Linking routinely collected social work and health data to enable monitoring of the health and healthcare of children in state care (‘looked after children’) in Scotland

a national demonstration project

David Clark, Albert King, Katharine Sharpe, Graham Connelly, Lawrie Elliott, Lorna M. D. Macpherson, Alex D. McMahon, Ian Milligan, Philip Wilson, David I. Conway, Rachael Wood

Research output: Contribution to journalArticle

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Abstract

Background and objectives
Children in state care (‘looked after children’) have poorer health than children who are not looked after. Recent developments in Scotland and elsewhere have aimed to improve services and outcomes for looked after children. Routine monitoring of the health outcomes of looked after children compared to those of their non-looked after peers is currently lacking. Developing capacity for comparative monitoring of population based outcomes based on linkage of routinely collected administrative data has been identified as a priority. To our knowledge there are no existing population based data linkage studies providing data on the health of looked after and non-looked after children at national level. Smaller scale studies that are available generally provide very limited information on linkage methods and hence do not allow scrutiny of bias that may be introduced through the linkage process.
Study design and methods
National demonstration project testing the feasibility of linking routinely collected looked after children, education, and health data.
Participants
All children in publicly funded school in Scotland in 2011/12.
Results
Linkage between looked after children data and the national pupil census classified 10,009 (1.5%) and 1,757 (0.3%) of 670,952 children as, respectively, currently and previously looked after. Recording of the unique pupil identifier (Scottish Candidate Number, SCN) on looked after children returns is incomplete, with 66% of looked after records for 2011/12 for children of possible school age containing a valid SCN. This will have resulted in some under-ascertainment of currently and, particularly, previously looked after children within the general pupil population. Further linkage of the pupil census to the NHS Scotland master patient index demonstrated that a safe link to the child’s unique health service (Community Health Index, CHI) number could be obtained for a very high proportion of children in each group (94%, 95%, and 95% of children classified as currently, previously, and non-looked after respectively). In general linkage rates were higher for older children and those living in more affluent areas. Within the looked after group, linkage rates were highest for children with the fewest placements and for those in permanent fostering.
Conclusions
This novel data linkage demonstrates the feasibility of monitoring population based health outcomes of school aged looked after and non-looked after children using linked routine administrative data. Improved recording of the unique pupil identifier number on looked after data returns would be beneficial. Extending the range of personal identifiers on looked after children returns would enable linkage to health data for looked after children who are not in publicly funded schooling (i.e. those who are pre- or post-school, home schooled, or in independent schooling).
Original languageEnglish
Pages (from-to)101-111
Number of pages11
JournalPublic Health
Volume150
Early online date27 Jun 2017
DOIs
Publication statusPublished - Sep 2017

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Scotland
Social Work
Delivery of Health Care
Health
Pupil
Child Health
Information Storage and Retrieval
Censuses
Population
Child Health Services
Foster Home Care
School Health Services

Keywords

  • Child in care
  • Looked after children
  • Delivery of healthcare
  • Dental health services
  • Medical record linkage
  • Public health informatics
  • Scotland

Cite this

Linking routinely collected social work and health data to enable monitoring of the health and healthcare of children in state care (‘looked after children’) in Scotland : a national demonstration project. / Clark, David; King, Albert ; Sharpe, Katharine ; Connelly, Graham ; Elliott, Lawrie ; Macpherson, Lorna M. D. ; McMahon, Alex D.; Milligan, Ian ; Wilson, Philip; Conway, David I.; Wood, Rachael.

In: Public Health, Vol. 150, 09.2017, p. 101-111.

Research output: Contribution to journalArticle

Clark, David ; King, Albert ; Sharpe, Katharine ; Connelly, Graham ; Elliott, Lawrie ; Macpherson, Lorna M. D. ; McMahon, Alex D. ; Milligan, Ian ; Wilson, Philip ; Conway, David I. ; Wood, Rachael. / Linking routinely collected social work and health data to enable monitoring of the health and healthcare of children in state care (‘looked after children’) in Scotland : a national demonstration project. In: Public Health. 2017 ; Vol. 150. pp. 101-111.
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title = "Linking routinely collected social work and health data to enable monitoring of the health and healthcare of children in state care (‘looked after children’) in Scotland: a national demonstration project",
abstract = "Background and objectivesChildren in state care (‘looked after children’) have poorer health than children who are not looked after. Recent developments in Scotland and elsewhere have aimed to improve services and outcomes for looked after children. Routine monitoring of the health outcomes of looked after children compared to those of their non-looked after peers is currently lacking. Developing capacity for comparative monitoring of population based outcomes based on linkage of routinely collected administrative data has been identified as a priority. To our knowledge there are no existing population based data linkage studies providing data on the health of looked after and non-looked after children at national level. Smaller scale studies that are available generally provide very limited information on linkage methods and hence do not allow scrutiny of bias that may be introduced through the linkage process.Study design and methodsNational demonstration project testing the feasibility of linking routinely collected looked after children, education, and health data.ParticipantsAll children in publicly funded school in Scotland in 2011/12.ResultsLinkage between looked after children data and the national pupil census classified 10,009 (1.5{\%}) and 1,757 (0.3{\%}) of 670,952 children as, respectively, currently and previously looked after. Recording of the unique pupil identifier (Scottish Candidate Number, SCN) on looked after children returns is incomplete, with 66{\%} of looked after records for 2011/12 for children of possible school age containing a valid SCN. This will have resulted in some under-ascertainment of currently and, particularly, previously looked after children within the general pupil population. Further linkage of the pupil census to the NHS Scotland master patient index demonstrated that a safe link to the child’s unique health service (Community Health Index, CHI) number could be obtained for a very high proportion of children in each group (94{\%}, 95{\%}, and 95{\%} of children classified as currently, previously, and non-looked after respectively). In general linkage rates were higher for older children and those living in more affluent areas. Within the looked after group, linkage rates were highest for children with the fewest placements and for those in permanent fostering.ConclusionsThis novel data linkage demonstrates the feasibility of monitoring population based health outcomes of school aged looked after and non-looked after children using linked routine administrative data. Improved recording of the unique pupil identifier number on looked after data returns would be beneficial. Extending the range of personal identifiers on looked after children returns would enable linkage to health data for looked after children who are not in publicly funded schooling (i.e. those who are pre- or post-school, home schooled, or in independent schooling).",
keywords = "Child in care, Looked after children, Delivery of healthcare, Dental health services, Medical record linkage, Public health informatics, Scotland",
author = "David Clark and Albert King and Katharine Sharpe and Graham Connelly and Lawrie Elliott and Macpherson, {Lorna M. D.} and McMahon, {Alex D.} and Ian Milligan and Philip Wilson and Conway, {David I.} and Rachael Wood",
note = "Acknowledgements We acknowledge the contribution of Winifried van der Sluijs and Carrie Graham to the project steering group. Funding This study was funded by a National Records of Scotland Cross-Sectoral Data Linkage Pathfinder grant (2013–2016). The funding body had no role in the design, conduct, or reporting of the study.",
year = "2017",
month = "9",
doi = "10.1016/j.puhe.2017.05.003",
language = "English",
volume = "150",
pages = "101--111",
journal = "Public Health",
issn = "0033-3506",
publisher = "Elsevier",

}

TY - JOUR

T1 - Linking routinely collected social work and health data to enable monitoring of the health and healthcare of children in state care (‘looked after children’) in Scotland

T2 - a national demonstration project

AU - Clark, David

AU - King, Albert

AU - Sharpe, Katharine

AU - Connelly, Graham

AU - Elliott, Lawrie

AU - Macpherson, Lorna M. D.

AU - McMahon, Alex D.

AU - Milligan, Ian

AU - Wilson, Philip

AU - Conway, David I.

AU - Wood, Rachael

N1 - Acknowledgements We acknowledge the contribution of Winifried van der Sluijs and Carrie Graham to the project steering group. Funding This study was funded by a National Records of Scotland Cross-Sectoral Data Linkage Pathfinder grant (2013–2016). The funding body had no role in the design, conduct, or reporting of the study.

PY - 2017/9

Y1 - 2017/9

N2 - Background and objectivesChildren in state care (‘looked after children’) have poorer health than children who are not looked after. Recent developments in Scotland and elsewhere have aimed to improve services and outcomes for looked after children. Routine monitoring of the health outcomes of looked after children compared to those of their non-looked after peers is currently lacking. Developing capacity for comparative monitoring of population based outcomes based on linkage of routinely collected administrative data has been identified as a priority. To our knowledge there are no existing population based data linkage studies providing data on the health of looked after and non-looked after children at national level. Smaller scale studies that are available generally provide very limited information on linkage methods and hence do not allow scrutiny of bias that may be introduced through the linkage process.Study design and methodsNational demonstration project testing the feasibility of linking routinely collected looked after children, education, and health data.ParticipantsAll children in publicly funded school in Scotland in 2011/12.ResultsLinkage between looked after children data and the national pupil census classified 10,009 (1.5%) and 1,757 (0.3%) of 670,952 children as, respectively, currently and previously looked after. Recording of the unique pupil identifier (Scottish Candidate Number, SCN) on looked after children returns is incomplete, with 66% of looked after records for 2011/12 for children of possible school age containing a valid SCN. This will have resulted in some under-ascertainment of currently and, particularly, previously looked after children within the general pupil population. Further linkage of the pupil census to the NHS Scotland master patient index demonstrated that a safe link to the child’s unique health service (Community Health Index, CHI) number could be obtained for a very high proportion of children in each group (94%, 95%, and 95% of children classified as currently, previously, and non-looked after respectively). In general linkage rates were higher for older children and those living in more affluent areas. Within the looked after group, linkage rates were highest for children with the fewest placements and for those in permanent fostering.ConclusionsThis novel data linkage demonstrates the feasibility of monitoring population based health outcomes of school aged looked after and non-looked after children using linked routine administrative data. Improved recording of the unique pupil identifier number on looked after data returns would be beneficial. Extending the range of personal identifiers on looked after children returns would enable linkage to health data for looked after children who are not in publicly funded schooling (i.e. those who are pre- or post-school, home schooled, or in independent schooling).

AB - Background and objectivesChildren in state care (‘looked after children’) have poorer health than children who are not looked after. Recent developments in Scotland and elsewhere have aimed to improve services and outcomes for looked after children. Routine monitoring of the health outcomes of looked after children compared to those of their non-looked after peers is currently lacking. Developing capacity for comparative monitoring of population based outcomes based on linkage of routinely collected administrative data has been identified as a priority. To our knowledge there are no existing population based data linkage studies providing data on the health of looked after and non-looked after children at national level. Smaller scale studies that are available generally provide very limited information on linkage methods and hence do not allow scrutiny of bias that may be introduced through the linkage process.Study design and methodsNational demonstration project testing the feasibility of linking routinely collected looked after children, education, and health data.ParticipantsAll children in publicly funded school in Scotland in 2011/12.ResultsLinkage between looked after children data and the national pupil census classified 10,009 (1.5%) and 1,757 (0.3%) of 670,952 children as, respectively, currently and previously looked after. Recording of the unique pupil identifier (Scottish Candidate Number, SCN) on looked after children returns is incomplete, with 66% of looked after records for 2011/12 for children of possible school age containing a valid SCN. This will have resulted in some under-ascertainment of currently and, particularly, previously looked after children within the general pupil population. Further linkage of the pupil census to the NHS Scotland master patient index demonstrated that a safe link to the child’s unique health service (Community Health Index, CHI) number could be obtained for a very high proportion of children in each group (94%, 95%, and 95% of children classified as currently, previously, and non-looked after respectively). In general linkage rates were higher for older children and those living in more affluent areas. Within the looked after group, linkage rates were highest for children with the fewest placements and for those in permanent fostering.ConclusionsThis novel data linkage demonstrates the feasibility of monitoring population based health outcomes of school aged looked after and non-looked after children using linked routine administrative data. Improved recording of the unique pupil identifier number on looked after data returns would be beneficial. Extending the range of personal identifiers on looked after children returns would enable linkage to health data for looked after children who are not in publicly funded schooling (i.e. those who are pre- or post-school, home schooled, or in independent schooling).

KW - Child in care

KW - Looked after children

KW - Delivery of healthcare

KW - Dental health services

KW - Medical record linkage

KW - Public health informatics

KW - Scotland

U2 - 10.1016/j.puhe.2017.05.003

DO - 10.1016/j.puhe.2017.05.003

M3 - Article

VL - 150

SP - 101

EP - 111

JO - Public Health

JF - Public Health

SN - 0033-3506

ER -