Suchergebnisse

IntroductionEvidence suggests that many women whose children enter care via family court proceedings (care proceedings) in England experience mental health and substance misuse problems. Further, an estimated 22% of women will return to court within 5 years for subsequent proceedings, often returning quickly with a new infant and with little time to address underlying health-related problems. With growing pressures on England's family justice system and the wider children's social care sector, there is a need to identify opportunities to engage with women in a healthcare setting to reduce the likelihood of (recurrent) care proceedings.
Objectives and ApproachWe used linked family court and mental health service data (n = 2843) for mothers who were referred to mental health services and were involved in care proceedings in South London between 2007 and 2019. We (1) describe differences in the frequency, type and timing of mental health and addictions service use between mothers who return to court and those who do not and (2) evaluate risk/protective factors for returning to court.
ResultsAfter resolving duplicate matches (n = 2808), 1028 women (36.6%) referred to mental health services over the study period subsequently returned to court. We will describe differences in characteristics of service use and care proceedings between women who return to court and those that do not. We will also explore a range of potential risk/protective factors for returning to court, including maternal age at first child, indicators for failure to engage with services, mental disorder type, substance misuse, and maternal neighbourhood deprivation status.
Conclusion / ImplicationsBetter understanding of how women use mental health and addictions services before, during and after proceedings, and identification of key risk/protective factors for returning to court, would inform strategies to reduce recurrent involvement in care proceedings among this population group.

ObjectivesLong-COVID (LC) diagnosis remains challenging due to its variable, multisystem, episodic symptoms, and lack of uniformity in the critical time points. We aim to classify diagnosis pathways and associated demographic and health determinants for clinically diagnosed LC patients in Wales.
ApproachWe created a cohort of LC-diagnosed adults in Wales from 2020 to 2023 using population-scale data within the SAIL Databank. To classify diagnosis pathways, we extracted a set of indicators suggestive of the general diagnosis process within 6-months before the diagnosis, including LC symptoms, clinical investigations, and management. We conducted Latent Class Analysis (LCA) to examine how these indicators cluster, adjusting the best-fit model for various covariates such as COVID-19 infection history and sociodemographic characteristics.
ResultsOf the 7,973 identified LC patients, 59% had clinical investigations, 59% had a clinical management record, and 39% had at least one related symptom. Using LCA, we identified 7 distinct patterns of diagnosis pathways, and how background characteristics associated with each.
ConclusionDespite existing guidelines, LC diagnosis is complex due to LC's diverse manifestations and the absence of exclusive symptoms/tests. Late or missed LC diagnosis can have a detrimental effect at individual, community, and national levels. Previous UK studies have indicated low recording rates of LC compared with self-reported surveys. Understanding current diagnosis pathways can shed light on this discrepancy and identify potential confounding factors that delay/impact LC diagnosis. This insight is crucial for standardising diagnosis pathways, enabling earlier and more accurate detection of LC and thereby mitigating its impact.

ObjectiveResearch evidence shows that COVID-19 has disproportionately affected people from more deprived backgrounds. In Wales (UK), there is strong evidence of a socioeconomic gradient in total hospitalisations, critical care admissions and deaths.
This study focussed on a cohort of the Welsh population using anonymised individual-level linked population-scale data in the SAIL Databank.
ApproachThis analysis examines the impact of confounding/mediating factors on severe health outcomes. We used logistic regression, considering the Welsh Index of Multiple Deprivation (WIMD) 2019 as a predictor, to investigate how the coefficient for WIMD is changed when other variables (such as comorbidities, smoking status, Body Mass Index) are added, aiming to understand whether inequalities are mediated by observed characteristics or related to other unobserved factors.
ResultsInitial findings show that age-standardised rates of hospital admissions, Intensive Care Unit (ICU) admissions and deaths were roughly twice as high in the most deprived vs least deprived WIMD quintile in Wales. We estimated Years of Life Lost per 1,000 due to COVID-19 as 28.9, with variation between WIMD quintiles of 38.4 for the most deprived and 22.2 for the least deprived. The project also produced regression formulas to evaluate the contribution of the different confounding factors.
ConclusionThis study built on existing research findings and further explored the potential reasons for known socioeconomic inequalities in relation to COVID-19 outcomes. Insights from this study have broadened the knowledge around the impact of mediating factors and may contribute to future pandemic preparedness and the formation of future policies.

ObjectivesThe COVID-19 pandemic greatly impacted the wellbeing of healthcare workers (HCWs) due to stress, longer hours, and risks of infection during an uncertain time. Post-pandemic, we need to understand the extent of the lasting impacts on wellbeing and staff retainment.
ApproachUsing linked administrative health and workforce records within the SAIL Databank, we conducted a cohort study of HCWs employed directly by the National Health Service in Wales between 2020 and 2023. We investigated trends in HCW turnover by fiscal quarter and staff group and the prevalence of occupational health issues per primary care records, including authorised sick leave. We analysed time until leaving the profession using Cox regression incorporating workforce, demographic and health characteristics.
ResultsFrom January 2020 to December 2023, HCW employment grew from 101,600 to 121,970 (+20.0%). During this period, 34,760 people left the profession, averaging a turnover of 4.4% per fiscal quarter. Equally, an average of 1.9% of HCWs were diagnosed with a mental health issue, and 17.9% received a related prescription per fiscal quarter. We present further results highlighting how staff turnover has increased over time and differed across staff groups. We also show the extent to which leaving the profession is associated with workforce, demographic and health characteristics.
ConclusionThe rate of mental health issues and increases in turnover from the profession highlight the need for additional support. Healthcare systems need to prioritise the welfare of their workforce to ensure sustained resilience and quality of care.

Objectives'Long COVID' (LC) is broadly defined as signs and symptoms that continue or develop after the acute phase of COVID-19, and can affect cardiovascular, respiratory and other organ systems. Using electronic health records, we investigated clinical coding of LC in primary and secondary care for the population of Wales.
MethodsWe conducted a cohort study for the population of Wales, using anonymised individual-level linked data in the Secure Anonymised Information Linkage (SAIL) Databank. We used the Welsh COVID-19 e-cohort (doi:10.1136/bmjopen-2020-043010), which consists of all people (adults and children) alive and resident in Wales from 1st January 2020. To this e-cohort we linked primary and secondary care, COVID-19 testing, and ethnic group data. We then calculated the proportion of people with a LC diagnosis code (in primary and secondary care data) overall and stratified by demographic variables.
ResultsOf 3.5m residents, 7,696 (0.2%) had a LC clinical diagnosis. Compared with the general population, a higher proportion of people with LC were female, middle age, white, and hospitalised within 28 days of a confirmed COVID-19 infection. LC affected all socioeconomic groups, as assessed using the Welsh Index of Multiple Deprivation. When looking at LC diagnosis codes in primary care, 30.9% of practices in SAIL have not used these codes at all. And the number of recorded events was low until the end of January 2021, after which there was an increase in coding. These findings are likely a substantial underestimate of LC prevalence in Wales. Earlier estimates from self-reported surveys, such as the Office for National Statistics, are much higher, ranging anywhere between 3-5%.
ConclusionLow recording rates of LC and variation between practices could be due to a delay in introducing clinical coding and lack of presentation/recording. Understanding prevalence of LC is vital for addressing the scale of the problem. Therefore developing additional data-driven approaches is necessary to obtain an accurate prevalence estimate.

Introduction
In England, in cases of child maltreatment or neglect, the state can intervene through the family court to remove them from their family home and place them in out-of-home care. The Children and Family Court Advisory and Support Service (Cafcass) collect and maintain administrative records of all public family law cases in England. While these records are primarily used to monitor and manage the case load of Cafcass teams across England, researchers have re-purposed this data for analysis to understand the drivers and outcomes of public family law intervention.
Data contents
The administrative dataset is a reflection of the cases Cafcass get involved with and the extent of their involvement. There are three main types of unit within the data: applicants (English local authorities), subjects (children) and parties (those with parental responsibility, typically biological mothers and fathers). As such, the data collected comprises information at the person-level (e.g. demographics of the children and adults), and information at the case-level (e.g. types of applications made, hearing dates and final legal outputs). Between 1 April 2007 and 31 March 2019, Cafcass have captured information on approximately172,100 public family law cases, involving 282,300 children, and 249,500 adults (of which 289,300 are recorded as biological parents). They record relations between adults and children making it possible to identify families. Additionally, Cafcass recording practices have improved over time, this has increased the availability of demographic information of all those involved, as well as child's final legal outcome.
Data access
Researchers can apply to the Secure Anonymised Information Linkage Databank (SAIL) for access to the Cafcass pseudonymised administrative data extract, where it is refreshed bi-annually.

BackgroundIn England, the rate at which infants enter care varies considerably by local authority, with little evidence on what drives these differences. Decisions instigating infant entry into care may be triggered by child protection concerns arising from parental ill-health or risky behaviour from pregnancy onwards.
Main AimWe explored the extent to which adversity indicated within women's hospitalisation history, pre-delivery, explained differences in rate of infant entry into care between local authorities.
Methods/ApproachCombining data from several sources (Office for National Statistics Population Estimates, Public Health England Fingertips, 2011 Census, Children Looked After Return, and Hospital Episode Statistics), we derived population-level predictors for entry into care (i.e. local case-mix) for 131 English local authorities from 2006/07 to 2013/14. Our primary outcome was rate of infant entry into care. We used linear mixed-effects models to analyse the relationship between the outcome and percentage of live births with maternal history of adversity-related hospital admissions (i.e. any admission indicating substance misuse, mental ill-health, or violence, up to 36 months pre-delivery), adjusting for other case-mix measures.
ResultsRate of infant entry into care (mean: 85.16 per 10,000 [min-max: 0.00-318.51]) and percentage of live births with maternal history of adversity-related hospital admissions (4.62%, [0.52-16.19%]) varied greatly by local authority. Prevalence of maternal adversity accounted for 24% of variation in rate of entry (95% CI: 14-35%). After adjustment, there was evidence that a percentage point increase in prevalence of maternal adversity - both over time and between local authorities - is associated with an extra 2.56 infants, per 10,000, entering care (1.31-3.82).
Conclusion Prevalence of maternal adversity prior to birth helps to explain differing rates of infant entry into care among local authorities. Further research using individual-level linked parent-child data is required to ascertain whether interventions to reduce maternal adversity before birth would decrease rate of infant entry into care.

AbstractThere is growing recognition, in the UK and internationally, of the huge costs of recurrent appearances of parents in local authority care proceedings. This paper contributes to pressing policy and practice concerns to reduce recurrence. It presents qualitative longitudinal data from the first study of fathers' experiences of recurrent care proceedings in England. Demonstrating the emotional impact of repeat proceedings and successive loss of children on fathers, in terms of grief, loss and shame, we highlight the trauma and abuse in their developmental histories. We consider complex connections between anger and shame for these fathers, including within the arena of family justice. With the use of literature on complex trauma, shame and parental disengagement, we explore ideas for re‐framing fathers', and professionals', resistance to engagement and for better understanding fathers' intense emotions. We suggest that the link between shame and complex trauma and the value of shame reducing, dignity promoting practice in response provide a valuable way forward for working with fathers. As is recognized to be the case for mothers, without holistic, empathic interventions to address the vulnerabilities of such fathers, the risks for children, mothers and fathers are unlikely to reduce.

IntroductionIn Wales, the Children in Need (CIN) dataset includes information relating to needs of children and social care support. Before the Social Services and Well-being (Wales) Act 2014 came into force in April 2016, this data collection was named the Children in Need census, changing to Children Receiving Care and Support (CRCS) after this date to reflect better the children eligible for inclusion. This paper describes these datasets, their potential for research and their limitations. We describe data that researchers can access via the Secure Anonymised Information Linkage (SAIL) Databank and exploratory linkages made to health records.
MethodsCIN and CRCS data were transferred to the SAIL Databank using a standardised approach to provide de-identified data with Anonymised Linking Fields (ALF) for successfully matched records. The linkage method relies on the use of Unique Pupil Numbers (UPN). As such, no records are currently available for children without a UPN, which includes most under age three. ALFs enabled linkage to individual-level health data within SAIL. Health service use was compared to non-CIN/CRCS populations.
ResultsCRCS data held within the SAIL Databank comprises 25,972 records, 81% of the total number of records reported by the Welsh Government. The CIN data contains 108,449 records, 79% of the Welsh Government's records for this data collection. Health service use of children in need, and children receiving care and support, was roughly equal to that of the non-CIN/CRCS population, except GP visits, where children in need had fewer consultations, and children receiving care and support had more consultations than the comparison population.
ConclusionResearchers can access Welsh CIN and CRCS datasets through the SAIL Databank, enabling research opportunities. Work is ongoing to improve records and to understand better the health and health service use among children captured by CIN and CRCS censuses.

This article presents data from the first large-scale study of fathers involved in repeat (or recurrent) care proceedings in England. The project complements important research on mothers and recurrence. It consisted of three elements: an analysis of population-level administrative data from the Child and Family Court Advisory and Support Service (CAFCASS), a survey of fathers in pre-proceedings and care proceedings, and a qualitative longitudinal (QL) study of recurrent fathers. Here we report findings from the survey and the QL study, offering an expanded definition and description of fathers and recurrence. Elsewhere, we reported that a significant number of fathers appear in recurrent care proceedings and that the majority return with the same partner. Alongside this, there is also a notable pattern of "missing" fathers demonstrated by the proportion of lone mothers reappearing before the court. Our survey indicates a certain profile of recurrent fathers, but also that recurrent fathers are not straightforwardly a homogenous group. We report on the significance of recurrent fathers' early lives, on the phenomenon of enduring couple relationships and on the prevalence of issues affecting parenting, such as poor mental health, substance use and domestic abuse. Insights from the QL study in particular reveal legacies of harm, loss, and a lack of emotional and relational resources in childhood, which have debilitating and far-reaching consequences. We argue the importance of understanding the vulnerabilities of recurrent fathers and of challenging certain assumptions in child welfare and family justice practices. There is much to be learnt from existing services for recurrent mothers, but also a need for bespoke or adapted services that may be more responsive to particular circumstances of recurrent fathers and couples.

BackgroundDespite progress in understanding mothers' (re)appearances within family justice, fathers have not yet received due attention in research on recurrent care proceedings.
Aims

Compare parents' gendered risks of entering subsequent care proceedings;
Map family relations underpinning recurrent care proceedings;
Investigate the role of family members' life course characteristics (e.g. age, number of children) in shaping the risk of returning to court.

MethodsAnalysis drew on 2007/08-2017/18 administrative records from the Child and Family Court Advisory and Support Services (Cafcass) in England. From a sample of recurrent parents (N = 24,460), a latent class analysis established profiles of who they returned with. A competing risks analysis of all parents (N = 165,550) modelled the risk of returning into each profile given index characteristics.
ResultsOverall rate of return for mothers was 1.7 times that of fathers: 22% after 5 years, compared to 13% for fathers, and 29% and 17% after 10 years, respectively.
Five distinct profiles of recurrent parents were established: 'recurrent family', 'recurrent couple', 're-partnered couple', 'complex recurrence', and 'lone parent'. The vast majority of fathers who entered subsequent proceedings did so as either a part of a recurrent family (41%) or recurrent couple (36%). However, these two profiles represented a much smaller proportion (25% and 19%, respectively) of all recurrent mothers, while the remainder returned with either a new partner or as a lone parent (49%), both with a new child. Complex recurrence represented a small proportion for both mothers and fathers (7% and 11%, respectively). The risk of each of these profiles is characterised by the distinct life course positions of the parent.
ConclusionThe results underscore the value of a relational approach and understanding a parent's position within the life course in social work research towards building a fuller picture of recurrence.

INTRODUCTION: In Wales, the Children in Need (CIN) dataset includes information relating to needs of children and social care support. Before the Social Services and Well-being (Wales) Act 2014 came into force in April 2016, this data collection was named the Children in Need census, changing to Children Receiving Care and Support (CRCS) after this date to reflect better the children eligible for inclusion. This paper describes these datasets, their potential for research and their limitations. We describe data that researchers can access via the Secure Anonymised Information Linkage (SAIL) Databank and exploratory linkages made to health records. METHODS: CIN and CRCS data were transferred to the SAIL Databank using a standardised approach to provide de-identified data with Anonymised Linking Fields (ALF) for successfully matched records. The linkage method relies on the use of Unique Pupil Numbers (UPN). As such, no records are currently available for children without a UPN, which includes most under age three. ALFs enabled linkage to individual-level health data within SAIL. Health service use was compared to non-CIN/CRCS populations. RESULTS: CRCS data held within the SAIL Databank comprises 25,972 records, 81% of the total number of records reported by the Welsh Government. The CIN data contains 108,449 records, 79% of the Welsh Government's records for this data collection. Health service use of children in need, and children receiving care and support, was roughly equal to that of the non-CIN/CRCS population, except GP visits, where children in need had fewer consultations, and children receiving care and support had more consultations than the comparison population. CONCLUSION: Researchers can access Welsh CIN and CRCS datasets through the SAIL Databank, enabling research opportunities. Work is ongoing to improve records and to understand better the health and health service use among children captured by CIN and CRCS censuses.

IntroductionMaternal mental health problems and substance misuse are key risk factors for child neglect or abuse and court-mandated placement into care. Linkage between mental health records and family court data could raise awareness about parent mental health needs and inform approaches to address them.
ObjectivesTo evaluate data linkage between administrative family court data and electronic mental health records for a population-based mental health service for 1.3 million people in South London.
MethodsWe deterministically linked administrative family court data for women (n=5463) involved in care proceedings in South London with service user records from the South London and Maudsley NHS Mental Health Trust (SLaM). We restricted the cohort to women involved in proceedings between 2007 and 2019, in local authorities where SLaM solely provides secondary/tertiary mental health services and the Improving Access to Psychological Therapies (IAPT) (n=3226). We analysed the associations between match status and sociodemographic/case characteristics using multivariable logistic regression.
ResultsTwo-thirds (2317/3226; 66%) of women linked to a SLaM service user record at some point; most (91%) who linked accessed secondary/tertiary mental health services, indicating serious mental illness. Accounting for possible missed matches, we estimated that 70-83% of women accessed SLaM services at some point. Older women at index proceedings (>35yrs OR: 0.69, 95%CI: 0.54-0.88vs<25yrs) and Black women or women from other ethnic groups (Black ethnic groups 0.65, 0.50-0.83; other ethnicity 0.59, 0.43-0.81 vs White ethnic groups) had lower odds of linking. Odds of linking were higher for women with an infant in proceedings (1.42, 1.18-1.71), or with curtailed/terminated parental responsibility (1.44, 1.20-1.73).
ConclusionsOur linkage supports growing evidence of a high burden of mental health problems and substance misuse among women whose children enter care in England, compared to the general population. Research using this linkage should inform strategies to address the considerable mental health needs of vulnerable women and their children.

Background/rationaleNations with advanced child protection systems place considerable emphasis on the developmental salience of infancy. However, this emphasis is not matched by any differentiated analysis of the timing of family court intervention in the lives of infants or the final legal order outcomes of these cases. This presentation shares findings from the first ever population profiling study of infants subject to care proceedings within the family justice system in England and Wales.
AimTo estimate the proportion of all infant care proceedings cases issued within 7 days and 4 weeks of birth and describe case and infant characteristics; to calculate incidence rates over time and by local authority and family court region; to describe and compare legal order outcomes according to age.
Methods/approachData was extracted from case management records produced by the Children and Family Court Advisory and Support Service (Cafcass) England and Wales. Records were first restructured to link infants to legal order outcome data and birth mother records. Incidence rates were calculated using ONS mid-year population estimates and annual live births. Within the SAIL Databank, Welsh infant records were linked to birth registration and community child health data to produce a fuller picture of infant characteristics in Wales.
ResultsThe cohort we created comprised all infants recorded as subjects within care proceedings in England (2007/08-2016/17) and Wales (2011/12-2018/19). The study captured the high proportion of infant cases that are issued at/close to birth, but also marked regional and local authority variation in incidence rates.
ConclusionHigh rates of adoption, particularly for babies born to mothers without a previous family court history, have prompted calls for new preventative solutions. The President of the Family (Court) Division in England has initiated a review of legal proceedings at birth.