Abstract
BackgroundChildren in care face adverse health outcomes, throughout the life-course, relative to the general population. In England, over the last decade, the rate of children entering care has increased. The rate of change differs markedly for older and younger children, who may also experience different preventative services. These services have been subject to inequitable spending reductions due to fiscal policies trailing the 2008 recession. ObjectiveTo assess the impact of cuts to prevention on rates of preschool children and adolescents entering care between 2012 and 2019. Participants and SettingChildren aged 1–4 and 16–17 years, across 150 English upper-tier local authorities. MethodsOur outcomes were annual rates of children entering care, aged 1–4 and 16–17. Our exposures were Children’s Services prevention spend per child under 5, and per child over 12. Regression models were used to quantify, within areas, associations between trends in prevention spend and trends in rates of children entering care, controlling for employment and child poverty rates. ResultsWe found no association between changes in prevention spend per child under 5 and changes in care entry for 1–4-year-olds. However, spending reductions per child over 12 were associated with rising rates of 16–17-year-olds entering care. Every £10 per child decrease in prevention spend was associated with an estimated additional 1.9 per 100,000 children aged 16–17 entering care the following year (95% CI 0.7 to 2.9), equivalent to 1 in 25 care entries in this age group between 2012 and 2019. ConclusionThis study offers evidence that rising rates of older children entering care has partly been driven by cuts to prevention services catering to their needs. Policies to tackle adverse trends should promote reinvestment in youth services, placing ordinary help on a robust statutory footing.
Highlights
Between 2011 and 2019, there was a precipitous rise in the rate of children entering state care in England, from 23 to 27 per 10,000 children (Department for Education, 2011, 2012a, 2021)
For the older age group, a Freedom of Information request yielded count data excluding unaccompanied children seeking asylum, who are likely to be older, and whose care status is unlikely to be related to changes in local authority prevention spend, our exposure of interest (Department for Education, 2020)
While the model for children aged 1–4 shows no association between changing prevention spend and rates of young children becoming looked after, our model for children aged 16–17 shows that, between 2011 and 2018, across English local authorities, and after controlling for local economic trends and regional child poverty, a £10 per child cut to prevention spend was associated with 1.9 per 100,000 additional 16–17 year olds becoming looked after the following year
Summary
Between 2011 and 2019, there was a precipitous rise in the rate of children entering state care in England, from 23 to 27 per 10,000 children (Department for Education, 2011, 2012a, 2021). The absolute rise has been greater in poorer areas, increasing inequalities (Bennett et al, 2020) It has been pronounced among children aged 16–17 years. Rates for these children more than doubled, from 26 to 53 children per 10,000 – a greater relative and absolute rise than for any other age group. Spending reductions per child over 12 were associated with rising rates of 16–17-year-olds entering care. Every £10 per child decrease in prevention spend was associated with an estimated additional 1.9 per 100,000 children aged 16–17 entering care the following year (95% CI 0.7 to 2.9), equivalent to 1 in 25 care entries in this age group between 2012 and 2019. Policies to tackle adverse trends should promote reinvestment in youth services, placing ordinary help on a robust statutory footing
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