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Background: Children in care and care leavers have worse health outcomes than their peers without care experience. This study addresses an evidence gap in exploring care-experienced young people's views and experiences of accessing general practice and dental services and attending health reviews in England. Methods: We conducted a qualitative study using podcasting as a creative medium. We recruited young people from two sites: one in South England (A) and one in greater London (B). We held two paired discussions in site A and two focus groups in site B, with 14 participants in total. Participants were aged between 13 and 22 years and were diverse in gender, ethnicity, and care experiences. Data were analysed thematically using candidacy theory as a theoretical framework. Results: Mental health was a prevailing concern for participants, but general practice was not considered a place to discuss it. Most participants reported distant relationships with primary healthcare professionals and considered opening-up to a professional to be risky, for example, it could result in an unknown/unwanted outcome. A lack of time and personal connection in appointments, and experiences of feeling judged, dismissed, or misunderstood, hindered young people's ability to disclose mental health or relationship concerns. Participants reported variation in the timeliness and location of services, with salient examples of extensive waiting periods for braces. Participants perceived annual health reviews to be largely inconsequential. Conclusions: Any primary care presentation by a care-experienced young person should trigger additional professional curiosity. To build rapport and trust, professionals should not underestimate the power of active listening, being reliable and honest, and small acts of thoughtfulness, for example, ensuring medical letters are provided promptly. Carers and other trusted professionals should help care-experienced young people to understand the role of primary care and support them with access. Health reviews may not be of value to all young people in care. Further research is needed to examine primary healthcare access for care-experienced young people with significant safeguarding and healthcare needs. [ABSTRACT FROM AUTHOR]

Family group conferences (FGCs) in child welfare share decision-making with family members by bringing the immediate and wider family together to make a plan to meet a child's needs. This paper reports survey findings on FGC provision in the UK in 2022 and explores whether in England the presence of an FGC service and the rate of FGC provision is associated with the rate of children in care, entering care, in kinship foster care and leaving care. Seventy-nine per cent (n  = 167) of local authorities in the UK provided FGCs to families, and 14 per cent (n  = 29) did not. Services that were more established offered a more diverse range of FGCs. The introduction of FGCs in English local authorities was associated with a higher rate of children in care, but also higher rates of kinship foster care, a key goal of FGCs where it is not possible for children to stay with their parents. Higher rates of FGCs were associated with more children leaving care, possibly due to reunification with birth families. To understand in more detail, the circumstances of children in and leaving care in local authorities with FGCs, individual data linkage studies are needed. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to consider some possible reasons for the relatively high rate in Wales of children looked after by local authorities. Design/methodology/approach: Selected potential explanations for Wales having higher rates were tested against aggregate data from published 2021 Government statistics. Wales was compared with England and English regions for area deprivation, local authority spending, placements at home and kinship foster care. Descriptive statistics were produced, and linear regression was used where appropriate. Findings: Wales has higher overall children looked-after rates and a bigger recent increase in these than any English region. Deprivation in Wales was higher than in most English regions. However, a smaller percentage of Welsh variation in local authority looked-after rates was explained by deprivation than was the case for England. Spending on preventative services has increased in recent years in Wales whilst decreasing in England, and there was not a clear relationship between spending on preventative services and the looked-after rate. Wales had a higher rate of care orders placed at home and more children per head of population in kinship foster care than any English region. Some of the explanations that have been suggested for Wales's particularly high looked-after rates seem to be supported by the evidence from aggregate data and others do not. Practice variation is likely to also be an important part of the picture. Originality/value: This is an original comparison of Wales, England and English regions using aggregate data. More fine-grained analysis is needed using individual-level data, multivariate analysis and qualitative methods. [ABSTRACT FROM AUTHOR]

As in many European states, a shortage of housing in England has resulted in some families who are 'waiting for' adequate and secure housing in England while also having the 'weight of' their children being placed outside their care hanging over them. This paper reports on the development of a practice guidance document that included an online survey with 38 children's social services practitioners in England regarding their practice experiences of responding to family homelessness. Findings suggest the complexity of the issue of family homelessness and implicitly highlight its neglect within contemporary research and policy in the UK. Homeless families are caught between the constraints of housing shortages and the complexity of the needs underpinning their homelessness. Despite these constraints, social work practice has an important role to play in providing, or facilitating families' pathway to, housing advocacy and advice. Most importantly of all, social work practice can maximise families' access to statutory family support provision so that families can be helped to remain together wherever this is safely possible. Suggestions for practice, policy, and research development are outlined. [ABSTRACT FROM AUTHOR]

Previous research has indicated that youth in care are at a disproportionally high risk of being suspended from school. Yet, research on this topic is scarce despite the detrimental effects such disciplinary actions can have on the educational development of this vulnerable group. Therefore, the goal of this study was to explore a longitudinal path model of factors associated with the risk of being suspended from secondary school among a national cohort of 3699 children placed in care in England. Using data from the National Pupil Database and the Children Looked after Database, children were tracked from School Year 2 through School Year 9 in order to test the direct and mediated effects of individual factors (i.e., gender, eligibility for free school meals, special educational needs, and belonging to an ethnic minority background), care factors (i.e., age of entry into care, reason for out-of-home placement, placement type and length of time in care) and educational factors (i.e., school type, achievements, absences and suspensions in Year 6 and school type in Year 9) on the risk of suspension in Year 9. Results indicated that approximately 1 in 5 children in care in England (19.4%) are suspended at least once during their secondary School Year 9; these proportions markedly exceed those previously found among their general population peers. Children found to be most at risk for out-of-school suspensions were (a) males; (b) late entrants into care; (c) children who had behavioral, emotional, or social difficulties; and (d) children with a history of suspensions. Surprisingly, being eligible for free school meals and having lower academic achievement was related to a decreased risk of being suspended. These findings are discussed in consideration of the interrelationships among variables and the mediating pathways found. Implications for schools and educators catering for youth in care are also discussed. [ABSTRACT FROM AUTHOR]

The goals of this article were to (a) examine the changes in educational achievements of children in care from preschool through the end of primary school; (b) identify subgroups exhibiting distinct educational trajectories; and (c) explore key predictive individual, care, and school characteristics. To this end, the study investigated a cohort of 1,834 children in England who had been in care in their final year of preschool. Data from the National Pupil Database and from the Children Looked After Database was used to examine national assessments of literacy and numeracy in preschool and School Years 2 and 6, as well as potential child (e.g., special educational needs), care (e.g., placement changes) and school predictors (e.g., school's mean ability level). The findings indicated that as early as preschool, children in care lagged substantially behind their peers and their relative academic condition worsened over time. Latent growth analyses revealed four distinct subgroups of children. One was a relatively resilient subgroup of children with "stable high" achievements over time, but more than 8 out of 10 children belonged to one of the other subgroups and exhibited maladaptive educational trajectories. Risk factors for a poorer trajectory included having special educational needs and spending more time in care during primary school, whereas attending higher performing schools was found to be related to better performing trajectories. The findings underscore the crucial need for early assessment and intervention efforts to deal with the unique educational needs of children in care. (PsycInfo Database Record (c) 2020 APA, all rights reserved). [ABSTRACT FROM AUTHOR]

Having a good understanding of one's origins and history is known to be significant in identity development. Drawing on a large‐scale online survey of looked after children's subjective well‐being, this paper demonstrates that a significant number of children and young people (age 4–18 years) did not fully understand the reasons for their entry to care. The paper explores the effect of this lack of knowledge on children's well‐being and on their feelings of being settled in their current placement. The study reiterates the need for professionals to be honest and open with children in out‐of‐home care and the need to specifically address, perhaps repeatedly, why a child is not living with their birth family. [ABSTRACT FROM AUTHOR]

There is a prevalent view in England that family-based care is the preferred placement option for children placed in out-of-home care. Nonetheless, it is acknowledged that for some young people residential group care can offer the best chance of positive outcomes, transition, and in some cases a route to permanence. With an emphasis on innovation, there has been a recent governmental focus on the role and purpose of these placements. This conceptual paper explores how the political and legislative context has influenced the current opinion and use of residential care, as well as examining the importance of factors such as attachment and relationships, parenting/intervention, the notion of home, a sense of belonging, and adolescent development. Evidence exploring associated risk and resilience factors is also discussed. We question whether adopting a child development perspective and moving the discourse away from placement type to placement purpose would better support children and young people to fulfill their life chances. Residential care undoubtedly offers a different experience to that of family-based care, although, further research assessing a wider range of attributable outcomes is necessary to understand how policy and practice can intervene to best support development and opportunity for children placed in out-of-home care. [ABSTRACT FROM AUTHOR]

This paper examines the interlocking roles of ethnicity and deprivation in producing inequities in the proportion of children who are subject to state child protection interventions. In contrast to the USA, ethnic inequities have had little attention in research or policy in the UK and across Europe, and administrative data are limited and methodologically weak. A study of over 10 per cent of all children on child protection plans or who were looked after in out-of-home care in England in March 2012 is reported. Children from ethnic minority categories were much more likely than 'White' children to be living in disadvantaged areas and this has to be taken into account when examining intervention rates. Controlling for deprivation and examining small subgroups of the broad ethnic categories radically alters the simple understanding that 'Black' children are overrepresented compared to White amongst children in out-of-home care, while 'Asian' children are under-represented. While this study could not explain these patterns, it reinforces the importance of both socio-economic circumstances and ethnicity for understanding inequities in intervention rates. The evidence underlines the powerful moral and economic case for action to reduce inequities in powerful state interventions in family life, not only in England, but internationally. [ABSTRACT FROM AUTHOR]

Placement in out-of-home care (OHC) indicates serious childhood adversity and is associated with multiple adverse outcomes. Each year 0.5% of children in England live in OHC but evidence is lacking on the cumulative proportion who enter during childhood and how this varies over time. We measured the proportion of children born between 1992 and 2011 who entered OHC, including variation in rates of entry over time, and explored the determinants of these changes using decomposition methods. We also described changes in placement type, duration and stability. By age 18, 3.3% of children born 1992–94 entered OHC. This proportion varied by ethnicity (1.6% of White vs. 4.5% of Black children born 2001–03 entered OHC by age 9, 95% CI [1.5–1.7] and [4.4–4.6], p < 0.001) and increased over time (0.8% of children born 2009–11 entered OHC by age 1 vs. 0.5% born 1992–94, 95% CI [0.7–0.9] and [0.4–0.6], p < 0.001). This overall increase was driven primarily by the increased rate of entry among White children and not by concurrent changes in the population's ethnic composition. The proportion of children entering OHC in England is increasing and characteristics of the care they receive are changing with earlier intervention and longer, more stable placements. Further research is required to understand the reasons for these changes in practice and whether they are cost-effective, sustainable, and improve outcomes for children and society. [ABSTRACT FROM AUTHOR]

Limited attention has been given to the concept of place in social work research and practice. This paper draws on the national evaluation of social work practices (SWPs) in England undertaken between 2009 and 2012. SWPs were pilot organisations providing independent social work services for children in out-of-home care in five sites. One factor distinguishing some of these pilots was their attention to place. The evaluation employed a mixed methods approach and we use data from interviews with 121 children and young people in out-of-home care, 19 birth parents and 31 interviews with SWP staff which explored their views and experiences of the SWP offices. Children and young people were alert to the stigma which could attach to social work premises and appreciated offices which were planned and furnished to appear less institutional and more 'normal'. Daily interactions with staff which conveyed a sense of recognition and value to service users also contributed to a view of some SWP offices as accessible and welcoming places. Both children and parents appreciated offices that provided fun activities that positioned them as active rather than passive. Staff valued opportunities for influencing planning decisions about offices and place was seen to confer a value on them as well as on service users. However, not all the SWPs were able to achieve these aspects of place, and engaging children and families in place was less likely when the service user population was widely dispersed. Recognising the importance of place and how place is constructed through relationships between people as well as through the physical environment appeared to be key to creating offices that combated the stigma attached to out-of-home care. Those leading and managing children's services should explore ways of involving local communities in planning social work offices and turn attention to making these offices accessible, welcoming, places. [ABSTRACT FROM AUTHOR]

Policies and thresholds vary for placing children into out-of-home care (OHC) at different ages. Evidence is lacking that quantifies the risk of entering OHC by age, and how this varies over time and between countries. We determined the age-specific cumulative incidence of ever entering OHC during childhood in Denmark and in eight local authorities in England. We used administrative data for any form of OHC (except respite care) provided by children's social services in Denmark and England from 1992 to 2008. Using life tables and national population estimates, we calculated the cumulative incidence of entry into OHC by year of age for cohorts born in 1992–1994 through to 2006–2008. The cumulative incidence of entry into OHC decreased over time in Denmark and increased in England at all ages. Cumulative incidence of OHC in the first year of life was similar in Denmark and England for infants born in 1992–1994 (Denmark 2.83/1,000, England 2.89/1,000), but infants born in 2007–2008 were nearly three times as likely to enter OHC before their first birthday in England (4.50/1,000) than in Denmark (1.61/1,000). Entry into OHC during adolescence was more common in Denmark than in England so that by 16 years old the cumulative incidence of ever entering OHC during childhood was twice as high in Denmark (33.83/1,000) as in England (15.62/1,000). Diverging trends over time in the use of OHC in Denmark and England are likely to reflect changing policies in the two countries. [ABSTRACT FROM AUTHOR]

This article explores the financial, housing, and emotional support provided to 16–19 year old care leavers, studying in further education in England. Drawing on 28 interviews with social workers and further education college professionals the article discusses the accessibility of existing provision in England, with a particular focus on the relationships and collaborative working practices between further education professionals and social work teams. The article argues that despite the individual commitment of further education professionals, the level of support they provide is, in the main, sketchy, reactive, and under-resourced. Given the significant austerity measures implemented by the Conservative–Liberal Coalition government, it is now all the more important for both education and social services to adopt a more collaborative interagency approach in order for them to address the complex problems experienced by care leavers studying in further education. [ABSTRACT FROM PUBLISHER]

Abstract: This paper reports on the evaluation of an English experiment which, for the first time, moved statutory social work support for children and young people in out-of-home care from the public to the private or independent sector. Five social work practices (SWPs), independent or semi-independent of local government, were established and evaluated using a matched control design with integrated process evaluation. Social work teams in the public sector, selected to correspond to key characteristics of the SWP sites, provided control sites. While most SWPs were perceived to be accessible and user-friendly organizations, children''s and young people''s accounts showed no differences between pilots and control sites in terms of workers'' accessibility and responsiveness. Perceptions of SWP staff''s decision-making were mixed. SWP staff reported spending more time in direct face-to-face work with children and families but this was attributed to reduced caseload size and a tight remit which excluded child protection work rather than to decreased bureaucracy. SWP staff morale was generally found to be high in terms of depersonalization and social support, reflecting an emphasis on staff supervision in these organizations. However, this was offset by slightly higher job insecurity which reflected the precariousness of employment in the independent as opposed to state sector. Staff retention varied between the SWPs, but although children and young people in the pilots were more likely to retain their key worker than those in control sites, they experienced disruption in the move into SWPs and back to public services when SWP contracts were not renewed. While some SWPs succeeded in reducing placement change rates for children and young people, a policy of switching placement providers to achieve flexibility and savings increased placement change rates in some SWPs. SWPs did not achieve financial independence from the local authority commissioners with only one assuming full responsibility for managing the placement budget. Payment by results was not used consistently. None of the commissioners interviewed considered that the SWP model had resulted in savings. The study highlighted the interdependence of public and private sectors. As small organizations, most of the SWPs succeeded in offering an accessible and personalized service, and public services should consider reorganizing to achieve similar outcomes. However, this evaluation found that contracted-out organizations struggled to provide children in out-of home care with the consistency and continuity they require. [Copyright &y& Elsevier]

• Preventing child maltreatment is an urgent public health goal. • In England, fiscal policies have resulted in cuts to preventative children's services. • Reductions in prevention spend were associated with rising adolescent care entry. • Policies should promote reinvestment in upstream services offering ordinary help. Children in care face adverse health outcomes, throughout the life-course, relative to the general population. In England, over the last decade, the rate of children entering care has increased. The rate of change differs markedly for older and younger children, who may also experience different preventative services. These services have been subject to inequitable spending reductions due to fiscal policies trailing the 2008 recession. To assess the impact of cuts to prevention on rates of preschool children and adolescents entering care between 2012 and 2019. Children aged 1–4 and 16–17 years, across 150 English upper-tier local authorities. Our outcomes were annual rates of children entering care, aged 1–4 and 16–17. Our exposures were Children's Services prevention spend per child under 5, and per child over 12. Regression models were used to quantify, within areas, associations between trends in prevention spend and trends in rates of children entering care, controlling for employment and child poverty rates. We found no association between changes in prevention spend per child under 5 and changes in care entry for 1–4-year-olds. However, spending reductions per child over 12 were associated with rising rates of 16–17-year-olds entering care. Every £10 per child decrease in prevention spend was associated with an estimated additional 1.9 per 100,000 children aged 16–17 entering care the following year (95% CI 0.7 to 2.9), equivalent to 1 in 25 care entries in this age group between 2012 and 2019. This study offers evidence that rising rates of older children entering care has partly been driven by cuts to prevention services catering to their needs. Policies to tackle adverse trends should promote reinvestment in youth services, placing ordinary help on a robust statutory footing. [ABSTRACT FROM AUTHOR]