Children and Families Policy Research Unit


NIHR Children and Families Policy Research Unit


Inequalities in health trajectories to adulthood of vulnerable adolescents

Inequalities in health trajectories from adolescence to adulthood for young people receiving social care or special educational needs support or with neurodevelopmental disorder


July 2022 – December 2023

Research Team

Dr Theodora Kokosi, Professor Ruth Gilbert, Professor Michelle Heys, Dr Johnny Downs, Dr Ania Zylbersztejn, Dr Ruth Blackburn


Long-term conditions and disability

What we hope to find out

We want to understand the healthcare pathways of vulnerable young people as they transition to adulthood and identify those with high healthcare needs who might benefit from earlier support. We also hope to find out whether these vulnerable groups who either have a neurodevelopmental condition or have received social and special educational needs support display symptoms of anxiety and depression and aggressive or antisocial behaviours that might require different therapeutic approaches.

Why are we doing this study

Adolescence is a period when half of all adult mental health disorders present, and it is also when several antisocial and aggressive behaviours can develop. Vulnerable adolescents can face more difficulties than their peers as they transition to adulthood from age 16, particularly those from disadvantaged backgrounds. By identifying the early patterns of attendance or contact with services that indicate groups at high risk of adverse physical and mental health in early adulthood we might be able to intervene early through health and social care, and the school environment. 

Why this is important

There is evidence that young people who are vulnerable due to a neurodevelopmental disorder or who received special educational needs support or social care support have worse physical and mental health outcomes as they enter adulthood. With this project, we hope to assess whether underlying vulnerabilities are exacerbated by inequalities in access to social care and special needs provision post-16.

We will use linked administrative data in the ECHILD Database to identify adolescents who have a neurodevelopmental condition or have received special educational needs or social care support at 11-16 years of age.

We will examine rates of overall hospital contacts including unplanned admissions overall and related to injuries, stress, violence or drugs, self-harm, or mental health, for different vulnerable groups aged 11-22. We will define groups of presentations consistent with internalising and externalising behaviours and determine whether these groups pre-16 are associated with different trajectories of hospital care from age 16 to 22. Finally, we will explore which of these people receive continuing statutory support post age-16 including support from social care or youth custody.