Linking data on women in public family law court proceedings concerning their children to mental health service records in South London.

INTRODUCTION: Maternal mental health problems and substance misuse are key risk factors for child neglect or abuse and court-mandated placement into care. Linkage between mental health records and family court data could raise awareness about parent mental health needs and inform approaches to address them. OBJECTIVES: To evaluate data linkage between administrative family court data and electronic mental health records for a population-based mental health service for 1.3 million people in South London. METHODS: We deterministically linked administrative family court data for women (n=5463) involved in care proceedings in South London with service user records from the South London and Maudsley NHS Mental Health Trust (SLaM). We restricted the cohort to women involved in proceedings between 2007 and 2019, in local authorities where SLaM solely provides secondary/tertiary mental health services and the Improving Access to Psychological Therapies (IAPT) (n=3226). We analysed the associations between match status and sociodemographic/case characteristics using multivariable logistic regression. RESULTS: Two-thirds (2317/3226; 66%) of women linked to a SLaM service user record at some point; most (91%) who linked accessed secondary/tertiary mental health services, indicating serious mental illness. Accounting for possible missed matches, we estimated that 70-83% of women accessed SLaM services at some point. Older women at index proceedings (>35yrs OR: 0.69, 95%CI: 0.54-0.88vs <25yrs) and Black women or women from other ethnic groups (Black ethnic groups 0.65, 0.50-0.83; other ethnicity 0.59, 0.43-0.81 vs White ethnic groups) had lower odds of linking. Odds of linking were higher for women with an infant in proceedings (1.42, 1.18-1.71), or with curtailed/terminated parental responsibility (1.44, 1.20-1.73). CONCLUSION: Our linkage supports growing evidence of a high burden of mental health problems and substance misuse among women whose children enter care in England, compared to the general population. Research using this linkage should inform strategies to address the considerable mental health needs of vulnerable women and their children.

Timing of paediatric orchidopexy in universal healthcare systems: international administrative data cohort study.

BACKGROUND: International guidelines in 2008 recommended orchidopexy for undescended testis at 6-12 months of age to reduce the risk of testicular cancer and infertility. Using administrative data from England, Finland, Ontario (Canada), Scotland and Sweden (with data from Victoria (Australia) and Iceland in supplementary analyses), the aim of this study was to investigate compliance with these guidelines and identify potential socioeconomic inequities in the timing of surgery before 1 and 3 years. METHODS: All boys born in 2003-2011 with a diagnosis code of undescended testis and procedure codes indicating orchidopexy before their fifth birthday were identified from administrative health records. Trends in the proportion of orchidopexies performed before 1 and 3 years of age were investigated, as were socioeconomic inequities in adherence to the guidelines. RESULTS: Across all jurisdictions, the proportion of orchidopexies occurring before the first birthday increased over the study period. By 2011, from 7·6 per cent (Sweden) to 27·9 per cent (Scotland) of boys had undergone orchidopexy by their first birthday and 71·5 per cent (Sweden) to 90·4 per cent (Scotland) by 3 years of age. There was limited evidence of socioeconomic inequities for orchidopexy before the introduction of guidelines (2008). Across all jurisdictions for boys born after 2008, there was consistent evidence of inequities in orchidopexy by the first birthday, favouring higher socioeconomic position. Absolute differences in these proportions between the highest and lowest socioeconomic groups ranged from 2·5 to 5·9 per cent across jurisdictions. CONCLUSION: Consistent lack of adherence to the guidelines across jurisdictions questions whether the guidelines are appropriate.

ANTECEDENTES: En el 2008, las guías internacionales recomendaban efectuar una orquidopexia para los testículos no descendidos entre los seis y los 12 meses de edad para reducir los riesgos de cáncer testicular e infertilidad. Utilizando datos administrativos de Inglaterra, Finlandia, Ontario (Canadá), Escocia y Suecia (con datos de Victoria, Australia e Islandia para análisis complementarios), el objetivo de este estudio fue investigar el cumplimiento de estas guías y la identificación de posibles desigualdades socioeconómicas con relación al momento de la cirugía antes de 1 y 3 años de edad. MÉTODOS: A partir de los registros administrativos de salud, se identificaron todos los niños nacidos entre 2003 y 2011 con código diagnóstico de testículos no descendidos y con código de procedimiento correspondiente a orquidopexia antes de cumplir 5 años. Se investigaron las tendencias en la proporción de orquidopexias realizadas antes de 1 y 3 años de edad, respectivamente, al igual que las desigualdades socioeconómicas en el cumplimiento de las directrices de las guías. RESULTADOS: En todas las jurisdicciones, la proporción de orquidopexias realizadas antes del primer año de vida aumentó durante el periodo de estudio. En 2011, del 7,6% (Suecia) al 27,9% (Escocia) de los niños habían sido sometidos a orquidopexia en su primer año de vida y del 71,5% (Suecia) al 90,4% (Escocia) a los 3 años de edad. Hubo evidencia limitada de las inequidades socioeconómicas para la orquidopexia antes de la introducción de las guías (2008). En todas las jurisdicciones para los niños nacidos después de 2008, hubo evidencia consistente de inequidades para la práctica de una orquidopexia en el primer año de vida en favor de una posición socioeconómica más alta (socioeconomic position, SEP). Las diferencias absolutas en estas proporciones entre los grupos SEP más altos y más bajos oscilaron entre el 2,5% y el 5,9% en todas las jurisdicciones. CONCLUSIÓN: La falta de adherencia a las guías observada consistentemente en todas las jurisdicciones cuestiona si las guías son apropiadas.

Data Resource: Children and Family Court Advisory and Support Service (Cafcass) public family law administrative records in England.

INTRODUCTION: In England, in cases of child maltreatment or neglect, the state can intervene through the family court to remove children from their family home and place them in out-of-home care. The Children and Family Court Advisory and Support Service (Cafcass) collects and maintains administrative records of all public family law cases in England. While these national records are primarily used to monitor and manage the workflow of Cafcass teams across England, researchers have re-purposed this data for analysis to understand the drivers and outcomes of public family law intervention. DATA CONTENTS: The administrative dataset is a reflection of the cases Cafcass is involved with and the extent of that involvement. The dataset contains information about the local authority that makes an application to initiate public family law proceedings, the children and families involved, and the duration and details of the case. Between 1 April 2007 and 31 March 2019, Cafcass captured information on approximately 172,100 public family law cases, involving 282,300 children, and 349,600 adults (of which 289,300 are recorded as biological parents). Amongst the information recorded are the relations between adults and children, making it possible for researchers to identify family groups. Additionally, recording practices at Cafcass have improved over time, this has increased the availability of demographic information of all those involved, as well as child's final legal outcome. DATA ACCESS: Researchers can apply to the Secure Anonymised Information Linkage databank (SAIL) for access to the Cafcass pseudonymised administrative data extract, where it is refreshed bi-annually. KEYWORDS: children, out of home care, family relations, family law.

Socioeconomic status and weight gain in early infancy.

CONTEXT: The association between low socioeconomic status (SES) and childhood obesity foreshadows lifelong inequalities in health. Insight into the causal mechanisms linking childhood adversity to long-term health could be provided by discovering when the negative SES gradient in weight emerges and what early life experiences are associated with it. OBJECTIVE: SES differences in infant weight gain in the first 3 months of life were examined, and contributions of parental body mass index, maternal smoking and feeding method to this association were assessed. DESIGN: Observational study using longitudinal weight data from 2402 families taking part in the Gemini Study; a twin birth cohort recruited from all twin births between March and December 2007 in England and Wales. OUTCOME MEASURES: Infant weights at birth and 3 months converted to standard deviation scores (SDS), change in weight SDS and rapid growth. SES was indexed by occupation and maternal education. RESULTS: There were no SES differences in birth weight, but lower SES was associated with higher 3-month weight, greater change in weight and a higher prevalence of rapid growth (all P < 0.01), with graded associations across levels of SES. Including parental overweight or smoking in pregnancy in the regression model did not affect the association between SES and weight gain, but including feeding method attenuated the SES effect on weight gain by at least 62% and rendered it nonsignificant. CONCLUSION: The foundations for lifelong socioeconomic inequalities in obesity risk may be laid in early infancy, with infant-feeding practices having a part in the diverging weight trajectories.