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Shedding new light on the adult outcomes of people who were in care as children

By Chris A Garrington, on 20 July 2021

by Fran Abrams

Census data from the ONS-LS has helped shed new light on outcomes for children who have been in care in a major research project led by the UCL Institute of Epidemiology and Healthcare. The study uses Census data to push forward the boundaries of knowledge by looking at what happens in mid-life to those who have been in care as children. It finds disturbing disparities – with some groups faring much worse than others. 

Care-leavers have long been known to suffer worse outcomes than their peers. Now a programme of research funded by the Nuffield Foundation has highlighted the ways in which these issues continue throughout the lives of those affected. At an event to share the project’s findings with those interested in improving the lives of children who cannot live with their parents, Josh MacAlister, who is leading an independent review of children’s social care, said the research had already had a major impact on its work. 

It is actually breaking new ground in our understanding of where care-experienced people end up in later life,” MacAlister told an audience of more than 200 practitioners, policymakers and academics.

“One of the questions we pose is: ‘How many parents don’t know where their own child is at 30, 40 or 50?’ It’s a common refrain that the state is the corporate parent, and actually not knowing really basic things about destination and outcomes for care-experienced people later on into life has been a huge blind spot. So this study is very significant in that respect,” he said.

Raising the bar

The Government review led by MacAlister was launched earlier this year with the aim of ‘raising the bar for vulnerable young people across England.

The UK’s National Statistician, Sir Ian Diamond, who chaired the event, told the audience the care research was an exemplary use of data from the ONS-LS dataset.

Sir Ian highlighted a key issue for those studying children’s social care: the evidence shows those who have been in care suffer worse outcomes than their peers – for example higher than average levels of unemployment, lower levels of educational qualification and early pregnancy. But that research tends to focus on recent care-leavers while this project follows them into mid-life.

The project, led by a team of researchers at University College London, used Census data from the ONS-LS to explore outcomes for those who experienced care from the 1970s onwards, up to the age of 50.

Census data

The ONS-LS has gathered information on approximately a million people, and from this the researchers were able to look at a sample of just under 500,000 children. Of those, around 3,500 were looked after by family members other than their parents, 2200 were in formal foster care and 900 in residential care. Over time, residential care had become less common and family or kinship care more so.

There were four main aims of the research:

  • To determine whether children who had experienced care had worse health and social experiences from 10 to 40 years later, compared to others.
  • To explore whether children in residential care did better or worse than children in foster or kinship care.
  • To look at care differences related to gender, ethnicity or migration status.
  • To investigate trends and look at whether longer-term outcomes had improved over time.

Amanda Sacker, Professor of Lifecourse Studies, Epidemiology and Public Health at UCL, who led the study, told the launch one of its strongest findings was that inequalities within the cared-for population were as great as inequalities between that group and those in parental care.

Impacts of a childhood in care

The research found the impact of being in care on health, socio-economic circumstances, family life and living arrangements varied according to the type of care experienced – those who were cared for by relatives had the best outcomes and those who had been in residential care the worst, with foster care sitting between the two. 

This did not necessarily mean the type of care had led to better or worse outcomes, Professor Sacker explained at the event – those who were most vulnerable or damaged by early experiences might be more likely to go into residential care rather than family care or a foster home.

In relation to employment there was some evidence these inequalities between care groups reduced with age, though adults in their 20s were twice as likely to be employed if they had been in their parental home rather than in residential care.

Social inequalities between care groups also extended to the age of death: while those brought up by parents had become less likely to die prematurely in the past 30 years, this was not true for those in non-parental care. Those in care in 1971 were 30 per cent more likely than average to die but by 2001, this ratio had grown to more than 300 per cent, most commonly from preventable causes such as car accidents, alcoholism and assault.

When the researchers looked at education, they found a similar picture: those in parental care had a 28 per cent chance of achieving an NVQ level 3 qualification compared with just 11 per cent for those in residential care. There was some good news, though – the care groups were more likely to be in education later in life, and this helped them to catch up with their peers.

The project’s findings on ethnicity were more mixed. White and south Asian groups were found to have worse outcomes if they had been in care, but for black children the study found having been in care did not seem to be associated with any additional detrimental effect over and above the inequalities seen for all black children. The researchers said more investigation was needed into this complex picture.

Caregivers’ children

The final key findings of the study were on the children of those who give care. They too, it found, were affected by their experiences – there had been reports that the children of foster parents or of kinship carers had felt disadvantaged.

The research looked at five ‘transition milestones into adulthood: leaving education, leaving home, starting work, forming a relationship and becoming a parent. It found children of care-givers were less likely to have higher qualifications, more likely to be unemployed, more likely to be married early and less likely to own their own home than others. If they were female, they were likely to be younger when they had their first child.

“Our work in the field of life course social epidemiology has highlighted that inequalities in health cannot be reduced without tackling social inequalities too,” Professor Sacker said.  “By shining a light on the life courses of children who have had to be placed in care, our aim is to get it right for care leavers.”

Further work

Sir Ian Diamond said the Office for National Statistics was keen to make more use of longitudinal data such as the ONS-LS to help inform policy on issues such as this one.

“Among the most disadvantaged in society are clearly those young people and children who have experienced care, and care  leavers, we know empirically, have not had great outcomes.  It’s always seemed to me that we needed better longitudinal data to understand the pathways that would help us to inform policy, which could improve the outcomes for people who are under-achieving because they have been let down early in their lives for all kinds of reasons.  So it seems to me there’s an enormous need for this work,” he said.

Tim Gardam, Chief Executive of the Nuffield Foundation, said the research fitted very well with its aim of viewing social wellbeing primarily through the lens of the experiences of the most disadvantaged and vulnerable.

“What we find here is the ONS-LS using Census data from five decades, painting a vivid and complex picture of vulnerable people’s lives and their health and social outcomes that in places brings the reader, quite frankly, up short in shock. 

“We have known for a long time that being in care as a child is associated with poorer outcomes in adulthood. But most research has previously ended with young adulthood and been based on small population samples. This research documents people’s lives in their 40s and enables us to understand the longer-term effects,” he said.

The lifelong health and wellbeing trajectories of people who have been in care: Findings from the Looked-after Children Grown up Project, is by Amanda Sacker with Emily Murray, Rebecca Lacey and Barbara Maughan. It is published by the Nuffield Foundation.

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