BLOG - Children’s Health in Care in Scotland

This month we are delighted that Dr Mirjam Allik has written a guest blog, describing the journey of accessing administrative data and sharing findings from the latest Children’s Health in Care in Scotland (CHiCS) report.

What is this latest report about?

The CHiCS (Children’s Health in Care in Scotland) project is the first population-wide longitudinal data analysis in the UK that links administrative data on social care, births, deaths, hospitalisations and prescriptions to compare the health of care experienced children with children in the general population. 

We looked at people who were in school in Scotland in 2009/2010 and followed their health backwards to birth and forwards to 2016. For those who had been in care, we also had information on care histories, such as the types and number of care placements and the age at which these took place. This gave us a timeline of events for over 660,000 children, of whom about 13,800 had some experience of care.

We compared the number and type of hospitalisations and prescriptions these children and young people had by sex, age and care experience. All data was deidentified and analysed with strict safety measures. The analysis showed that care experienced people had poorer health outcomes and they were in more contact with the health services. Often differences between those with experiences of care and their peers increased with age.

What was one of the most significant findings?

Our work showed that many of the adverse health events actually occur either before the child enters care or after the young person leaves care and not while the child or young person is receiving formal care. This is a novel and a very important finding in terms of policy. It suggests that poor health may contribute to entering care and much more support could be provided to all families in early childhood, particularly if the child is diagnosed with an underlying health problem, such as a disability, a neurodevelopmental condition, or chronic illness. It also suggests that when young people leave care and start independent life, they do not always have enough skills, experience and support in place to take care of their health and well-being.

What would your key message be to care experienced children who may be reading this?

This is a difficult question, but don’t ever think that you are destined to have certain health, education or income outcomes or that you are less worthy of a healthy, safe and a happy life than any other person. While our research may seem distant, we do it with the aim to improve outcomes for future generations. We encourage you to tell us what you think of our work if you can. When we hear direct feedback from those who are affected by our work, we get a much better sense of what we are getting wrong (or maybe occasionally right) about the relationship between childhood social care and health.

Who was on the advisory group and how did they help the project?

We had a diverse group of people advising us which made us think very hard about what kind of work we wanted to produce. Representatives from The National Society for the Prevention of Cruelty to Children (NSPCC) and Who Cares? Scotland helped us to better understand the language related to children in care and pointed us to a lot of helpful resources to best present our findings.

The Scottish Children’s Reporter Administration (SCRA), Scottish Government and other participants at our knowledge exchange event picked up on issues such as regulations regarding how care is provided and what actually happens when children come into contact with the social service. Again, we lack that close vision of what goes on in day-to-day work.

Insights from Scottish Government were also very important because they could highlight what is useful for them to know when considering future policies. We also received advice from academics with a clinical background which was extremely useful in understanding how difficult it can be for parents to manage the health of their children.

Without all these different perspectives our work would have been so much more limited in its understanding of the real lives behind the numbers in the work we have published.

If you could, what additional data would be most valuable to link to in future?

We are often asked what we know about the family unit and the reasons why a child entered care. Unfortunately, we have to answer, “very little”. More information on fathers, brothers, sisters, or care proceedings would substantially enrich our work but are not currently available.

The dream list is long, not just in terms of additional variables, but also the additional metadata that would make a difference – such as knowledge on the quality and potential biases of administrative data.

What do you hope this report will lead to?

We hope our work adds to what we know about health outcomes among children and young people and how these change from birth to young adulthood, especially for those who have experienced care.

Read the full report here.

This article was published on 08 Dec 2022

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Dr Mirjam Allik