Health outcomes for looked-after children

Health outcomes for looked-after children

This research used data made available via the Office for National Statistics Secure Research Service, which is being expanded and improved with ADR UK funding. 

Author: Dr Emily Murray, University College London (UCL)

Date: November 2020

Research summary

Research carried out by University College London (UCL), and funded by the Nuffield Foundation, built a comprehensive picture of the health and social functioning of adults who had been looked-after in childhood.

Using the Office for National Statistics’ (ONS) Longitudinal Study data between 1971 and 2001, this research extended previous studies to investigate the outcomes of looked-after children beyond their early adult years. The research concluded that adults in England and Wales who grew up in care had worse self-rated health, and were more likely to die prematurely, compared to other adults in the population. The researchers were consulted about these findings by a charity who run the All-Party Parliamentary Group for Adoption and Permanence. The findings were circulated to three different fostering and adoption services and cited by renowned safeguarding child protection organisations.

Data used

The UCL researchers used the ONS Secure Research Service (SRS) to analyse data from the Longitudinal Study of England and Wales. The Longitudinal Study contains linked census and life event data for a 1% sample of the population. Starting with the 1971 Census, data from subsequent censuses has been supplemented with civil (births and deaths), NHS and cancer registrations and life events.

Methods used

The UCL researchers ran two analyses using the ONS Longitudinal Study data. The first analysis used data for more than 350,000 individuals and a Cox proportional hazards regression model with time-varying covariates to test whether mortality risk varied for those in care. The variables modelled included age and gender. The second analysis used multi-level logistic regressions to investigate whether the self-rated health outcomes of adults who had been in non-parental care differed by care type, up to 30 years later.

Research findings

Adults in England and Wales who grew up in any type of care setting between 1971 and 2001 had worse self-rated health and were more likely to die prematurely, in the decades after they had been in care.

With up to 42 years of follow-up, premature death was 70% more likely in adults who had spent time in care as children. The risk of death in adults who had been in care as children increased over time, from 40% in the 1971 cohort to 360% in the 2001 cohort.

Predicted mortality hazard ratios for care status by baseline census year.

Adults who had been in residential care were up to four times more likely to report their health as ‘not good’ compared to ‘good when compared to adults who were raised by their parents.

Research impact

The UCL research team published two journal papers (in May and July 2020), which were accompanied by an exclusive newspaper article to increase the reach and impact of the work.

The researchers were consulted by UK fostering and adoption charity Home for Good who run the All-Party Parliamentary Group for Adoption and Permanence, and the research findings were circulated to children's services by three Borough Shared Fostering and Adoption Services.

A spokesperson from Hammersmith and Fulham Borough Shared Fostering and Adoption Services said: "[the research] is coming at a good time as we are trying to find research about outcomes for children in long-term care."

The research outcomes were showcased across multiple websites and cited in CASPAR, the National Society for the Prevention of Cruelty to Children (NSPCC)'s safeguarding child protection email newsletter.

Research outputs

Publications and reports

Blogs, news posts, and videos

Presentations and awards

  • Society for Longitudinal and Lifecourse Studies conference symposium, September 2019: Out of home care during childhood: impacts on individuals and families
  • Poster, September 2018: The health of adults who had been in care up to 30 years earlier: are there differences by type of care?
  • Special Recognition, ONS Research Excellence Award 2020

About the ONS Secure Research Service

The ONS Secure Research Service (SRS) is an accredited trusted research environment, using the Five Safes Framework to provide secure access to de-identified, unpublished data. If you would like to discuss writing a future case study with us, please get in touch:

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