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Abstract
The rate of children in care in Wales is one of the highest in the world and has increased considerably in the past two decades. Whilst many factors may be driving these increases, there is considerable variation between local authorities. This article presents findings from a survey completed by children's social care workers in Wales (n = 792). It compares the views, values and responses to case study vignettes of workers in authorities with increasing to those with decreasing care rates over five years (2016–2020). Statistically significant differences were found relating to the values and the practices of workers, with workers in local authorities with reducing rates having stronger pro-family values, less risk averse responses to case vignettes, more confidence in the decisions made in their local authority and being more positive about support for practice. The findings indicate that variations in local authority values and practices may influence the rate of children in care and that some with significant social problems seem able to avoid the large numbers of children in care found in other authorities. The challenge faced in Wales and the UK is how local authorities can learn from one another to ensure consistency and quality in services.

Appropriate allegation investigations within social care are paramount to protect children. However, many allegations are unsubstantiated ( Biehal et al., 2014 ) and result in stress and anxiety for fostering families ( Adams, Hassett and Lumsden, 2018 ), financial uncertainty ( Boffey, Stanton and Thomas, 2019 ), unplanned endings and foster carers leaving their role ( Adams, Hassett and Lumsden, 2018 ). There is little research into the prevalence, nature and outcomes of allegations against foster carers. This UK-based study uses The Fostering Network's State of the Nation's Foster Care (SOTN) 2021 survey and analyses responses from 3,352 UK foster carers and 99 fostering service staff. Qualitative findings reflect six themes: (1) emotional impacts, (2) financial implications, (3) independent support, (4) social services involvement, (5) understanding allegations, and (6) children being removed or foster carers leaving their role. Quantitative findings show only 25% of those experiencing an allegation believed they were sufficiently communicated with, only 20% believed specified timescales were adhered to, 57% did not receive independent support, and 36% said no support was offered to children in their home. Poor information-sharing and lack of support were found to have exacerbated the stress experienced.

For young people the online world affords creative, entertainment and socialisation opportunities but also poses risks including cyberbullying, grooming and harmful content. Little is known about online experiences of care-experienced young people, a vulnerable group who may benefit from online experiences but may be at increased risk online. This cross-sectional study used data from 11- to 16-year-olds in Wales from the School Health Research Network (SHRN) Student Health and Wellbeing Survey 2017/18 ( n = 103,971). Cyberbullying, face-to-face bullying and other online experiences were analysed. The prevalence of these experiences and associated mean wellbeing scores were compared for young people in care ( n = 1,921) and not in care ( n = 83,551), controlling for socio-demographic variables gender, ethnicity and year group. Higher numbers of young people in care were involved in cyberbullying, bullying, sharing explicit images, problematic social media use and regular contact with online only friends. These online experiences were associated with lower mean wellbeing scores. Lower numbers of young people in care had access to smartphones and social networking sites from age 12, and lower numbers were regularly in online contact with close friends and a wider peer group. These online experiences were associated with higher mean wellbeing scores. Young people in care appear to be less involved with online experiences that positively impact wellbeing and more involved in online experiences that negatively impact wellbeing. Promoting positive online experiences and education around problematic social media use may be particularly valuable in helping young people living in care develop healthy, safe and positive online lives.

ABSTRACT
ObjectivesTo use routinely collected datasets and data linkage to identify patterns of healthcare utilisation by children and young people (CYP) with adolescent mental health (AMH) disorders across the four UK Nations, with a particular focus on self-harm, anxiety and depression and eating disorders. The analysis will focus on healthcare utilisation during transition from child to adult services and, where possible, on the interface between different care settings e.g. primary and secondary care and health and social care.
In addition we will determine the extent to which routinely collected datasets can contribute to an assessment of the health needs and the quality of care that CYP with AMH disorders receive.
ApproachData has been requested from the national data providers in each country:

The Health and Social Care Information Centre - England
The Secure Anonymised Information Linkage (SAIL) databank - Wales
Information Services Division – Scotland
The Honest Broker Service- Northern Ireland

As well as other sources:

The Clinical Practice Research Datalink
The Paediatric Intensive Care Audit Network.

A number of restrictions and information governance regulations have had to be negotiated and put in place in order to access and store the data in the SAIL Databank, Swansea University. Descriptive cross sectional analysis is underway to address the key questions.
RationalThe project has arisen from the report 'Overview of Child Deaths in Four UK Countries' which found that 30-40% of 13-18 year olds were affected by mental health, learning difficulties or behavioural conditions. The diagnosis, management and services available for mental disorders in CYP are of growing concern and a source of controversy in the UK. Transitional care between child and adult services and the interface between primary and secondary/ specialist services, as well as, that between the NHS and other sectors is often disjointed. Thresholds for referral to Child and Adolescent Mental Health Services (CAMHS) are high and many adolescents are treated, at least initially, in primary health care systems.
ImplicationsAnalysis of routinely collected health datasets has the potential to describe the nature and extent of health needs and health care utilisation for CYP with AMH disorders (self-harm, depression/anxiety, eating disorders). Furthermore the knowledge obtained from using routinely collected healthcare data, will inform future routine data collection across the UK for CYP with AMH disorders.

IntroductionThe diagnosis, management and services available for mental disorders are of growing concern and controversy in the UK. Transitional care between child and adult services and the interface between primary and secondary/ specialist services is often disjointed and thresholds for referral to Child and Adolescent Mental Health Services are high.
Objectives and ApproachRoutinely collected healthcare datasets and data linkage were used to identify patterns of healthcare utilisation by young people and young adults with mental health disorders across the four UK Nations. We explored the extent to which routinely collected datasets can contribute to an assessment of the health needs and the quality of care that children and young people with mental health disorders receive.
Data was requested from the national data providers in each country. A series of descriptive analyses were performed and methods were developed for cross- national comparisons to be made (e.g. Four Nation Person Spell).
ResultsIt is feasible to explore healthcare utilisation across the four countries of the UK using routine data. However the recording, availability and access varied considerably between countries, making meaningful comparisons challenging.
Descriptive analyses showed strong deprivation gradients in the diagnoses and care provided for young people and young adults with mental health disorders. Depression and anxiety were the most commonly recorded mental health conditions in primary care. In secondary care drug/alcohol disorders and self-harm were the most commonly recorded. Re-admissions to emergency departments were higher for those admitted for self-harm or psychiatric conditions.
Conclusion/ImplicationsRoutine data has the potential to make a difference to care. However collection and access needs to be standardised in order to improve efficiency and effectiveness in improving the care for children and young people with mental health disorders. MQ has funded an Adolescent Data Platform to facilitate this.

Purpose
Secure children's homes (SCHs) restrict the liberty of young people considered to be a danger to themselves or others. However, not all young people referred to SCHs find a placement, and little is known about the outcomes of the young person after an SCH or alternative placement. The purpose of this paper is to understand which characteristics most likely predict allocation to an SCH placement, and to explore the outcomes of the young people in the year after referral.


Design/methodology/approach
A retrospective electronic cohort study was conducted using linked social care data sets in England. The study population was all young people from England referred to SCHs for welfare reasons between 1st October 2016 to 31st March 2018 (n = 527). Logistic regression tested for differences in characteristics of SCH placement allocation and outcomes in the year after referral.


Findings
In total, 60% of young people referred to an SCH were allocated a place. Factors predicting successful or unsuccessful SCH allocation were previous placement in an SCH (OR = 2.12, p = 0.01); being female (OR = 2.26, p = 0.001); older age (OR = 0.75, p = 0.001); and a history of challenging behaviour (OR = 0.34, p = 0.01). In the year after referral, there were little differences in outcomes between young people placed in a SCH versus alternative accommodation.


Originality/value
The study raised concerns about the capacity of current services to recognise and meet the needs of this complex and vulnerable group of young people and highlights the necessity to explore and evaluate alternatives to SCHs.

IntroductionInpatient datasets in the UK are primarily organised by episodes (periods of care under an individual consultant), while researchers often want to measure admissions (periods of stay in hospital). We developed a standardized method for identifying admissions in inpatient data, while accounting for differences between the four UK nations.
Objectives and ApproachAll UK inpatient datasets include date variables, permitting chronological sequencing of episodes. They include flags describing whether an episode is a transfer of care, although structures and definitions differ. Data quality is variable leading to concurrent and overlapping episodes, duplication and "orphan" or "childless" transfer episodes, where no originating or destination episode can be identified.
Our objective was to define a method for classifying individual episodes into a continuous period of stay in hospital, which would be consistently applicable to the analysis of inpatient datasets of all four UK nations, while prioritising clinical meaningfulness. Three permutations were considered.
ResultsFor each permutation, episodes for an individual were linked when they related to the same individual and met the following criteria:

Zero or one day gap between episode end and subsequent episode start
Evidence of transfer according to admission method or discharge destination variables
Episode overlapping or completely nested within another episode

Permutations:

a and b
a only
a and c

Permutation three was adopted, as it was felt to be the most clinically meaningful approach, was not dependent on accurate recording of transfers and captured nested or overlapping episodes, which may occur for example when a patient is in a long-stay psychiatric or elderly care ward but requires care from a different specialty. Importantly it permitted consistent analysis of episodes across all UK nations.
Conclusion/ImplicationsThe output of this work provides a useful guide for the classification of inpatient episodes into more clinically meaningful periods of care, and is applicable to the inpatient datasets of all four UK nations. It describes important issues to consider when classifying episodes of care, particularly relating to data quality.

Abstract
Identifying which approaches can effectively reduce the need for out-of-home care for children is critically important. Despite the proliferation of different interventions and approaches globally, evidence summaries on this topic are limited. This study is a scoping review using a realist framework to explore what research evidence exists about reducing the number of children and young people in care. Searches of databases and websites were used to identify studies evaluating intervention effect on at least one of the following outcomes: reduction in initial entry to care; increase in family reunification post care. Data extracted from papers included type of study, outcome, type and level of intervention, effect, mechanism and moderator, implementation issues and economic (EMMIE) considerations. Data were coded by: primary outcome; level of intervention (community, policy, organisation, family or child); and type of evidence, using the realist EMMIE framework. This is the first example of a scoping review on any topic using this framework. Evaluated interventions were grouped and analysed according to system-level mechanism. We present the spread of evidence across system-level mechanisms and an overview of how each system-level mechanism might reduce the number of children in care. Implications and gaps are identified.

Abstract
Family group conferences (FGCs) in child welfare share decision-making with family members by bringing the immediate and wider family together to make a plan to meet a child's needs. This paper reports survey findings on FGC provision in the UK in 2022 and explores whether in England the presence of an FGC service and the rate of FGC provision is associated with the rate of children in care, entering care, in kinship foster care and leaving care. Seventy-nine per cent (n = 167) of local authorities in the UK provided FGCs to families, and 14 per cent (n = 29) did not. Services that were more established offered a more diverse range of FGCs. The introduction of FGCs in English local authorities was associated with a higher rate of children in care, but also higher rates of kinship foster care, a key goal of FGCs where it is not possible for children to stay with their parents. Higher rates of FGCs were associated with more children leaving care, possibly due to reunification with birth families. To understand in more detail, the circumstances of children in and leaving care in local authorities with FGCs, individual data linkage studies are needed.