School performance in primary school and psychosocial problems in young adulthood among care leavers from long term foster care

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Abstract

We used data from Swedish national registers for ten entire birth year cohorts (1972–1981) to examine psychosocial outcomes in young adulthood for youth that left long term foster care after age 17, comparing them with majority population peers, national adoptees and peers who had received in-home interventions before age 13. The population was followed in the registers from age 16 to 2005. Data were analyzed in Cox regression models.

Youth who left long term foster care had six-to eleven fold sex and birth year adjusted excess risks for suicide attempts, substance abuse and serious criminality from age 20, and for public welfare dependency at age 25. Overrisks were considerably lower for the in-home intervention group and the national adoptees. Adjusting results for poor school performance in the final year in primary school (ages 15–16) reduced overrisks by 38–52% for care leavers from long term foster care.

Irrespective of issues of causality, poor school performance seems to be a major risk factor for future psychosocial problems among youth who age out of long term foster care. The results suggest that promoting foster children's school performance should be given high priority by agencies.

Highlights

► All Swedish residents born 1972-1981 were followed in a host of national registers from age 16 to 2005. ► Care leavers from long term foster care had substantially poorer school performance than majority population peers. ► They had lower chances of getting a secondary education than majority population peers with similar school performance. ► They had high excess risks for future suicide attempts, substance abuse, serious criminality and welfare dependency. ► Up to 55% of these excess risks could be statistically “explained” by poor school performance.

Introduction

Low education has for decades been linked to increased risks of early death, somatic and mental disorders, and a range of social problems (e.g. Danielsson & Talbäck, 2009). However, there is less knowledge about the link between school performance and child development over the life course. Two recent Swedish longitudinal studies found a strong correlation between low grades from the final year in primary school and later suicidal behavior, after controlling for socio-economic background (Björkenstam et al., 2010, Jablonska et al., 2009).

Several interesting results from the Stockholm Birth Cohort Study have recently been published. In these studies, a large number of Stockholm children were followed from infancy to age 48. One study found substantial correlations between low school grades in the final year in primary school and crime, both in adolescence and adulthood, after controlling for socio-economic background and a range of other childhood factors. When the analysis was adjusted for school performance, there was only a weak independent relationship between poverty in childhood and frequent criminality over time (Nilsson & Estrada, 2009). In another study, based on the same data, the scholars found strong links between poor school performance in 6th grade at primary school (age 12) and high mortality, presence of social assistance, and weak labor market attachment in the middle age (Halleröd, 2010).

A number of factors influence children's performance in school, especially parental education (higher education of the parents has a positive correlation with better school grades of children) (Vinnerljung, Berlin, & Hjern, 2010). Child maltreatment increases risk for poor school performance (e.g. Boden et al., 2007, Lansford et al., 2002, McGloin and Widom, 2001, Stone, 2007). In contrast, good performance in school – and higher education after primary school – has a strong protective influence on vulnerable children's development by reducing the probability of unfavorable long term outcome, such as antisocial behavior during adolescence (Werner, 1992, Werner and Smith, 2001, Zingraff et al., 1994).

Most Western countries report that youth who leave long term out-of-home care tend to have been low achievers in school, and are at high risk of entering adulthood with a low level of education (e.g. Bohman and Sigvardsson, 1980a, Bohman and Sigvardsson, 1980b, Cashmore and Paxman, 1996, Cheung and Heath, 1994, Christoffersen, 1993, Clausen and Kristofersen, 2008, Dumaret et al., 1997, Egelund et al., 2008, Jackson, 1994, Pecora et al., 2006, Runyan and Gould, 1985, Vinnerljung, 1996). In this article, we used Swedish national register data to analyze longitudinal associations between average grade points in primary school, future education, and adverse psychosocial outcomes in young adulthood among youth who aged out of long term foster care, comparing them with majority population peers, national adoptees and peers who received in-home interventions before their teens. The study was guided by the following research questions:

  • How did care leavers from long term foster care perform in primary school compared to majority population peers, national adoptees and children who received in-home interventions before their teens?

  • How did poor performance in primary school relate to later education achievements?

  • How did poor performance in primary school relate to psychosocial problems in young adulthood?

We choose to study care leavers from long term foster care for several reasons. Firstly, long term foster care represents the most invasive child welfare intervention society administers, except adoption without parental consent (which does not exist in Swedish legislation). Subsequently, outcomes for this group are worth special scrutiny in child welfare research. Secondly, it represent a long term societal commitment – 24 h a day, seven days a week for many years – of assumed parental responsibilities (in loco parentis). Thirdly, several other cohort studies have found these youth to be more vulnerable in young adult age than most other youth with a history of child welfare intervention during their formative years (e.g. Hjern et al., 2004, Vinnerljung, Hjern and Lindblad, 2006). The exception is youth leaving out-of-home care after having originally been placed for antisocial behavior problems (Vinnerljung & Sallnäs, 2008). Fourthly, they represent a reasonably homogenous group. Practically all youth who leave long term foster care at age of legal majority were originally placed for reasons related to parental behavior, not their own (Vinnerljung, 1996). Other groups of Swedish care leavers are considerably more heterogenic, e.g. youth who were placed in out-of-home care during adolescent years (Sallnäs, Vinnerljung, & Kyhle-Westermark, 2004). Fifthly, they constitute a large group: 41% of all Swedish care leavers born 1972–1981 who left out-of-home care after their 17th birthday graduated from long-term care.

Section snippets

Method

This study was based on record-linkages between national registers held by different Swedish authorities. The overall quality of the registers used in this study is regarded as high. National registers were linked by use of the unique ten digits ID numbers given to all Swedish residents at birth or immigration, making it possible to study outcomes with adjustment for socio-economic background and other confounders. The study was approved by the regional ethics committee at Karolinska

Statistical analysis

All analyses were made with the aid of the SAS software package (procedure given in brackets). Cox regression (PROC PHREG) was used to analyze 1) risks of poor school performance (no or low average grade points) in the final ninth year in the Swedish compulsory school system, 2) chance of achieving a secondary school education despite poor school performance. A first model was adjusted for sex and year of birth, while maternal education (birth mothers educational level) and birth parents

Results

Table 1 presents descriptive data on the study groups. Except gender and year of birth, all background variables are related to birth parents. Around 40% of the birth parents of youths that had left long term foster care had been admitted to hospital or had died of substance abuse. Approximately half of the birth mothers and a quarter of the birth fathers had been admitted to hospital or died with a psychiatric diagnosis.

Table 2a shows the mean of average grade points and of grade points in

Discussion

In this study, we used national register data covering the entire Swedish population in ten birth cohorts – in a longitudinal design – to assess school performance among care leavers from long term foster care, and the relation between school performance and future psychosocial problems. The results are surprisingly clear, but paint a dark picture of poor school performance, low educational attainments and high risks of future psychosocial problems. The “good” news is that half of the

Methodological issues

The strength of this study is the national cohort design, which includes all Swedish residents born in 1972–1981. The quality of the national registers is high, but there are limitations. It was not possible to identify reasons for missing values in the National School Register (NSR), which holds one of the key variables in this study — grades in primary school. Approximately 3% in the study population were missing in NSR. We assumed that those who received disability benefits or early

Conclusions and implications for practice

Youth who age out of long term foster care have very high excess risks of future psychosocial problems compared to other peers. Up to 55% of these overrisks were statistically attributable to their dismal school performance. The general message from this study is: If society wants to improve life opportunities for care leaver, it is necessary to give them effective help with their schooling and education while they are in care.

Poor educational performance should be regarded as a main

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