Research into practice

Brian Morgan looks at research that argues the emotional
well-being of looked-after children needs as much attention as their physical

This report is perhaps the first large-scale study anywhere in
the world examining the health of children after they have entered care.
Previous studies have either paid attention to the health of children entering
care, and used uncontrolled observational studies only, or worked with small

This study evaluated the health of 142 children aged five to
16 who had already been in care for six months in four unitary Welsh
authorities, comparing them with a control group of 119 children matched for
age and sex.

This work builds on a number of key earlier reports, for
example, the Children’s Safeguards Review 1997 and Sir Ronald
Waterhouse’s Lost in Care report 1999. There was already a high degree
of concern and understanding in Wales of the risks associated with being in public
care, particularly by community paediatricians in co-operation with local

The researchers, from Swansea University, say their findings
confirm what had been suggested by Canadian research, that "looked-after
children may be in better health than the literature would lead us to
believe". 2

All children entering care in Wales are now offered a health
assessment by a community paediatrician including hearing and eyesight tests,
and social services told if a child fails to attend. Guidance from BAAF
Adoption & Fostering is followed and there are clear lines of
responsibility to see that recommended actions are carried out. For example, in
immunisation and growth monitoring – though there is evidence that monitoring
of immunisation could be improved.

However, the report is sceptical about child and adolescent
mental health services and also about the effectiveness of the delivery of
health promotion advice. And it compares parental and foster carer
interpretations of children’s emotional and behavioural health with the
children’s own views – showing that foster carers significantly
under-appreciated children’s difficulties.

The Royal College of Psychiatrists already recognises the
difficulty social services have in getting mental health services for
looked-after children. Children in care may have moved on before being seen,
and the absence of timely care may cause their placement to break down.

Bed-wetting, interpersonal problems, anxieties and worries
are more common in looked-after children generally. The report says that after
the age of nine children in care were "more likely to smoke, use illegal
drugs, have been cautioned or charged with a criminal offence and admit to
having done something that could get them into serious trouble".

The researchers argue that, in Wales at least, the message
that looked-after children really do need looking after has sunk home, but that
this has been too literally interpreted as looking after their physical health
needs. The emotional health needs of children in care urgently need to be
addressed through improved liaison between school, social work, community
mental health teams and foster carers.

– J Williams, S Jackson, A Maddocks, W Cheung, A Love, H
Hutchings, "Case-control study of the health of those looked after by
local authorities", Archives of Disease in Childhood, 85(4), 2001

Brian Morgan is a freelance journalist specialising in
medical and social care issues.


1 H Payne & I Butler, "Improving the
health care process and determining health outcomes for children looked after
by the local authority", Ambulatory Child Health, Vol 4, 1998

2 K Kufeldt, JVachon, MSimard, Looking
after Children in Canada
, University of New Brunswick, Universit‚ Laval,

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