1
|
Melis G, Bedston S, Akbari A, Bennett D, Lee A, Lowthian E, Schlüter D, Taylor-Robinson D. Impact of socio-economic conditions and perinatal factors on risk of becoming a child looked after: a whole population cohort study using routinely collected data in Wales. Public Health 2023; 224:215-223. [PMID: 37856904 DOI: 10.1016/j.puhe.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 08/23/2023] [Accepted: 09/01/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVES Between 1997 and 2021, the number of children looked after (CLA) in Wales, UK, increased steadily, with stark inequalities. We aimed to assess how deprivation and maternal and child perinatal characteristics influence the risk of becoming CLA in Wales. STUDY DESIGN We constructed a prospective longitudinal cohort of children born in Wales between April 2006 and March 2021 (n = 395,610) using linked administrative records. METHODS Survival models examined the risk of CLA from birth by small-area deprivation and maternal and child perinatal characteristics. Population attributable fractions quantify the potential impact of action on modifiable risk factors. RESULTS Children from the most deprived fifth of the population were 3.4 times more likely to enter care than those in the least deprived (demographic adjusted hazard ratios [aHRs] 3.40, 95% confidence interval [CI] 3.08, 3.74). Maternal mental health problems in pregnancy (fully aHR, 2.03, 95% CI 1.88, 2.19) and behavioural factors, such as smoking (aHR 2.46, 95% CI 2.34-2.60), alcohol problems (aHR 2.35, 95% CI 1.70-3.23) and substance use in pregnancy (aHR 5.72, 95% CI 5.03-6.51), as well as child congenital anomalies (aHR 1.46, 95% CI 1.16-1.84), low birth weight (aHR 1.28, 95% CI 1.17, 1.39) and preterm birth (aHR 1.16, 95% CI 1.06, 1.26), were associated with higher risk of CLA status. The risk of CLA in the population may be reduced by 35% (95% CI 0.33, 0.38) if children in the two most deprived fifths of the population experienced the conditions of those in the least deprived. CONCLUSIONS Deprivation and perinatal maternal health are important modifiable risk factors for children becoming CLA. Our analysis provides insight into the mechanisms of intergenerational transfer of disadvantage in a vulnerable section of the child population and identifies targets for public health action.
Collapse
Affiliation(s)
- G Melis
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK; NHS England, National Disease Registration Service, UK.
| | - S Bedston
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, UK
| | - A Akbari
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, UK
| | - D Bennett
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - A Lee
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, UK
| | - E Lowthian
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Swansea, UK; Department of Education & Childhood Studies, School of Social Sciences, Swansea University, Swansea, UK
| | - D Schlüter
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - D Taylor-Robinson
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| |
Collapse
|
2
|
Hammarlund M, Granqvist P, Forslund T. Experiences of Interpersonal Trauma Among Parents With Intellectual Disabilities: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2023; 24:2843-2862. [PMID: 36062575 PMCID: PMC10486176 DOI: 10.1177/15248380221119237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Research has suggested highly elevated levels of interpersonal trauma (IPT) among parents with intellectual disabilities (ID), and that such experiences may contribute to the caregiving and child developmental problems often seen in this population. Conflicting results have however been reported, and there is no systematic review on this matter. This study therefore systematically reviewed the empirical evidence concerning (a) prevalence of IPT among parents with ID, and links with (b) caregiving-relevant and (c) child developmental outcomes, in accordance with the PRISMA 2020 guidelines. Searches were conducted in MEDLINE, CINAHL, PsycINFO, and PTSDpubs. Peer-reviewed empirical articles reporting exposure to any form of systematically assessed IPT (unspecified IPT, physical, sexual, and emotional abuse, neglect, prolonged childhood separations from caregivers, witnessing abuse in the family) among parents with ID were included, yielding a final selection of 20 studies. Findings consistently indicated markedly elevated levels of IPT among parents with ID, with a majority (>50%) having experienced some form of IPT. Estimates for both unspecified and specific forms were typically higher than corresponding estimates in other groups at elevated risk, and than meta-analytical general population estimates in comparable countries. Findings regarding caregiving-relevant outcomes were mixed but indicated links with adverse outcomes, particularly regarding parental mental health. Reports pertaining to child developmental outcomes were scant and inconsistent. We highlight important limitations in the extant literature and provide directions for future research and clinical practice.
Collapse
Affiliation(s)
| | | | - Tommie Forslund
- Department of Psychology, Stockholm University, Sweden
- SUF Resource Center, Uppsala, Sweden
| |
Collapse
|
3
|
Malvaso C, Montgomerie A, Pilkington RM, Baker E, Lynch JW. Examining the intersection of child protection and public housing: development, health and justice outcomes using linked administrative data. BMJ Open 2022; 12:e057284. [PMID: 35688602 PMCID: PMC9189815 DOI: 10.1136/bmjopen-2021-057284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE We described development, health and justice system outcomes for children in contact with child protection and public housing. DESIGN Descriptive analysis of outcomes for children known to child protection who also had contact with public housing drawn from the South Australian (SA) Better Evidence Better Outcomes Linked Data (BEBOLD) platform. SETTING The BEBOLD platform holds linked administrative records collected by government agencies for whole-population successive birth cohorts in SA beginning in 1999. PARTICIPANTS This study included data from birth registrations, perinatal, child protection, public housing, hospital, emergency department, early education and youth justice for all SA children born 1999-2013 and followed until 2016. The base population notified at least once to child protection was n=67 454. PRIMARY OUTCOME MEASURE Contact with the public housing system. SECONDARY OUTCOME MEASURES Hospitalisations and emergency department presentations before age 5, and early education at age 5, and youth justice contact before age 17. RESULTS More than 60% of children with at least one notification to child protection had contact with public housing, and 60.2% of those known to both systems were known to housing first. Children known to both systems experienced more emergency department and hospitalisation contacts, greater developmental vulnerability and were about six times more likely to have youth justice system contact. CONCLUSIONS There is substantial overlap between involvement with child protection and public housing in SA. Those children are more likely to face a life trajectory characterised by greater contact with the health system, greater early life developmental vulnerability and greater contact with the criminal justice system. Ensuring the highest quality of supportive early life infrastructure for families in public housing may contribute to prevention of contact with child protection and better life trajectories for children.
Collapse
Affiliation(s)
- Catia Malvaso
- BetterStart Health and Development Research, School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Alicia Montgomerie
- BetterStart Health and Development Research, School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Rhiannon Megan Pilkington
- BetterStart Health and Development Research, School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Emma Baker
- Australian Centre for Housing Research, School of Social Sciences, Faculty of Arts, Business, Law and Economics, The University of Adelaide, Adelaide, South Australia, Australia
| | - John W Lynch
- BetterStart Health and Development Research, School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| |
Collapse
|
4
|
O'Connor Funcheon S, Brady E. An exploration of professional and practice-based perspectives on reunification of children in out-of-home care in Ireland: The road less travelled? CHILD ABUSE & NEGLECT 2021; 122:105366. [PMID: 34715453 DOI: 10.1016/j.chiabu.2021.105366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 09/26/2021] [Accepted: 10/12/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The reunification of children in out-of-home care has gained increasing attention from both researchers and policy makers in many jurisdictions in recent years. In Ireland, however, reunification has received little attention and there is a dearth of data, research, policy and guidance in this area. OBJECTIVE This paper explores perspectives on, and experiences of, reunification in Ireland among respondents from a range of professional and practice backgrounds. The authors suggest that there are lessons to be learned from the Irish case for other jurisdictions with limited policy and research in the area of reunification. PARTICIPANTS & METHODS The research was carried out using a qualitative approach. Semi-structured interviews were carried out with 12 respondents from a range of professional and practice backgrounds and/or experience of reunification in Ireland. FINDINGS Findings suggest that there is a lack of clarity and a limited focus on the process of reunification for children in care in Ireland. This lack of focus on reunification and absence of national guidance appears to have resulted in some children 'drifting' through the care system with little exploration of the possibility to return home. Minimal emphasis on working with birth parents to support and enable them to resume caring for their children is reported. CONCLUSION Findings suggest that future efforts in this area should focus on: 1) developing a comprehensive research agenda in relation to reunification; 2) ensuring reunification is clearly placed on the policy agenda in Ireland; and 3) establishing a framework for practice guidance and a specialised reunification service to promote working with birth parents.
Collapse
Affiliation(s)
- Susan O'Connor Funcheon
- Dundalk Institute of Technology, Co., Louth, Ireland; Tusla, Child & Family Agency, Ireland.
| | - Eavan Brady
- School of Social Work & Social Policy, Trinity College Dublin, Dublin 2, Ireland
| |
Collapse
|
5
|
Putnam-Hornstein E, Ahn E, Prindle J, Magruder J, Webster D, Wildeman C. Cumulative Rates of Child Protection Involvement and Terminations of Parental Rights in a California Birth Cohort, 1999-2017. Am J Public Health 2021; 111:1157-1163. [PMID: 33856882 PMCID: PMC8101595 DOI: 10.2105/ajph.2021.306214] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2021] [Indexed: 11/04/2022]
Abstract
Objectives. To document the cumulative childhood risk of different levels of involvement with the child protection system (CPS), including terminations of parental rights (TPRs).Methods. We linked vital records for California's 1999 birth cohort (n = 519 248) to CPS records from 1999 to 2017. We used sociodemographic information captured at birth to estimate differences in the cumulative percentage of children investigated, substantiated, placed in foster care, and with a TPR.Results. Overall, 26.3% of children were investigated for maltreatment, 10.5% were substantiated, 4.3% were placed in foster care, and 1.1% experienced a TPR. Roughly 1 in 2 Black and Native American children were investigated during childhood. Children receiving public insurance experienced CPS involvement at more than twice the rate of children with private insurance.Conclusions. Findings provide a lower-bound estimate of CPS involvement and extend previous research by documenting demographic differences, including in TPRs.Public Health Implications. Conservatively, CPS investigates more than a quarter of children born in California for abuse or neglect. These data reinforce policy questions about the current scope and reach of our modern CPS.
Collapse
Affiliation(s)
- Emily Putnam-Hornstein
- Emily Putnam-Hornstein is with the School of Social Work, University of North Carolina at Chapel Hill. Eunhye Ahn and John Prindle are with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles. Joseph Magruder and Daniel Webster are with the School of Social Welfare, University of California, Berkeley. Christopher Wildeman is with the Department of Sociology, Duke University, Durham, NC
| | - Eunhye Ahn
- Emily Putnam-Hornstein is with the School of Social Work, University of North Carolina at Chapel Hill. Eunhye Ahn and John Prindle are with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles. Joseph Magruder and Daniel Webster are with the School of Social Welfare, University of California, Berkeley. Christopher Wildeman is with the Department of Sociology, Duke University, Durham, NC
| | - John Prindle
- Emily Putnam-Hornstein is with the School of Social Work, University of North Carolina at Chapel Hill. Eunhye Ahn and John Prindle are with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles. Joseph Magruder and Daniel Webster are with the School of Social Welfare, University of California, Berkeley. Christopher Wildeman is with the Department of Sociology, Duke University, Durham, NC
| | - Joseph Magruder
- Emily Putnam-Hornstein is with the School of Social Work, University of North Carolina at Chapel Hill. Eunhye Ahn and John Prindle are with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles. Joseph Magruder and Daniel Webster are with the School of Social Welfare, University of California, Berkeley. Christopher Wildeman is with the Department of Sociology, Duke University, Durham, NC
| | - Daniel Webster
- Emily Putnam-Hornstein is with the School of Social Work, University of North Carolina at Chapel Hill. Eunhye Ahn and John Prindle are with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles. Joseph Magruder and Daniel Webster are with the School of Social Welfare, University of California, Berkeley. Christopher Wildeman is with the Department of Sociology, Duke University, Durham, NC
| | - Christopher Wildeman
- Emily Putnam-Hornstein is with the School of Social Work, University of North Carolina at Chapel Hill. Eunhye Ahn and John Prindle are with the Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles. Joseph Magruder and Daniel Webster are with the School of Social Welfare, University of California, Berkeley. Christopher Wildeman is with the Department of Sociology, Duke University, Durham, NC
| |
Collapse
|
6
|
Falster K, Hanly M, Pilkington R, Eades S, Stewart J, Jorm L, Lynch J. Cumulative Incidence of Child Protection Services Involvement Before Age 5 Years in 153 670 Australian Children. JAMA Pediatr 2020; 174:995-997. [PMID: 32539137 PMCID: PMC7296451 DOI: 10.1001/jamapediatrics.2020.1151] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This study examines the incidence of notifications to and investigations, substantiations, and out-of-home care placements by child protection services for children aged 0 to 5 years in New South Wales, Australia.
Collapse
Affiliation(s)
- Kathleen Falster
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia,Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia,National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia,ANU Centre for Social Research Methods, Australian National University, Canberra, Australia
| | - Mark Hanly
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Rhiannon Pilkington
- School of Public Health, University of Adelaide, Adelaide, Australia,Robinson Research Institute, University of Adelaide, Adelaide, Australia
| | - Sandra Eades
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Jessica Stewart
- Department of Communities and Justice, New South Wales Government, Sydney, Australia
| | - Louisa Jorm
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - John Lynch
- School of Public Health, University of Adelaide, Adelaide, Australia,Robinson Research Institute, University of Adelaide, Adelaide, Australia,Population Heath Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| |
Collapse
|
7
|
Pearson RJ, Jay MA, Wijlaars LPMM, De Stavola B, Syed S, Bedston SJ, Gilbert R. Association between health indicators of maternal adversity and the rate of infant entry to local authority care in England: a longitudinal ecological study. BMJ Open 2020; 10:e036564. [PMID: 32792438 PMCID: PMC7430489 DOI: 10.1136/bmjopen-2019-036564] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Infants enter care at varying rates across local authorities (LAs) in England, but evidence is lacking on what is driving these differences. With this ecological study, we aimed to explore the extent to which adversity indicated within women's hospitalisation histories, predelivery, explained the rate of infant entry into care. METHODS We used two longitudinal person-level data sets on hospitalisations and entries to care to create annual measures for 131 English LAs, between 2006/2007 and 2013/2014 (April-March). We combined these measures by LA and financial year, along with other publicly available data on LA characteristics. We used linear mixed-effects models to analyse the relationship between the outcome-LA-specific rate of infant entry into care (per 10 000 infants in the LA population) - and LA-specific percentage of live births with maternal history of adversity-related hospital admissions (ie, substance misuse, mental health problems or violence-related admissions in the 3 years before delivery), adjusted for other predictors of entry into care. RESULTS Rate of infant entry into care (mean: 85.16 per 10 000, SD: 41.07) and percentage of live births with maternal history of adversity-related hospital admissions (4.62%, 2.44%) varied greatly by LA. The prevalence of maternal adversity accounted for 24% of the variation in rate of entry (95% CI 14% to 35%). After adjustment, a percentage point increase in prevalence of maternal adversity-both within and between LAs-was associated with an estimated 2.56 (per 10 000) more infants entering care (1.31-3.82). CONCLUSIONS The prevalence of maternal adversity before birth helped to explain the variation in LA rates of infant entry into care. Preventive interventions are needed to improve maternal well-being before and during pregnancy, and potentially reduce risk of child maltreatment and therefore entries to care. Evidence on who to target and data to evaluate change require linkage between parent-child healthcare data and administrative data from children's social care.
Collapse
Affiliation(s)
- Rachel Jane Pearson
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Matthew Alexander Jay
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - Bianca De Stavola
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Shabeer Syed
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Stuart John Bedston
- Centre for Child and Family Justice Research, Department of Sociology, Lancaster University, Lancaster, UK
| | - Ruth Gilbert
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| |
Collapse
|
8
|
Neil AL, Islam F, Kariuki M, Laurens KR, Katz I, Harris F, Carr VJ, Green MJ. Costs for physical and mental health hospitalizations in the first 13 years of life among children engaged with Child Protection Services. CHILD ABUSE & NEGLECT 2020; 99:104280. [PMID: 31783310 DOI: 10.1016/j.chiabu.2019.104280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 10/03/2019] [Accepted: 11/11/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Longitudinal data on health costs associated with physical and mental conditions are not available for children reported to child protection services. OBJECTIVE To estimate the costs of hospitalization for physical and mental health conditions by child protection status, including out-of-home-care (OOHC) placement, from birth until 13-years, and to assess the excess costs associated with child protection contact over this period. PARTICIPANTS AND SETTING Australian population cohort of 79,285 children in a multi-agency linkage study. METHODS Costs of hospitalization were estimated from birth (if available) using Round 17, National Hospital Cost Data Collection (2012-13; deflated to 2015-16 AUD). Records of the state child protection authority determined contact status. Data were reported separately for children in OOHC. Hospital separations were classified as mental disorder-related if the primary diagnosis was recorded in ICD-10 Chapter V (F00-F99). RESULTS Hospital separations were more common in children with child protection contact. Physical health care costs per child decreased with age for all children, but were significantly higher for children with contact. Mental health costs per child were always significantly higher for children with contact, with marked increases at 3 ≤ 4 years and 8 ≤ 9 years. Point estimates of annual costs per child were always highest for children with an OOHC placement. The net present value of the excess costs was $3,224 per child until 13- years, discounted at 5 %. CONCLUSIONS Children in contact with child protection services show higher rates and costs for physical and mental health hospitalizations in each of their first 13 years of life.
Collapse
Affiliation(s)
- Amanda L Neil
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
| | - Fakhrul Islam
- School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Maina Kariuki
- School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Kristin R Laurens
- School of Psychiatry, University of New South Wales, Sydney, Australia; School of Psychology and Counselling, and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Ilan Katz
- Social Policy Research Centre, University of New South Wales, Sydney, Australia
| | - Felicity Harris
- School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Vaughan J Carr
- School of Psychiatry, University of New South Wales, Sydney, Australia; Department of Psychiatry, Monash University, Melbourne, Australia; Neuroscience Research Australia, Sydney, Australia
| | - Melissa J Green
- School of Psychiatry, University of New South Wales, Sydney, Australia; Neuroscience Research Australia, Sydney, Australia
| |
Collapse
|
9
|
Mayer SS. Enhancing the Lives of Children in Out-Of-Home Care: An Exploration of Mind-Body Interventions as a Method of Trauma Recovery. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2019; 12:549-560. [PMID: 32318221 PMCID: PMC7163818 DOI: 10.1007/s40653-019-0250-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The prevalence and impact of trauma exposure among young people in the child welfare system in Canada warrants holistic intervention as a means of trauma recovery for this vulnerable population. A trauma-informed approach to practice is outlined through consideration of traditional trauma treatments and mind-body interventions that serve as complementary methods of therapy. Despite limited research on the effectiveness of mind-body interventions with children and adolescents in out-of-home care in Canada, a review of available literature on mindfulness, arts-based methods, and yoga suggests these therapeutic interventions promote resilience and positive development. Additional research is needed to support the use of mind-body interventions with young people in out-of-home care. Practice implications and recommendations for future research within Canada are included to increase awareness and support a working understanding of the pervasiveness of trauma exposure among this population and the value of trauma-informed, holistic intervention.
Collapse
Affiliation(s)
- Sarah S. Mayer
- Graduate Centre for Applied Psychology, Faculty of Health Disciplines, Athabasca University, Athabasca, AB Canada
- Ranch Ehrlo Society, P.O. Box 570, Pilot Butte, SK SOG 3Z0 Canada
| |
Collapse
|
10
|
Högberg U, Sennerstam R, Wester K, Högberg G, Andersson J, Thiblin I. Medical diagnoses among infants at entry in out-of-home care: A Swedish population-register study. Health Sci Rep 2019; 2:e133. [PMID: 31463369 PMCID: PMC6707026 DOI: 10.1002/hsr2.133] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 04/10/2019] [Accepted: 05/17/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND AND AIMS Identification of child abuse involves a medical investigation and assessment of problems related to social environment and upbringing and might necessitate out-of-home care. The objective of this study was to analyse infants placed in out-of-home care in Sweden by incidence, medical diagnoses, and perinatal factors. METHODS This was a population-based register study of infants born in Sweden 1997 to 2014. Data were retrieved from registers at the Swedish National Board of Health and Welfare and Statistics Sweden. Outcome measures were out-of-home care categories: (a) "Problems Related to Social Environment/Upbringing", (b) "Abuse diagnoses without SDH (subdural haemorrhage), RH (retinal haemorrhage), rib fracture, or long bone fracture", and (c) "SDH, RH, rib fracture, or long bone fracture." As a reference population, we randomly selected infants without medical diagnoses born the same year. RESULTS Overall incidence of out-of-home care was 402 per 100 000. For subcategories (a), (b), and (c), the incidences were 14.8 (n = 273), 3.77 (n = 70), and 9.83 (n = 182) per 100 000, respectively. During the study period, the first remained unchanged; the latter two have been increasing. Compared with other reasons for out-of-home care, children in category (c), "SDH, RH, rib fracture, or long bone fracture", had increased odds of being boys (adjusted odds ratio [aOR] 1.60; 95% confidence interval [CI], 1.08-2.38) and decreased odds of having a mother being single (aOR 0.49; 95% CI, 0.32-0.75) and a smoker (aOR 0.60; 95% CI, 0.37-0.96). Compared with the reference population, children in this category were more often twin born (7.7% versus 2.8%), preterm (18.5% versus 5.5%), and small-for-gestational age (5.2% versus 2.1%). CONCLUSION SDH, RH, rib fracture, or long bone fracture constitute a minor part of medical diagnoses for infants entered in out-of-home care, but have been increasing, both in numbers and proportion. Overdiagnosis of abuse might be a possible reason but cannot be ascertained by this study design.
Collapse
Affiliation(s)
- Ulf Högberg
- Department of Women's and Children's HealthUppsala UniversityUppsalaSweden
| | - Roland Sennerstam
- Department of Oncology and Pathology, Cancer CenterKarolinska University Hospital and Karolinska InstitutetStockholmSweden
| | - Knut Wester
- Department of Clinical Medicine—K1University of BergenBergenNorway
- Department of NeurosurgeryHaukeland University HospitalBergenNorway
| | - Göran Högberg
- Formerly Department of Women's and Children's Health, Child and Adolescent Psychiatric UnitKarolinska InstitutetStockholmSweden
| | - Jacob Andersson
- Forensic Medicine, Department of Surgical SciencesUppsala UniversityUppsalaSweden
| | - Ingemar Thiblin
- Forensic Medicine, Department of Surgical SciencesUppsala UniversityUppsalaSweden
| |
Collapse
|
11
|
Green MJ, Kariuki M, Chilvers M, Butler M, Katz I, Burke S, Tzoumakis S, Laurens KR, Harris F, Carr VJ. Inter-agency indicators of out-of-home-care placement by age 13-14 years: A population record linkage study. CHILD ABUSE & NEGLECT 2019; 93:91-102. [PMID: 31075574 DOI: 10.1016/j.chiabu.2019.04.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 03/11/2019] [Accepted: 04/22/2019] [Indexed: 05/24/2023]
Abstract
BACKGROUND Cross-agency administrative data can improve cost-effective triage systems for child protection and other human service delivery. OBJECTIVE To determine the minimum set of cross-agency indicators that could accurately classify placement in out-of-home-care (OOHC) before age 13-14 years. PARTICIPANTS AND SETTING Participants were 72,079 Australian children (mean age = 13.16 years; SD = 0.37; 51.4% male) and their parents, for whom linked administrative records spanning the years 1994-2016 were available for analysis within the 'New South Wales Child Development Study'. METHODS First, a series of logistic regression analyses were conducted to examine associations between cross-agency (health, justice, education) risk indicators and membership of the sub-cohort of 1239 children who had an OOHC placement prior to age 13-14 years, relative to (1) the sub-cohort of 55,473 children who had no previous contact with child protection services, and (2) the sub-cohort of 15,367 children who had been reported to child protection services but had no record of OOHC placement. We then explored the classification characteristics associated with a smaller combination of risk factors, and the utility of specific familial risk factors, for classifying membership of the OOHC subgroup. RESULTS A combination of six risk indicators evident before OOHC placement can classify children placed in OOHC with approximately 95% accuracy, and the presence of at least four of these risk indicators provides excellent specificity (99.6%). CONCLUSIONS A combination of risk factors observable in administrative datasets held by multiple government agencies may be used to target support services to prevent entry into OOHC for children from vulnerable families.
Collapse
Affiliation(s)
- Melissa J Green
- School of Psychiatry, University of New South Wales, Sydney, Australia; Neuroscience Research Australia, Sydney, Australia.
| | - Maina Kariuki
- School of Psychiatry, University of New South Wales, Sydney, Australia
| | | | - Merran Butler
- NSW Department of Family and Community Services, NSW, Australia
| | - Ilan Katz
- Social Policy Research Centre, University of New South Wales, Sydney, Australia
| | - Sharon Burke
- NSW Department of Family and Community Services, NSW, Australia
| | - Stacy Tzoumakis
- School of Social Sciences, University of New South Wales, Sydney, Australia
| | - Kristin R Laurens
- School of Psychiatry, University of New South Wales, Sydney, Australia; School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia
| | - Felicity Harris
- School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Vaughan J Carr
- School of Psychiatry, University of New South Wales, Sydney, Australia; Neuroscience Research Australia, Sydney, Australia; Department of Psychiatry, Monash University, Melbourne, Australia
| |
Collapse
|
12
|
Maclean MJ, Taylor CL, O'Donnell M. Relationship between out-of-home care placement history characteristics and educational achievement: A population level linked data study. CHILD ABUSE & NEGLECT 2017; 70:146-159. [PMID: 28609694 DOI: 10.1016/j.chiabu.2017.05.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 05/03/2017] [Accepted: 05/27/2017] [Indexed: 06/07/2023]
Abstract
Studies generally show children who have entered out-of-home care have worse educational outcomes than the general population, although recent research suggests maltreatment and other adversities are major contributing factors. Children's out-of-home care experiences vary and may affect their outcomes. This study examined the influence of placement stability, reunification, type of care, time in care and age at entry to care on children's educational outcomes. We conducted a population-based record-linkage study of children born in Western Australia between 1990 and 2010 who sat State or national Year 3 reading achievement tests (N=235,045 children, including 2160 children with a history of out-of-home care). Children's educational outcomes varied with many aspects of their care experience. Children placed in residential care were particularly likely to have low scores, with an unadjusted OR 6.81, 95% CI[4.94, 9.39] for low reading scores, which was partially attenuated after adjusting for background risk factors but remained significant (OR=1.50, 95% CIs [1.08, 2.08]). Reading scores were also lower for children who had experienced changes in care arrangements in the year of the test. A dose-response effect for multiple placements was expected but not found. Older age at entering care was also associated with worse reading scores. Different characteristics of a child's care history were interwoven with each other as well as child, family and neighbourhood characteristics, highlighting a need for caution in attributing causality. Although the level of educational difficulties varied, the findings suggest a widespread need for additional educational support for children who have entered care, including after reunification.
Collapse
Affiliation(s)
- Miriam J Maclean
- Telethon Kids Institute, The University of Western Australia, Perth, Australia.
| | - Catherine L Taylor
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| | - Melissa O'Donnell
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
| |
Collapse
|
13
|
Turney K, Wildeman C. Adverse childhood experiences among children placed in and adopted from foster care: Evidence from a nationally representative survey. CHILD ABUSE & NEGLECT 2017; 64:117-129. [PMID: 28086178 DOI: 10.1016/j.chiabu.2016.12.009] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 12/03/2016] [Accepted: 12/20/2016] [Indexed: 05/05/2023]
Abstract
Despite good reason to believe that children in foster care are disproportionately exposed to adverse childhood experiences (ACEs), relatively little research considers exposure to ACEs among this group of vulnerable children. In this article, we use data from the 2011-2012 National Survey of Children's Health (NSCH), a nationally representative sample of non-institutionalized children ages 0-17 in the United States, to estimate the association between foster care placement and exposure to an array of ACEs. In adjusted logistic regression models, we find that children placed in foster care or adopted from foster care, compared to their counterparts, were more likely to experience parental divorce or separation, parental death, parental incarceration, parental abuse, violence exposure, household member mental illness, and household member substance abuse. These children were also more likely to experience ACEs than children across different thresholds of socioeconomic disadvantage (e.g., children in households with incomes below the poverty line) and across different family structures (e.g., children in single-mother families). These results advance our understanding of how children in foster care, an already vulnerable population, are disproportionately exposed to ACEs. This exposure, given the link between ACEs and health, may have implications for children's health and wellbeing throughout the life course.
Collapse
Affiliation(s)
- Kristin Turney
- University of California, Irvine, Department of Sociology, 3151 Social Science Plaza, Irvine, CA 92697, United States.
| | - Christopher Wildeman
- Cornell University, Department of Policy Analysis and Management, 137 Martha Van Rensselaer Hall, Ithaca, NY 14853, United States.
| |
Collapse
|