Useful Research

Question 1

I would report to Prof Ruth Gilbert, Professor of Clinical Epidemiology at UCL and Health Data Research (HDR UK) London Public Health Theme Lead.

Answer 1

• Ruth Gilbert is a clinical epidemiologist, who trained in paediatrics.
• Much of her research uses de-identified, administrative data to address clinical and policy questions related to the health of children and families.
• She is interested in how policy and service provision can improve outcomes for vulnerable families.
• Ruth supports the Child Health Informatics Group, a group of researchers at UCL who are using novel cross-sectoral linkages between public services and surveys to conduct research focussed on children and families.
• Examples of recent work supervised by Ruth include a study using linked maternal mental health data and family court proceedings.
• Until recently, she was Deputy Director for the Administrative Data Research Centre for England, where she developed research initiatives involving cross-sectoral linkages between health and non-health data and established a record linkage methodology group.

Question 2

What is the mission of The UCL Great Ormond Street Institute of Child Health (GOS ICH)?

Answer 2

• Mission: To improve the health and well-being of children, and the adults they will become, through world-class research, education and public engagement.
• Activities include active engagement with children and families, to ensure that our work is relevant and appropriate to their needs.

Question 3

Post Context

Answer 3

• This post is an opportunity to analyse a newly created de-identified database to provide an evidence base for policy on the health needs of mothers involved in the public law family courts.
• The project will provide evidence for national policy on responding to the health needs of mothers involved in family court proceedings. The study uses novel linkage between national hospital data and public family court proceedings from Cafcass.
• The project is also ideal for an early career researcher to develop a fellowship proposal building on novel data, which is accessible for the first time in England.

Question 4

What is the aim of the project?

Answer 4

To investigate health before during and after court proceedings, time to next pregnancy and variation in health and risk factors across England.

Question 5

Who will the results from this project be relevant to?

Answer 5

• Health services
• Judical services
• Social care services

Question 6

Who is the post funded by?

Answer 6

This post is funded by the Nuffield Foundation, an independent charitable trust with a mission to advance educational opportunity and social well-being.

Question 7

What is the study’s overall aim?

Answer 7

To understand health needs and outcomes of mothers involved in care proceedings relative to their peers, to inform preventive strategies post proceedings to reduce the risks of returning to court.

Question 8

What are the 4 objectives of the study?

Answer 8

• Identifying maternal health histories associated with time to a subsequent deliveries and return to court, among women involved in care proceedings.
• Estimating differences in maternal mortality risk, overall and due to avoidable causes, among mothers exposed/unexposed to care proceedings.
• Describing regional variation in rates of subsequent births, return to court, and mortality, among mothers involved in care proceedings.
• Evaluate linkage accuracy between CAFCASS care proceedings data and Hospital Episode Statistics (HES) data.

Question 9

Dr Linda Wijlaars
Senior Research Associate

Answer 9

• I am interested in life course epidemiology and use of routinely collected health data (general practice databases and hospital admission records) to explore how parental factors (such as mental health) influence child outcomes.
• I am currently working on a project in the Child Policy Research Unit (CPRU), using hospital admission records and primary care data to determine how primary care is associated with emergency use of secondary care services by children and young people
• Has analysed Hospital Episode Statistics (HES) data before
  *

Question 10

What data will be linked in this project?

Answer 10

CAFCASS care proceedings data and Hospital Episode Statistics (HES) data

Question 11

There are nine.

Name UCL’s Core Behaviours

Answer 11

1. Leading by Example
2. Effective Communication
3. Working Collaboratively
4. Delivering Successful Outcomes
5. Continuous Personal and Team Development
6. Managing Resources, Performance and Risk
7. Championing Effective Change
8. Analysis and Problem Solving
9. Organisational Citizenship

Question 12

Dr Vincent Nguyen

Answer 12

I am a final-year PhD student in Epidemiology at University College London with an undergraduate degree in Computer Science, and an MSc in Health and MBA. I am currently running a National Public Health priority COVID research project, which builds on prior experience of software engineering in the aeronautical industry, machine learning and m-health. With these interdisciplinary skills, I aim to progress as a modern academic who can utilise state of the art analytical approaches on big data to answer vital epidemiological questions. I am currently completing my doctorate with a submission date of March 2021 which uses linked electronic healthcare records for England to evaluate the effectiveness of public health interventions on cardiovascular disease. This work has consolidated epidemiology and data science skills allowing me to develop a more profound and synoptic understanding of public health interventions and the complexities of impact evaluation. I have also completed an MBA to gain the management and leadership qualities required to contribute to public health. My skills and experience spanning 10-years demonstrate my strengths as an interdisciplinary researcher and ability to work independently or as part of a team. My main objective is to become a leading expert in the field of Public Health Data Science by positively contributing towards the advancement of public health as an academic who applies vast computational skills in the field of epidemiology and healthcare. As a core member of the UCL/UCLH’s Virus Watch study, my role involves using a combination of gold standard epidemiological standards and emerging data science techniques to study actions associated with a lower risk of catching COVID-19

Question 13

Mental health service use among mothers involved in public
family law proceedings: linked data cohort study in South London 2007–2019

Answer 13

Published online: 16 March 2022
Authors: Rachel J. Pearson · Claire Grant · Linda Wijlaars · Emily Finch · Stuart Bedston · Karen Broadhurst ·
Ruth Gilbert

Question 14

Types of family court cases:

Answer 14

• Marriage dissolution - divorce/annulment/separation
• Paternity and child custody
• Name changes
• Guardianship
• Termination of parental rights and adoptions
• Juvenile matters (child abuse, child neglect, minor participating in illegal behaviour)
• Emancipation and approval of underage marriages

Question 15

Cafcass (Children and Family Court Advisory and Support Service)

Answer 15

• divorce and separation, sometimes called ‘private law’, where parents or carers can’t agree on arrangements for their children
• care proceedings, sometimes called ‘public law’, where social services have serious concerns about the safety or welfare of a child
• adoption, which can be either public or private law.

Question 16

Hospital Episode Statistics (HES)

Answer 16

Hospital Episode Statistics (HES) is a database containing details of all admissions, A and E attendances and outpatient appointments at NHS hospitals in England.

Each HES record contains a wide range of information about an individual patient admitted to an NHS hospital, including:

-clinical information about diagnoses and operations
-patient information, such as age group, gender and ethnicity
-administrative information, such as dates and methods of admission and discharge
-geographical information such as where patients are treated and the area where they live

We apply a strict statistical disclosure control in accordance with the NHS Digital protocol, to all published HES data. This suppresses small numbers to stop people identifying themselves and others, to ensure that patient confidentiality is maintained.

Question 17

What was the purpose of the “Mental health service use among mothers involved in public family law proceedings: linked data cohort study in South London 2007–2019” research project?

Answer 17

Mental health problems and substance misuse are common among the mothers of children who experience courtmandated
placement into care in England, yet there is limited research characterising these health needs to inform evidencebased
policy. In this descriptive study, we aimed to generate evidence about the type, severity, and timing of mental health
and substance misuse needs among women involved in public family law proceedings concerning child placement into care
(‘care proceedings’).

Question 18

What were the methods of the “Mental health service use among mothers involved in public family law proceedings: linked data cohort study in South London 2007–2019” research project?

Answer 18

This is a retrospective, matched cohort study using linked family court and mental health service records for 2137
(66%) of the 3226 women involved in care proceedings between 2007 and 2019 in the South London and Maudsley NHS
Mental Health Trust (SLaM) catchment area. We compared mental health service use and risk of dying with 17,096 femalematched controls who accessed SLaM between 2007 and 2019, aged 16–55 years, and were not involved in care proceedings.

Question 19

What were the results of the “Mental health service use among mothers involved in public family law proceedings: linked data cohort study in South London 2007–2019” research project?

Answer 19

Most women (79%) were known to SLaM before care proceedings began. Women had higher rates of schizophrenia
spectrum disorders (19% vs 11% matched controls), personality disorders (21% vs 11%), and substance misuse (33% vs 12%).
They were more likely to have a SLaM inpatient admission (27% vs 14%) or to be sectioned (19% vs 8%). Women had a 2.15
(95% CI 1.68–2.74) times greater hazard of dying, compared to matched controls, adjusted for age.

Question 20

What was the conclusion of the “Mental health service use among mothers involved in public family law proceedings: linked data cohort study in South London 2007–2019” research project?

Answer 20

Women involved in care proceedings experience a particularly high burden of severe and complex mental
health and substance misuse need. Women’s increased risk of mortality following proceedings highlights that interventions
responding to maternal mental health and substance misuse within family courts should offer continued, long-term support.

Question 21

Data privacy

Answer 21

The SLaM Clinical Data Linkage Service
(CDLS) performed the linkage using a rule-based
method with names, date of birth and postcode history,
applying the separation principle. Under the separation
principle, no one has access to a data set containing both
person identifiers (e.g. names, date of birth and addresses)
and attribute data (e.g. information about family court proceedings and mental health service use). This helps maintain
the privacy of individuals in the linked data.

Question 22

What is an advantage of analysing routinely collected data compared with logitudinal research?

Answer 22

Analysis of routinely collected data offers unique insight into individual-level health service patterns for vulnerable mothers and mitigates common challenges with longitudinal research, such as selection bias, self-reporting bias and attrition

Question 23

What is an disadvantage of analysing routinely collected data compared with logitudinal research?

Answer 23

However, as data in Cafcass and CRIS are primarily collected for administrative purposes and not research, this study is limited by the scope and quality of available data.

Question 24

Potential limitations of research project

Answer 24

• Doesn’t capture conditions that are managed at primary care level e.g. hypertension, some mental health issues

Question 25

What are some examples of research we do at the UCL Great Ormond Street Institute of Child Health?

Answer 25

• Your work published this year about the mental health
  and substance misuse needs of women involved in public family law proceedings concerning child placement into care
• Determinants of A&E attendances and emergency admissions in infants: birth cohort study.
• Identifying adverse childhood experiences with electronic health records of linked mothers and children in England: a multistage development and validation study
• Characteristics of enrolment in an intensive home-visiting programme among eligible first-time adolescent mothers in England: a linked administrative data cohort study
• Effect of nutritionally modified infant formula on academic performance: linkage of seven dormant randomised controlled trials to national education data

Question 26

Dr Vincent Nguyen

Answer 26

I am a Research Fellow contributing to the HOPE study where I investigate the use of trial emulation and dynamic panel modelling to inform public policies to improve the health of children who are in need of SEND provisions.

My main interest in research is using appropriate methods on large datasets to provide data-driven policies to governmental bodies to enact changes that improve population health.

Prior to joining the Child Health Informatics Group, I worked as a research associate and essential worker in the public fight against COVID-19 on the Virus Watch programme. I also have experience in engineering systems used in aeronautical environments.

My Public Health England sponsored PhD in epidemiology is investigating the impact of public health interventions on preventing type 2 diabetes using linked primary and secondary care datasets. I also hold an engineering degree, and two Master’s degrees, one in Business Administration and the other in Health Informatics.

Question 27

HOPE study

Answer 27

The HOPE Study (Health Outcomes of young People throughout Education) is a new study at UCL and is funded by the National Institute for Health Research Programme for Applied Health Research. The Hope Study is investigating the impact of adjustments for special educational needs or disability (SEND) on children’s health using linked education and hospital data for all children in England (the ECHILD database).

The HOPE Study aims to provide enduring public health benefits by establishing methods and tools for the ongoing evaluation, monitoring and improvement of SEND services for better health and wellbeing in children and young people.

The findings will enable policy makers, service providers and users to make evidence-informed decisions about the benefits of SEND provision for health and education, and which children benefit.

Question 28

Legal Epidemiology Group

Answer 28

The UCL Legal Epidemiology Group is an interdisciplinary research group based at the UCL Great Ormond Street Institute of Child Health in the Population, Policy & Practice Programme.

What do we do?
We carry out epidemiological research with the aim of better understanding how the law operates on a day-to-day basis and how it affects the health and well-being of the population. We specialise in the use of population-level quantitative methodology to analyse administrative data sets including those from the courts, health, social care and education sectors.

What is legal epidemiology?
We define legal epidemiology as the branch of epidemiology that seeks to bridge the gap between the fields of legal and health and well-being research in order to provide answers to policy- and practice-relevant research questions. It aims to contribute to the understanding of how legal processes operate on a population level and the short- and long-term outcomes for the individuals whom they affect, in all domains of health and well-being. Promoting the use of empirical methods to understand law and effectively disseminating research findings to improve the quality of policy and individual-level decision-making are both central to its approach.

Legal epidemiology is not just about the law of health or healthcare. Instead it recognises that a host of upstream, social factors influence health and well-being across life. As such, legal epidemiology seeks to understand law in all its manifestations in society. You can read more about our conceptualisation of legal epidemiology in Jay MA. Legal epidemiology, evidence-informed law and administrative data: new frontiers in the study of family justice. In: Creutzfeldt N, Mason M, McConnachie K. Routledge Handbook of Socio-Legal Theory and Methods. London: Routledge, 2019.

Group members
Matthew A Jay
Claire Grant
Louise Mc Grath-Lone
Linda Wijlaars
Ruth Gilbert