Using longitudinal administrative data to characterise the use of out-of-home care among looked after children in England

BACKGROUND: Children in out-of-home care are a vulnerable population. In England, disaggregated data related to out-of-home care have been collected since 1992 through the Children Looked After (CLA) dataset. However, official analyses of CLA data produce annual statistical ‘snapshots’, which cannot account for the complexity of care placements throughout childhood. AIM: To characterise the use of out-of-home care among children in England using longitudinal administrative data. METHODS: Using longitudinal CLA data for a large, representative sample of children born 1992-94 (N=19,848), I estimated the cumulative incidence of placement in out-of-home care during childhood, described variation in childhood care histories and identified latent classes of out-of-home care. I also explored the stability of care placements and exits from care using sequence analysis and Cox proportional hazards modelling. Finally, I described how the use of out-of-home care changed over time using data for children born between 1992 and 2012 (N=93,652). RESULTS: Overall, one in thirty children born 1992-94 (3.3%) entered out-of-home care by age 18, with higher rates observed among ethnic minorities. Although childhood care histories were varied, distinct sub-groups based on legal status, duration and stability of care were evident and more than 40% of children had a single, short, voluntary placement. Most children appeared to achieve some form of permanence either within or outside the care system; however, some groups were at increased risk of exiting and re-entering care. Since 1992, the cumulative incidence of entering care has increased and placements have become longer and more stable. CONCLUSIONS: Longitudinal analyses of administrative social care data can refine our understanding of how out-of-home care is used as a social care intervention among children in England. However, the utility of the CLA dataset for evaluating changes in practice and policy is limited by the scope of information it collects

Changes in first entry to out-of-home care from 1992 to 2012 among children in England.

Placement in out-of-home care (OHC) indicates serious childhood adversity and is associated with multiple adverse outcomes. Each year 0.5% of children in England live in OHC but evidence is lacking on the cumulative proportion who enter during childhood and how this varies over time. We measured the proportion of children born between 1992 and 2011 who entered OHC, including variation in rates of entry over time, and explored the determinants of these changes using decomposition methods. We also described changes in placement type, duration and stability. By age 18, 3.3% of children born 1992-94 entered OHC. This proportion varied by ethnicity (1.6% of White vs. 4.5% of Black children born 2001-03 entered OHC by age 9, 95% CI [1.5-1.7] and [4.4-4.6], p<0.001) and increased over time (0.8% of children born 2009-11 entered OHC by age 1 vs. 0.5% born 1992-94, 95% CI [0.7-0.9] and [0.4-0.6], p<0.001). This overall increase was driven primarily by the increased rate of entry among White children and not by concurrent changes in the population's ethnic composition. The proportion of children entering OHC in England is increasing and characteristics of the care they receive are changing with earlier intervention and longer, more stable placements. Further research is required to understand the reasons for these changes in practice and whether they are cost-effective, sustainable, and improve outcomes for children and society

Data Resource: the National Pupil Database (NPD)

Introduction The National Pupil Database (NPD) is a record-level administrative data resource curated by the UK government’s Department for Education that is used for funding purposes, school performance tables, policy making, and research. Processes Data are sourced from schools, exam awarding bodies, and local authorities who collect data on an on-going basis and submit to the Department for Education either termly or yearly. Data contents NPD contains child-level and school-level data on all pupils in state schools in England (6.6 million in the 2016/17 academic year). The primary module is the census, which has information on characteristics and school enrolment. Other modules include alternative provision, exam attainment, absence and exclusions. Data from children’s social care are also available on children referred for support and those who become looked after. Children’s records are linkable across different modules and across time using a nationally unique, anonymised child-level identifier. Linkage to external datasets has also been accomplished using child-level identifiers. Conclusions The NPD is an especially valuable data resource for researchers interested in the educational experience and outcomes of children and young people in England. Although limited by the fact that children in private schools or who are home schooled are not included, it provides a near-complete picture of school trajectories and outcomes for the majority of children. Linkage to other datasets can enhance analyses and provide answers to questions that would otherwise be costly, time consuming and difficult to find

Risk of school exclusion among adolescents receiving social care or special educational needs services: A whole-population administrative data cohort study

BACKGROUND: Exclusion from school is associated with health, well-being and social detriments and disproportionately affects vulnerable children. No study in England has examined the total cumulative risk of exclusion across secondary school among children with a history of children's social care (CSC) or special educational needs (SEN). OBJECTIVE: To assess the risk of any secondary school exclusion among adolescents receiving CSC or SEN services compared with their peers. METHODS: An administrative data cohort study comparing children in English state schools (n = 1,031,500) with no history of CSC or SEN provision with children who had received different levels of CSC and SEN in combination. Outcomes were proportions of students with any fixed-term or permanent exclusion in years 7 to 9 (age 11 to 14) and years 10 to 11 (age 14 to 16). RESULTS: Overall, 13 % of children were excluded at least once across years 7 to 11. CSC exposure was associated with exclusion risk: 32 % of children in need (or formerly in need) and 40 % of current or former children looked after and those subject to child protection plans were excluded at least once across years 7 to 11, compared to 12 % of the non-exposed group. After adjusting for confounders, children with SEN history were more at risk of exclusion, regardless of CSC exposure category (except for exclusions among children looked after during years 10 to 11). Rates of exclusion varied significantly between local authorities. CONCLUSIONS: Large inequalities in school exclusion rates between CSC-exposed and unexposed children were observed, with even higher rates observed for children with SEN history. These inequalities undermine the right to education of these vulnerable groups of children

Gestational age at birth, chronic conditions and school outcomes: a population-based data linkage study of children born in England

INTRODUCTION: We aimed to generate evidence about child development measured through school attainment and provision of special educational needs (SEN) across the spectrum of gestational age, including for children born early term and >41 weeks of gestation, with and without chronic health conditions. METHODS: We used a national linked dataset of hospital and education records of children born in England between 1 September 2004 and 31 August 2005. We evaluated school attainment at Key Stage 1 (KS1; age 7) and Key Stage 2 (KS2; age 11) and any SEN by age 11. We stratified analyses by chronic health conditions up to age 2, and size-for-gestation, and calculated population attributable fractions (PAF). RESULTS: Of 306 717 children, 5.8% were born <37 weeks gestation and 7.0% had a chronic condition. The percentage of children not achieving the expected level at KS1 increased from 7.6% at 41 weeks, to 50.0% at 24 weeks of gestation. A similar pattern was seen at KS2. SEN ranged from 29.0% at 41 weeks to 82.6% at 24 weeks. Children born early term (37-38 weeks of gestation) had poorer outcomes than those born at 40 weeks; 3.2% of children with SEN were attributable to having a chronic condition compared with 2.0% attributable to preterm birth. CONCLUSIONS: Children born with early identified chronic conditions contribute more to the burden of poor school outcomes than preterm birth. Evaluation is needed of how early health characteristics can be used to improve preparation for education, before and at entry to school

Changes in adolescents' planned hospital care during the COVID-19 pandemic: analysis of linked administrative data

OBJECTIVE: To describe changes in planned hospital care during the pandemic for vulnerable adolescents receiving children's social care (CSC) services or special educational needs (SEN) support, relative to their peers. DESIGN: Observational cohort in the Education and Child Health Insights from Linked Data database (linked de-identified administrative health, education and social care records of all children in England). STUDY POPULATION: All secondary school pupils in years 7-11 in academic year 2019/2020 (N=3 030 235). MAIN EXPOSURE: Receiving SEN support or CSC services. MAIN OUTCOMES: Changes in outpatient attendances and planned hospital admissions during the first 9 months of the pandemic (23 March-31 December 2020), estimated by comparing predicted with observed numbers and rates per 1000 child-years. RESULTS: A fifth of pupils (20.5%) received some form of statutory support: 14.2% received SEN support only, 3.6% received CSC services only and 2.7% received both. Decreases in planned hospital care were greater for these vulnerable adolescents than their peers: -290 vs -225 per 1000 child-years for outpatient attendances and -36 vs -16 per 1000 child-years for planned admissions. Overall, 21% of adolescents who were vulnerable disproportionately bore 25% of the decrease in outpatient attendances and 37% of the decrease in planned hospital admissions. Vulnerable adolescents were less likely than their peers to have face-to-face outpatient care. CONCLUSION: These findings indicate that socially vulnerable groups of children have high health needs, which may need to be prioritised to ensure equitable provision, including for catch-up of planned care postpandemic

Reductions in hospital care among clinically vulnerable children aged 0-4 years during the COVID-19 pandemic

OBJECTIVE: To quantify reductions in hospital care for clinically vulnerable children during the COVID-19 pandemic. DESIGN: Birth cohort. SETTING: National Health Service hospitals in England. STUDY POPULATION: All children aged <5 years with a birth recorded in hospital administrative data (January 2010-March 2021). MAIN EXPOSURE: Clinical vulnerability defined by a chronic health condition, preterm birth (<37 weeks' gestation) or low birth weight (<2500 g). MAIN OUTCOMES: Reductions in care defined by predicted hospital contact rates for 2020, estimated from 2015 to 2019, minus observed rates per 1000 child years during the first year of the pandemic (March 2020-2021). RESULTS: Of 3 813 465 children, 17.7% (one in six) were clinically vulnerable (9.5% born preterm or low birth weight, 10.3% had a chronic condition). Reductions in hospital care during the pandemic were much higher for clinically vulnerable children than peers: respectively, outpatient attendances (314 vs 73 per 1000 child years), planned admissions (55 vs 10) and unplanned admissions (105 vs 79). Clinically vulnerable children accounted for 50.1% of the reduction in outpatient attendances, 55.0% in planned admissions and 32.8% in unplanned hospital admissions. During the pandemic, weekly rates of planned care returned to prepandemic levels for infants with chronic conditions but not older children. Reductions in care differed by ethnic group and level of deprivation. Virtual outpatient attendances increased from 3.2% to 24.8% during the pandemic. CONCLUSION: One in six clinically vulnerable children accounted for one-third to one half of the reduction in hospital care during the pandemic

What makes administrative data "research-ready"? A systematic review and thematic analysis of published literature.

Introduction: Administrative data are a valuable research resource, but are under-utilised in the UK due to governance, technical and other barriers (e.g., the time and effort taken to gain secure data access). In recent years, there has been considerable government investment in making administrative data "research-ready", but there is no definition of what this term means. A common understanding of what constitutes research-ready administrative data is needed to establish clear principles and frameworks for their development and the realisation of their full research potential. Objective: To define the characteristics of research-ready administrative data based on a systematic review and synthesis of existing literature. Methods: On 29th June 2021, we systematically searched seven electronic databases for (1) peer-reviewed literature (2) related to research-ready administrative data (3) written in the English language. Following supplementary searches and snowball screening, we conducted a thematic analysis of the identified relevant literature. Results: Overall, we screened 2,375 records and identified 38 relevant studies published between 2012 and 2021. Most related to administrative data from the UK and US and particularly to health data. The term research-ready was used inconsistently in the literature and there was some conflation with the concept of data being ready for statistical analysis. From the thematic analysis, we identified five defining characteristics of research-ready administrative data: (a) accessible, (b) broad, (c) curated, (d) documented and (e) enhanced for research purposes. Conclusions: Our proposed characteristics of research-ready administrative data could act as a starting point to help data owners and researchers develop common principles and standards. In the more immediate term, the proposed characteristics are a useful framework for cataloguing existing research-ready administrative databases and relevant resources that can support their development

Number and timing of primary cleft lip and palate repair surgeries in England: whole nation study of electronic health records before and during the COVID-19 pandemic

Objective: To quantify differences in number and timing of first primary cleft lip and palate (CLP) repair procedures during the first year of the COVID-19 pandemic (1 April 2020 to 31 March 2021; 2020/2021) compared with the preceding year (1 April 2019 to 31 March 2020; 2019/2021)./ Design: National observational study of administrative hospital data./ Setting: National Health Service hospitals in England./ Study population: Children <5 years undergoing primary repair for an orofacial cleft Population Consensus and Surveys Classification of Interventions and Procedures-fourth revisions (OPCS-4) codes F031, F291)./ Main exposure: Procedure date (2020/2021 vs 2019/2020)./ Main outcomes: Numbers and timing (age in months) of first primary CLP procedures./ Results: 1716 CLP primary repair procedures were included in the analysis. In 2020/2021, 774 CLP procedures were carried out compared with 942 in 2019/2020, a reduction of 17.8% (95% CI 9.5% to 25.4%). The reduction varied over time in 2020/2021, with no surgeries at all during the first 2 months (April and May 2020). Compared with 2019/2020, first primary lip repair procedures performed in 2020/2021 were delayed by 1.6 months on average (95% CI 0.9 to 2.2 months). Delays in primary palate repairs were smaller on average but varied across the nine geographical regions./ Conclusion: There were significant reductions in the number and delays in timing of first primary CLP repair procedures in England during the first year of the pandemic, which may affect long-term outcomes