Explaining local variation in referrals from health services to children's social care in England 2013-16: a study using 'children in need' administrative data.

E H Emmott,K Harron,L Mc Grath-Lone,J Woodman

doi:10.1093/pubmed/fdz050

E H Emmott, K Harron + Show 2 more

Open Access

https://doi.org/10.1093/pubmed/fdz050

Copy DOI

Abstract

BackgroundReferral rates from Health service to Children’s Social Care (CSC) services vary across England. In 2019, the National Audit Office (re)iterated the urgent need to understand the drivers of such variation.MethodsUsing administrative data (Children in Need Census, 2013–16), we calculated annual referral rates from Health to CSC services (Health referral rate) by Local Authority (LA) areas. We used multilevel linear regression to investigate the relationship between age-adjusted Health referral rates and local need (demand factors) and local practice/systems (supply factors). We present a tool to compare unadjusted and adjusted LA rates.ResultsThere was high LA variation in Health referral rates, particularly for infants (mean = 29.0/1000 children < 1 y; range = 6.5–101.8; sd = 12.4). LA variation persisted after age-adjustment. Child poverty (local need) and overall referral rate (local practice/systems) explained 60% of variation in age-adjusted Health referral rates. Overall referral rate was the strongest predictor. Adjusted referral rates were substantially different from unadjusted rates. After adjustment, 57.7% of LAs had higher/lower Health referral rates than expected.ConclusionsWhile higher levels of local need are associated with higher Health referrals, some areas have high Health referrals irrespective of local need. Our tool demonstrates the benefits of using adjusted rates to compare LAs.

Highlights

Child abuse and neglect is common, affecting approximately 1 in 10 children each year in the Global North, estimates vary according to definitions and measures.[1]
Our tool demonstrates the benefits of using adjusted rates to compare Local Authority (LA)
We modelled the association between age-adjusted LAlevel Health referral rates and LA-characteristics using linear regression with a multilevel structure to take account of repeat measures of referral rates within LAs across census years

Summary

Introduction

Child abuse and neglect (maltreatment) is common, affecting approximately 1 in 10 children each year in the Global North, estimates vary according to definitions and measures.[1]. In England, Children’s Social Care (CSC) is the local government agency tasked with coordinating, commissioning and delivering welfare interventions for children who require additional support to achieve a reasonable standard of health and development. A substantial minority of children are referred to CSC for ‘suspected child abuse or neglect’ (45%), ‘family dysfunction’ (18%), and ‘family in acute stress’ (10%), while a small proportion relate to complex health needs in the child or family (5%).[5] This means that the vast majority of referrals to CSC are due to concerns about current or future harm to a child’s development and health. In 2019, the National Audit Office (re)iterated the urgent need to understand the drivers of such variation

Objectives

Methods

Results

Conclusion