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      Early life adversity, contact with children’s social care services and educational outcomes at age 16 years: UK birth cohort study with linkage to national administrative records

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          Abstract

          Objectives

          To use record linkage of birth cohort and administrative data to study educational outcomes of children who are looked-after (in public care) and in need (social services involvement), and examine the role of early life factors.

          Setting, design

          Prospective observational study of children from the Avon Longitudinal Study of Parents and Children (ALSPAC), which recruited pregnant women in and around Bristol, UK in the early 1990s. ALSPAC was linked to the annual Children Looked-After (CLA) Data Return and Children In Need (CIN) Census. Educational outcomes at 16 years were obtained through linkage to the National Pupil Database (NPD). These included passing 5+ good GCSEs (grades A*-C, including English and Maths). Covariates included early life adversity and social position.

          Participants

          12 868 ALSPAC participants were linked to the NPD. The sample for the main educational outcomes analyses comprised 9545 children from the ALSPAC core sample who had complete education data.

          Results

          Overall, of the 12 868 ALSPAC participants linked to NPD data, 137 had a CLA record and a further 209 a CIN record during adolescence. These children were more disadvantaged than their peers and had little active study participation beyond infancy. In the main educational outcomes analyses, achievement of 5+ good GCSEs was low in the CLA (OR 0.14, 95% CI 0.05 to 0.35) and CIN (0.11, 0.05 to 0.27) groups relative to their peers. Measured early life factors explained little of this difference.

          Conclusions

          Data linkage enabled the study of educational outcomes in children with social services contact. These children had substantially worse educational outcomes relative to their peers, for reasons likely to be multifactorial.

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          Most cited references26

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          Maternal smoking during pregnancy and child outcomes: real or spurious effect?

          Maternal smoking during pregnancy (MSDP) is a major public health concern with clearly established consequences to both mother and newborn (e.g., low birth weight, altered cardiorespiratory responses). MSDP has also been associated with higher rates of a variety of poor cognitive and behavioral outcomes in children, including attention deficit hyperactivity disorder (ADHD), conduct disorder, impaired learning and memory, and cognitive dysfunction. However, the evidence suggesting causal effects of MSDP for these outcomes is muddied in the existing literature due to the frequent inability to separate prenatal exposure effects from other confounding environmental and genetic factors. Carefully designed studies using genetically sensitive strategies can build on current evidence and begin to elucidate the likely complex factors contributing to associations between MSDP and child outcomes.
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            History of maltreatment and mental health problems in foster children: a review of the literature.

            Foster children often experience compromising situations such as neglect, physical abuse, or sexual abuse before out-of-home placement. This article aims to give a literature review related to the development and mental health of foster children with special consideration of trauma history. A computer-based literature search was conducted in the databases Medline, PsycINFO, PSYNDEXplus, and SCOPUS. We determined a time frame from 1998 to 2009. The literature search resulted in 32 articles reporting empirical data about development and mental health in foster children. Very high rates of exposure to maltreatment, developmental delays and mental disorders were found. A broad spectrum of externalizing as well as internalizing symptoms and a high prevalence of comorbid mental disorders were found. Foster children exhibit a broad pattern of developmental problems and psychopathology. The etiology of these disorders is discussed in the context of multiple risk factors, especially that of persistent maltreatment.
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              Adult health and social outcomes of children who have been in public care: population-based study.

              To examine adult socioeconomic, educational, social, and health outcomes of being in public care in childhood. The 1970 British birth cohort was followed up at 5 (N = 13135), 10 (14875), 16 (11622), and 30 years (11261). Cases were defined as those ever in statutory or voluntary public care at 5, 10, and 16 years. Self-reported adult outcomes were occupation, educational achievement, general health, psychological morbidity, history of homelessness, school exclusion, and convictions. A total of 343 (3.6%) of 9557 had been in public care <17 years. Nonwhite children were more likely to have been in care (odds ratio [OR]: 3.3; 95% confidence interval [CI]: 2.1-5.4). Controlling for socioeconomic status, men with a history of public care were less likely to attain high social class (OR: 0.6; 95% CI: 0.4-0.9) and more likely to have been homeless (OR: 2.0; 95% CI: 1.1-3.8), have a conviction (OR: 2.3; 95% CI: 1.5-3.4), have psychological morbidity (OR: 1.8; 95% CI: 1.1-3.0), and be in poor general health (OR: 1.6; 95% CI: 1.1-2.6). Similar associations were found in women. Men but not women with a history of care were more likely to be unemployed (OR: 2.6; 95% CI: 1.4-5.0) and less likely to attain a higher degree (OR: 0.4; 95% CI: 0.2-0.7). Nonwhite ethnicity was associated with poorer adult outcomes of being in care. Public care in childhood is associated with adverse adult socioeconomic, educational, legal, and health outcomes in excess of that associated with childhood or adult disadvantage.
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                Author and article information

                Journal
                BMJ Open
                BMJ Open
                bmjopen
                bmjopen
                BMJ Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2044-6055
                2019
                7 October 2019
                : 9
                : 10
                : e030213
                Affiliations
                [1 ] departmentBristol Medical School, Population Health Sciences , University of Bristol , Bristol, UK
                [2 ] departmentSchool for Policy Studies , University of Bristol , Bristol, UK
                Author notes
                [Correspondence to ] Dr Alison Teyhan; alison.teyhan@ 123456bristol.ac.uk
                Author information
                http://orcid.org/0000-0002-4965-3139
                Article
                bmjopen-2019-030213
                10.1136/bmjopen-2019-030213
                6797348
                31594881
                4d9f7a3b-8f67-4de4-8109-8dd56f3bf4e3
                © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

                History
                : 05 March 2019
                : 15 August 2019
                : 02 September 2019
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100000265, Medical Research Council;
                Award ID: 102215/2/13/2
                Funded by: Elizabeth Blackwell Institute for Health Research;
                Award ID: 105612/Z/14/Z
                Funded by: FundRef http://dx.doi.org/10.13039/100004440, Wellcome Trust;
                Award ID: 102215/2/13/2
                Award ID: WT086118
                Categories
                Epidemiology
                Original Research
                1506
                1692
                Custom metadata
                unlocked

                Medicine
                alspac,record linkage,education,social care,looked-after,adolescence
                Medicine
                alspac, record linkage, education, social care, looked-after, adolescence

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