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When physical health is not looked after

We know that looked-after children and young people face greater risks of mental health and behavior difficulties than do those in the general population, but there has been little exploration of the relationship between these problems and children’s physical health.

However, research from Florida suggests that the link might be stronger than is often realized. This means that it is possible that attention to physical health may have beneficial effects on other aspects of children’s lives.

It has been widely found in population studies that children with a chronic illness can display other problems. For example, depression is known to be associated with delinquency. As adolescents in foster care usually come from disadvantaged backgrounds, for them this link between chronic illness and problematic behavior might be even stronger.

This is a hypothesis tested by the Florida study, where research scrutinised 188 adolescents, 11-16 years old, living in foster, kinship and residential settings. It explored whether chronic physical illness was associated with externalized and internalized problematic behavior, in particular, delinquency.

The study then explored how far, if at all, depression was involved. To do this a mixture of methods, including self-report studies, questionnaires to carers and analysis of records was employed.

Fifty of the 188 adolescents were described by their caregivers as having a recurring health problem, such as asthma or an allergy. In self-report questionnaires, the young people recounted significantly more externalizing behavior problems, such as aggression, while their foster carers reported higher rates of internalizing problems, such as anxiety. Overall delinquent behavior was also greater, although when measured according to young people’s self reports as opposed to carers’ questionnaires, this difference was less marked.

This study is important for prevention in that it links three aspects of young people’s lives – physical health, mental health and delinquency – and explores this for an especially disadvantaged group, looked-after children. As it reveals statistically significant associations, there are implications for policy and practice.

In assessing the needs of adolescents, physical illnesses can easily be overlooked or assumed to be adequately dealt with by health services. But this might not be the case and some conditions like depression might be ignored by professionals working in other services, especially if the welfare system is fragmented. Similarly, the debilitating effects of other medical conditions, such as asthma, might be underestimated in concerns about other, seemingly more serious, problems.

Thus, professionals working with looked-after adolescents need to be aware of the possibility and significance of chronic physical illness and ensure that this knowledge is incorporated into assessments, care plans and inter-service collaboration. Ignoring physical health might mean missing the underlying causes of problems attracting attention.

Reference:
Woods, S. B., Farineau, H. M., & McWey, L. M. (in press). Physical health, mental health, and behaviour problems among early adolescents in foster care. Child: Care, health and development, doi: 10.1111/j.1365-2214.2011.01357.x

News item
4 July 2012

http://www.preventionaction.org/research/when-physical-health-not-looked-after/5839

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