Permanently Progressing? Building Secure Futures for Children in Scotland: Pathways and outcomes for looked after children

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Linda Cusworth
Jade Hooper
Nina Biehal
Marina Shapira
Helen Whincup
Published online: Jun 11, 2018


Background
Each year many children in Scotland who cannot be cared for by their birth parents become looked after by Local Authorities. Where reunification is not an option, children need to be settled as soon as possible in safe and secure alternative homes. However, more research evidence is needed to guide the placement decisions that are so crucial to children’s wellbeing.


Objectives
The Permanently Progressing? study aims to help identify factors that are associated with children achieving a permanent home. The study hopes to inform policy, planning and practice in relation to young children who cannot live with a birth parent.


Methods
Using the Children Looked After Statistics that are collected by the Scottish Government from all 32 Local Authorities, the study followed a group of children who became ‘looked after and accommodated’ at age five or under (n=1355) in 2012-13. Children’s pathways through the system over a four-year period were investigated and compared to another group of children aged five or under who became ‘looked after’ in the same year but remained with their birth parent(s) at this time (n=481).


Findings
The paper discusses children’s pathways through the looked after system, together with factors which may influence these pathways, such as age when becoming looked after, number and type of placements, and types of permanence achieved 3-4 years after becoming looked after.


Conclusions
This longitudinal analysis of administrative data offers unique insights into factors that may influence child welfare system responses to vulnerable children, which will be discussed, along with issues surrounding the difficulties associated with the definition and measurement of outcomes using these data.


Background

Multimorbidity is recognised as a complex and growing health challenge. Currently there is no ``gold standard'' multimorbidity measure and few studies have compared measures in hospitalised patients.

Objectives

We aimed to evaluate two published multimorbidity measures in routine hospital episode data in NHS Grampian, Scotland.

Methods

We used the Scottish Morbidity Record (SMR) data for the years 2009-2016. We included all adults admitted to hospital in the Grampian region of Scotland (population 588,100) during 2014. Morbidities were identified from inpatient admissions during the five years prior to admission date in 2014 (ICD-10 codes). Two multimorbidity measures were used: Charlson (Quan 2005), and Tonelli et al (2015); and multimorbidity was defined as \(\geq\)2 morbidities. Kappa statistics assessed agreement between the two measures in classifying patients as multimorbid. The association between multimorbidity and mortality, readmissions, and length of stay was examined using regression methods with odds ratios (OR) or incidence rate ratios (IRR) calculated as appropriate.

Findings

In 41,545 adults (median age 62 years, 52.6% female), multimorbidity prevalence was 15.1% (95% CI 14.8%-15.5%) using Charlson and 27.4% (27.0%-27.8%) using Tonelli - agreement 85.1% (Kappa 0.57). After adjusting for covariates, multimorbidity was associated with an increased risk of longer length of stay, (Charlson IRR 1.10 (1.03, 1.18; p=0.005); Tonelli IRR 1.11 (1.04, 1.18; p<0.001)) and readmission (Charlson OR 2.06 (1.94, 2.19; p<0.001); Tonelli OR 2.12 (2.01, 2.22; p<0.001)). Multimorbidity had a higher risk of mortality when measured using Charlson (Charlson OR 2.71 (2.52, 2.92; p=<0.001); Tonelli OR (1.84 (1.72, 1.98; p<0.001)).

Conclusions

Multimorbidity measures operationalised in hospital episode data identified those at risk of poor outcomes and will be useful for future multimorbidity research and use in secondary care data systems.

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