Moments that matter: How children's social care referrals can change health trajectories

In this blog, Dr Eliazar Luna explores how linked administrative data reveals critical patterns in children's healthcare around the moment of social care referral. Drawing on research using the ECHILD dataset, this study demonstrates how secure data linkage can help us better understand healthcare trajectories, offering vital evidence to inform policy and earlier intervention for families in need. Eliazar is part of the ADR England Research Community Catalyst: Children at risk of poor outcomes.

When Maya was eight years old, her teachers noticed she was often unwell and missing school. At home, her mum was struggling with debt, and the family had few support networks. One evening, after several asthma attacks, Maya had one that led to an emergency hospital admission, and social services became involved.

For many children like Maya, this first referral to children’s social care (CSC) marks a critical turning point. Our new study, using the Education and Child Health Insights from Linked Data (ECHILD) - England dataset, shows just how pivotal that moment can be.

What our study found

We examined hospital records for over 1.3 million children in England with a first accepted referral to children’s social care (CSC) between 2009 and 2018, including Children in Need, those on a Child Protection Plan, and Children Looked After. Together, these children accounted for more than 12 million hospital contacts, which we categorised into planned care (outpatient visits and planned admissions) and unplanned care (A&E attendances and emergency admissions). Using an interrupted time series design, we modelled healthcare use before and after referral for these types of care, and estimated what would have happened had CSC involvement not occurred. We also compared the healthcare utilisation of CSC groups with matched peers without CSC involvement.

Our results show that:

• Healthcare utilisation peaked in the months around referral for all health services, with sharper peaks for Children Looked After compared to those who remain in their home with CSC support
• After CSC involvement, there was a shift towards planned care (outpatient visits and planned admissions), suggesting children’s health needs were increasingly recognised and managed
• At the same time, the increase in unplanned care was reduced, following CSC involvement
• Two years after referral, healthcare use was lower than expected had pre-CSC involvement trends continued
• Compared to matched children with no CSC involvement, those referred to CSC had much higher rates of hospital contacts across all types of care.

See the graphs

Taken together, these findings show that CSC referral is a potential inflexion point towards more proactive, coordinated healthcare.

The results speak directly to the UK Government’s Families First Partnership, which is seeking to rebalance children’s services towards prevention and earlier help. Our evidence suggests why this approach is so vital. The referral moment brings health and social care systems into close contact with families at a time of very high need. If this moment is seized, it can become more than a reaction to crisis — it can be the starting point for better coordinated care.

The observed increase in planned care after referral shows that, when agencies work together, children’s health needs are more likely to be identified and addressed. Meanwhile, the reduction in unplanned care suggests that crisis visits to A&E can be prevented when services anticipate problems earlier.

This study responds directly to the Children at Risk of Poor Outcomes Research Agenda, which emphasised the need for research that:

• looks beyond children in out-of-home care to include Children in Need and those on Child Protection Plans
• examines the healthcare trajectories of children over time, not just after CSC involvement
• spans across different sectors to get a more holistic view of children’s journeys.

By understanding children’s healthcare trajectories over four years around their first CSC referral, and comparing them to matched cohorts, our work addresses each of these priorities and provides important insights for policymakers.

Why data matters

Without linked datasets like ECHILD, these patterns would remain hidden. Surveys cannot capture millions of hospital contacts or distinguish pre- and post-referral trajectories. ADR UK’s investment in secure data linkage and research infrastructure has made it possible to follow children’s journeys across education, health and social care, and to ask the “what if” questions that are crucial for policy.

This evidence gives policymakers a clearer picture: CSC referrals are not just administrative milestones, but real opportunities to reshape health trajectories. They are windows to provide more planned support, reduce reliance on emergency care, and support families.

Looking ahead

Maya’s story is fictional, but the data represents very real lives. Behind every peak in A&E attendances or outpatient appointments is a child with complex needs and a family navigating stress. The challenge is to ensure that every referral is treated not only as a sign of crisis, but as the start of coordinated support across schools, hospitals, and social care.