Linking administrative data on children's social care to investigate the outcomes of provision

Objectives This paper will present findings from a study of linked administrative data on children’s social care (CSC) services in England. Its objectives were to identify and profile the underlying categories of demand for CSC services in England and compare the outcomes of provision between these categories, using a range of measures. Methods An anonymised longitudinal dataset was assembled for children in need and children in care who received services in England between 2015-21. Latent Class Analysis (LCA) was used to identify mutually exclusive categories of demand for all children subject to a statutory social work assessment within that period, based on the factors identified at assessment. Descriptive profiles of these categories were constructed using demographic data as well as children’s intervention pathway following assessment. Survival analysis using adjusted Cox regression models was then undertaken to compare rates of re-referrals, repeat child protection plans, and re-entries to care, for children receiving services within each category. Results The latent class analysis found twelve distinct categories of demand for children’s social care services, which were consistent across local authorities. Conditional probabilities were used to interpret the demand represented by each category, in consultation with stakeholders. The most prevalent category was domestic abuse and violence (19.7%), followed by complexities around parental mental health (18.4%). Other categories included disability, child mental health, risks outside the home, complex domestic abuse, and concerns about another person in the family or household. The profile of children varied across these categories, including age, gender, ethnicity, the level of risk identified by services, and the type of provision received. Significant differences were also found in the outcomes of provision across categories, especially in re-referrals and re-entries to care. Conclusion The categories create an evidence-based typology of demand to supplement conventional performance measures. Local profiling of these categories can be support designing and planning services and aligning the textual information gathered in assessments with the statistical data used for audit and inspection

Exploring demand and provision in English child protection services

This paper presents the results of an exploratory study linking the national data-sets for all children in need and child protection services in England. The study was informed by an emerging literature on systems thinking in public services, and aimed to examine variations and patterns of response in local authorities to demand for child welfare services in their area. One hundred and fifty-two local authority census returns and other statistical indicators covering up to a thirteen-year period were combined into a single data-set. Statistical analysis was undertaken to explore the characteristics of demand, workload and workforce, trends over time and variations between local authorities. The results showed that the overall system has become increasingly geared towards protective interventions, especially since the Baby P scandal of 2008. Deprivation levels continue to be the key driver of referrals and other categories of demand, and are strongly associated with variations in service response, particularly in the initial stages of referral and assessment. Implications are considered for the current organisation of child welfare services in light of recent reviews and reforms

Admission to hospital for bronchiolitis in England: Trends over five decades, geographical variation and association with perinatal characteristics and subsequent asthma

Background: Admission of infants to hospital with bronchiolitis consumes considerable healthcare resources each winter. We report an analysis of hospital admissions in England over five decades. Methods: Data were analysed from the Hospital In-Patient Enquiry (HIPE, 1968-1985), Hospital Episode Statistics (HES, 1989-2011), Oxford Record Linkage Study (ORLS, 1963-2011) and Paediatric Intensive Care Audit Network (PICANet, 2003-2012). Cases were identified using International Classification of Diseases (ICD) codes in discharge records. Bronchiolitis was given a separate code in ICD9 (used in England from 1979). Geographical variation was analysed using Local Authority area boundaries. Maternal and perinatal risk factors associated with bronchiolitis and subsequent admissions for asthma were analysed using record-linkage. Results: All-England HIPE and HES data recorded 468 138 episodes of admission for bronchiolitis in infants aged <1 year between 1979 and 2011. In 2011 the estimated annual hospital admission rate was 46.1 (95% CI 45.6 to 46.6) per 1000 infants aged <1 year. Between 2004 and 2011 the rates rose by an average of 1.8% per year in the all-England HES data, whereas admission rates to paediatric intensive care changed little (1.3 to 1.6 per 1000 infants aged <1 year). A fivefold geographical variation in hospital admission rates was observed. Young maternal age, low social class, low birth weight and maternal smoking were among factors associated with an increased risk of hospital admission with bronchiolitis. Conclusions: Hospital admissions for infants with bronchiolitis have increased substantially in recent years. However, cases requiring intensive care have changed little since 2004