Peer-reviewed article
The emotional and behavioural symptom trajectories of children in long-term out-of-home care in an English local authority
Rachel M. Hiller, Michelle St Clair ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study tracked the emotional and behavioural symptoms of 207 children in long-term out-of-home care in England over five years using yearly questionnaires completed by carers. Most children showed chronic mental health problems from their first year in care and remained in the abnormal range throughout the five-year period. Children with more placement moves had worse outcomes, and those removed from maltreatment at a later age showed more internalising problems. The findings show that simply removing children from adverse environments is not sufficient to ensure their mental health recovery.
Key points
- Most children in long-term out-of-home care had chronic emotional and behavioural problems from their first year onwards, remaining in the abnormal range for five years
- Children with resilient trajectories had significantly fewer placement moves than those with chronic symptom profiles
- Later age of removal from the maltreatment environment was associated with more chronic internalising problems
- Removal from maltreatment alone is insufficient for children to be resilient to their earlier experiences
Limitations
The study uses carer-completed questionnaires only, which may not capture the full picture of children's mental health and may be subject to reporting bias. The data is from one local authority in South West England, limiting generalisability to other regions or care systems.
Abstract
The significant mental health needs of young people in out-of-home care has been well-documented. However, there is little empirical evidence on the timing or development of these difficulties, once these young people have been removed from the maltreatment-environment. Such information may provide useful clinical insight in to how problems develop and persist and whether intervention timings may allow for the prevention of later mental health problems. The current service-data study explored the emotional and behavioural symptom trajectories of 207 young people under the long-term care of a local authority in the South West of England, over their first five years in the care system. Data were extracted from the yearly carer-completed strengths and difficulties questionnaire - providing an index of emotional problems, peer problems, conduct problems and hyperactivity. Trajectories were analysed using growth mixture modelling. For most domains the largest trajectories were chronic symptom profiles, where young people were rated in the abnormal range from their first year in care and remained in this range across the full five years. These young people had significantly more placement moves than their peers on resilient trajectories. There was some evidence that later age of removal was associated with more chronic internalising problems. Overall, findings demonstrate the significant mental health needs of young people in care and particularly highlight that, in many cases, the removal from the adverse environment is simply not enough to expect a young person in care to be resilient to their earlier experiences.