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28 January
NO 1257
Children in state care
There is an increasing amount of evidence emerging within the United Kingdom and across Europe to suggest that children in state care are prone to social exclusion on the grounds of many of their experiences prior to entering the care system (physical, sexual, severe emotional abuse, neglect and abandonment, alcohol and drug problems of parents, poverty and deprivation, criminal behaviour, and so forth) as well as their experiences in care. A recent prevalence study in the United Kingdom (Meltzer et al., 2003) places the rate of mental disorder (in all categories) for looked after children at nearly 66% for children in residential care, and at 40% for those children in foster care. This compares with rates of mental disorder (in all categories) of 10% for children within the general population (Meltzer et al., 2000). This is an extremely concerning result, but possibly not that surprising in that we know that children wouldn't be within the state care system unless they had experienced significant trauma.
But these high rates indicate the need for services and resources designed to meet the needs of these very vulnerable children. So what is the state of play? Do such services exist? What are the prevalence rates in other European countries? Do they show the same level of need as the UK statistics? What are the differences? Do good services exist that use an evidence base when working with children in public care? How are such services evaluated?
A 22 month EU funded project, which began in December 2001, was designed to begin addressing some of these questions. The project focused on the prevalence of mental health problems among children in state care and on the initiatives that were undertaken in different European countries to treat these problems. The partner countries and representative agencies involved in this research project were: NCH – The Bridge Child Care Development Service (United Kingdom – project co-ordinators), Barnardo's (United Kingdom), the Katholieke Universiteit Leuven (Belgium) and the Institute of Child Health (Greece). Now over two and a half years later we are not sure that we have come any closer to providing definitive answers to any of the questions listed above, but we have attempted to provide a little more information into what is known about mental health for children in state care across Europe, and have given ourselves many more questions to answer in the process. A topic of this magnitude cannot provide easy, `quick fix' answers to the problems many children in public care face. Indeed the evidence base concerning what interventions are known to work with these children remains thin. What can be stated categorically is that the solutions to working with complex problems are also complex. What we have seen from some of the innovative work in this field to date is that the most effective work will also on occasion involve a whole network of other people working with the child: the social worker, foster carer, teacher and other professionals, not just a specialist mental health professional.
However, what makes working with children in public care so difficult and demanding is the sheer unpredictable nature of the care process as experienced by the child. In the UK, even when offering these children mental health services, there is no guarantee that there won't suddenly be a placement change for that child (for whatever reason), necessitating a change in school, friendship networks, reduced family contact, and changes in class and culture. This must and does have an effect on children's resilience, self esteem and ultimately will affect their mental health. For the services working with children in public care there are also considerable challenges ahead regarding the robustness of the evaluation methods such services currently use (or don't use) to evidence their work.
CHRISTINE COCKER AND
HANS GRIETENS
REFERENCES
Cocker, C. (2003). The mental health of children in state care: A European study (final report). London. NCH – The Bridge Care Development Service.
Meltzer, H., Gatward, R., Corbin, T., Goodman, R., & Ford, T. (2003). The mental health of young people looked after by local authorities in England. London. TSO.
Meltzer, H., Gatward, R., Goodman, R., & Ford, T. (2000). Mental health of children and adolescents in Great Britain. London. TSO.
Cocker, C. and Grietens, H. (2004). Editor's Note. International Journal of Child and Family Welfare, 7, 2-3, pp. 82-83.
