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Legal Epidemiology Group

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. Current and recent projects include:

  • Health of families involved in family court proceedings
  • Overlap between public and private family court proceedings
  • The percentage of children who ever have social care involvement
  • Off-rolling and exclusion of children with social care and/or special educational needs provision
  • Administrative data methodology

Further details are available below. For more information about our work, please contact Matthew Jay.

What is legal epidemiology?

Legal epidemiology is a branch of epidemiology that studies law and legal processes (such as provision of legal advice, court-based litigation and alternative dispute resolution) as exposures, mediators, effect modifiers, outcomes or other variables relevant to health-related events, states and processes. Legal epidemiology is a transdisciplinary field that integrates legal and epidemiological expertise, data and methodology to understand how health and law are related, including in civil, criminal, family, public and any other branch of law. In legal epidemiology, law and legal processes are understood as a set of upstream or downstream variables relevant to health and subject to epidemiological investigation where the interest is in “law in the real world” enacted by a range of stakeholders such as litigants, public and private bodies, lawyers, judges, policy makers and lawmakers, rather than in law solely as a set of rules. You can read more about our conceptualisation of legal epidemiology in:

Current projects

Understanding the healthcare needs of families involved in care proceedings

Why is this research needed?

Family courts deal with a “sharp end” of disputes concerning the upbringing of children. These include public family court proceedings where social care services seek removal of a child from the family home, also known as care proceedings, or private family court proceedings, where there is a dispute between parents about their children’s living arrangement and upbringing. Emerging evidence shows poor existing parental health is associated with higher rates of proceedings. Discovering upstream health and social determinants of family proceedings could inform early interventions to support parenting, improve child and family health, reduce conflict and adversity and prevent court involvement. Findings will also inform whether court processes are harmful to parent and child health. Legal aid, for example, was abolished for most private proceedings in 2013 on the belief that private matters do not merit state intervention, without acknowledging the health needs of families. Consequently, parents undergo private proceedings without legal representation, which may be harmful due to stresses of court processes, facing abusive partners in court and the consequences of inappropriate decisions.

This project is an on-going programme of research that seeks to address some of these evidence gaps by using datasets from health and courts that have been linked for the first time. We aim to provide information that will be useful to policy makers, health care services, social workers, lawyers, judges and others to address some of the very difficult challenges that the family justice system currently faces.

The project has proceeded in two broad phases: phase 1 was conducted between 2017 and 2024 and phase 2 will be carried out over 2025 to 2029. 

Phase 1

In Phase 1 (data supplied in June 2023), we used data from public family court proceedings (i.e., applications for care or supervision orders) supplied by the Children and Family Court Advisory and Support Service (Cafcass). These data were securely linked to the Hospital Episode Statistics (HES) from NHS England (NHSE) for all mothers involved in public family court proceedings in England. Separately, we linked Cafcass public family court data for South London to the South London and Maudsley NHS Trust mental health services data. We demonstrated the feasibility and accuracy of linkage between mothers’ data in Cafcass and their administrative healthcare data. Research findings revealed the cumulative incidence of public family court involvement following first live birth, a high mental health burden among mothers in public family court, as well as higher risk of death than comparison mothers and findings shed light on patterns of return to court. This work also found that in South London around two-thirds (66%) of mothers involved with care proceedings had a record of contact with mental health services between April 2007 and March 2019. Amongst women who had a record of contact with mental health services, four-fifths (79%) were known to mental health services prior to the initiation of care proceedings, around 1 in 5 women had a diagnosis of schizophrenia spectrum disorders (19%) and personality disorders (21%), and 1 in 3 (33%) had a record of substance misuse. Approximately 20% of women involved in an initial set of care proceedings and known to mental health services prior to initiation will return to court with a subsequent infant within eight years.

Further details can be found in the final report for Phase 1 at Ireland G, Wijlaars L, Jay MA, Grant C, Pearson R, Downs J, Gilbert R (2024). Social and health characteristics of mothers involved in family court care proceedings in England.

Phase 2

In this second phase of research, there will be two work packages. In work package 1, we aim to identify maternal and child risk factors, in particular in the first 1,000 days of life, that are associated with private or public law family court involvement and amenable to intervention by community services supporting families. In work package 2, we aim to describe the health status of mothers and children before and after private or public law family court proceedings, the extent to which health and social factors explain variation in rates of family court proceedings across the country and the possible health impact of abolition of legal aid in most private family matters on 1 April 2013.

Publications from Phase 1

More information about how your data are used and objecting to the use of your data for research

You can view the privacy notice for the first phase of this research here under the title "Understanding the health needs of mothers involved in family court cases". Phase 1 of the research is complete. The University research team cannot identify you and cannot remove your records from the study directly at your request. We will outline here how you can object to the use of your data for Phase 2 when agreements are in place.

Additionally, you have the right to tell NHS England if you do not want the information you provide to the NHS to be used beyond the purpose of providing healthcare. This is known as a ‘patient objection.’ Please visit the NHS website for further details: https://digital.nhs.uk/your-data. If you are an adult Cafcass has worked with, you can also contact Cafcass to withdraw consent for using your Cafcass data for research: https://www.cafcass.gov.uk/about-us/privacy-and-data-protection/privacy-notice-adults-family-court-proceedings. Your choice will not affect the health care or the court resources you receive.

Funding

Phase 1 was funded by the Nuffield Foundation. Phase 2 is funded by the Wellcome Trust via an Early-Career Award to Matthew Jay

Further information

Contact Matthew Jay.

 

Past projects

Public and private family law: understanding the overlap

Why was this research needed?

Within the context of the Children Act 1989, a distinction is frequently drawn between public and private family law. The public branch concerns state interventions in the lives of families in connection with child protection. Local authorities (LAs) have duties to safeguard the welfare of children in their areas and a range of powers at their disposal to discharge this duty. By contrast, the private domain is characterised by disputes between private parties concerning the upbringing of a child. This typically occurs in the context of relationship breakdown (whether or not there is a divorce or dissolution of a civil partnership). Recourse to the court is available where the parties cannot agree between themselves, with section 8 orders (e.g. child arrangements orders) being the most common private law orders. It has been suggested, however, that this neat dichotomy breaks down in practice and in fact many cases are a hybrid of both. The extent to which this occurs, and the extent to which children who come through the private system return to it or the public system is currently unknown. Our study therefore seeks to answer the question: to what extent is there an overlap between English private and public family child law?

What did we do?

We had been granted access by the Ministry of Justice to its Children in Family Justice Data Share. This contained linked data from the family courts administrative database named FamilyMan, Children and Family Court Advisory and Support Service (Cafcass) data, Children Looked After data and National Pupil Database data. Using these data we quantified the extent to which children who are involved in private family law proceedings return to court or are otherwise found to be in the public family law system.

Publications

  • Jay MA, Pearson R, Wijlaars L, Olhede S, Gilbert R. Using administrative data to quantify overlaps between public and private children law in England: report for the Ministry of Justice on the Children in Family Justice Data Share pilot. Download the full report or a one-page summary.

Funding

The Medical Research Council via a UCL-Birkbeck Doctoral Training Partnership Flexible Training Supplement provided salary funding for the duration of this project.

Further information

Contact Matthew Jay.

Understanding local authority variation in receiving children into care

Why was this research needed?

The number of children in England who become looked after (i.e., children who are in the care of their local authority or accommodated by children’s social care services) has continued to rise in recent years. However, there is large variation among local authorities and some have even seen a decrease in the number children becoming looked after each year.

What did we do?

This analysis looked at how much of this variation can be explained by risk factors for entry into care. In particular, we explored the impact of poor health outcomes among mothers such as mental ill health, substance misuse and experience of violence or adversity on the variation in the number of children received into local authority care.

Publications

Funding

This work was supported by the Nuffield Foundation; the Medical Research Council through the UCL Birkbeck Doctoral Training Partnership; the National Institute for Health Research (NIHR) Children and Families Policy Research Unit; the NIHR Great Ormond Street Hospital Biomedical Research Centre; and Health Data Research UK.

Further information

This work was mainly carried out by Dr Rachel Pearson. For further information, please contact Matthew Jay.

Exclusion from secondary schooling of children receiving social care and special educational needs in England

Why was this research needed?

Every child has a fundamental human right to education, enshrined in a range of international human rights instruments. In England, all school-aged children must receive full-time and effective education which, for most children, occurs through state-funded schools. Some children, however, miss out on their education through off-rolling and formal exclusion. Off-rolling occurs where a school removes a child from their roll for some illegitimate purpose, such as to game league tables. Children can be formally excluded, either temporarily or permanently, as a disciplinary measure. It is known that children otherwise vulnerable to poor outcomes, such as children looked after, children in need and children who get special educational needs services, are more likely to miss out but evidence as to the extent to which this occurs is limited.

We therefore aimed to use whole-of-England data to quantify the extent to which children leave school early and are excluded across the entirety of secondary school and how this varies geographically. In particular, we aimed to quantify the extent to which children in need, children on child protection plans, children looked after and/or children who get special educational needs services (including children who previously held these statuses) are more at risk of these adverse outcomes and exclusion.

What did we do?

We used the National Pupil Database linked to data from children’s social care on children in need and children looked after. Our core analyses used a dataset of just over one million children enrolled in year 7 in state schools in 2012 and 2013, followed up to the end of secondary school. We used indicators from data across primary and secondary school to determine whether children had children's social care or special educational needs provision and the level of that provision. We then examined whether and to what extent that provision was related to two outcomes in secondary school:

  • Non-enrolment, in other words, whether children left state school before school leaving age.
  • Exclusion, including fixed-term (temporary) suspenions and permanent expulsions.

We found that children with social care involvement and/or special educational needs were more likely to experience these negative outcomes. This was especially the case for children who had both. We also found associations with other factors, such as children living in higher levels of deprivation were more likely to leave state school before school leaving age or be excluded.

Publications

Funding

This work was supported by the Medical Research Council through the UCL-Birkbeck Doctoral Training Partnership. Funding from the National Institute for Health Research contributed to this work through the GOSH Biomedical Research Centre, and funding for RG (Senior Investigator award; and Children and Families Policy Research Unit).

Further information

Contact Matthew Jay.

The percentage of children who ever receive interventions from children's social care in England

Why was this research needed?

Children’s social care (CSC) provides a range of interventions to support children and families and to protect children from harm. The population of children served by CSC is large. Official Department for Education figures show that 4% to 5% of all children in England are referred to CSC each year. Just over 3% of children are recorded as children "in need" on any given day. This means that they need CSC as defined under the Children Act 1989. Further, 0.4% are subject to a child protection plan, and 0.4% are placed into care. These annual figures, however, do not reflect the extent to which all children are involved with CSC at some point across childhood. A high proportion of children who were ever a child in need implies a high proportion of families without sufficient resources to meet their needs privately, even if only temporarily. National monitoring of the proportion of children ever "in need" across childhood would inform debates on the place and purpose of CSC services and policies to tackle upstream determinants of social need and to improve support for parenting and children. Evidence on who was ever a child in need would also inform government interventions to mitigate the adverse health, development and economic outcomes for these children and as they become adults and parents themselves.

Using a national dataset called the child in need census, we aimed to estimate the cumulative incidence of being referred, assessed, found to be a child in need or made subject to a child protection plan (CPP) before age 18.

What did we do?

We used an anonymised copy of the child in need census, which includes data on all children referred to CSC services in England. This dataset also includes information on children who are recognised as being "in need" and who are given a child protection plan. We used data from the 2012/13 financial year and combined results from different cohorts in order to estimate what percentage of children, from birth to age 18:

  • are ever referred to CSC
  • are assessed by a social worker
  • are ever recognised as being "in need"
  • are ever placed on a child protection plan

We found that of all children living in England, 35.4% were referred, 32.3% were assessed, 25.3% were recorded as "in need" and 6.9% were subject to a child protection plan.

Publications

Jay MA, Troncoso P, Bilson A, Thomson D, Dorsett R, Pearson R, De Stavola B, Gilbert R. Estimated cumulative incidence of intervention by children’s social care services to age 18: a whole-of-England administrative data cohort study using the child in need census. Int J Pop Data Sci 2024;10:1:02.

 

Funding

This research benefits from and contributes to the National Institute of Health and Care Research (NIHR) Children and Families Policy Research Unit (PR-PRU-1217-21301) but was not commissioned by the National NIHR Policy Research Programme. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

Further information

Contact Matthew Jay.

 

Publications