Healthcare utilisation among children in contact with social services in England : An interrupted time series using ECHILD

Luna, Eliazar and Griffiths, Lucy J and Obe, Karen Broadhurst and Hargreaves, Dougal and Woodman, Jenny and Holmes, Lisa and Tranter, Kat and Bailey, Grace A and Harron, Katie (2026) Healthcare utilisation among children in contact with social services in England : An interrupted time series using ECHILD. Child Abuse & Neglect, 173: 107916. ISSN 0145-2134

Abstract

Children in contact with children's social care (CSC) services have high levels of hospital utilisation, but patterns before and after referral remain insufficiently understood. To evaluate healthcare utilisation two years before and after CSC referral. Retrospective cohort using ECHILD linked health and social care data, including children with a first CSC referral between 2009 and 2018 in England. We compared monthly planned and unplanned hospital contact rates for Children in Need, Children under Protection Plans, and Children Looked After with age-sex-matched cohorts. We used interrupted time series analysis to examine how healthcare utilisation changed following referral. We also explored reasons for hospital contacts. We analysed >12 million hospital contacts for 1,014,330 Children in Need, 204,240 Children under Protection Plan and 177,640 Children Looked After. Children Looked After had the highest average number of total contacts (11.8 per child over a 4 year period), followed by Children in Need (8.8) and Children under Protection Plans (8.4). All CSC groups had about twice the contacts of matched peers. Healthcare utilisation increased sharply prior to referral, with a peak around referral. After referral, planned care increased and unplanned care decreased, with pre referral upward trends slowing or reversing. The most common reason for healthcare utilisation was mental health-related. At a population level, CSC referral marks a pivotal point in healthcare utilisation, with a shift from unplanned to planned care. This may reflect more structured engagement with health services and coordinated support for children and families.