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.
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.
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.
Organisations
Publications
| Description | A survey of children in State care in England was carried out as part of this research study. These surveys provided the first insight into the impact of the Covid-19 pandemic on the mental health of children growing up in State care in England, through two surveys carried out during the pandemic, with responses from 1,356 children from 18 Local Authorities in England. Confirming findings from previous research, the results of the two surveys indicated that children and young people in care are significantly more likely to experience mental ill health when compared with those in the general population. Scores on the Strengths and Difficulties Questionnaire showed that of the 11-18-year-old children and young people in care who responded to the survey, 22% in Wave 1 and 24% in Wave 2 were at high risk of experiencing mental ill health. The results of analyses also showed that, controlling for other factors, various individual characteristics and contextual factors were significantly associated with the mental health of children and young people in care. These findings have implications for policy and practice. Promoting placements with siblings and kin: As seen in previous research, the results of the surveys indicate that being placed with siblings and kin generally acts as a protective factor for the mental health of children and young people in care. This supports the current statutory guidance to place children and young people who need a placement in State care with relatives (or friends/other connected persons) and siblings where possible (Section 22, Children Act 1989). Importance of positive relationships: The results also showed that children and young people in care who had positive relationships with their carer(s), friend(s) and social worker(s) were more likely to have better mental health, irrespective of the length of time they had spent in care or the number of previous placements they had had. This highlights the importance of ensuring the continuity, stability, and quality of relationships with key people throughout children and young people's time in care. These results have direct implications for addressing the high prevalence of placement instability and the ongoing high turnover rate of social work staff. It also emphasises the importance of facilitating better matching of foster carers with the children and young people; ensuring that children and young people are supported to settle into new placements and schools; and ensuring the continuity of important relationships when changes in placements or schools are necessary. Optimum contact with social workers: This research also highlights the importance of maintaining optimum contact levels with social workers, which requires stability of the social worker workforce and has direct implications for addressing the current and ongoing high turnover rate of social work staff. It also shows the importance of periodically consulting children and young people on their wishes and feelings about social work contact. Positive school environments: The results from the survey analyses have some implications for school-related practices. Children who have positive feelings about their school were more likely to have better mental health; while, as has been seen in the general population and other research studies, those excluded and those who had been bullied at school were negatively impacted. This has implications for how school exclusions of children in State care are managed and how children and young people who have been bullied are supported. Furthermore, younger adolescents in secondary education were more likely to have mental health difficulties, which might have implications for how children in care are supported (more) during their primary to secondary school transitions. Healthy behaviours: The research findings also highlight the benefits of promoting healthy behaviours for better mental health, such as reducing screen time; not engaging in risky behaviours (smoking, drinking, taking drugs); and having opportunities to develop hobbies. Other risk factors: Complex structural issues around risk factors affect children and young people in care as well as their peers in the general population. This research found that, when all other factors are held constant, girls and children and young people who identified their ethnicity as white were more likely to be at higher risk of mental ill health. This mirrors trends in the general population, where for example, it has been shown girls were more than twice as likely as boys of the same age to experience mental ill health and that children and young people who were white were most likely to experience mental ill health compared to those from all other ethnic groups. Impact of multiple risk factors: Children and young people who are impacted by multiple risk factors identified by this research would be more likely to be at risk of mental ill health than those who are impacted by fewer or no risk factors. This has implications on how these risks are monitored and managed by carers, schools/virtual schools and children's social care teams when assessing and supporting the mental health of children and young people in care. |
| Exploitation Route | This research provided the first insight into the impact of the Covid-19 pandemic on the mental health of children growing up in State care in England, through two surveys carried out during the pandemic, with responses from 1,356 children from 18 Local Authorities in England. As well as a national report, the team produced individualised, local authority-level reports that were shared with the local authorities. Some local authorities have created 'Action Plans' based on the research output ; and some are using the findings to influence decisions being made by the Corporate Parenting Boards on mental health service provision for children and young people in care. The PI continues to train social workers and senior managers in local authorities on how mental health service provision can be improved. The PI was also invited to present the results from the surveys to the team conducting the Independent Review of Children's Social Care in England and the Department for Education Policy and Analyses Teams. The research output was used as evidence in the final report of the National Independent Review of Children's Social Care in England (2022). The research output is therefore useful for national-level policy making as well as local-level and individual social work decision making in terms of signposting children who might be most at risk and in need of additional support and for promoting of protective factors. |
| Sectors | Communities and Social Services/Policy,Healthcare,Government, Democracy and Justice |
| URL | https://mhcat.blogs.bristol.ac.uk/ |
| Description | This research provided the first insight into the impact of the Covid-19 pandemic on the mental health of children growing up in State care in England, through two surveys carried out during the pandemic, with responses from 1,356 children from 18 Local Authorities in England. As well as a national report, the team produced individualised, local authority-level reports that were shared with the local authorities. Some local authorities have created 'Action Plans' based on the research output ; and some are using the findings to influence decisions being made by the Corporate Parenting Boards on mental health service provision for children and young people in care. The PI continues to train social workers and senior managers in local authorities on how mental health service provision can be improved. The PI was also invited to present the results from the surveys to the team conducting the Independent Review of Children's Social Care in England and the Department for Education Policy and Analyses Teams. The research output was used as evidence in the final report of the National Independent Review of Children's Social Care in England (2022). The research output is therefore useful for national-level policy making as well as local-level and individual social work decision making in terms of signposting children who might be most at risk and in need of additional support and for promoting of protective factors. |
| Sector | Communities and Social Services/Policy,Government, Democracy and Justice |
| Impact Types | Societal,Policy & public services |
| Description | National Independent Review of Children's Social Care |
| Geographic Reach | National |
| Policy Influence Type | Citation in other policy documents |
| URL | https://www.gov.uk/government/groups/independent-review-of-childrens-social-care |
| Description | National Independent Review of Children's Social Care |
| Geographic Reach | National |
| Policy Influence Type | Contribution to a national consultation/review |
| URL | https://www.gov.uk/government/groups/independent-review-of-childrens-social-care |
| Description | MH-CAT: A longitudinal survey of the mental health of children in State Care in England through the COVID-19 pandemic |
| Amount | £207,378 (GBP) |
| Funding ID | ES/V015699/1 |
| Organisation | Economic and Social Research Council |
| Sector | Public |
| Country | United Kingdom |
| Start | 11/2020 |
| End | 05/2022 |
| Description | Presentation of findings to local authority managers (ID3) |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Local |
| Primary Audience | Professional Practitioners |
| Results and Impact | As well as a national report, on the mental health of children growing up in State care in England, the team produced individualised, local authority-level reports (where the numbers were sufficient for analyses). The PI also offered training events to all local authorities. This meeting was attended by Local Authority Social Care Team Managers. The managers agreed to cascade the information down to their teams on the importance of monitoring children's mental health. |
| Year(s) Of Engagement Activity | 2021 |
| Description | Presentation to the Corporate Parenting Board (ID2) |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | Local |
| Primary Audience | Policymakers/politicians |
| Results and Impact | As well as a national report, on the mental health of children growing up in State care in England, the team produced individualised, local authority-level reports (where the numbers were sufficient for analyses).Dinithi Wijedasa (PI) presented the findings of the survey at a meeting of the Corporate Parenting Board of the local authority. The Corporate Parenting Board agreed to create a workstream linked to the findings of the survey. |
| Year(s) Of Engagement Activity | 2021 |
| Description | Training of senior local authority managers (1D4) |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Local |
| Primary Audience | Professional Practitioners |
| Results and Impact | As well as a national report, on the mental health of children growing up in State care in England, the team produced individualised, local authority-level reports (where the numbers were sufficient for analyses) that were shared with the local authorities The PI also offered training events to all local authorities. This meeting was attended by Senior Managers in the Children's Social Care Team. They pledged to incorporate the findings on the mental health of children in care towards their strategy to improve socio-emotional and mental health of children looked after by the State.(Study ref ID4). |
| Year(s) Of Engagement Activity | 2021 |
| Description | Training of senior local authority managers and social work staff (ID1) |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | Local |
| Primary Audience | Professional Practitioners |
| Results and Impact | As well as a national report, on the mental health of children growing up in State care in England, the team produced individualised, local authority-level reports (where the numbers were sufficient for analyses). The PI also offered training events to all local authorities. This meeting was attended by the Assistant Director of children's services, IRO (Independent Reviewing Officers), Quality Assurance Team Manager, Assistant Team Managers, Specialist Nurses and social workers. It was discussed that the results of the survey align with their Pledge to improve the mental health of children in care. |
| Year(s) Of Engagement Activity | 2021 |