental health concern, when compared to 10% of children in the general population. Despite the evidence of high prevalence of mental health need shown by this group of children, there is a dearth of knowledge on the longitudinal patterns of mental health of children in care in England.

This project, which maps on to the ESRC strategic priority area of mental health, aims to fill this gap in knowledge through: (1) secondary analyses of longitudinal, national-level administrative data on children in care and (2) a survey of children in care in 15 local authorities, which will provide supplementary data to enable analyses of how children's characteristics, school and care related factors influence the mental health patterns of children in care.

Apart from the use of secondary data, the study's main innovation will be to use statistical modelling techniques known as latent trajectory models. Use of advanced statistical methods such as these have been signposted as lacking in social work research by the ESRC Strategic Adviser for Social Work and Social Care Research, with recent reviews indicating that only a very small proportion of social work research studies currently use advanced quantitative methodologies.

The study will benefit from the continuous involvement of and collaboration with a range of stakeholders through the establishment of both a 'stakeholder' advisory group (policy makers, practitioners, academics, charities and other organisations such as the Children's Commissioner) as well as a 'children in care' participation group at the outset of the project. The 'children in care' participation group will be directly involved in creating the survey for children in care and in designing feedback reports that will be sent to all children in care in the participating local authorities. Additionally, the research team will work directly with the management and practitioners of the 15 local authorities to feedback the results and organise peer-learning activities to facilitate changes to local policy and practices pertaining to the assessment of and provision for mental health services for children in care.

In recent years, there has been renewed recognition of the mental health needs of children and young people, aided by a significant push by the UK Government to provide more streamlined support for children and young people with mental health needs. New and timely information from this study on the specific groups of children in State care who are most at risk for mental illness and the factors that positively/negatively influence mental health outcomes would enable policy makers, practitioners and other organisations who champion children's mental health to better inform policy formation, policy implementation and effective resource allocation for children in care, who will be the ultimate beneficiaries of this research.

Planned Impact

This research will generate new academic, political and public knowledge and understanding on the longitudinal mental health patterns of children in care and whether and how different contextual factors influence their mental health over time. This new evidence base has the potential to impact policies regarding mental health service provision for children in care at local and national level in England. Disaggregated analyses of patterns, risks and protective factors of mental health at local authority level will be made freely available on the, online 'Mental Health Profiler', which will provide a starting point for the Department for Education and local authorities to understand differing local practices that may lead to variation in outcomes over time. It will also provide an evidence base for local authorities and policy makers to better target the most vulnerable and at-risk groups of children whilst facilitating policy formation, implementation and effective resource allocation to improve the mental health standards for all children in care. This research also aims to raise the profile of this vulnerable group of children and harness political will to change policy and practice regarding how the mental health needs of these children are assessed and addressed.

The research output, in terms of identifying the groups of children most at risk will be useful for social work decision making. It will also benefit looked after children's nurses, medical advisers, GPs, Child and Adolescent Mental Health Service (CAMHS) teams, Children and Family Court Advisory and Support Service (CAFCASS) and educational services in terms of signposting children who may be most in need of their support.

The evidence will be of further use and interest to stakeholders such as third sector organisations that lobby for changes and those campaigning for children's rights (e.g. Children's Commissioner, Become, NSPCC, CoramVoice, YoungMinds, Children and Young People's Mental Health Coalition, Care Leavers' Association). The establishment of the stakeholder advisory group and the 'children in care' participation group at the outset of the project will enable the research to act as a conduit to collaborative work and debate between various stakeholders (including children in care, policymakers at various levels, third sector organisations, academics, and practitioners).

The direct collaborative feedback loop established with the 15 local authorities participating in the survey will provide information at local authority level. This would allow management teams, professionals and practitioners within local authorities to better target the vulnerable groups of children through the formation of new policies and practices. The planned peer learning seminar, which will bring the 15 local authorities together, will facilitate sharing of good practice and new ways of working.

The survey will be given free of charge to the local authorities, to enable monitoring of children's mental health outcomes in the long-term. If the local authority response is positive, further funding will be sought to enable evaluation of the impact of local changes on the mental health of children.

The UK Government has pledged to address the policies and gaps in service provision for children's mental health. Thus, the results of this study on protective factors and 'what works' over the long-term in facilitating better mental health for children in care will be of significant use to policy makers to facilitate this goal. It is hoped that through harnessing political will to change policy and practices on how mental health needs of children in care are addressed, the project in the longer term can lead to better mental health for more children in care, thus decreasing the high prevalence of mental health concerns in this population.

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