Support and relief: the Swedish contact person and contact family program

Consumption of psychotropic drugs among adults who were in societal care during their childhood-A Swedish national cohort study

BACKGROUND

Previous studies have demonstrated greatly increased risks of severe psychiatric morbidity for former child welfare clients. We investigated psychotropic medication in this population as a proxy indicator of less severe mental health problems.

METHODS

This register-based cohort study comprises the Swedish birth cohorts between 1973 and 1981, 765,038, including 16,986 former children from societal care and 1296 national adoptees. Estimates of risk of retrieval of prescribed psychotropic medications during 2009 were calculated in four categories (any such drug, neuroleptics, antidepressants and anxiolytics/hypnotics) as hazard ratios (HRs) with 95% confidence intervals (CIs) using Cox regression analysis, adjusting for birth parental background including psychiatric morbidity.

RESULTS

17-25% of men and 25-32% of the women with childhood experiences of societal care retrieved at least one prescription of a psychotropic drug, equivalent to age-adjusted HRs of between 2.1 and 3.3, compared with the general population. Adjusting the analysis for birth parental confounders attenuated risks to between 1.5 and 2.7, depending on subgroup and sex. Men-especially those that entered care settings during their teens-tended to have higher risks of all outcomes. Adjusted HRs for national adoptees were similar to former children in care.

CONCLUSIONS

Former residents of societal care are a high-risk group for mental health problems well into mature adult age, demonstrating the need for systematic screening and implementation of effective prevention/treatment during time in care.

Long-term outcomes of Sweden's Contact Family Program for children

OBJECTIVES

To assess the long-term impacts of Sweden's Contact Family Program (CFP) for children on participants' future outcome profiles, here conceptualized as combinations of outcomes related to mental health problems, public welfare receipt, illicit drug use, placement in out-of-home care, educational achievement, and offending.

METHODS

We analyzed longitudinal register data on more than 950,000 children born 1980-90, including 6693 children who entered CFP at 2-5 years of age, with a follow-up until 2008. Children's outcome profiles were identified by latent class analysis. The average program impact was estimated by means of propensity score matching.

RESULTS

Long-term outcomes for those who had received the intervention were not better than for matched peers who did not receive the intervention. Simulation-based sensitivity analyses indicate that some of our estimated negative treatment effects may be affected by unobserved factors related to program participation and outcomes. However, both selection and outcome effects must be extremely strong in order to generate notable positive effects of CFP participation.

CONCLUSIONS

The results did not find support for CFP effectiveness in reducing risks of compromised long-term development in children. Since the intervention reaches a high-risk group of children and is popular among users, volunteer families and professionals, the program should be reinforced with knowledge-based components that target known risk factors for child welfare recipients.

Suicide attempts and severe psychiatric morbidity among former child welfare clients--a national cohort study

BACKGROUND

Few large sample studies have examined psychiatric morbidity among former child welfare/protection clients. In this study, risks for suicide attempts and severe psychiatric morbidity in younger years were assessed for former child welfare clients in ten national birth cohorts, comparing them with general population peers and inter-country adoptees.

METHODS

We used national register data for almost one million people: 22,305 former child welfare clients who had experienced interventions before their teens, 955,326 general population cohort peers and 12,240 inter-country adoptees. Multivariate Cox regression models were used to estimate risks of hospitalisation for suicide attempts and psychiatric disorders from age 13 to age 18-27.

RESULTS

Former child welfare clients were in year of birth and sex standardised risk ratios (RRs) four to five times more likely than peers in the general population to have been hospitalised for suicide attempts. They were five to eight times more likely to have been hospitalised for serious psychiatric disorders in their teens, four to six times in young adulthood. High excess risks were also found for psychoses and depression. Individuals who had been in long-term foster care tended to have the most dismal outcome. Adjusting for birth parents' hospitalisations with a psychiatric diagnosis or for substance abuse, and for birth-home-related socio-economic factors, reduced excess risks to around twofold.

CONCLUSIONS

Irrespective of issues of causality, findings suggest that former child welfare/protection clients should be considered a high-risk group for suicide attempts and severe psychiatric morbidity. Results have substantial practice implications for mental health and social agencies serving this group in adolescence and/or young adulthood.

Teenage parenthood among child welfare clients: a Swedish national cohort study of prevalence and odds

To assess prevalence and odds for teenage parenthood among former child welfare clients, we used national register data for all children born in Sweden 1972-1983 (n=1,178,207), including 49,582 former child welfare clients with varying intervention experiences. Logistic regression models, adjusted for demographic, socio-economic and familial background factors, were used to estimate odds ratios. Among youth who received interventions in adolescence, 16-19% of the girls and 5-6% of the boys became teenage parents, compared to 3% for girls and 0.7% for boys without child welfare experiences. Youths who entered child welfare services in their teens had four- to fivefold adjusted odds for becoming a teenage parent. For other child welfare clients, adjusted odds were mostly twofold. Youth of both sexes who receive child welfare services in adolescence are a high-risk group for teenage parenthood. Child welfare agencies should, as a minimum, provide each individual client youth with access to birth control counselling and contraceptives.