Hospital admissions among adolescents with local authority care experience or special educational needs in England: a population-based cohort study using linked administrative data from health, education and social care services

TL;DR

Adolescents in state care or with special educational needs in England face higher hospital admission rates, especially for mental health and pregnancy-related issues.

Contribution

This study provides population-based evidence on hospital admissions for adolescents with care experience or special educational needs in England.

Findings

Unplanned hospital admissions were highest in care-experienced girls with an EHCP at 21.9 per 100 person-years.

Mental health-related admissions accounted for 48% of all unplanned admissions in girls and 33% in boys.

Pregnancy-related admission rates were highest in care-experienced girls at 14 per 100 person-years.

Abstract

Children and young people in state care or with special educational needs (SEN) experience disproportionately higher rates of long-term physical and mental illness compared with their peers. However, few large-scale studies have explored the intersection of social care, education systems and healthcare services during adolescence. We aimed to quantify planned and unplanned hospital admissions during adolescence for pupils with SEN and/or experience of state care in England.

We analysed linked administrative records from hospital, education and social care systems for adolescents in England using the Education and Child Health Insights from Linked Data (ECHILD) database. The cohort comprised pupils starting secondary school between 2007–2008 and 2011–2012 (aged 11 years), with follow-up until March 2020 (aged 18–23 years). Hospital admission rates were examined by gender and age across six mutually exclusive groups reflecting statutory support during school: (1) no support, (2) school-based SEN support only, (3) formalised SEN support only (education, health and care plan; EHCP), (4) care-experienced only, (5) SEN support and care-experienced and (6) EHCP and care-experienced. Rate ratios were estimated for each group relative to no support using negative binomial regression models.

The cohort included 2 807 230 pupils: 64% (1 791 190) received no support, 31% (876 400) received SEN support only, 3% (84 410) received EHCP only and 1% (29 330) received SEN support and care experience, with the remaining groups accounting for <1%. Unplanned admissions were higher in all groups receiving support than peers with no support and were highest in care-experienced girls with an EHCP (21.9 (95% CI 21.4 to 22.4)/100 person-years (100PY)). Mental health-related admissions accounted for 48% of all unplanned admissions in girls and 33% in boys. Pregnancy-related admission rates were highest in care-experienced girls (14/100PY).

We found evidence of high levels of unplanned admissions coupled with low levels of planned care for pupils with multiple needs, indicating a need for preventative care.

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