Educational and health outcomes of schoolchildren in local authority care in Scotland: A retrospective record linkage study

Abstract

Background Looked after children are defined as children who are in the care of their local authority. Previous studies have reported that looked after children have poorer mental and physical health, increased behavioural problems, and increased self-harm and mortality compared to peers. They also experience poorer educational outcomes, yet population-wide research into the latter is lacking, particularly in the United Kingdom. Education and health share a bidirectional relationship; therefore, it is important to dually investigate both outcomes. Our study aimed to compare educational and health outcomes for looked after children with peers, adjusting for sociodemographic, maternity, and comorbidity confounders. Methods and findings Linkage of 9 Scotland-wide databases, covering dispensed prescriptions, hospital admissions, maternity records, death certificates, annual pupil census, examinations, school absences/exclusions, unemployment, and looked after children provided retrospective data on 715,111 children attending Scottish schools between 2009 and 2012 (13,898 [1.9%] looked after). Compared to peers, 13,898 (1.9%) looked after children were more likely to be absent (adjusted incidence rate ratio [AIRR] 1.27, 95% confidence interval [CI] 1.24 to 1.30) and excluded (AIRR 4.09, 95% CI 3.86 to 4.33) from school, have special educational need (SEN; adjusted odds ratio [AOR] 3.48, 95% CI 3.35 to 3.62) and neurodevelopmental multimorbidity (AOR 2.45, 95% CI 2.34 to 2.57), achieve the lowest level of academic attainment (AOR 5.92, 95% CI 5.17 to 6.78), and be unemployed after leaving school (AOR 2.12, 95% CI 1.96 to 2.29). They were more likely to require treatment for epilepsy (AOR 1.50, 95% CI 1.27 to 1.78), attention deficit hyperactivity disorder (ADHD; AOR 3.01, 95% CI 2.76 to 3.27), and depression (AOR 1.90, 95% CI 1.62 to 2.22), be hospitalised overall (adjusted hazard ratio [AHR] 1.23, 95% CI 1.19 to 1.28) for injury (AHR 1.80, 95% CI 1.69 to 1.91) and self-harm (AHR 5.19, 95% CI 4.66 to 5.78), and die prematurely (AHR 3.21, 95% CI 2.16 to 4.77). Compared to children looked after at home, children looked after away from home had less absenteeism (AIRR 0.35, 95% CI 0.33 to 0.36), less exclusion (AIRR 0.63, 95% CI 0.56 to 0.71), less unemployment (AOR 0.53, 95% CI 0.46 to 0.62), and better attainment (AIRR 0.31, 95% CI 0.23 to 0.40). Therefore, among those in care, being cared for away from home appeared to be a protective factor resulting in better educational outcomes. The main limitations of this study were lack of data on local authority care preschool or before 2009, total time spent in care, and age of first contact with social care. Conclusions Looked after children had poorer health and educational outcomes than peers independent of increased neurodevelopmental conditions and SEN. Further work is required to understand whether poorer outcomes relate to reasons for entering care, including maltreatment and adverse childhood events, neurodevelopmental vulnerabilities, or characteristics of the care system.

Changes in adolescents’ planned hospital care during the COVID-19 pandemic: analysis of linked administrative data

“…These disproportionate changes to planned hospital care for vulnerable adolescents are likely to have contributed to further widening of the inequalities 15 that already existed before the pandemic, in terms of health, education and social care outcomes. 7 8 …”

“…Based on this framework, we hypothesised that adolescents receiving children’s social care (CSC) services or special educational needs (SEN) support were likely to have been more affected by the large reductions in planned hospital care during the pandemic as they have higher rates of chronic health conditions than their peers. 7 8 …”

Detaining children: Are we sure we are doing the right things?

“…Data on outcomes in the existing literature is patchy with varied outcomes measured; further, they often lack an economic analysis (Edmunds et al., 2018). However, children subject to welfare systems, internationally, tend to have poorer physical and mental health, educational and criminal justice outcomes than others but robust, comparative research seems unlikely to focus on secure settings (Fleming et al., 2021; Kaariala & Hiilamo, 2017; Porter et al, 2020). Children in secure hospitals are usually returned to the wider community (Livanou et al., 2020) but longer term outcomes are less clear.…”

Physical health of care-experienced young children in high-income countries: a scoping review protocol

“…Fleming et al also reported no significant difference in asthma prevalence (after adjustment for birth and socioeconomic factors) in their population-level administrative health data study of school-aged children. 19 Reviewing the available literature can help to clarify such ambiguities. There is, of course, some risk that differences between care-experienced and other children in the prevalence of diagnosed health conditions are due to differences in health-seeking behaviour rather than truly better health.…”

“…Hospitalisations due to both injury and self-harm have been found to be more common in school-aged children in care than in their non-care peers, after adjusting for a range of socioeconomic and maternal factors. 19 Neglectful parenting also has consequences for conditions where proactive health behaviours are vital. For example, dental health problems were significantly more frequently identified in children in care than in the general population during a universal dental health screening programme in Scotland.…”