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 | The following key findings and recommendations for policy and practice are based on two national surveys (with responses from 1,356 children in care), a survey of local authority managers (from 10 local authorities) and longitudinal tracking of the mental health of 12,050 children in care over 5 years using national administrative data. More than half of the children and young people in care were at risk for mental ill health. Addressing mental ill-health early and during childhood would enable children to reach their full potential whilst reducing the risk of persistent mental-ill health during adulthood which can affect productivity and long-term financial and socio-emotional outcomes. Placement with kin carers and siblings (where possible) is a protective factor for mental health. There should be an increased awareness in social work practice that female children and those who identify their ethnicity as white are at higher risk of mental ill-health. Contrary to the trend observed in the general population, younger adolescents in care are at a higher risk of experiencing mental health issues during and immediately after the transition to secondary school. We, therefore, recommend specialised support for children in care during the transition to secondary school to enable adjustment to the schools. It is a statutory requirement of the local authorities to evaluate the mental health of children in care annually (primarily based on caregiver reports) if the children and young people have been in care for over a year. This data is returned to the Department for Education as part of the annual statistical returns. Our survey of local authority practice showed that not all local authorities utilise this data to provide mental health support for children. The children and young people responding to our survey further highlighted that timely access to necessary mental health support is not available to all children. Given that mental health is dynamic, a child's mental health needs will fluctuate over time. This underlines the need for ongoing mental health assessments and emphasises the importance of involving children in ongoing discussions about their mental health. Stable and high-quality relationships with foster and other carers, friends, and social workers provide a buffer for mental ill health for children and young people in care. It is therefore important to facilitate and maintain positive and supportive relationships across developmental contexts and across time. This can be mainly addressed through the maintenance of high-quality, stable placements and by ensuring a stable social care workforce. The statutory guidance on fostering and National Minimum Standards emphasise the necessity for foster caregivers to cater to the children's needs at the time of placement. However, there is a lack of continuous evaluation of the quality and success of these relationships over time. In cases where reunification with the birth family is either not successful or not possible, we recommend that the foster carers' ability to meet the child's needs as well as the relationship quality is assessed (via separate consultations with the children and the carers) before confirming a long-term fostering arrangement. This would necessitate further information sharing with and training of the social workers. Our research also highlights the advantages of promoting positive health behaviours for improved mental health. Children and young people who limit the time spent on screens; avoid risky activities like smoking, drinking, and drug use; and those who have opportunities to pursue interests and hobbies have better mental health. Supportive school settings serve as a safeguard against mental ill health and children in care who have a positive attitude towards school tend to have better mental health. However, experiences of bullying and school exclusion can negatively impact their mental health. Our survey revealed that a substantial proportion of children in foster care, up to one-third, have faced either temporary or permanent exclusion from school. Furthermore, almost a quarter of the respondents reported being bullied in the past six months. Schools must take proactive measures to tackle bullying, and the policy of excluding foster children from school needs to be reassessed. |
| Exploitation Route | The research output is 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 output from this research was submitted to the Education Select Committee Inquiry into Children's Social Care (2024) in England and the PI was invited to provide oral evidence to the committee in February 2024. The research output has therefore fed into national-level policy informing/making processes 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 | Cited in OECD Policy Document: Assisting Care Leavers |
| Geographic Reach | Multiple continents/international |
| Policy Influence Type | Citation in other policy documents |
| URL | https://www.oecd-ilibrary.org/social-issues-migration-health/assisting-care-leavers_1939a9ec-en |
| Description | Invited to provide Oral Evidence to the Education Select Committee Inquiry into Children's Social Care |
| Geographic Reach | National |
| Policy Influence Type | Contribution to a national consultation/review |
| URL | https://committees.parliament.uk/event/20796/formal-meeting-oral-evidence-session/ |
| Description | Invited to provide oral evidence: Education Select Committee Inquiry into Children's Social Care |
| Geographic Reach | National |
| Policy Influence Type | Contribution to a national consultation/review |
| URL | https://committees.parliament.uk/event/20796/formal-meeting-oral-evidence-session/ |
| 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 | Written evidence submitted to the Education Select Committee Inquiry into Children's Social Care |
| Geographic Reach | National |
| Policy Influence Type | Contribution to a national consultation/review |
| URL | https://committees.parliament.uk/writtenevidence/127559/pdf/ |
| 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 | 05/2023 |
| Description | Dissemination of findings to a Corporate Parenting Board (ID9) |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| 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).Dinithi Wijedasa (PI) presented the findings of the survey at a meeting of the Corporate Parenting Board of the local authority. Post presentation, there was a discussion about how the results of the survey support the activities in the local authority and how they will continue to support: Placement stability meetings (involving all parties, including VSH, carers. Specific team (Compass team) is there to support relationships. In discussing the importance of sibling relationships, 'Together and apart' assessment to promote contact when when sib placements not possible. School relationships monitored through virtual school heads and PEP (personal educational plans). In terms of health and wellbeing provision, children and young people have access to Kooth; there is a specialist LAC CAMHS worker; there are also plans around what to do with borderline/abnormal scores- currently team managers are involved. Re social worker relationship with children and young people, it is part of the LA pledge to improve this, for example, through 'goodbyes and intros' to new social workers. |
| Year(s) Of Engagement Activity | 2021 |
| Description | Dissemination of findings to the Department for Education Policy and Research Teams |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Policymakers/politicians |
| Results and Impact | Invited by the Department to present the findings from the two surveys of mental health of children in State care to policy and research teams. Event: Department for Education and University of Bristol seminar: Mental health, vulnerabilities and wellbeing in schools. |
| Year(s) Of Engagement Activity | 2021 |
| Description | Invited presentation to the team conducting the National Review of Children's Social Care |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Policymakers/politicians |
| Results and Impact | Invited to present the emerging findings from the survey to the review team. Was asked to share the briefing paper/final report with the review team, which was later cited in the final review report. |
| Year(s) Of Engagement Activity | 2021 |
| Description | Meeting with the Assistant Director of Children's Social Care to discuss how the survey can be used within the local authority to promote mental health of children in State care (ID10) |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| Part Of Official Scheme? | No |
| Geographic Reach | Local |
| Primary Audience | Professional Practitioners |
| Results and Impact | Discussion whether the survey results can be introduced as part of the the reviews of children in State care. This local authority has indicated that they are would like to opt-in to an evaluation to check feasibility of this. Also want to do a workshop with children in care. |
| Year(s) Of Engagement Activity | 2022 |
| Description | National roundtable event: A Spotlight on the Mental Health of Care-experienced Children and Young People: Setting Future Research, Practice and Policy Priorities |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | National |
| Primary Audience | Third sector organisations |
| Results and Impact | The aim of this event was to bring together key stakeholders, policy-makers, managers and senior civil servants for a multi-disciplinary conversation about the pathways for policy and practice changes required to address the mental health of children in care, based on current research evidence. Four other academics researching the mental health of children in care from other Universities (Cambridge, UCL, Sussex, Cardiff) were invited to join a research symposium to deliver a comprehensive review of contemporary evidence in this area, which was followed by a roundtable discussion to set future priorities. The main outcomes of the event were: - facilitating conversation and networking between a varied group of stakeholders. - increased awareness of participants of the latest mental health research evidence. -a briefing paper collating the information gathered during the roundtable discussion (forthcoming). |
| Year(s) Of Engagement Activity | 2023 |
| URL | https://corambaaf.org.uk/updates/spotlight-mental-health-care-experienced-children-and-young-people |
| 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 (ID11) |
| Form Of Engagement Activity | A formal working group, expert panel or dialogue |
| 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).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 | 2022 |
| 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 (1D11) |
| 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. |
| Year(s) Of Engagement Activity | 2022 |
| 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 (1D5) |
| Form Of Engagement Activity | A talk or presentation |
| Part Of Official Scheme? | No |
| Geographic Reach | Local |
| Primary Audience | Patients, carers and/or patient groups |
| 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 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 |