Is It Enough? A Comparative Examination of 'Care Leaver's' Health Trajectories in Scotland and Ontario

Children placed in State care, either voluntarily or through legal orders, experience numerous challenges upon leaving care that include - but are not limited to - a lack of supportive housing and potential homelessness (Dixon 2008; Randall 1988, 1989), lower educational attainment and occupational status (O'Sullivan and Westerman 2007; Day et al. 2012), and greater likelihood of experiencing poverty (Tarren-Sweeney 2008; Dixon et al. 2006; Saunders and Broad 1997). These adverse outcomes - which are interrelated - shape children's present and future health status (Dixon 2008). Those in and leaving care are more likely to experience adverse physical and mental health outcomes such as premature mortality, drug abuse, depression, and anxiety (Akister et al. 2010; Hjern et al. 2004; Kerker and Dore 2006; Meltzer et al. 2003; National Audit Office 2015; Pilowsky and Wu 2006; Tarren-Sweeney 2008; Tine and Mette 2009). While some of this may be due to the characteristics of those entering care, as 6% of children with disabilities are located within care facilities (Gordon et al. 2000), most of this can be attributed to their exposure to social disadvantage and isolation prior to, during, and after leaving care.
Whilst there exists a significant body of research illuminating the precarious position of this population of care experienced young adults, it fails to situate them within a wider public policy environment (Power and Raphael 2017). Current models linking care experience to later outcomes generally focus on individual behaviours/characteristics, the consolidation of positive identities though the development of supportive networks, and the effects of specific social policies germane to this group. Whilst informative, these models neglect key environmental and contextual factors that shape the living and working conditions of this vulnerable population. Accordingly, there is a need to revaluate existing models and insights which examine the poor health trajectories of those in and leaving care.
Within their evaluation of poor health trajectories amongst young people in and leaving care, Power and Raphael (2017) incorporate insights from existing literature into a model that illuminates the implications of contextual characteristics on care leaver's health (Figure 1). This holistic model incorporates individual mechanisms, family and local area characteristics, social determinants of health, the public policy environment, and macro-structural concepts associated with power distribution. It incorporates a pathway model to show how stages in the life course interact with these factors to shape care leavers health.
This project shall be a comparative of two policy environments: Edinburgh, Scotland and Toronto, Canada. The rationale for this is that the political economy of health literature groups these countries together under the banner 'liberal welfare state' (Esping-Andersen 1990, 1999). Whilst useful, this model fails to acknowledge complexity within these jurisdictions. Moreover, the role of devolutionary politics in Scotland and the federal system in Canada makes these interesting case studies. For while both have a level of autonomy in constructing social policies, the economic dominance of Westminster and Ottawa can be restricting.
The proposed research project shall utilize a two-tier methodological approach that will reflect the model developed by Power and Raphael. The first stage will be a demographic profile survey alongside a health screening questionnaire (EQ-5D) and the second will be semi-structured, non-standardised interviews. Moreover, the project shall utilize a mixed-methods approach (Brewer and Hunter 2006) which will enable one to (1) illuminate associations between quantified variables and (2) qualitatively contextualize and understand these relations. This consequently has the potential to lead to the development of empirically informed policies that derive from the experiences of care leavers.