Factors associated with the ability of the care system to meet the physical and mental health needs of young people looked after in England: a mixed-methods study
Keywords: mental health
foster care
physical health
looked after children
co-production
creative research methods

Background: Evidence suggests that children and young people in the care system have exceptional physical and mental health needs. Before entering the care system, they are likely to have experienced childhood poverty, child abuse and/or neglect, domestic violence and other adverse experiences, all of which have been associated with adverse health outcomes in adulthood. Government initiatives have endeavoured to meet the health of needs of children and young people in care in England by developing nationwide specialist health services to assess and monitor their health. However, little is known about how well the health needs of children and young people in care are met, or how children and young people in care experience specialist health services.
Methods: The aim of this study was to explore what factors were associated with the ability of the care system to meet the physical and mental health needs of children and young people in care, and to consider the barriers that prevent them accessing or engaging with routine and specialist health services. Drawing on Bronfenbrenner’s ecological systems theory as the conceptual framework, this convergent mixed-methods study, undertook statistical analyses of the English Children Looked After Database (SSDA903) and National Pupil Database to identify characteristics and care or educational experiences that were associated with health assessments, dental checks, and immunisations being up to date. These statistical analyses also explored factors that were associated with young people having mental health difficulties, substance misuse problems or criminal convictions. Visual and creative methods were employed during extensive, in-depth interviews, in which eight young people in care (aged 12 to 18) collaged life-size human bodies to represent their own health and health experiences.
Results: Analyses of the data in this study revealed several factors associated with the ability of the care system to meet the health needs of young people in the care system. The interviews with young people in care suggest that children and young people enter the care system with a poor understanding of normative health care (such as primary care, dental care, healthy eating, and sleep and exercise routines). The statistical analyses revealed that young people who had been in care longer were more likely to be up to date with immunisations but less likely to be up to date with health assessments. Moreover, young people who had experienced multiple placement changes, had been placed in residential care, had received a fixed-term exclusion or had a special educational need were more likely to have mental health difficulties, substance misuse problems and criminal convictions. The results also suggest that young people begin to disengage with specialist services due to their desire to feel normal and not wanting to be treated differently to their peers in the general population.
Conclusion: The results suggest that, at least to some extent, the care system is providing compensatory health care for those children and young people with the greatest needs. However, this study has also shown that the current data collection for the Children Looked After Database (SSAD903) does not facilitate the understanding of some key issues relating to the health needs of children and young people in care, such as the range of physical and mental health issues they may have and whether they have access to other specialist services (such as outpatients) to ensure that any identified health needs are met. Moreover, young people in care are striving for normality and yet do not understand how to navigate normative health services such as primary care. These findings may inform future interventions to promote the health and well-being of children and young people in care.