Case-control study of the health of those looked after by local authorities

Abstract

Aims-To assess the health needs and provision of health care to school age children in local authority care. Methods-A total of 142 children aged 5 to 16 in local authority care, and 119 controls matched by age and sex were studied. Main outcome measures were routine health care, physical, emotional, and behavioural health, health threatening and antisocial behaviour, and health promotion. Results-Compared with children at home, those looked after by local authorities were significantly more likely to: experience changes in general practitioner; have incomplete immunisations; receive inadequate dental care; suVer from anxieties and diYculties in interpersonal relationships; wet the bed; smoke; use illegal drugs; and have been cautioned by police or charged with a criminal oVence. They also tend to receive less health education. They were significantly more likely to have had a recent hearing or eye sight test, and reported significantly less physical ill health overall. Conclusions-The overall health care of children who have been established in care for more than six months is significantly worse than for those living in their own homes, particularly with regard to emotional and behavioural health, and health promotion. In contrast to uncontrolled observational studies we have not found evidence of problems with the physical health of these children. (Arch Dis Child 2001;85:280-285) Keywords: looked-after children; physical health; emotional and behavioural health; health promotion No comparative controlled study of the health and health needs of children in the care system has yet been reported, but there have been uncontrolled observational studies from Britain and the United States with findings that give cause for concern. Children entering the care system often come from severely disadvantaged families and are at high risk of poor mental and physical health.

Social health outcomes following thermal injuries: a retrospective matched cohort study

“…Controls were derived from the Community Child Health Database as in previous research projects 16. Controls were selected blindly from the child health computer as the next child of the same age (within 3 months), same sex and residing in the same enumeration district as the case.…”

Physical illness in looked-after children: a cross-sectional study

“…The only comparative data given are for hearing, visual and speech problems 7. Williams et al 8 in 2001 reported that looked-after children in Wales have lower immunisation rates, inadequate dental care, higher illegal drugs use and smoking and received less health education compared with matched controls.…”

“…There are several other possible reasons why looked-after children may have worse physical health than their peers living in private households; failure of advocacy with rapid changes of primary caregivers and poor communication between carers,1 more frequent changes in location of community services such as general practitioner8 and non-adherence in children who may have emotional and behavioural problems. It is important to recognise that some children with chronic health problems can be more difficult to care for, which in families who are struggling to cope with other multiple stressors, may itself precipitate a need for local authority care 11…”

Outcomes among young adults placed in therapeutic residential care as children

“…The current and lifetime use of substances by the young adults from The Orchards is, in general, lower than that of other care leavers (Scottish Health Feedback, 2001;Ward, Henderson and Pearson, 2003) and former LAC drawn from NBCSs (Ward, 1998;Williams, Jackson, Maddocks, Cheung, Love and Hutchings, 2001), but also young people and adults in the general population (NHS, 2008; …”