CHILDS Research Group: applied child health systems and policy research
Childhood is the optimal time for establishing good health and preventing illness to enable children to reach their maximal potential for life-long benefit. Child health in the UK is not as good as it could be - or should be. Child survival is the ultimate measure for how well children fare. Infant mortality is a marker of societal health used globally. After decades of reductions year on year, infant mortality is rising and is highest among families living in poverty. Child survival in the UK is worse than other European and high-income countries, and the gaps are widening. Health and care systems for children are the universal lens through which social, economic, environmental, commercial, and political determinants of health are experienced. Health and social care systems are also determinants of health and well-being from prevention to early intervention and care, rehabilitation, and palliation. The CHILDS research group is dedicated to improving outcomes for child health, by working at the intersection of paediatrics, public health, health systems, and policy.
Health systems and policy need to evolve to meet needs, ensuring better prevention and early intervention, precision health and integrated care models, joined-up physical and mental healthcare, and tailored care for children with medical complexity. There are intergenerational effects associated with poor child health outcomes, so a life-course approach to prevention and care is needed. Adverse childhood experiences are common and can synergise to worsen outcomes when they cluster together. These complex problems require transdisciplinary approaches to secure effective solutions. However, there is a lack of high-quality evidence about healthcare and health systems interventions, with additional challenges in translation, implementation, and scale-up into frontline care and policy.
The CHILDS research group strategy focuses on health system strengthening by investigating the causes of poor health and healthcare outcomes for children and applying knowledge to design and test interventions including innovative healthcare pathways and health systems interventions to improve outcomes and enhance equity. CHILDS conducts research to improve health, for each child, and for all children. Our group is grounded in public health sciences and uses quantitative and qualitative methods for theoretically underpinned research into health systems and healthcare. Our mixed methods research includes evidence synthesis, clinical and hybrid trials of healthcare models and complex interventions, with nested qualitative and process studies.
CHILDS brings together academics, researchers, clinicians, service users and community groups across King’s Faculties of Life Sciences and Medicine, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Institute of Psychiatry, Psychology, and Neuroscience, Faculty of Social Sciences and Public Policy, and King’s Health Partners including Evelina London Children’s Hospital and King’s College Hospital. We collaborate nationally, for example within the NIHR Applied Research Collaboration network, and internationally with child health systems researchers in Australia, and the US, and with WHO Europe.
Methods
Our strategy currently focuses on three areas: health systems and services for children with complex needs and disabilities, healthcare for children with long-term conditions, and child population health. Cross-cutting themes include experimental health systems strengthening studies, population health medicine in healthcare, and system-level evaluation with pragmatic trials. Our group is involved in research infrastructure grants across health and social care and public health.
Improving health care and health systems for children
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Integrated care for children with common and long-term conditions (cluster RCT) |
Professor Ingrid Wolfe Professor Raghu Lingam |
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Improving support for children with complex needs with family support workers and specialist medical care (intervention design and evaluation) (NIHR ARC) |
Professor Ingrid Wolfe Professor Lorna Fraser |
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Technology-enhanced integrated care for children with asthma (RCT) |
Professor Ingrid Wolfe Professor Jonathan Grigg |
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JuSTage - Towards a Just Stage-of-Life Allocation of Resources, considering how stages of life should feature in healthcare policy decision-making |
Professor Ingrid Wolfe Dr Sapfo Lignou |
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A Learning Health Systems approach to using linked data to identify inequalities and unmet need in healthcare to enable targeted early intervention |
Professor Ingrid Wolfe Dylan Clarke (Doctoral student, applied statistical modelling and health informatics) |
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A Learning Health Systems approach to predicting need for speech and language therapy for children |
Professor Ingrid Wolfe Olivia Dann (Doctoral student, Speech and Language therapist) |
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An assets-based healthcare model for children with serious illness |
Professor Ingrid Wolfe Paola Rosati (Doctoral student, Paediatrician) |
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Childhood vaccination - opportunities to support uptake in the antenatal period: a mixed methods study in South-East London |
Professor Ingrid Wolfe Dr Lucy Pickard (Doctoral student, Paediatrician) |
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Developing and feasibility testing model of care for young adults with cerebral palsy |
Professor Ingrid Wolfe Susie Turner (NIHR Clinical Pre-Doctoral Fellow) |
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Models of Child Health Appraised (MOCHA) EU Horizon 2020 |
Professor Ingrid Wolfe Professor Mitch Blair |
Child population health
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Early identification and intervention for children at risk of low school readiness (analysis and intervention design) (NIHR ARC) |
Professor Ingrid Wolfe Professor Raghu Lingam |
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OveRcoming Adverse ChiLdhood Experiences (ORACLE) |
Professor Ingrid Wolfe Professor David Taylor Robinson Professor Eileen Kaner |
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A child’s lifecourse journey in data |
Professor Ingrid Wolfe |
Research Infrastucture programmes
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Director, NIHR Applied Research Collaboration South London |
Professor Ingrid Wolfe |
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Theme Lead for Children and Young People, NIHR Applied Research Collaboration South London |
Professor Ingrid Wolfe Professor Lorna Fraser |
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NIHR Health Determinants Research Collaboration (Lambeth HEART) |
Professor Ingrid Wolfe |
People
PhD Student
Senior Research Fellow
Professor of Palliative Care and Child Health
Consultant paediatrician and PhD Student
PhD Student
Lecturer in Health Economics
Projects
TEAMCare: Technology Enhanced integrAted asthMa Care
This NIHR funded research study is a randomised control trial of technology aiming to improve outcomes among children with asthma. The project is aiming to improve health for children with asthma by testing a new type of more joined-up care that is about the whole child and not just the disease and combining it with special technologies for asthma management. We think the new type of care is already helping children, but we could do even better by adding new ways of helping children and families to keep track of asthma symptoms and medications using apps. By combining the new type of integrated care with technology, we want to help children and families and their doctors and nurses take better care of asthma together, to help keep asthma under control between visits to the doctor or nurse, and to improve asthma care so much that children can avoid needing emergency care. As part of an RCT, we will test two types of asthma technology. We will measure how often children need emergency care for asthma, their health, children and parents' mental health and wellbeing, how often children need healthcare and medicines for asthma, and whether children and their parents or carers miss school or work because of asthma, costs, and how easy the technologies are to use. The evidence from our project should help improve health for children with asthma.
eLIXIR (Born in South London) Data-Linkage
This project uses opt-out consent to collect routine maternity and neonatal clinical patient data (GSTT and KCH NHS Trusts), mental health data from the SLaM CRIS platform, and primary care data from the LDN platform, for those registered with a GP in Lambeth. The project holds approval to also link with emergency and admissions data (HES), national fertility data (HFEA), and immunisation records (NIMS), as well as expanding primary care data to other boroughs in South London, namely: Southwark, Lewisham, and Bromley; the process to link these new data sources is currently ongoing. At present, eLIXIR holds over 40,000 records. All records are deidentified, including masking of identifying information in open-text fields and use of pseudonymised identifiers. The data refresh process occurs every 6 months, and each update includes all retrospective data since conception of the cohort (October 2018), thus building a dynamic cohort.
NIHR Applied Research Collaboration (ARC) South London: Children and Young People Theme
The ARC South London children and young people theme aims to improve the lives of children and young people locally, generate evidence for how this can be done nationally and internationally and integrate services and experiences. Our work is focused on improving the health and social care system for children and young people who have complex needs and multiple health problems. This is split into two projects (1) INCLUDE: ImproviNg Care for chiLdren with complex needs and DisabilitiEs. INCLUDE will co-develop and test a novel integrated care model, and aims to improve health outcomes, care quality and system sustainability. (2) INSPIRE: Identify family Needs for Support, Prevention, & rIsk Reduction. INSPIRE will co-develop a screening/early identification tool, and tailored needs-based prevention and support. This project aims to improve school readiness, and outcomes among children who are exposed to multiple adverse experiences.
OveRcoming Adverse ChiLdhood Experiences (ORACLE)
ORACLE was funded by the National Institute for Health Research using funds from the Department of Health and Social Care and aims to improve outcomes for children and young people experiencing parental mental health problems, substance misuse, domestic violence and abuse, and associated adverse childhood experiences (ACEs) and risks, through prevention and improved support. This mixed-methods study is a collaboration between three universities and is led by PIs Ingrid Wolfe (KCL) and Eileen Kaner (University of Newcastle), with a University of Liverpool team lead by David Taylor-Robinson. ORACLE has two phases, the first focuses on improving understanding of risks, experiences, needs, and outcomes, and the current state of interventions. The second phase focuses on designing a new intervention to improve outcomes for children, young people, and families. Working with the NCB and King’s Policy Institute, ORACLE looks to inform policy in health, social care, education, and criminal justice sectors.
Children & Young People's Health Partnership (CYPHP)
CYPHP was a Guy’s and St Thomas’s Charity funded cluster-randomised control trial aiming to produce: (1) an evidence‐based, clinically effective and cost effective, comprehensive day-to-day healthcare model for children and young people that meets current and evolving health needs; (2) a learning healthcare system so that continuous improvement becomes part of everyday practice; and (3) rigorous evaluation that builds the evidence base for improving children's healthcare and strengthening health systems. It was unique in the UK and Europe in its cross-organisational, system-wide, transformative, and academically rigorous approach to improving child health services. The model of care was designed to deliver better health, better healthcare outcomes, and better value for children and young people (CYP). CYPHP partners included local CYP and families; Lambeth and Southwark CCGs, Councils, and GP Federations; King’s College Hospital NHS Foundation Trust, Evelina London Children’s Healthcare, and King’s College London.
Child’s Life Course Journey in Data
This was an ESRC funded project, aiming to produce a child’s life course map in data, with practical benefits for clinicians, academics, and policy makers to assist them in translating data to benefits for health and wellbeing. We will produce a clear simple infographic describing a life course journey in data from pregnancy through 18 years, mapping all the data points and sources available for children, young people, adults. The infographic will be embedded with links to data sources. This project also provides an opportunity to collaborate with colleagues in Australia, New Zealand, and Sweden to produce data maps with the potential to support comparative studies.
Publications
Improving health care and health systems for children
Evidence syntheses:
- Lignou S, Greenwood J, Sheehan M, Wolfe I. Changes in healthcare provision during Covid-19 and their impact on children with chronic illness: A scoping review. Inquiry: The Journal of Health Care Organization, Provision, and Financing. 2022; 59: 1–14. DOI: 10.1177/00469580221081445.
- Flynn AC, Suleiman F, Windsor-Aubrey H, Wolfe I, O’Keeffe M, Poston L, Dalrymple K. Preventing and treating childhood overweight and obesity in children up to 5 years old: A systematic review by intervention setting. Matern Child Nutr. 2022; 213354. https://doi.org/10.1111/mcn.13354
- Integrated Care Models and Child Health: A Meta-analysis. Pediatrics. 2020;145(1):e20183747
- Integrated care for children and young people with special health and care needs. Arch Dis Child
- Crowley, R., Wolfe I, Lock, K. & McKee, M. 2011. Improving the transition between paediatric and adult healthcare: a systematic review. Archives of Disease in Childhood, 96, 548-53.
Health systems performance
- Lingam R, Hu N, Cecil E, Forman J, Newham J, Satherley R, Soley Bori M, Cousens S, Fox-Rushby J, Wolfe I. Changing contexts of child health: an assessment of unmet physical, psychological and social needs of children with common chronic childhood illness. Archives of Disease in Childhood Published doi: 10.1136/archdischild-2023-326766
- Kelly C, Soley-Bori M… Wolfe I & Fox-Rushby J (joint last authors) Mapping CHU9D utility score from the PedsQLTM for children with chronic conditions in a multi-ethnic and deprived metropolitan population. Accepted: Quality of Life Research 2023
- Reed, D., Wolfe, I., Greenwood, J. et al.Accessing healthcare during the COVID-19 pandemic: a qualitative exploration of the experiences of parents and carers of children with chronic illness to inform future policies in times of crisis. BMC Health Serv Res 23, 530 (2023). https://doi.org/10.1186/s12913-023-09452-1
- Wolfe I, Thompson M, Gill P, Tamburlini G, Blair M, van den Bruel A, Ehrich J, Pettoello-Mantovani M, Janson S, Karanikolos M, McKee M. Health services for children in western Europe. The Lancet 2013; 381: 1224-34.
- Wolfe I, Cass H, Thompson M, et al. Improving child health services in the UK: insights from Europe. BMJ 2011; 342: 90-04.
- Schröder-Bäck P, Schloemer T, Clemens T, Alexander D, Brand H, Martakis K, Rigby M, Wolfe I, Zdunek K, Blair M. A Heuristic Governance Framework for the Implementation of Child Primary Health Care Interventions in Different Contexts in the European Union. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 2019; 56: 1–9
- Cecil E, Bottle A, Cowling T, Majeed A, Wolfe I, Saxena S. Primary care access, emergency department visits, and unplanned short hospitalizations in the UK. Pediatrics. 137:2; 2016
- Wolfe I, Mandeville, K, Harrison K, Lingam R. Child survival in England: Strengthening governance for health. Health Policy http://dx.doi.org/10.1016/j.healthpol.2017.09.004
Health systems strengthening – intervention design, implementation studies, trials and evaluations
- Wolfe, I.,Forman, J., Cecil, E., Newham, J., Hu, N., Satherley, R., Soley-Bori, M., Fox-Rushby, J., Cousens, S. & Lingam, R., Effect of the Children and Young People's Health Partnership model of paediatric integrated care on health service use and child health outcomes: a pragmatic two-arm cluster randomised controlled trial. Dec 2023, In: The Lancet Child and Adolescent Health. 7, 12, 830-843.
- Soley-bori M, Forman J, Cecil L, Newham J, Lingam R, Wolfe I (joint senior author), Fox-Rushby J. Cost-effectiveness of the children and young people’s health partnership (CYPHP) model of integrated care versus enhanced usual care: analysis of a pragmatic cluster randomised controlled trial in South London. Lancet Regional Health Europe, volume 42, 2024. https://doi.org/10.1016/j.lanepe.2024.100917
- Muir, C., Kedzior, S.G.E., Barrett, S.et al. Co-design workshops with families experiencing multiple and interacting adversities including parental mental health, substance use, domestic violence, and poverty: intervention principles and insights from mothers, fathers, and young people. Res Involv Engagem 10, 67 (2024). https://doi.org/10.1186/s40900-024-00584-0
- Cecil E, Forman J, Newham J, Hu N, Lingam R, Wolfe I. Investigating a novel population health management system to increase access to healthcare for children: a nested cross-sectional study within a cluster randomised controlled trial. BMJ Qual Saf, doi:10.1136/bmjqs-2024-017223
- Barrett, S.,Muir, C., Burns, S., Adjei, N., Forman, J., Hackett, S., Hirve, R., Kaner, E., Lynch, R., Taylor-Robinson, D., Wolfe, I. & McGovern, R., Interventions to Reduce Parental Substance Use, Domestic Violence and Mental Health Problems, and Their Impacts Upon Children’s Well-Being: A Systematic Review of Reviews and Evidence Mapping Jan 2024, In: Trauma, Violence, and Abuse. 25, 1, 393-412
- Kedzior SGE, Barrett S, Muir C, Lynch R, Kaner E, Forman JR, Wolfe I, McGovern R. "They had clothes on their back and they had food in their stomach, but they didn't have me": The contribution of parental mental health problems, substance use, and domestic violence and abuse on young people and parents. Child Abuse Negl. 2024 Jan 4;149:106609. doi: 10.1016/j.chiabu.2023.106609.
- Newham JJ, Forman JR (joint 1st), Heys M, Cousens S, Lemer C, Elsherbiny M, Satherley R, Lingam R*, Wolfe I*(*joint last). The Children and Young People’s Health Partnership (CYPHP) Evelina London Model of Care: Protocol for an Opportunistic Cluster Randomised Evaluation (cRCT) to Assess Child Health Outcomes, Healthcare Quality, and Health Service Use. BMJ Open 2019;9:e027301.
- Satherley R, Lingam R, Green J, Wolfe I. Integrated health services for children: a qualitative study of family perspectives. BMC Health Services Research 2021, 21:167 org/10.1186/s12913-021-06141
- Soley-Bori M, Lingam R, Satherley R, Forman J, Cecil L, Fox-Rushby J, Wolfe I. Children and Young People’s Health Partnership Evelina London Model of Care: economic evaluation protocol of a complex system change, BMJ Open 2021;11:e047085. doi: 10.1136/bmjopen-2020-047085
- Satherley R, Wolfe I, Lingam R. Experiences of healthcare for mothers of children with ongoing illness, living in deprived neighbourhoods health and place. Health & Place, 71,2021. 10.1016/j.healthplace.2021.10266
Child population health
- Adjei, N. K.,Schlüter, D. K., Melis, G., Straatmann, V. S., Fleming, K. M., Wickham, S., Munford, L., Mcgovern, R., Howard, L. M., Kaner, E., Wolfe, I. & Taylor-Robinson, D. C., Impact of Parental Mental Health and Poverty on the Health of the Next Generation: A Multi-Trajectory Analysis Using the UK Millennium Cohort Study, Jan 2024, In: Journal of Adolescent Health. 74, 1, 60-70
- Adjei, N. K., Schlüter, D. K., Straatmann, V. S., Melis, G., Fleming, K. M., McGovern, R., ... & Taylor-Robinson, D. C. (2022). Quantifying the contribution of poverty and family adversity to adverse child outcomes in the UK: evidence from the UK Millennium Cohort Study (Accepted LANCET).
- Odd D, Stoianova S, Williams T,… Wolfe, I, Luyt K. What is the relationship between deprivation, modifiable factors, and childhood deaths: a cohort study using the English National Child Mortality Database. BMJ Open, 2022, 12(23), e066214
- Odd D, Stoianova S, Willians T, Sleap V, Blair P, Fleming P, Wolfe I, Luyt K. Child Mortality in England during the COVID-19 pandemic. Arch Dis Child, doi:10.1136/archdischild-2020-320899
- Adjei, N. K., Schlüter, D. K., Straatmann, V. S., Melis, G., Fleming, K. M., McGovern, R., Howard, L. M., Kaner, E., Wolfe, I., Taylor-Robinson, D. C., & ORACLE consortium (2021). Impact of poverty and family adversity on adolescent health: a multi-trajectory analysis using the UK Millennium Cohort Study. The Lancet regional health. Europe, 13, 100279. https://doi.org/10.1016/j.lanepe.2021.100279 SSRN:https://ssrn.com/abstract=3844825 or http://dx.doi.org/10.2139/ssrn.3844825
- Ward JL, Wolfe I, Viner RM. Cause-specific child and adolescent mortality in the UK and EU15+ countries. Arch Dis Child. doi:10.1136/archdischild-2019-318097
- Shoari, N., Ezzati, M., Doyle, Y. G.,Wolfe I., Brauer, M., Bennett, J. & Fecht, D., 2021, Journal of urban Nowhere to Play: Available Open and Green Space in Greater London Schools
- Viner R, Hargreaves D, Coffey C, Patton G, Wolfe I. Deaths in young people 0-24 years in the UK compared with the EU15+ countries, 1970-2008: analysis of the WHO mortality database. The Lancet 2014; doi10.1016/S0140-6736(14)60485-2
- Viner R, Amin R, Hargreaves D, Khanolkar A, Charalampopoulos D, Candler T, Wolfe I, Stephenson T. Diabetes mortality trends 1990-2010 in the UK compared with the EU15 and the USA. Arch Dis Child DOI:10.1136/archdischild-2015-308599.430
- GBD 2015 SDG Collaborators. Measuring the health-related Sustainable Development Goals in 188 countries: a baseline analysis of the Global Burden of Disease Study 2015. The Lancet 2016; http://dx.doi.org/10.1016/ S0140-6736(16)31467-2
- Bennet J, Pearson-Studdard J, Kontis V, Capewell S, Wolfe I, Ezzati M. Contributions of diseases and injuries to widening life expectancy inequalities in England from 2001 to 2016: a population-based analysis of vital registration data. Lancet Public Health Online November 22, 2018. http://dx.doi.org/10.1016/ S2468-2667(18)30214-7.
- Elia, C.,Karamanos, A., Dregan, A., O'Keeffe, M., Wolfe, I., Sandall, J., Morgan, C., Cruickshank, J. K., Gobin, R., Wilks, R. & Harding, S., Association of macro-level determinants with adolescent overweight and suicidal ideation with planning: A cross-sectional study of 21 Latin American and Caribbean Countries 29 Dec 2020, In: PLoS Medicine. 17, 12, e1003443
- Armour-Marshall J, Wolfe I, Lock K, et al. Childhood deaths from injuries: trends and inequalities in Europe. European Journal of Public Health 2011; doi 10 1093/eurpub/ckr004
- Bamber A, Mifsud W, Wolfe I, Cass H, Pryce J, Malone M, Sebire N. Potentially preventable infant and child deaths identified at autopsy; findings and implications. Forensic science medicine and pathology DOI: 10.1007/s12024-015-9681-9
- McKee M, Hurst L, Aldridge R, Raine R, Mindell JS, Wolfe I, Holland W. Public Health in England: an option for the way forward? The Lancet DOI:10.1016/S0140-6736(11)60241-9
Policy
- Lignou S, Sheehan M, Parker M and Wolfe I. Healthcare resource allocation decisions and non-emergency treatments in the aftermath of Covid-19 pandemic. How should children with chronic illness feature in prioritisation processes? Wellcome Open Res 2023, 8:385 https://doi.org/10.12688/wellcomeopenres.19571.1
- Lignou S, Wolfe I. Healthcare prioritisation and inequitable inequalities: why a child health perspective should be incorporated into the current NHS guidance. Archives of Disease in Childhood.Published Online First: 19 May 2023. doi: 10.1136/archdischild-2023-325634
- Jansen D, Carai S, Scott E, Butu C, Pop I, Park M, Rajan D, Weber M, Wolfe I. COVID-19 has exposed the need for health system assessments to be more child health- sensitive. J Glob Health 2022;12:03048.
- Hodgins M, van Leeuwen D, Braithwaite J, Hanefeld J, Wolfe I, Lau C, Dickins E, McSweeney J, McCaskill M, Lingam R. The COVID-19 System Shock Framework: Capturing Health System Innovation During the COVID-19 Pandemic. Int J Health Policy Manag. 2021 Sep 8. doi: 10.34172/ijhpm.2021.130. Epub ahead of print. PMID: 34814662.
- De Souza R, Wolfe I. Covid19 vaccines in high-risk ethnic groups. The Lancet 2021, Online April 1 2021 https://doi.org/10.1016/ S0140-6736(21)00624-3
- Roland, D., Wolfe, I., Klaber, R. E., & Watson, M. (2021). Final warning on the need for integrated care systems in acute paediatrics. Archives of Disease in Childhood. 10.1136/archdischild-2020-320828
- Von Dadelszen P, Khalil A, Wolfe I, Kametas N, O’Brien P, Magee L. “Women and Children last” – effects of the Covid19 pandemic on reproductive, perinatal, and paediatric health. BMJ 2020; 369:m2287
- Kennedy H, Balaam M-C, Dahlen H, Declercq E, de Jonge A, Downe S, Ellwood D, Homer C, Sandall J, Vedam S, Wolfe I. The role of midwifery and other international insights for maternity in the United States: an analysis of four countries. Birth. 2020; DOI:1111/birt.12504
- Wolfe I. Disproportionate disadvantage of the young: Britain, the UNICEF report on child wellbeing, and political choices. Arch Dis Child 2013 doi: 10.1136/archdischild-2013-304437
- Viner R, Ward J, Wolfe I. Countdown for UK Child Survival 2017. Archives of Disease in Childhood 2018; 103(5):474-79.
- Willott, CD, Devakumar D, Mandeville K, Satherley RM, Hall J, Sutaria S, Yarrow K, Mohan K, Wolfe I The political views of doctors in the United Kingdom: a cross-sectional study. Journal of Epidemiology and Community Health; 2018
- McKee M, Hurst L, Aldridge R, Raine R, Mindell JS, Wolfe I, Holland W. Public Health in England: an option for the way forward? The Lancet DOI:10.1016/S0140-6736(11)60241-9
- Del Torso S, Pettoello-Mantovani M, Tenore A, Grossman Z, Wolfe I, Ehrich J. A Strategic Pediatric Alliance for the Future Health of Children in Europe. The Journal of Pediatrics 2013; 162(3): 659-660
Activity
Voluntary and Advisory groups
Ingrid Wolfe’s activities include:
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- Co-chair of British Association for Adolescent and Child Public Health
- Member, National Child Mortality Database Programme
- Member, Health Liaison Committee, NSPCC
- Member, Health Promotion Committee, Royal College of Paediatrics and Child Health
- Member, Health Policy Influencing Group, National Children’s Bureau
- Member, Expert Advisory Group, European University Hospitals Alliance
- Member, Steering Group on Maternal Inequalities, NHS England
People
PhD Student
Senior Research Fellow
Professor of Palliative Care and Child Health
Consultant paediatrician and PhD Student
PhD Student
Lecturer in Health Economics
Projects
TEAMCare: Technology Enhanced integrAted asthMa Care
This NIHR funded research study is a randomised control trial of technology aiming to improve outcomes among children with asthma. The project is aiming to improve health for children with asthma by testing a new type of more joined-up care that is about the whole child and not just the disease and combining it with special technologies for asthma management. We think the new type of care is already helping children, but we could do even better by adding new ways of helping children and families to keep track of asthma symptoms and medications using apps. By combining the new type of integrated care with technology, we want to help children and families and their doctors and nurses take better care of asthma together, to help keep asthma under control between visits to the doctor or nurse, and to improve asthma care so much that children can avoid needing emergency care. As part of an RCT, we will test two types of asthma technology. We will measure how often children need emergency care for asthma, their health, children and parents' mental health and wellbeing, how often children need healthcare and medicines for asthma, and whether children and their parents or carers miss school or work because of asthma, costs, and how easy the technologies are to use. The evidence from our project should help improve health for children with asthma.
eLIXIR (Born in South London) Data-Linkage
This project uses opt-out consent to collect routine maternity and neonatal clinical patient data (GSTT and KCH NHS Trusts), mental health data from the SLaM CRIS platform, and primary care data from the LDN platform, for those registered with a GP in Lambeth. The project holds approval to also link with emergency and admissions data (HES), national fertility data (HFEA), and immunisation records (NIMS), as well as expanding primary care data to other boroughs in South London, namely: Southwark, Lewisham, and Bromley; the process to link these new data sources is currently ongoing. At present, eLIXIR holds over 40,000 records. All records are deidentified, including masking of identifying information in open-text fields and use of pseudonymised identifiers. The data refresh process occurs every 6 months, and each update includes all retrospective data since conception of the cohort (October 2018), thus building a dynamic cohort.
NIHR Applied Research Collaboration (ARC) South London: Children and Young People Theme
The ARC South London children and young people theme aims to improve the lives of children and young people locally, generate evidence for how this can be done nationally and internationally and integrate services and experiences. Our work is focused on improving the health and social care system for children and young people who have complex needs and multiple health problems. This is split into two projects (1) INCLUDE: ImproviNg Care for chiLdren with complex needs and DisabilitiEs. INCLUDE will co-develop and test a novel integrated care model, and aims to improve health outcomes, care quality and system sustainability. (2) INSPIRE: Identify family Needs for Support, Prevention, & rIsk Reduction. INSPIRE will co-develop a screening/early identification tool, and tailored needs-based prevention and support. This project aims to improve school readiness, and outcomes among children who are exposed to multiple adverse experiences.
OveRcoming Adverse ChiLdhood Experiences (ORACLE)
ORACLE was funded by the National Institute for Health Research using funds from the Department of Health and Social Care and aims to improve outcomes for children and young people experiencing parental mental health problems, substance misuse, domestic violence and abuse, and associated adverse childhood experiences (ACEs) and risks, through prevention and improved support. This mixed-methods study is a collaboration between three universities and is led by PIs Ingrid Wolfe (KCL) and Eileen Kaner (University of Newcastle), with a University of Liverpool team lead by David Taylor-Robinson. ORACLE has two phases, the first focuses on improving understanding of risks, experiences, needs, and outcomes, and the current state of interventions. The second phase focuses on designing a new intervention to improve outcomes for children, young people, and families. Working with the NCB and King’s Policy Institute, ORACLE looks to inform policy in health, social care, education, and criminal justice sectors.
Children & Young People's Health Partnership (CYPHP)
CYPHP was a Guy’s and St Thomas’s Charity funded cluster-randomised control trial aiming to produce: (1) an evidence‐based, clinically effective and cost effective, comprehensive day-to-day healthcare model for children and young people that meets current and evolving health needs; (2) a learning healthcare system so that continuous improvement becomes part of everyday practice; and (3) rigorous evaluation that builds the evidence base for improving children's healthcare and strengthening health systems. It was unique in the UK and Europe in its cross-organisational, system-wide, transformative, and academically rigorous approach to improving child health services. The model of care was designed to deliver better health, better healthcare outcomes, and better value for children and young people (CYP). CYPHP partners included local CYP and families; Lambeth and Southwark CCGs, Councils, and GP Federations; King’s College Hospital NHS Foundation Trust, Evelina London Children’s Healthcare, and King’s College London.
Child’s Life Course Journey in Data
This was an ESRC funded project, aiming to produce a child’s life course map in data, with practical benefits for clinicians, academics, and policy makers to assist them in translating data to benefits for health and wellbeing. We will produce a clear simple infographic describing a life course journey in data from pregnancy through 18 years, mapping all the data points and sources available for children, young people, adults. The infographic will be embedded with links to data sources. This project also provides an opportunity to collaborate with colleagues in Australia, New Zealand, and Sweden to produce data maps with the potential to support comparative studies.
Publications
Improving health care and health systems for children
Evidence syntheses:
- Lignou S, Greenwood J, Sheehan M, Wolfe I. Changes in healthcare provision during Covid-19 and their impact on children with chronic illness: A scoping review. Inquiry: The Journal of Health Care Organization, Provision, and Financing. 2022; 59: 1–14. DOI: 10.1177/00469580221081445.
- Flynn AC, Suleiman F, Windsor-Aubrey H, Wolfe I, O’Keeffe M, Poston L, Dalrymple K. Preventing and treating childhood overweight and obesity in children up to 5 years old: A systematic review by intervention setting. Matern Child Nutr. 2022; 213354. https://doi.org/10.1111/mcn.13354
- Integrated Care Models and Child Health: A Meta-analysis. Pediatrics. 2020;145(1):e20183747
- Integrated care for children and young people with special health and care needs. Arch Dis Child
- Crowley, R., Wolfe I, Lock, K. & McKee, M. 2011. Improving the transition between paediatric and adult healthcare: a systematic review. Archives of Disease in Childhood, 96, 548-53.
Health systems performance
- Lingam R, Hu N, Cecil E, Forman J, Newham J, Satherley R, Soley Bori M, Cousens S, Fox-Rushby J, Wolfe I. Changing contexts of child health: an assessment of unmet physical, psychological and social needs of children with common chronic childhood illness. Archives of Disease in Childhood Published doi: 10.1136/archdischild-2023-326766
- Kelly C, Soley-Bori M… Wolfe I & Fox-Rushby J (joint last authors) Mapping CHU9D utility score from the PedsQLTM for children with chronic conditions in a multi-ethnic and deprived metropolitan population. Accepted: Quality of Life Research 2023
- Reed, D., Wolfe, I., Greenwood, J. et al.Accessing healthcare during the COVID-19 pandemic: a qualitative exploration of the experiences of parents and carers of children with chronic illness to inform future policies in times of crisis. BMC Health Serv Res 23, 530 (2023). https://doi.org/10.1186/s12913-023-09452-1
- Wolfe I, Thompson M, Gill P, Tamburlini G, Blair M, van den Bruel A, Ehrich J, Pettoello-Mantovani M, Janson S, Karanikolos M, McKee M. Health services for children in western Europe. The Lancet 2013; 381: 1224-34.
- Wolfe I, Cass H, Thompson M, et al. Improving child health services in the UK: insights from Europe. BMJ 2011; 342: 90-04.
- Schröder-Bäck P, Schloemer T, Clemens T, Alexander D, Brand H, Martakis K, Rigby M, Wolfe I, Zdunek K, Blair M. A Heuristic Governance Framework for the Implementation of Child Primary Health Care Interventions in Different Contexts in the European Union. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 2019; 56: 1–9
- Cecil E, Bottle A, Cowling T, Majeed A, Wolfe I, Saxena S. Primary care access, emergency department visits, and unplanned short hospitalizations in the UK. Pediatrics. 137:2; 2016
- Wolfe I, Mandeville, K, Harrison K, Lingam R. Child survival in England: Strengthening governance for health. Health Policy http://dx.doi.org/10.1016/j.healthpol.2017.09.004
Health systems strengthening – intervention design, implementation studies, trials and evaluations
- Wolfe, I.,Forman, J., Cecil, E., Newham, J., Hu, N., Satherley, R., Soley-Bori, M., Fox-Rushby, J., Cousens, S. & Lingam, R., Effect of the Children and Young People's Health Partnership model of paediatric integrated care on health service use and child health outcomes: a pragmatic two-arm cluster randomised controlled trial. Dec 2023, In: The Lancet Child and Adolescent Health. 7, 12, 830-843.
- Soley-bori M, Forman J, Cecil L, Newham J, Lingam R, Wolfe I (joint senior author), Fox-Rushby J. Cost-effectiveness of the children and young people’s health partnership (CYPHP) model of integrated care versus enhanced usual care: analysis of a pragmatic cluster randomised controlled trial in South London. Lancet Regional Health Europe, volume 42, 2024. https://doi.org/10.1016/j.lanepe.2024.100917
- Muir, C., Kedzior, S.G.E., Barrett, S.et al. Co-design workshops with families experiencing multiple and interacting adversities including parental mental health, substance use, domestic violence, and poverty: intervention principles and insights from mothers, fathers, and young people. Res Involv Engagem 10, 67 (2024). https://doi.org/10.1186/s40900-024-00584-0
- Cecil E, Forman J, Newham J, Hu N, Lingam R, Wolfe I. Investigating a novel population health management system to increase access to healthcare for children: a nested cross-sectional study within a cluster randomised controlled trial. BMJ Qual Saf, doi:10.1136/bmjqs-2024-017223
- Barrett, S.,Muir, C., Burns, S., Adjei, N., Forman, J., Hackett, S., Hirve, R., Kaner, E., Lynch, R., Taylor-Robinson, D., Wolfe, I. & McGovern, R., Interventions to Reduce Parental Substance Use, Domestic Violence and Mental Health Problems, and Their Impacts Upon Children’s Well-Being: A Systematic Review of Reviews and Evidence Mapping Jan 2024, In: Trauma, Violence, and Abuse. 25, 1, 393-412
- Kedzior SGE, Barrett S, Muir C, Lynch R, Kaner E, Forman JR, Wolfe I, McGovern R. "They had clothes on their back and they had food in their stomach, but they didn't have me": The contribution of parental mental health problems, substance use, and domestic violence and abuse on young people and parents. Child Abuse Negl. 2024 Jan 4;149:106609. doi: 10.1016/j.chiabu.2023.106609.
- Newham JJ, Forman JR (joint 1st), Heys M, Cousens S, Lemer C, Elsherbiny M, Satherley R, Lingam R*, Wolfe I*(*joint last). The Children and Young People’s Health Partnership (CYPHP) Evelina London Model of Care: Protocol for an Opportunistic Cluster Randomised Evaluation (cRCT) to Assess Child Health Outcomes, Healthcare Quality, and Health Service Use. BMJ Open 2019;9:e027301.
- Satherley R, Lingam R, Green J, Wolfe I. Integrated health services for children: a qualitative study of family perspectives. BMC Health Services Research 2021, 21:167 org/10.1186/s12913-021-06141
- Soley-Bori M, Lingam R, Satherley R, Forman J, Cecil L, Fox-Rushby J, Wolfe I. Children and Young People’s Health Partnership Evelina London Model of Care: economic evaluation protocol of a complex system change, BMJ Open 2021;11:e047085. doi: 10.1136/bmjopen-2020-047085
- Satherley R, Wolfe I, Lingam R. Experiences of healthcare for mothers of children with ongoing illness, living in deprived neighbourhoods health and place. Health & Place, 71,2021. 10.1016/j.healthplace.2021.10266
Child population health
- Adjei, N. K.,Schlüter, D. K., Melis, G., Straatmann, V. S., Fleming, K. M., Wickham, S., Munford, L., Mcgovern, R., Howard, L. M., Kaner, E., Wolfe, I. & Taylor-Robinson, D. C., Impact of Parental Mental Health and Poverty on the Health of the Next Generation: A Multi-Trajectory Analysis Using the UK Millennium Cohort Study, Jan 2024, In: Journal of Adolescent Health. 74, 1, 60-70
- Adjei, N. K., Schlüter, D. K., Straatmann, V. S., Melis, G., Fleming, K. M., McGovern, R., ... & Taylor-Robinson, D. C. (2022). Quantifying the contribution of poverty and family adversity to adverse child outcomes in the UK: evidence from the UK Millennium Cohort Study (Accepted LANCET).
- Odd D, Stoianova S, Williams T,… Wolfe, I, Luyt K. What is the relationship between deprivation, modifiable factors, and childhood deaths: a cohort study using the English National Child Mortality Database. BMJ Open, 2022, 12(23), e066214
- Odd D, Stoianova S, Willians T, Sleap V, Blair P, Fleming P, Wolfe I, Luyt K. Child Mortality in England during the COVID-19 pandemic. Arch Dis Child, doi:10.1136/archdischild-2020-320899
- Adjei, N. K., Schlüter, D. K., Straatmann, V. S., Melis, G., Fleming, K. M., McGovern, R., Howard, L. M., Kaner, E., Wolfe, I., Taylor-Robinson, D. C., & ORACLE consortium (2021). Impact of poverty and family adversity on adolescent health: a multi-trajectory analysis using the UK Millennium Cohort Study. The Lancet regional health. Europe, 13, 100279. https://doi.org/10.1016/j.lanepe.2021.100279 SSRN:https://ssrn.com/abstract=3844825 or http://dx.doi.org/10.2139/ssrn.3844825
- Ward JL, Wolfe I, Viner RM. Cause-specific child and adolescent mortality in the UK and EU15+ countries. Arch Dis Child. doi:10.1136/archdischild-2019-318097
- Shoari, N., Ezzati, M., Doyle, Y. G.,Wolfe I., Brauer, M., Bennett, J. & Fecht, D., 2021, Journal of urban Nowhere to Play: Available Open and Green Space in Greater London Schools
- Viner R, Hargreaves D, Coffey C, Patton G, Wolfe I. Deaths in young people 0-24 years in the UK compared with the EU15+ countries, 1970-2008: analysis of the WHO mortality database. The Lancet 2014; doi10.1016/S0140-6736(14)60485-2
- Viner R, Amin R, Hargreaves D, Khanolkar A, Charalampopoulos D, Candler T, Wolfe I, Stephenson T. Diabetes mortality trends 1990-2010 in the UK compared with the EU15 and the USA. Arch Dis Child DOI:10.1136/archdischild-2015-308599.430
- GBD 2015 SDG Collaborators. Measuring the health-related Sustainable Development Goals in 188 countries: a baseline analysis of the Global Burden of Disease Study 2015. The Lancet 2016; http://dx.doi.org/10.1016/ S0140-6736(16)31467-2
- Bennet J, Pearson-Studdard J, Kontis V, Capewell S, Wolfe I, Ezzati M. Contributions of diseases and injuries to widening life expectancy inequalities in England from 2001 to 2016: a population-based analysis of vital registration data. Lancet Public Health Online November 22, 2018. http://dx.doi.org/10.1016/ S2468-2667(18)30214-7.
- Elia, C.,Karamanos, A., Dregan, A., O'Keeffe, M., Wolfe, I., Sandall, J., Morgan, C., Cruickshank, J. K., Gobin, R., Wilks, R. & Harding, S., Association of macro-level determinants with adolescent overweight and suicidal ideation with planning: A cross-sectional study of 21 Latin American and Caribbean Countries 29 Dec 2020, In: PLoS Medicine. 17, 12, e1003443
- Armour-Marshall J, Wolfe I, Lock K, et al. Childhood deaths from injuries: trends and inequalities in Europe. European Journal of Public Health 2011; doi 10 1093/eurpub/ckr004
- Bamber A, Mifsud W, Wolfe I, Cass H, Pryce J, Malone M, Sebire N. Potentially preventable infant and child deaths identified at autopsy; findings and implications. Forensic science medicine and pathology DOI: 10.1007/s12024-015-9681-9
- McKee M, Hurst L, Aldridge R, Raine R, Mindell JS, Wolfe I, Holland W. Public Health in England: an option for the way forward? The Lancet DOI:10.1016/S0140-6736(11)60241-9
Policy
- Lignou S, Sheehan M, Parker M and Wolfe I. Healthcare resource allocation decisions and non-emergency treatments in the aftermath of Covid-19 pandemic. How should children with chronic illness feature in prioritisation processes? Wellcome Open Res 2023, 8:385 https://doi.org/10.12688/wellcomeopenres.19571.1
- Lignou S, Wolfe I. Healthcare prioritisation and inequitable inequalities: why a child health perspective should be incorporated into the current NHS guidance. Archives of Disease in Childhood.Published Online First: 19 May 2023. doi: 10.1136/archdischild-2023-325634
- Jansen D, Carai S, Scott E, Butu C, Pop I, Park M, Rajan D, Weber M, Wolfe I. COVID-19 has exposed the need for health system assessments to be more child health- sensitive. J Glob Health 2022;12:03048.
- Hodgins M, van Leeuwen D, Braithwaite J, Hanefeld J, Wolfe I, Lau C, Dickins E, McSweeney J, McCaskill M, Lingam R. The COVID-19 System Shock Framework: Capturing Health System Innovation During the COVID-19 Pandemic. Int J Health Policy Manag. 2021 Sep 8. doi: 10.34172/ijhpm.2021.130. Epub ahead of print. PMID: 34814662.
- De Souza R, Wolfe I. Covid19 vaccines in high-risk ethnic groups. The Lancet 2021, Online April 1 2021 https://doi.org/10.1016/ S0140-6736(21)00624-3
- Roland, D., Wolfe, I., Klaber, R. E., & Watson, M. (2021). Final warning on the need for integrated care systems in acute paediatrics. Archives of Disease in Childhood. 10.1136/archdischild-2020-320828
- Von Dadelszen P, Khalil A, Wolfe I, Kametas N, O’Brien P, Magee L. “Women and Children last” – effects of the Covid19 pandemic on reproductive, perinatal, and paediatric health. BMJ 2020; 369:m2287
- Kennedy H, Balaam M-C, Dahlen H, Declercq E, de Jonge A, Downe S, Ellwood D, Homer C, Sandall J, Vedam S, Wolfe I. The role of midwifery and other international insights for maternity in the United States: an analysis of four countries. Birth. 2020; DOI:1111/birt.12504
- Wolfe I. Disproportionate disadvantage of the young: Britain, the UNICEF report on child wellbeing, and political choices. Arch Dis Child 2013 doi: 10.1136/archdischild-2013-304437
- Viner R, Ward J, Wolfe I. Countdown for UK Child Survival 2017. Archives of Disease in Childhood 2018; 103(5):474-79.
- Willott, CD, Devakumar D, Mandeville K, Satherley RM, Hall J, Sutaria S, Yarrow K, Mohan K, Wolfe I The political views of doctors in the United Kingdom: a cross-sectional study. Journal of Epidemiology and Community Health; 2018
- McKee M, Hurst L, Aldridge R, Raine R, Mindell JS, Wolfe I, Holland W. Public Health in England: an option for the way forward? The Lancet DOI:10.1016/S0140-6736(11)60241-9
- Del Torso S, Pettoello-Mantovani M, Tenore A, Grossman Z, Wolfe I, Ehrich J. A Strategic Pediatric Alliance for the Future Health of Children in Europe. The Journal of Pediatrics 2013; 162(3): 659-660
Activity
Voluntary and Advisory groups
Ingrid Wolfe’s activities include:
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- Co-chair of British Association for Adolescent and Child Public Health
- Member, National Child Mortality Database Programme
- Member, Health Liaison Committee, NSPCC
- Member, Health Promotion Committee, Royal College of Paediatrics and Child Health
- Member, Health Policy Influencing Group, National Children’s Bureau
- Member, Expert Advisory Group, European University Hospitals Alliance
- Member, Steering Group on Maternal Inequalities, NHS England
Our Partners
Group lead
Professor of Paediatrics and Child Population Health