From care to education and work? : Education and employment trajectories in early adulthood by children in out-of-home care

Background: Temporal dynamics during the early adulthood transition among children in out-of-home care is a neglected research area, leaving the possibility of coping with childhood adversity over time a poorly understood topic. Objective: To explore early adulthood education and employment trajectories among young adults who experienced out-of-home care during childhood and to examine how various care history factors predict these trajectories. Participants: We use longitudinal birth cohort data comprising individual-level information from national registers of all children born in Finland in 1987 (N = 59,476, of whom 1893 were in care). Setting and methods: We use trajectory clustering from a previous study on the 1987 birth cohort to compare trajectories between children in care and a propensity score-matched group of peers never in care. We investigated the association between care history factors and trajectories with multinomial logistic regression modeling. Results: Compared with the matched peer group, children in care were less likely to enter trajectories characterized by education and employment (38%) and more likely to enter trajectories involving early parenthood (14%) or long periods of fragmented social assistance benefit receipt and unemployment (21%). Those on early parenthood trajectories were almost exclusively women, whereas those receiving social assistance benefits and experiencing unemployment for lengthy periods were mostly men. Entering disadvantaged trajectories was associated with, inter alia, placement as an adolescent, residential care, and aging out of care. Conclusion: The study demonstrates the relevance of examining longitudinal trajectories in children in care's early adulthood. Many young adults with care experience need support in education and employment beyond young adult age.Peer reviewe

School performance and later diagnoses of nonaffective psychoses, bipolar disorder, and depression

Publisher Copyright: © 2022 The Authors. Acta Psychiatrica Scandinavica published by John Wiley & Sons Ltd.Objective: It is unclear whether there are differences between specific school subject performance and later psychiatric disorders. We examined whether mean grade point average (MGPA) and specific school subjects associated with diagnoses of nonaffective psychoses, bipolar disorder and depression. Methods: In this register-based study, we studied the Finnish population born in 1987 who had available MGPA and six specific school grades (age = 15.4–16.4 years; n = 50,508). Grades were analyzed with smoothing splines. Covariates included sex, urbanicity, parental education level and parental diagnosed psychiatric disorders. Outcomes were incident nonaffective psychosis, bipolar disorder and depression diagnosed in specialized services until year 2015 (age = 28.0–28.9 years). Results: During the follow-up, 727 individuals were diagnosed with nonaffective psychoses, 489 with bipolar disorder and 3492 with depression. MGPA was inversely associated with all outcomes. In multivariate models including specific school subjects and covariates, the school subject with largest risk ratios (RR) was Physical Education (RR and Bonferroni-corrected confidence interval [CI] at −1.5 SD: nonaffective psychoses 1.63, 1.36–1.95; bipolar disorder 1.64, 1.30–2.05; depression 1.72, 1.53–1.93). Higher grades in Art were associated with nonaffective psychoses and depression (RR and Bonferroni-corrected CI at +1.5 SD: nonaffective psychoses 1.48, 1.11–1.96; depression 1.22, 1.07–1.38). Conclusion: There was a robust association between poorer scores on Physical Education and risk for psychosis, bipolar disorder and depression. Higher grades in Art were also associated with risk for later disorders. Subject specific school performance may be more informative about mental disorder risk than overall school performance.Peer reviewe

Long-term NEET among young adults with experience of out-of-home care : A comparative study of three Nordic countries

Peer reviewe

Päijät-Hämeen hyvinvointikuntayhtymän lapsiperhepalvelujen arviointi : Nykytila ja toimenpide-ehdotukset

Terveyden ja hyvinvoinnin laitos arvioi marraskuun 2019 ja helmikuun 2020 välisenä aikana Päijät-Hämeen hyvinvointikuntayhtymän lapsi- ja perhepalveluiden toimivuutta. Arvioinnin tavoitteena oli esittää toimenpiteitä, jotka vaikuttavat ennen muuta lastensuojelun kulukehitykseen Päijät-Hämeessä mutta myös laajemmin lapsiperheiden hyvinvointiin alueella. Arvioinnissa tarkasteltiin lapsiperhepalvelujen nykytilaa ja kehittämistarpeita. Analysointi kohteita olivat kuntayhtymän lapsiperhepalvelujen sekä lastensuojelun nykyiset toimintakäytännöt ja organisointi, resurssien käyttö ja niiden kohdentaminen, osaaminen ja sen kehittämistarve, aikuisille suunnatut sosiaalipalvelut ja niiden merkitys lapsiperheiden hyvinvoinnille sekä yhdyspintatyö ja sen toimivuus. Kehittämisehdotukset perustuvat lastensuojelun asiakasprosessin vaiheisiin. Ensimmäisessä vaiheessa on kyse siitä, kuinka terveyttä edistävät ja ehkäisevät palvelut toimivat ja kuinka paljon lastensuojeluilmoituksia tehdään. Toisessa vaiheessa keskeistä on palvelutarpeen arviointi. Kolmannessa vaiheessa tarkastellaan muiden kuin lastensuojelun sosiaalihuoltopalveluiden (ml. kolmannen sektorin palveluiden) toimintaa. Neljännessä vaiheessa kyse on lastensuojelun toiminnasta lastensuojeluasiakkuuden alkamisen jälkeen

School performance and later diagnoses of nonaffective psychoses, bipolar disorder, and depression

Objective: It is unclear whether there are differences between specific school subject performance and later psychiatric disorders. We examined whether mean grade point average (MGPA) and specific school subjects associated with diagnoses of non-affective psychoses, bipolar disorder and depression.Methods: In this register-based study, we studied the Finnish population born in 1987 who had available MGPA and compulsory specific school grades (age = 15.4-16.4 years; n = 50,508). Grades were analyzed with smoothing splines. Covariates included sex, urbanicity, parental education level and parental diagnosed psychiatric disorders. Outcomes were incident non-affective psychosis, bipolar disorder and depression diagnosed in specialised services until year 2015 (age = 28.0-28.9 years).Results: During the follow-up, 727 individuals were diagnosed with non-affective psychoses, 489 with bipolar disorder and 3492 with depression. MGPA was inversely associated with all outcomes. In multivariate models including specific school subjects and covariates, the school subject with largest risk ratios (RR) was Physical Education (RR and Bonferroni-corrected confidence interval [CI] at -1.5 SD: non-affective psychoses 1.63, 1.36-1.95; bipolar disorder 1.64, 1.30-2.05; depression 1.72, 1.53-1.93). Higher grades in Art were associated with non-affective psychoses and depression (RR and Bonferroni-corrected CI at +1.5 SD: non-affective psychoses 1.48, 1.11-1.96; depression 1.22, 1.07-1.38).Conclusion: There was a robust association between poorer scores on Physical Education and risk for psychosis, bipolar disorder and depression. Higher grades in Art were also associated with risk for later disorders. Subject specific school performance may be more informative about mental disorder risk than overall school performance.Keywords: Academic Performance Psychotic Disorders; Bipolar Disorder; Depression; Epidemiology.This article is protected by copyright. All rights reserved.</p

Psychiatric and neurodevelopmental diagnoses in adolescence and adulthood over-indebtedness among Finns born in 1987

Background Adolescence psychiatric and neurodevelopmental diagnoses are common but their link to adulthood over-indebtedness is unknown. This study aims to determine this relationship and explores the possible mediating role of upper secondary education completion. Methods We analyzed the 1987 Finnish Birth Cohort, which consisted of a complete census of children born in Finland in 1987 and registered in the Medical Birth Register (n = 53 743). Records of debt payment defaults, at the age of 33, were used as a measure of over-indebtedness. Adolescent psychiatric and neurodevelopmental diagnoses at ages 13-17 were derived from the national hospital discharge register. Inverse probability treatment weighting was used to investigate the role of pre-exposure variables in this relationship, and the mediating role of upper secondary education completion. Results Compared to unexposed individuals, those affected by an adolescent psychiatric or neurodevelopmental diagnosis had a 15 percentage points higher prevalence of over-indebtedness in adulthood. This association was more common for males and was additionally notably strong for suicidality and conduct and oppositional disorders. Controlling for measured potential confounding factors, the diagnoses were linked to a 11-percentage point (95% confidence interval 9-12) higher risk of over-indebtedness. Completing at least upper secondary education reduced this effect by some 39%. Conclusion People with psychiatric and neurodevelopmental disorders diagnosed in adolescence are at elevated risk of over-indebtedness in adulthood. Recognizing this high risk may help in efforts to prevent further debt problems. Better education may serve as a protective factor against over-indebtedness and perhaps similar other behavioural consequences.</p

The association between treated psychiatric and neurodevelopmental disorders and out-of-home care among Finnish children born in 1997

Comprehensive overviews of the use of psychiatric services among children and adolescents placed in out-of-home care (OHC) by child welfare authorities are scarce. We examine specialized service use for psychiatric and neurodevelopmental disorders among children and adolescents in a total population involving children in OHC. We used the longitudinal administrative data of a complete Finnish birth cohort 1997 (N = 57,174). We estimated risk ratios (RRs) for a range of diagnosed psychiatric and neurodevelopmental disorders among children in OHC. We also estimated RRs for OHC among those with diagnosed disorders. We used descriptive methods to explore the timing of first entry into OHC relative to the first diagnosis. Among children in OHC, 61.9% were diagnosed with any psychiatric or neurodevelopmental disorder, compared with 18.0% among those never in OHC (RR: 3.7; 95% CI 3.6-3.8). The most common diagnosed disorders among children in OHC were depression and anxiety disorders, neurodevelopmental disorders, and oppositional defiant disorder/conduct disorder (ODD/CD). Among all children with any diagnosis, 18.1% experienced OHC, compared with 2.5% among those without a diagnosis (RR: 7.4; 95% CI 6.9-7.9). Of those diagnosed with self-harm and suicidality, ODD/CD, substance-related disorders, and psychotic and bipolar disorders, 43.5-61.2% experienced OHC. Of the children in OHC receiving psychiatric services, half were diagnosed before first placement in OHC. The majority of children with experience in OHC were diagnosed with psychiatric or neurodevelopmental disorders. They comprised a significant proportion of individuals treated for severe and complex psychiatric disorders and self-harm.Peer reviewe