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Childhood risk factors for disability pension among adult former Swedish child welfare clients: Same or different as for majority population peers?
Abstract
This study contributes to the literature on preventing social exclusion, here indicated by collecting disability pension in adulthood, by asking whether the pattern and strength of childhood related risk factors is the same for high-risk child welfare clients, as for their peers in the majority population. Longitudinal register data on more than 500,000 Swedes, including around 18,000 former child welfare clients, were analyzed by means of linear probability models and calculations of population attributable fractions. Systematic comparisons of effect sizes suggest that the differences in pattern were marginal, but there were significant differences in strength. Overall, poor educational achievement and low educational attainment were the two most prominent risk factors across all groups, also when prevalence was taken into account. In the majority population, the hypothetical reduction of collecting disability pension was on the scale of 20 percent if either of the two risk factors could be eliminated. Among child welfare alumni, however, the hypothetical reduction was even larger, nearly 30 percent on average. Prevention strategies targeting poor school performance and low educational attainment may thus substantially reduce the prevalence of disability pension among adults with a history of child welfare involvement.
... , housing (Clare et al., 2017;Courtney et al., 2011), substance abuse, delinquency, and imprisonment (Borczyskowski et al., 2013;Carr & McAlister, 2016;Vinnerljung & Hjern, 2014). Poor outcomes in various mental health indicators are also well documented (Brännström et al., 2018;Hiller & St Clair, 2018;Zlotnick et al., 2012). ...
Empirical evidence on life satisfaction of care leavers is scant and often based on small and nonrepresentative samples. Based on the life course perspective, this study explored the role of objective and subjective factors in explaining life satisfaction among care leavers, both general and domain-specific (work-financial-housing, social relationships-emotional state). The sample was randomly drawn from the whole population of eight graduating birth cohorts of alumni of educational residential care in Israel and consists of 2, 295 alumni (24-31 years old). The study is based on an extensive set of longitudinal administrative records combined with structured phone interviews. Bivariate analysis and multiple regression models were used to assess associations between precare context, in-care and postcare experiences and achievements with general and domain-specific life satisfaction. Gender differences were found in both domain-specific life satisfactions with men having greater satisfaction. Family background indicators were generally more predictive of general and social relationships- emotional state satisfaction. In-care experiences of peer and staff support and postcare experience of material deprivation were strong predictors of general and domain-specific life satisfaction. Postcare contacts with care staff, surprisingly, were associated with lower general satisfaction and satisfaction with social relationships-emotional state. Higher educational attainment at the end of placement and integration into postsecondary education were associated with greater general and work-financial-housing satisfaction. The effects of in-care preparation for independent adult living, employment and parenthood are not consistent across different domains of life satisfaction. Implications for policy and practice during and after care are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
... They tend to perform substantially poorer in school than peersand adopted childrenwith similar cognitive competence (Vinnerljung et al., 2010;. Low grades in school and having only compulsory education has in Swedish population studies statistically explained most of the over-risks for teenage parenthood and disability pension among alumni from long-term foster care, as well as being a powerful predictor of basically all negative long-term outcomes (Brännström, Karlsson, Vinnerljung, & Hjern, 2018;Brännström, OUTCOMES OF ADOPTION AFTER FOSTER CARE 18 Vinnerljung, & Hjern, 2015Vinnerljung et al., 2010;Vinnerljung et al., 2015). But Swedish national population studies have shown that this is not the case for adoptees (Vinnerljung et al., 2010). ...
Prior research has reported a positive impact of adoption on developmental outcomes for children with experience of foster care. To inform decisions about permanent care arrangements, we used Swedish national population registers to create a sibling population consisting of 194 children born 1973-82 who had been in out-of-home care (OHC) at least five years before adolescence but were never adopted (50% boys) and their 177 maternal birth siblings who also had been in OHC at least five years before their teens but were adopted before adolescence (52.5% boys). We constructed 14 outcome variables spanning social, educational and health outcomes in adult age with information from Swedish national registers. Based on multilevel logistic random-effects and fixed-effects regression models (supplemented with a sensitivity analysis assessing the potential impact of unobserved confounding), results showed that adopted siblings tended to have considerably better outcomes in adult age in educational achievement, income, criminality, disability and suicidality. Outcomes related to mental health and substance abuse were more similar, but differences pointed in the same direction. Implications for child welfare policy and practice are discussed.
BACKGROUND:
Exposure to childhood out-of-home care (foster family and residential care) is associated with an increased risk of ill-health and disability in adulthood, but the risk for cardiovascular disease has not previously been studied longitudinally.
METHODS:
This was a national cohort study generated from linkage of a range of population-based registers, resulting in a national cohort of 881 731 of whom 26 310 (3.0%) had a history of out-of-home care. The study population, born 1972 to 1981, was followed from age 18 to age 39 to 48 years for hospitalizations and death.
RESULTS:
After adjusting for year of birth and maternal education, individuals with a history of childhood out-of-home-care experienced a doubling of the risk for coronary disease (hazard ratio; 95% confidence interval: 2.05; 1.74–2.41) and stroke (hazard ratio 1.85; 1.59–2.15), compared with the general population, with similar estimates for men and women. Women with a history of out-of-home care had a more than doubled risk for cigarette smoking in early pregnancy, with a relative risk of 2.26; (2.18–2.34) and a moderately increased risk for gestational diabetes relative risk 1.49 (1.19–1.86). There was marked attenuation (40% to 90%) in effect estimates for disease and risk factors after further control for cohort members educational achievement at age 15–16 years.
CONCLUSIONS:
A history of childhood out-of-home care was associated with a doubled risk of early cardiovascular disease events. Cigarette smoking and educational underachievement were the main identified risk factors.
Background
Little is known about the long-term labor force attachment (LFA) of care leavers and how they compare with similar youth.
Objectives
This study aims to: (1) examine LFA from age 21 to 34 among care leavers and a comparison group; (2) explain variability in age-related LFA.
Participants and setting
Two groups were studied: all alumni of 14 consecutive birth cohorts (1982–1995) of care leavers of youth villages in Israel (22,670) and a double-sized matched comparison group drawn from the corresponding cohorts in the general population (45,340).
Methods
The study is based on a longitudinal cross-sequential between-groups design.
The dataset integrates an extensive set of longitudinal administrative records. Descriptive statistic was used to describe and compare care leavers and their matched peers, in terms of background and achievements. Bivariate analyses examined differences in age-related LFA between care leavers and their matched peers. A multilevel multinomial model was employed to predict LFA levels throughout the age span.
Results
In terms of achievements, care leavers show poorer educational attainment, greater reliance on social welfare services and experienced more difficulties during the mandatory military service. The rate of care leavers strongly connected to the labor market gradually increased as they grew older, reaching to about 65 % by age 34, whereas the rate of those disconnected from the labor market decreased with age, standing on 19 % by age 34. Care leavers had stronger LFA than their matched peers during their entire 20's, and similar levels thereafter. Multiple factors (e.g., family background, educational attainments) were associated with different levels of LFA.
Conclusions
Differential policy measures, while in-care and afterward, are needed to address care leavers' variability in labor market experience.
A vast literature exists on the relationship between family background and health outcomes. However, there is a shortage of evidence on the relationship between parental resources and offsprings' disability pension, a severe form of general poor health and functionability. This article analyses how parental income and education are associated with offsprings' disability pension in young adulthood (19–27 years) among 1980–1985 birth cohorts using Finnish register data. The results of discrete-time event history analysis demonstrate that parental income and education have contrasting impacts. High parental income is found to decrease, and parental education to increase, the probability of offspring having disability pension, although mainly among offspring with compulsory education. Further, young adults with high parental resources are better off two years after their first disability pension. We conclude that the influence of parental resources operates via offsprings' educational attainment but also has divergent direct impacts on offsprings’ disability pension.
International research has consistently reported that children placed in out-of-home care (OHC) have poor outcomes in young adulthood. Yet, little is known about their outcomes in midlife. Using prospective data from a cohort of more than 14,000 Swedes born in 1953, of which nearly 9% have been placed in OHC, this study examines whether there is developmental continuity or discontinuity of disadvantage reaching into middle age in OHC children, compared to same-aged peers. Outcome profiles, here conceptualized as combinations of adverse outcomes related to education, economic hardship, unemployment, and mental health problems, were assessed in 1992-2008 (ages 39-55). Results indicate that having had experience of OHC was associated with two-fold elevated odds of ending up in the most disadvantaged outcome profile, controlling for observed confounding factors. These findings suggest that experience of OHC is a strong marker for disadvantaged outcomes also in midlife.
Background:
Few studies have examined the association between adverse childhood experiences (ACEs) and disability pension (DP). The current study aimed to investigate the relationship between different ACEs, cumulative ACEs, and DP, and the mediating role of school performance.
Methods:
We used a Swedish cohort of 522 880 individuals born between 1973 and 1978. ACEs included parental death, parental substance abuse and psychiatric disorder, substantial parental criminality, household public assistance, parental DP and child welfare intervention. Estimates of risk of DP in 2008 were calculated as odds ratios (OR) with 95% confidence intervals (CIs).
Results:
A total of 2.3% (3.0% females, 1.7% males) received DP in 2008. All studied ACEs increased the odds for DP, particularly child welfare intervention and household public assistance. Cumulative ACEs increased the odds of DP in a graded manner. Females exposed to 4+ ACEs had a 4-fold odds (OR: 4.0, 95% CI 3.5-4.5) and males a 7-fold odds (OR: 7.1, 95% CI: 6.2-8.1). School performance mediated the ACEs-DP association.
Conclusion:
This study provides evidence that ACEs is associated with increased odds of DP, particularly when accumulated. The effects of ACEs should be taken into account when considering the determinants of DP, and when identifying high-risk populations.
Children whose parents experience adverse social, economic, or health-related living conditions are more likely to face similar types of disadvantage in their adult life. However, a limitation of many earlier studies is that they do not account for the multidimensionality of the concept of living conditions, and that the child generation's life courses are targeted as static and independent from the societal context in which they are imbedded. The current investigation addressed these aspects by focusing on the complexity, duration, and timing of disadvantage with regard to how adverse circumstances in the family of origin are associated with trajectories of social, economic, and health-related living conditions across adulthood. We also examined the role of educational attainment for these associations. Analyses were based a Swedish cohort born in 1953 (n=14,294). We first conducted sequence analysis, followed by hierarchical cluster analysis, to generate 'outcome profiles', i.e. trajectories of adult disadvantage. Second, several indicators of adverse circumstances in childhood were analysed by means of multinominal regression analysis, showing the odds of ending up in the different trajectories. The results indicated that individuals who grew up under adverse conditions were more likely to experience disadvantaged social, economic, and health-related trajectories. This was particularly the case for trajectories characterised by a high degree of complexity, i.e. coexisting disadvantages, and - among men only - by a longer duration of disadvantage. Educational attainment was identified as a powerful mediator, suggesting that efforts to increase equal educational opportunity may be a way of reducing the intergenerational transmission of disadvantage.
Foster care is often preferred to other placement options for children in the child welfare system. However, it is not clear how the developmental outcomes of foster children relate to children in other living arrangements. In this study, a series of meta-analyses are performed to compare the cognitive, adaptive, and behavioral functioning of children placed in foster care (n = 2,305) with children at risk who remained with their biological parents (n = 4,335) and children from the general population (n = 4,971). A systematic literature search in PsycINFO, Medline, ERIC, and ProQuest identified 31 studies suitable for inclusion (N = 11,611). Results showed that foster children had generally lower levels of functioning than children from the general population. No clear differences were found between foster children and children at risk who remained at home, but both groups experienced developmental problems. Improving the quality of foster care and future research to identify which children are best served by either foster care or in-home services are recommended.
A replication of the Helsingborg study (Tideman, et al., 2011) was conducted in the municipality of Norrköping in 2008–2011. Results confirm the conclusions from the original study that children in foster care can benefit from a working model aimed to improve school performance. Furthermore, a possible way to address poor numeracy skills by computerised working memory training was identified. Implications for further research in active interventions to address underachieving foster children are discussed.
Objectives
To estimate the impacts of Sweden’s Contact Family/Person Program (CFPP) for older children on participants’ long-term outcomes related to mental health problems, illicit drug use, public welfare receipt, placement in out-of-home care, educational achievement, and offending.
Method
We analyzed longitudinal register data on more than 1,000,000 individuals born between 1973 and 1984, including 6,386 individuals who entered CFPP at 10–13 years of age, with a follow-up until 2008. The program impact was estimated by means of propensity score matching.
Results
Outcomes for those who had received the intervention were not better than that for matched peers who did not receive the intervention.
Conclusions
The results did not find support for CFPP effectiveness in reducing risks of compromised long-term development in older children.
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.
The aim of this study is to examine the prevalence of mental disorders in 6- to 12-year-old foster children and assess comorbidity and risk factors.
Information on mental health was collected from foster parents and from teachers using Developmental and Well-Being Assessment (DAWBA) Web-based diagnostic interview. Child welfare services provided information about care conditions prior to placement and about the child's placement history.
Diagnostic information was obtained about 279 (70.5%) of 396 eligible foster children. In total, 50.9% of the children met the criteria for one or more DSM-IV disorders. The most common disorders were grouped into 3 main diagnostic groups: Emotional disorders (24.0%), ADHD (19.0%), and Behavioural disorders (21.5%). The comorbidity rates among these 3 main groups were high: 30.4% had disorders in 2 of these 3 diagnostic groups, and 13.0% had disorders in all 3 groups. In addition, Reactive attachment disorder (RAD) was diagnosed in 19.4% of the children, of whom 58.5% had comorbid disorders in the main diagnostic groups. Exposure to violence, serious neglect, and the number of prior placements increased the risk for mental disorders.
Foster children in Norway have a high prevalence of mental disorders, compared to the general child population in Norway and to other societies. The finding that 1 in 2 foster children presented with a mental disorder with high rates of comorbidity highlight the need for skilled assessment and qualified service provision for foster children and families.
High school dropout and long-term sickness absence/disability pension in young adulthood are strongly associated. We investigated whether common risk factors in adolescence may confound this association.
Data from 6612 school-attending adolescents (13--20 years old) participating in the Norwegian Young-HUNT1 Survey (1995--1997) was linked to long-term sickness absence or disability pension from age 24--29 years old, recorded in the Norwegian Labour and Welfare Organisation registers (1998--2008). We used logistic regression to estimate risk differences of sickness or disability for school dropouts versus completers, adjusting for health, health-related behaviours, psychosocial factors, school problems, and parental socioeconomic position. In addition, we stratified the regression models of sickness and disability following dropout across the quintiles of the propensity score for high school dropout.
The crude absolute risk difference for long-term sickness or disability for a school dropout compared to a completer was 0.21% or 21% points (95% confidence interval (CI), 17 to 24). The adjusted risk difference was reduced to 15% points (95% CI, 12 to 19). Overall, high school dropout increased the risk for sickness or disability regardless of the risk factor level present for high school dropout.
High school dropouts have a strongly increased risk for sickness and disability in young adulthood across all quintiles of the propensity score for dropout, i.e. independent of own health, family and socioeconomic factors in adolescence. These findings reveal the importance of early prevention of dropout where possible, combined with increased attention to labour market integration and targeted support for those who fail to complete school.
School readiness is a strong predictor of adjustment in elementary school and beyond. Children in foster care are at particular risk for academic and social difficulties in school. Limitations in self-regulatory skills and caregiver involvement among these children might contribute to a lack of school readiness. This study presents the immediate effects on school readiness of a targeted, short-term intervention designed to improve children's early literacy, prosocial, and self-regulatory skills during the summer before kindergarten entry: Kids in Transition to School (KITS). Using a randomized controlled trial design, 192 children in foster care were assigned to either an intervention or services as usual comparison condition. Multimethod, multiagent assessments were conducted immediately prior to and following the completion of the intervention. The results from structural equation modeling indicated that the intervention had significant, positive effects on early literacy and self-regulatory skills.
An efficacious, short-term, readily scalable, theoretically-based intervention targeted at specific vulnerabilities for children in foster care may help to improve their school readiness and eventual school adjustment.
Whilst child welfare systems in the United Kingdom, Australia and the United States may share a number of common goals, they are not designed to identify families with multiple problems. Where system output measures have been utilised as proxy measures to detect such families they indicate the presence of families in the population served by child and family social work. In interviews with practitioners and managers working within contrasting welfare systems, we explore how families with multiple problems are identiifed, what repsonses they currently recieve and how their needs might be better met.
Few studies have examined the effects of educational level, intellectual performance, mental function, body mass index and height as well as their interrelationship on the risk of disability pension (DP), taking other life course factors into account.
We linked several national registers, comprising the Medical Birth Registry, the Central Population Register, the Education Register, the Norwegian Labour and Welfare Organisation and the Norwegian Armed Forces Personnel Data Base, providing personal data on biological and social variables from childhood to young adult age. Participants were all males live born during the period 1967-76, followed up through 2003. Men were excluded who died, emigrated or were granted a DP until age 23 years (when follow-up started) and persons who did not become gainfully employed during the study period. Thus, the study population comprised 302 330 men, and the study outcome was being granted a DP after age 23 years.
3651 men (1.2%) were granted a DP. The DP rate was inversely associated with both educational level and intellectual performance. The adjusted population attributable risks (PAR) values for these two variables were 47% and 35%, respectively. The effect of the other variables was modest. Over- and underweight and short stature were associated with DP, but the effect was largely reduced after adjusting for intellectual performance. Impaired mental function seemed to have an independent effect.
Receiving an early DP is dependent on several factors acting at different stages of life, above all educational level and intellectual performance. High education can modify some of the effects of low intellectual performance.
This article offers a formal identification analysis of the problem in comparing coefficients from linear probability models (LPM) between groups. We show that differences in coefficients from these models can result not only from genuine differences in effects, but also from differences in one or more of the following three components: outcome truncation, scale parameters and distributional shape of the predictor variable. These results point to limitations in using LPM coefficients for group comparisons. We also provide Monte Carlo simulations and real examples to illustrate these limitations, and we suggest a restricted approach to using LPM coefficients in-group comparisons.
The objective of this article is to investigate how psychosocial difficulties, functional level and school factors affect social security dependence among former students with special needs (N = 373). These individuals have been followed prospectively from their teens and into their late twenties. The study is theoretically inspired by life-course perspectives, with emphases on transitions, linked lives, geographical and historical location and human agency. More than one-third of the study participants are dependent on social security. The logistic regression analyses show how each of the seven independent variables - while simultaneously controlling for the other covariates - impacts adult adaptation to social security. Women have almost a threefold higher risk of social security dependence than men. The covariates affect males and females differently. For men, the risk is especially high if they have psychosocial problems, are supported by teaching assistants in class or experienced delayed educational transitions. For women, the risk is elevated if their functional level is low or school results are poor.
The article analyses how living conditions during childhood and adolescence structure socio-economic circumstances in midlife. The data are drawn from a new longitudinal Swedish data set—the Stockholm Birth Cohort Study— in which we can follow 14,294 individuals from birth (1953) to the age of 48 (2001). The analysis proceeds in three steps. The first step establishes the link between precarious living conditions in childhood and midlife social exclusion. In the second step, structural equation modelling is used to depict the pathways by which this association is mediated. The analysis produces tentative evidence that the long-term effect of financial poverty primarily runs via educational failure, whereas the effect of other social problems in the family of origin runs via deviant behaviour. In the third step, we analyse whether or not children who were raised in poor families or in families with other social problems are more sensitive to new risk exposures as adults. This is tested by examining the effect of long-term unemployment during the economic crisis of the 1990s on social exclusion risks 7-9 years later.
We used data from several national registers for fifteen entire cohorts (n > 1.5 million) of Swedish children and youth to examine the influence of parental socio-economic background on the risk of
entry into out-of-home care. Logistic regression models were used to analyse the statistical impact of twelve background variables,
including parental psycho-social risk markers. The results confirm and expand findings from a classic study by Bebbington
and Miles, published in 1989. After controlling for other background variables, including parent hospitalizations for attempted
suicide, psychiatric disorders or addiction problems, children of single mothers had three to four-fold higher odds of entering
care than children from two-parent households. Low maternal education and receipt of social assistance were strongly associated
with higher odds for care entries. Aggregations of socio-economic risk factors increased dramatically the risk of entering
care. Among pre-school children with mothers who had received basic education only, were unemployed and received social assistance
during three consecutive years, one in seven was placed in care before their seventh birthday. Among same-age children from
two-parent families whose mothers were educated to post-secondary level, were employed and had not received social assistance
for three consecutive years in the middle of the observation period, fewer than one in 2,000 entered care.