Looked-after children grown up

This webinar launched the Nuffield-funded report The lifelong health and well-being trajectories of people who have been in care, a report on the findings from and implications of research by a team at University College London and Kings College London. The study used data on more than 350,000 people, including some 5,700 who spent time in care as children, to examine their health and social outcomes in adulthood. In this online webinar, chaired by UK statistician Sir Ian Diamond, Professor Amanda Sacker and Dr Emily Murray presented key findings from the project and discussed their implications for policy and practice. Following the presentation from the research team, we heard from Victoria Langer, Interim CEO at Become, Professor Ingrid Schoon, University College London, and Josh MacAlister. This timely event coincided with Josh MacAlister’s Independent Review of Children’s Social Care which is currently underway. The Independent Review recently published its Case for Change, which is aimed at all those interested in the development of evidence-based policy to improve the lives of children who are unable to live with their parents.

The overarching aim of the Looked-after Children Grown Up Project (LACGro) was to use the unique data in the Office for National Statistics Longitudinal Study to build a comprehensive picture up to mid-life of the health and social functioning of care experienced members of the study. To achieve that, we set ourselves a number of objectives: • To determine whether children in residential care, kinship care and in foster care have different health and social experiences 10 to 40 years later compared to children in parental homes. • To explore if children cared for in residential settings do better or worse than children in kinship or foster care, and if children in kinship care fare better than children in foster care. • To understand if any differences in health and social difficulties vary by gender or ethnicity/migration status for those who have been looked after in childhood. • To investigate if care experiences and their outcomes differ by the census in which children are observed. • To find out what evidence there is for later resilience. Are there continuities or discontinuities in outcomes? • To explore if there is evidence that a long-term experience of care predicts better or worse outcomes than a short-term experience. • To consider if caregivers’ children are affected in the long-term by living with a child in care. Through the research, our goal was to describe the scale of inequalities in outcomes for children cared for in different places, of different ages and identities, and to begin to understand how these factors interact to produce inequalities.

Background Children who spent time in non-parental care report poor outcomes in many aspects of their later lives on average, but less is known about differences by ethnicity. We examined whether the health, socioeconomic, family, and living arrangements of adults who had been in non-parental care across the first three decades of adult life varied by ethnicity (White, Black, South Asian). Methods We used longitudinal data from the Office for National Statistics Longitudinal Study (LS). Participants were aged<18 years and had never been married at baseline of each census year from 1971-2001 (n= 672,648). Separately for each adult follow-up age group (20 to 29; 30 to 39; 40 to 49), multi-level regression models were used to compare socioeconomic, family, and living arrangements by non-parental care and ethnicity interactions. Results Adverse adult outcomes following an experience of non-parental care were conditional on the interaction of non-parental care with ethnicity, mainly in the socioeconomic domain. More negative adult outcomes among the ethnic minority groups following non-parental care in childhood were not found consistently: for some outcomes the White group had poorer outcomes; South Asian individuals had better outcomes than Black people who had been in non-parental care but the within-ethnic group differences were smaller for Black than for South Asian children; and findings differed across the lifespan from early to mid-adulthood as work and family lives evolved. Conclusion We uncovered much complexity, with minority ethnicity moderating the non-parental care to adult outcomes relationship in both positive and negative ways. Previous work that has sampled children from the population with experience of non-parental care provides incomplete evidence from which to base policy decisions.

Background Children who spent time in non-parental care report poor outcomes in many aspects of their later lives on average, but less is known about differences by type of care. We examined whether socioeconomic, family, and living arrangements of adults who had been in non-parental care across the first three decades of adult life varied by type of care (residential, non-relative and relative).Methods We used longitudinal data from the Office for National Statistics Longitudinal Study (LS). Participants were aged<18 years and had never been married at baseline of each census year from 1971-2001 (n=242,843). Separately for each adult follow-up age (20 to 29; 30 to 39; 40 to 49), multi-level logistic regression models were used to compare socioeconomic, family, and living arrangements by different out-of-home care (OHC) experiences.ResultsAny OHC increased the likelihood of poorer functioning in the three domains of socioeconomic circumstances, family formation and relationships, and living arrangements. This was evident in their 20s, 30s and 40s; the most adverse outcomes were observed for those with a history of residential care, followed by non-relative OHC, and the least adverse outcomes for relative OHC. Moderation by childhood census year, age in OHC, and gender altered the relationship between OHC and some, but not all, adult outcomes. The strongest, most consistent, evidence was for widening of inequalities in age 20-29 outcomes across childhood census years and weakest evidence for any moderation of age 40-49 outcomes by age when in OHC.Conclusion Enduring inequalities in social and economic functioning for OHC-experienced adults were found. The evidence overwhelmingly supports the policy to place children in relative care whenever possible, with residential care the least favoured option.

Background Children who spend time in non-parental care report worse health later in life on average, but less is known about differences by type of care. We examined whether self-rated health of adults who had been in non-parental care up to 30 years later varied by type of care. Methods We used longitudinal data from the office for National Statistics Longitudinal Study. Participants were aged <18 and never-married at baseline of each census year from 1971 to 2001. Separately for each follow-up period (10, 20 and 30 years later), multi-level logistic regression was used to compare self-rated health outcomes by different care types. Results For combined census years, sample sizes were 157 896 dependent children with 10 years of follow-up, 166 844 with 20 years of follow-up and 173 801 with 30 years of follow-up. For all follow-up cohorts, longitudinal study members who had been in care in childhood, had higher odds of rating their health as ‘not good’ vs. ‘good’; with highest odds for residential care. For example, 10-year follow-up odds ratios were 3.5 (95% confidence interval: 2.2–5.6) for residential care, 2.1 (1.7–2.5) for relative households and 2.6 (2.1–3.3) for non-relative households, compared with parental households after adjustment for childhood demographics. Associations were weakest for 10-year, and strongest for 20-year, follow-up. Additional adjustment for childhood social circumstances reduced, but did not eliminate, associations. Conclusion Decades after children and young people are placed in care, they are still more likely to report worse health than children who grew up in a parental household.

Background: The adverse life-long consequences of being looked-after as a child are well recognised, but follow-up periods for mortality risk have mostly ended in young adulthood and mortality suggested to differ by age of placement, gender and cohort in small samples. Methods: Data on 353,601 Office for National Statistics Longitudinal Study (LS) members during census years 1971-2001, and Cox proportional hazards regression models with time-varying covariates (age as the timescale), were used to examine whether childhood out-of-home care was associated with all-cause mortality until the end of 2013. After adjusting for baseline age and age2, gender, born outside the United Kingdom, number of census observations in childhood and baseline census year we tested whether mortality risk varied for those in care by age, gender and baseline census year, by separate assessment of interaction terms. Supplementary analyses assessed robustness of findings. Results: Adults who had been in care at any census (maximum of two) had an adjusted all-cause mortality hazard ratio 1.62 (95% CI 1.43, 1.86) times higher than adults who had never been in care. The excess mortality was mainly attributable to deaths categorised as self-harm, accidents and mental & behavioural causes. Mortality risk was elevated if the LS member was initially assessed in 1981 or 2001, compared to 1971. There was no significant variation in mortality risk for those in care by age or gender. The main findings were consistent irrespective of choice of comparison group (whole population, disadvantaged population), care placement (residential, non-residential) and age at death (all ages, adulthood only). Conclusions: In this large, nationally representative study of dependent children resident in England and Wales, those who had been in care during childhood had a higher risk of mortality long after they had left care on average, mainly from unnatural causes. No differences by age or gender were found. Children in care have not benefitted from the general decline in mortality risk over time.

Background The adverse life-long consequences of being looked after as a child are well recognised. However, systematic evidence on outcomes for looked-after children beyond the early adult years is currently very limited. Methods Data were used from »1 20 000 dependent children (aged <18 and never-married) in the ONS Longitudinal Study (LS) in each of the census years 1971, 1981, 1991 and 2001 (total n=495,165). Separately for each census, logistic regression was used to compare odds of long-term limiting illness and self-rated health 10, 20 and 30 years later for LS members with different care experiences in childhood (parental household, relative household, non-relative household and residential care). Results In this nationally-representative sample of children in England and Wales, approximately 1.4% of dependent children were looked after in non-parental households, 3664 children in relative households, 2351 in unrelated households and 1007 in residential care. From 1971 to 2001, there was a general trend of an increasing percentage of dependent children residing in relative households (0.4% to 1.2%) and decreasing percentage in residential care (0.3% to 0.1%)(p-values<0.001). At 10, 20 and 30-year follow-up, LS members who had resided outside the parental home in childhood, had higher odds of a long-term limiting illness and rating their health as ‘not good’ vs ‘good’; with the highest odds for residential care. For example, for LS members who were dependent children in 1991, odds of a long-term limiting illness 10 years later were 7.8 (95% confidence interval: 5.3, 11.4) higher for those who had resided in residential care, 1.9 (1.4, 2.7) higher in relative households and 2.4 (1.9, 3.1) higher in non-relative households, compared to residence in a parental household. For non-relative and residential care, odds ratios increased with each successive census year. The longer the follow-up period the weaker the strength of association, but with all associations remaining significant. Weaker associations were seen for self-rated health compared to long-term limiting illness. Additional analysis to be presented will make step-wise adjustments for childhood demographics and social circumstances. Conclusion Decades after children and youths are placed in out-of-home care; they are still likely to report worse health than children who grew up in a parental household. Future work from this project will investigate how much of these associations are due to socio-demographic selection into different care experiences, compared to effects of being in care.