Cardiovascular Disease Events in Adults with a History of State Care in Childhood: Pooling of Unpublished Results from 9 Cohort Studies.

Background: Individuals who were separated from their biological family and placed into the care of the state during childhood (out-of-home care) are more prone to developing selected physical and mental health problems in adulthood, however, their risk of cardiovascular disease (CVD) is uncertain. Accordingly, we pooled published and unpublished results from cohort studies of childhood care and adult CVD. Methods: We used two approaches to identifying relevant data on childhood care and adult CVD (PROSPERO registration CRD42021254665). First, to locate published studies, we searched PubMed (Medline) until November 2023. Second, with the aim of identifying unpublished studies with the potential to address the present research question, we scrutinised retrieved reviews of the impact of childhood state care on related adult health outcomes. All included studies were required to have prospective measurement of state care in childhood and a follow-up of CVD events in adulthood as the primary outcome (incident coronary heart disease and/or stroke). Collaborating investigators provided study-specific estimates which were aggregated using random-effects meta-analysis. The Newcastle-Ottawa Scale was used to assess individual study quality. Findings: Thirteen studies (2 published, 11 unpublished) met the inclusion criteria, and investigators from nine provided viable results, including updated analyses of the published studies. Studies comprised 611,601 individuals (301,129 women) from the US, UK, Sweden, Finland, and Australia. Relative to the unexposed, individuals with a care placement during childhood had a 50% greater risk of CVD in adulthood (summary rate ratio after basic adjustment [95% confidence interval]: 1.50 [1.22, 1.84]); range of study-specific estimates: 1.28 to 2.06; I2 = 69%, p = 0.001). This association was attenuated but persisted after multivariable adjustment for socioeconomic status in childhood (8 studies; 1.41 [1.15, 1.72]) and adulthood (9 studies, 1.28 [1.10, 1.50]). There was a suggestion of a stronger state care-CVD association in women. Interpretation: Our findings show that individuals with experience of state care in childhood have a moderately raised risk of CVD in adulthood. For timely prevention, clinicians and policy makers should be aware that people with a care history may need additional attention in risk factor management.

Health outcomes of children in state care in Aotearoa New Zealand.

AIM: This study aims to provide an overview of the association between being in the custody of the chief executive of Oranga Tamariki (the child welfare agency of the New Zealand (NZ) government) and all-cause hospitalisation and mortality. METHODS: This was a national retrospective cohort study using linked administrative data from the Integrated Data Infrastructure. Data were obtained for all 0-17 year-olds living in NZ on 31 December 2013. In-care status was ascertained at this point. Outcomes of all-cause hospitalisation and all-cause mortality were assessed between 1 January 2014 and 31 December 2018. Adjusted models incorporated age, sex, ethnicity, level of socioeconomic deprivation and rural/urban status. RESULTS: There were 4650 in-care children and 1 009 377 not-in-care children in NZ on 31 December 2013. Of those in care, 54% were male, 42% lived in the most deprived areas and 63% identified as Maori. Adjusted models showed that in-care children were 1.32 (95% CI 1.27-1.38) times more likely to be hospitalised than not-in-care children and 3.64 (95% CI 2.47-5.40) times more likely to die. CONCLUSION: This cohort study highlights that the care and protection system prior to 2018 was not preventing children in its care from experiencing severe adverse outcomes. Overseas research has previously been relied on when making practice and policy decisions around child care and protection in NZ, so this research will provide valuable insight into best practice in an NZ context.

A scoping review of system-level mechanisms to prevent children being in out-of-home care.

Identifying which approaches can effectively reduce the need for out-of-home care for children is critically important. Despite the proliferation of different interventions and approaches globally, evidence summaries on this topic are limited. This study is a scoping review using a realist framework to explore what research evidence exists about reducing the number of children and young people in care. Searches of databases and websites were used to identify studies evaluating intervention effect on at least one of the following outcomes: reduction in initial entry to care; increase in family reunification post care. Data extracted from papers included type of study, outcome, type and level of intervention, effect, mechanism and moderator, implementation issues and economic (EMMIE) considerations. Data were coded by: primary outcome; level of intervention (community, policy, organisation, family or child); and type of evidence, using the realist EMMIE framework. This is the first example of a scoping review on any topic using this framework. Evaluated interventions were grouped and analysed according to system-level mechanism. We present the spread of evidence across system-level mechanisms and an overview of how each system-level mechanism might reduce the number of children in care. Implications and gaps are identified.

Corporate parenting in a pandemic: Considering the delivery and receipt of support to care leavers in Wales during Covid-19.

This paper considers the support available to care leavers during the Covid-19 pandemic from their corporate parents. The paper contributes to a developing evidence base concerned with social work efforts to adapt and maintain support provision during the unprecedented circumstances, and provides insight into how such support was perceived and experienced. Funded by Voices from Care Cymru and Cardiff University, a qualitative, mixed method study was conducted which included a survey of Welsh Local Authority professionals (n = 22) and interviews with Welsh care-experienced young people aged 17-24 (n = 17). The findings of this paper show the propensity of corporate parents to provide protection against the adversities of the pandemic, or to compound difficulties. While some young people reported being both practically and emotionally supported, for others corporate parenting support was perceived as unavailable, unhelpful and / or uncaring. The Covid-19 pandemic provides a unique lens to consider the strengths, flaws and future opportunities for corporate parenting. The findings emphasise the need for parity of support for young people leaving care and consideration of national, local and individual responses is included. Yet consistent with findings pre-dating the pandemic, the findings reaffirm the enduring importance of both relationships and resources in ensuring good support for care leavers.

Where will telemedicine go from here?

The COVID-19 pandemic accelerated the adoption of telemedicine internationally. The reproductive clinics that thrived in this tumultuous time had access to fully electronic medical records with user-friendly telehealth platforms and remote support staff for physicians. However, complete transition from in-person visits to telehealth uncovered many opportunities for innovation. At-home semen testing is not yet widely recognized, and patients still require an in-person visit for ultrasounds, procedures, and physical examinations. Although emergency policies and waivers have made it easier for providers to legally practice across state borders and receive payments from insurance companies, they vary from state to state and have not been cemented into law. Finally, clinical training for medical students, residents, and fellows has been affected by decreased clinical and surgical volume. However, trainees have also proven to be the most adaptable, quickly shifting to remote learning practices through social media, online surgical atlases, and wide distribution of "virtual visiting professor" lectures. As countries have eased physical distancing guidelines, patients ultimately benefit from having the option of a telehealth appointment. Although there is still much work to be done to improve telehealth, the COVID-19 pandemic has at least proven that it is a safe method of patient care and teaching.

The Lake Alice Hospital Child and Adolescent Unit: Accountability - The Response to Date.

In the 1970s Dr Selwyn Leeks, a registered psychiatrist set up a child and adolescent unit in the grounds of Lake Alice Hospital, a New Zealand psychiatric facility. The adolescents were not diagnosed as having mental disorders but were placed there for behavioural issues. They were controlled by "aversion therapy" and subjected to electroconvulsive therapy treatment, paraldehyde injections and other forms of abuse. A number of complaints followed, which led to Government inquiries and reports. In 1999 a class action was commenced which was settled by the Government making "ex gratia" payments and issuing apologies. Dr Leeks relocated to Australia and continued to practise. He was the subject of complaints and proceedings. In 2006 he surrendered his practising certificate. The New Zealand Police have declined to prosecute Dr Leeks. A complaint was taken to the United Nations Committee Against Torture. This was upheld in 2019.

"There are carers, and then there are carers who actually care"; Conceptualizations of care among looked after children and care leavers, social workers and carers.

BACKGROUND: Looked after children and care leavers (LACCL) are some of the most vulnerable and marginalized young people in our communities. Existing research demonstrates that this group often interprets care in terms of genuineness and tends to feel uncared for. Less work exists from the perspective of social workers and formal carers. OBJECTIVE: This study aims to explore how care is perceived and practiced among LACCL and those with a duty of care for them. We use a theoretical lens of care ethics to compare and contrast understandings in order to explore how they affect the delivery and receipt of care. PARTICIPANTS & SETTING: There were 44 participants from four local authorities in north-east England including nineteen LACCL aged 12-20, eight social workers, and nineteen formal carers. METHOD: Twenty-eight semi-structured 1:1 interviews, four dyad interviews and three focus group interviews. RESULTS: LACCL desired care that felt familial, went beyond minimum standards and involved understanding. Social workers had to manage LACCL expectations and build relationships by both rationing care according to role constraints whilst sometimes going 'above and beyond' statutory care. Carers conceptualized care in terms of dedication and discipline but felt limited in their ability to achieve care in this way. CONCLUSION: Bridging different conceptualizations of care is necessary to achieve integrated support for these vulnerable young people whilst also helping them to develop key skills for later adult life. A deeper understanding of frameworks of care has implications for social worker and formal carer training and practice.

The perceived impact of interprofessional information sharing on young people about their sexual healthcare.

This article presents the results from an analysis of data from service providers and young adults who were formerly in state care about how information about the sexual health of young people in state care is managed. In particular, the analysis focuses on the perceived impact of information sharing between professionals on young people. Twenty-two service providers from a range of professions including social work, nursing and psychology, and 19 young people aged 18-22 years who were formerly in state care participated in the study. A qualitative approach was employed in which participants were interviewed in depth and data were analysed using modified analytical induction (Bogdan & Biklen, 2007). Findings suggest that within the care system in which service provider participants worked it was standard practice that sensitive information about a young person's sexual health would be shared across team members, even where there appeared to be no child protection issues. However, the accounts of the young people indicated that they experienced the sharing of information in this way as an invasion of their privacy. An unintended outcome of a high level of information sharing within teams is that the privacy of the young person in care is compromised in a way that is not likely to arise in the case of young people who are not in care. This may deter young people from availing themselves of the sexual health services.