Title: Children in households with substance misuse, domestic violence or mental health problems: Who is at risk of entering care?
Funder: Health and Care Research Wales (Welsh Government)

Abstract: Background The numbers of children in care in Wales have been increasing since the mid-1990s and rates vary across local authorities. Although some studies have looked at variations between local authorities at one point in time, and there has been considerable speculation about reasons for the overall increases over time, there is almost no direct research evidence to date on why rates have been rising year on year and how this trend varies between authorities. Certain family problems have been identified as risk factors for care entry including mental health issues, substance misuse and domestic violence. However, the relationship between the occurrence of these problems and changes in the numbers of children in care, both over time and across local authorities, is not clear. Aim This is a mixed methods study that will ask what is the risk of a child in a household with substance misuse, domestic violence or mental health problems being taken into care in Wales, and how this association has varied across time and across Welsh local authorities. Methods The quantitative stage of the study will be a case-cohort study using linked administrative datasets. These datasets will be used to identify children who have entered care during any of the years between 2003 to 2019, and adults resident in their households that year. They will be compared to children who did not enter care during each of those years and their households. Proxy variables will be identified from Welsh health datasets to indicate mental health problems, substance misuse or domestic violence in adults residing with children. Logistic regression models will be used to derive odds ratios showing the chances of a child in a house where one of these risk factors is present entering care as compared to a child where the risks are not present. These models will look at these risk factors both individually and cumulatively, and control for demographic factors and levels of deprivation. Multilevel models will be used to explore how these effects vary across local authorities. These will be developed both with and without variables indicating the prevalence of the risk factors in that local authority. This will help to identify if any changes in the odds of a risk factor being present across local authorities are due to the prevalence of these risks in that population. Subgroups of data will be used to explore care entry for children in different years, to identify how trends have changed over time. The findings of the quantitative analysis will be used to identify local authorities where the rates of care entry for children from families with specific problems are lower than might be expected or have decreased over time. Such cases will be followed up by qualitative focus groups with those working in children’s and/or adult services to find out if there are any elements of policy or practice that they think may account for the differences. Benefits Findings will be of benefit to policy makers working to reduce the need for children to enter care as they will provide vital new understanding about some of the factors responsible for increasing care numbers and variations across local authorities. The qualitative analysis will highlight ways of working or support services that practitioners feel are responsible for lower rates.

Lay abstract: Children’s social services are facing challenging times, with the numbers of children in care increasing year on year. These numbers have been increasing since the mid-1990s but the reasons why are not clear. There has been speculation about possible reasons but almost no direct research on the issue. The rise could be associated with changing problems in society. Alternatively, it may be due to the way local authority social service departments respond to family problems. This project aims to unpick some of the reasons why the numbers are increasing. It will do this by looking at the sorts of problems that the adults living with children before they go into care have, to see whether this has changed over the years between 2003 and 2019. It will use data that have already been collected by local authorities and health services to explore these problems, looking particularly at mental health problems, substance misuse and domestic violence. It is understood by the researchers that these data sets will not be able to show the full extent of these problems in families. However, what they will be able to do is show how these problems have changed over the period between 2003 and 2019, and whether a child in a family where there are indications of for example, mental health problems in 2003, was as likely to be taken into care as a child in 2019. It will also look at how prevalent the problems are in society and find out if children are more likely or less likely to be taken into care when these problems are more common in the whole population. The project will consider, not just how these issues affect children across the whole of Wales, but also how they vary from one local authority to another. We know the rates of care vary between local authorities, but might it be that children with specific types of family problems might be more likely to enter care in one local authority than another? If there are local authorities where children from families with a certain type of problem appear to be less likely to enter care, then there are questions to be asked about why. Is it because of the way social services responds to such cases, or particular services offered to families that prevent the need for children to enter care in such circumstances? The second part of the research will set out to find answers to this, by using focus groups to talk to those working in both adult and children’s services in such local authorities. Public involvement will be really important throughout this study, and both care-experienced young people and adults who have been involved in children’s social services will be consulted regularly. They will provide advice about the family problems to look at, discuss interim findings, and help to shape the focus groups that will take place in local authorities. They will also be consulted about the final recommendations of the project and the materials used to disseminate findings. Different materials will be prepared to ensure the findings are widely spread to policy makers, practitioners, academics and the wider public. The findings will be discussed at academic conferences and published in academic journals. There will also be a project report, and two briefings, one aimed at practitioners and the other a young person-friendly version. Seminars will be held for practitioners to discuss the findings and a press release will be issued so that the findings can be spread across the wider population.

Research activity codes: 2.3 PSYCHOLOGICAL, SOCIAL AND ECONOMIC FACTORS;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: DISPUTED AETIOLOGY AND OTHER