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Podcast series from the MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Ruth Dundas:
Welcome to 15 Minutes on Health Inequalities and a podcast discussing a report that used linked administrative data to understand the health of care experienced children in Scotland. I'm Ruth Dundas from the MRC/CSO Social and Public Health Sciences Unit at the University of Glasgow and with me is
Anna Pearce:
Anna Pearce also from SPHSU and today we're interviewing two of our colleagues.
Mirjam Allik:
Hi, I'm Mirjam Allik and
Edit Gedeon:
Hi, I'm Edit Gedeon.
Ruth Dundas:
Welcome. Why is it important to study the health of care experienced children?
Edit Gedeon:
So what we know is that health inequalities in Scotland are among the largest in Europe and have remained high for a few decades now. This also applies to children and young people who have little influence over the circumstances they live in. And for now there is not a lot of evidence on how childhood social care affects health, but all available work to date has shown that care experienced people have some of the worst physical and mental health and higher mortality compared to their peers. To improve health outcomes for all population groups, the Scottish Government has identified reducing health inequalities as one of its priorities and is currently also taking action to improve the way the care system works. We need more detailed national level evidence from Scotland so that these aims could be achieved and resources and services are allocated to where they are was needed.
Anna Pearce:
Thanks Edit. So can one of you tell us or describe to us the health of care experienced children, and in particular, does it differ across their life stages?
Edit Gedeon:
Yes. So overall, our work shows that children and young people who have experienced care at any point in their life have more contact with health services and worse health outcomes, including more avoidable hospital hospitalizations and higher mortality. This applies to both physical and mental health. For example, care experienced children are more likely to be hospitalised for chronic conditions such as asthma, type one diabetes, epilepsy, but also for depression, severe stress and mental and behavioural disorders related to substance use. For many outcomes, the inequalities in health between the care experienced and general population children increase with age. In the case of mental health, before the age of 12, care experienced children are about two to four times more frequently hospitalised compared to general population children. But this increases to about 8 to 9 times by ages 18 and above.
Ruth Dundas:
They're quite striking, but do these different experiences of care, such as the type of care placement, the length and the number of placements experience also have an effect on health?
Mirjam Allik:
Yeah. So the data allows us to compare health outcomes by the type of care such as whether the child is at home, under a supervision order in kinship, fostering or residential care. When we compared hospitalizations for chronic conditions like asthma, type one diabetes and epilepsy across the different placement types and across the life course, we noticed that hospitalizations often tended to be highest before and after care and were generally much lower while children were in care. Particularly, our analysis suggests that children who are in kinship or foster care do not have more hospitalizations for chronic conditions compared to children who have never been in care. This means that childhood social care, especially kinship and foster placements, can be protective. We also have information on the length of time spent in care and the number of care placements the child has had during their whole care period. But our initial analysis shows that these are not associated with hospitalizations when it comes to chronic conditions.
Anna Pearce:
Thanks. So, were you able to examine social inequalities and health alongside overall health?
Edit Gedeon:
Yes, so, we were able to examine social inequalities in health as the birth records were available for both the general population and the care experienced children. Therefore, we could tell that 59…59% of care experienced children in our study were born into the most deprived areas, compared to 25% of children in the general population. Thanks to data recorded on the people Census, we could also see that by 2009, so by the start of the study, the proportion of care experienced children living in the most deprived areas has decreased, which perhaps reflects being taken into care and moving to less deprived areas following birth. In addition to being born into more deprived areas, our data also shows that the mothers of care experienced children were more likely to be younger and that the parents were more likely to be unemployed compared to the parents of general population children. Looking at the link between deprivation and health outcomes, we observed that it affects differently the general population children and care experienced children. For the general population our data suggests an increase in prevalence of physical and mental health problems as deprivation increases. However, among the care experienced children, in most cases, we did not see any clear pattern. Or as well the case with the prevalence of epilepsy reverse gradient was noted, so deprivation increased the prevalence of epilepsy decreased.
Ruth Dundas:
That's quite an interesting finding. So why do you think that these socioeconomic inequalities in health are not visible in the same way among care experienced children as in the general population?
Mirjam Allik:
Well, socioeconomic disadvantage, while important, is really just one among many social and environmental factors influencing health. It is possible that care experienced children have faced additional challenges, um, in their lives that have had a much more substantial effect on health compared to economic deprivation. However, I'd like to emphasise that it could also be an issue of access to services. Families in the most deprived areas might not be as aware of the different community services and support available to them, or they might be afraid of feeling judged when they reach out for support. And of course, it is equally likely that support services are very oversubscribed, such that help is just simply not received by families in deprived areas. And this all means that the socioeconomic inequalities are there, they're present and potentially quite large. We're just unable to pick them up with the data that we have.
Anna Pearce:
Thanks, Mirjam. Um so the work is clearly really important. Um, how did you go about ensuring that the research questions were going to be as useful as they could be for interested stakeholders? And also how have you gone about maximising the impact of any results that are coming out of the project?
Mirjam Allik:
So, throughout doing this research over the past three years, we've regularly engaged with our advisory group that includes representatives from the Scottish Government, the Scottish Children's Reporter Administration and other organisations such as the National Society for the Prevention of Cruelty to Children and their Centre for Excellence for Children's Care and Protection. We've discussed our work with Who Cares? Scotland and Public Health Scotland and our aim has always been to hear their thoughts and expectations for us and the analysis…analysis that we're doing in terms of what is useful for them to know in planning the future policies and practises and everything that they do. Many of these partners were able to pick up on issues related to regulation of of how care is provided and what actually happens to children when they come to contact with social services. And we ourselves, that lack lack that close vision of what goes on in the day-to-day work. We also received advice from academics with clinical background, which was really useful in understanding how difficult it can be for parents to manage some health conditions in young children. And, last but not least, the advisory group turned our attention to the language we use when talking about children in care. And uh pointed us to a lot of resources to improve our messaging. Overall, we were very lucky to have a diverse, diverse group of people advising us as it made us think very hard about what kind of work we wanted to produce. And having had these different perspectives, means that the work we do is much more useful for the stakeholders involved and who are actually doing the the improving of the lives for the care experienced children and young people on the ground.
Ruth Dundas:
I mean, it's a really interesting sort of research project. You've got some really interesting findings and you've also got a really interested in the project group of stakeholders. So what plans do you have next for the research or what's what's next for this project?
Edit Gedeon:
So, I'm currently developing work into the mental health of care experienced and the general population children, and there are three main questions I'm working on, with the first one looking to answer how physical and mental health, hospitalisation are associated. So, I'm looking to answer what portion of children with physical illnesses, have an overlapping mental health diagnosis. How deprivation affects the results and how results differ between sexes and the general population, and care experienced children. The second question I will try to answer is whether our mental health hospitalizations are preceded by outpatient consultation, prescriptions, or hospitalizations due to poisoning, injuries, including self-harm. If I were to find out that those who are hospitalised have had little prior contact with health services, it could perhaps mean that services are not equally accessible for all and it would be worth like to investigate the reasons for this. And lastly, the third question I will work on is whether the age of entering care and the care histories, meaning the placement lengths, number of placements and type of placements affect mental health hospitalisation.
Mirjam Allik:
Yes. And in addition to all this ongoing work, we have actually recently secured data access to extend the scope and timeframe of the study. As an example, this will allow us to look at completely new outcomes, such as if and how vaccinations, missing doctor's appointments or adhering to medications differ between these two groups of children. And that can tell us if and how treatment adherence um and preventive behaviours can be part of the reason why we see big inequalities in health between care experienced and other children.
Anna Pearce:
Sounds really exciting and important work. So, I think we'll finish up now by asking what are the implications for health inequalities?
Mirjam Allik:
People who have experienced care in childhood have poorer health, and these differences can be very large. That we now know. However, our work suggests that it is not the social care that they receive that produces these differences, and often inequalities are already present at very young ages before entering care. In fact, poor health may contribute to a child entering care. And therefore what our work shows is that all families with young children who have chronic illnesses, neurodevelopmental condition or or other kinds of disabilities are likely to require much more support to manage these conditions and to help keep the families together.
Ruth Dundas:
Thanks very much. Really interesting findings. Really interesting project. And we’d just like to thank both Mirjam and Edit for talking to us today. Details and links about where to find more information about the project, where to find the report and engagement events, together with information about the participants, Mirjam and Edit in this podcast, can be found in the podcast notes. You can also find the rest of the 15 Minutes on Health Inequalities podcast on most major platforms. So thank you for listening.