A significant number of children are abused or neglected every year. This exposure is
associated with short- and long-term consequences for their mental and somatic health,
making child abuse a real challenge for society, both on an individual level, in terms of
equal opportunities, and on a collective level, from a public health and economic point
of view. In France, 308,000 minors benefit from at least one child protection service or
measure. There are few data available on the health status of this population and its
evolution over time, but they all point to the poor health status of children when first
placed into care, with a particularly high prevalence of mental disorders, a low
proportion of children benefiting from an initial health check-up, and poor quality of
medical follow-up once in care.
In this context, interventions are needed to address early and comprehensively the many
needs of children put into care, both in the short and long term. In particular, early
detection and reduced delays in the initiation of appropriate medical care appear to have
positive long-term effects, reducing medico-social needs. As such, the PEGASE program,
which is funded by the French government under Article 51, was developed to ensure
adequate medical follow-up - both somatic and psychiatric - for children taken into care
by child protective services (CPS).
Children in the PEGASE program are monitored with regular, standardized check-ups, with
an initial standardized check-up when the child enters the care facility followed by 20
regular assessments at fixed ages up to the age of 7. Most of these assessments are
reinforced in PEGASE by the systematic use of standardized scales to identify potential
disorders and developmental delays, so that the necessary care can be implemented at an
early stage.
An evaluation of the program's effectiveness and efficiency is needed to inform public
decision-making on the appropriateness of extending it to all children in care. As there
is no control group in the PEGASE program, this requires the creation of a control cohort
of children followed by CPS but not benefiting from the PEGASE program. This is the ESPER
cohort (Prospective cohort study of protected children), which will enable us to carry
out a comparative evaluation of the PEGASE program, as well as to provide information on
the health of children taken into care by the CPS at the time of their placement, and on
its evolution over time, data which are rare in France.
The primary objective is to evaluate the effectiveness of the PEGASE program on the
evolution of the mental health of children followed by the CPS after 2 years of
follow-up.
The secondary objectives are:
To evaluate the effectiveness of the PEGASE program on the evolution of children
followed by the CPS after 1 and 2 years of follow-up, in terms of: mental health,
physical health, development (communication, gross motor skills and fine motor
skills), care pathway, and school integration,
To evaluate the cost-effectiveness of the PEGASE program after 2 years of follow-up,
and its budgetary impact in the case of generalization,
To describe the health of children when they are put into care.
An ancillary study is also planned to compare the health of children followed by CPS to
the health of children in the general population.
This is a comparative study with an external control group and propensity score matching,
calculated from a multivariate logistic regression model that will include a priori:
corrected age at inclusion, gender, gestational age, ASQ-SE and ASQ-3 scores at
inclusion, reason for placement, current protective measure, and social situation of both
parents.
The PEGASE program is already the subject of a separate protocol describing recruitment
procedures and follow-up of children benefiting from the program.
The population included in the ESPER study are children taken into care by CPS in 8
volunteer departments not participating in the PEGASE program. They must be aged less
than 42 months (i.e. 3 and a half years), arriving for the first time in a participating
center, and the holders of parental authority must not object to participation in the
study.
The children included the ESPER cohort will be followed as usual by the participating
center during the two years of follow-up. Additional data collection by questionnaire
will be added to the usual care at inclusion, and then at 1 and 2 years of follow-up
either in person or by telephone by the study's local coordinators (if the child is no
longer in the facility at the time of collection).
At the inclusion visit, parents or legal guardians will be informed of the study, and
their non-opposition will be sought. All socio-demographic, health and school data will
be collected by the local coordinators. The ASQ-SE and ASQ-3 questionnaires will be
completed, as well as antenatal and pre-placement health data. The data will then be
entered into the eCRF by the local coordinators.
At one year of follow-up, the local coordinators will collect health data (from the
health records) and school data. If the child is no longer in the facility, data will be
collected by telephone from the child's care takers, or from the parents (or holders of
parental authority) if the child lives with them. The ASQ-SE and ASQ-3 questionnaires
will be completed by the same person. The local coordinators will then enter the data
into the tool. The 2-year follow-up visit will be identical to the 1-year visit.
It is planned to include 400 children in the ESPER cohort. The inclusion period is 12
months, and the duration of each child's participation in the study is 24 months.