The shaping of mental health and the mechanisms leading to (un)successful transitions for care-experienced young people

One in 30 UK children are taken into care before their 18th birthday and placed with foster carers, in residential care, or are adopted. Children who are removed from their families are a very vulnerable group. Many have experienced abuse and other difficulties, such as seeing violence and drug use. Once in care, they are often separated from brothers and sisters and live with many different carers. We know that these experiences can have a big effect on young people, that lasts long into their adult life. Compared to other young people, those who have been in care are five times more likely to have a mental health problem, like anxiety or depression. They are also more likely to be excluded from school, be exploited, and during adulthood have higher rates of not having a job and being homeless. Care-experienced young people are also twice as likely to die early, particularly by suicide. But, these types of outcomes do not have to be so common - some young people flourish in care or after adoption. We know little about why some young people struggle with mental health difficulties, while others struggle less, and others do well. Our project addresses this gap and will provide important information that can be used to improve the lives of this group.

The aim of our research is to learn what processes are linked to the mental health of care-experienced young people and how they manage at two key periods ('transitions'). These are: moving from primary into secondary school and moving into adulthood. Specifically, we are interested in understanding the role of: (a) pre-care experiences (what they experienced before they came in to care); (b) service-level issues (e.g., their experiences in care and in school); and (c) individual psychological and social processes (e.g., how they see themselves and others, manage emotions, and their feelings about support from friends and at home). If we can understand what processes are important and what they mean for these young peoples' wellbeing, we can help social workers, teachers, and mental health workers better identify those who might need help, and design better prevention and intervention programmes. More effective support could enable young people in care to feel better about themselves and reach their full potential.

We will complete three studies in four years. In one, we will link national data in England and Wales on 14,000 care-experienced young people. Using data on care histories, mental health, and school, this study will help us to understand what 'successful' and 'unsuccessful' transitions look like, and what factors are linked with successful transitions through to adulthood. In two further studies we will identify the role of service-level and psychological processes that are thought to shape mental health and transition 'success'. To do this we will recruit two groups, each of 300 young people. One group will be ages 10-13 (moving into secondary school) and one will be ages 17-18 (moving into early adulthood). They will answer questions twice, 1-year apart. We will also talk twice to 30 children (10-11yrs) and 30 young people (17-18yrs) and their caregiver, to learn more about their hopes and worries before and after the move, and the support they received and would have liked.

We are researchers from social policy, psychology, social work, education, and medicine supported by leading charities: Adoption UK and Coram Voice. Three panels of care-experienced young people (11-14yrs; 17-25yrs) and adopted young people (13-21yrs) will contribute to every stage of the research. We will also offer work experience in our universities to at least four care-experienced young people. Alongside care experienced young people and our partners, we will share our findings widely via articles, blogs, interviews, academic papers, and workshops with services, foster carers and adoptive parents, and policy makers such as the Department for Education.

Care-experienced young people (CEYP) have often experienced maltreatment and there is robust evidence of high rates of mental health difficulties in this group. The failure to adequately address the mental health of CEYP is considered a key driver of a range of poor outcomes across the lifespan, including the high rates of school exclusion, unemployment and homelessness. Despite knowledge of the scale of the problem there remains a dearth of the high-quality empirical evidence necessary to address it, particularly via identifying mechanisms that may drive risk or resilient outcomes. Our mixed method cross-discipline research programme addresses this, via a series of linked ambitious research studies that will provide the most robust evidence to-date on key drivers of the mental health and broader wellbeing of CEYP. Our programme focuses on disentangling the role of pre-care experiences, social-care and education experiences, and individual psychological and social processes (e.g., threat biases, perceived support). This is not just in relation to the transdiagnostic mental health of CEYP, but also their wellbeing at two key times: the transition i) from primary into secondary school and ii) from adolescence into early adulthood. These are two crucial points of vulnerability for CEYP, where deteriorations in mental health and relationship breakdowns are common. To disentangle drivers of outcomes at these complex periods of time our programme includes i) a large administrative data linkage study combining data on education, mental health, and social care in England and Wales, ii) two theory-driven longitudinal quantitative studies targeting our two transitions, and iii) two longitudinal qualitative studies focused on these same periods that allow for particularly in-depth understanding of the experiences of CEYP. Output from the programme provides the essential high-quality evidence for informing cross-sector evidence-informed prevention and intervention programme(s).