The paper discussed here is a Swedish national cohort study by Eva Franzen and colleagues looking at the epidemiology of children and adolescents who go into care home. The authors begin with a discussion of a classic study by Miles and Bebbington published in 1989 (‘The background of children who enter local authority care’) who looked at 2,165 children in care homes (compared with 5407 children remaining at home) and found that being a single mother increased risk of entry into care home just under 8-fold after other factors were taken into consideration. There were a number of other factors that impacted on the risk including the number of children, receipt of benefits and a home with fewer rooms than people in the family. The authors noted a paucity of similar studies in the intervening period before the present study.
In this study, the authors used information from several Swedish registry studies. However only Swedish born children were included in the study as they wanted to control for factors including the length of time that children were exposed to risk of placement in a care home. The final numbers included in the study were astounding – 1,555,385 children composed of 4968 children born 1992-1996 and entered into care before their 7th birthday, 3485 children born between 1986 and 1990 entered into care between the ages of 7 and 13 and 6386 children born between 1981 and 1985 and first entered into care aged 13-18. The remainder were in the control group. A number of relevant variables were identified in the registries and these included parental cohabitation status, maternal income, maternal country of birth and mental health factors (as the data wasn’t clear in this case – they were referred to as markers rather than factors). The researchers were able to link child and parents through a ‘Multi-Generation Register’.
Logistic regression analyses were used. There were a large number of results displayed in the tables and these were stratified according to the age at which the children had entered into care (or not if they were in the control group). The vast majority of mother’s were born in Sweden and most of the mothers lived in cities and towns. The odds ratios for risk of care home placement tended to be more pronounced in the children placed in care homes between the ages of 0-6. Thus a mother with ‘social assistance’ in 1996-1998 was 4 times as likely (CI 3.7-4.3) to have a child placed in a care home as a mother who was not on ‘social assistance’. When certain risk factors were aggregated there was a high risk of care home placement. Thus the authors comment on children born between 1992 and 1996. If the mother was married in 1997, in a cohabiting relationship, had post-secondary education and had no social assistance then 1 in 2000 of the 120,015 children in the sample were placed in care before the age of 7. If the mother was single in 1997, had basic education and was out of work receiving social assistance (1996-1998) then 1 in 7 of the 8053 children were placed in a care home.
The authors identify limitations in their study including possible underestimates in registry data which they wouldn’t expect to influence the results and consideration of socio-economic variables as independent. This is a very large study and the authors have accomplished an impressive undertaking. No doubt many people will now be looking at bridging the gap between experiential factors, clinical practice and the epidemiological data to inform interventions. This will most likely become another classic in the same vein as the Miles and Bebbington paper.
Eva Franzen, Bo Vinnerljung and Anders Hjern. British Journal of Social Work. 2008. 38. 1043-1059. The Epidemiology of Out-of-Home Care for Children and Youth: A National Cohort Study.
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