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Phillips AR, Halligan SL, Lavi I, Macleod JAA, Robinson S, Wilkins D, Hiller RM. A Scoping Review of Factors Associated With the Mental Health of Young People Who Have "Aged Out" of the Child Welfare System. TRAUMA, VIOLENCE & ABUSE 2024; 25:1780-1798. [PMID: 37776530 PMCID: PMC11155215 DOI: 10.1177/15248380231196107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Abstract
Young people who grow up in care and then exit care around the age of 18 (care-leavers) are a particularly vulnerable group, at increased risk for mental health problems even relative to other care-experienced groups. Yet, little is understood about the factors underpinning this association. We used scoping review methods to synthesize the quantitative and qualitative literature on factors that are associated with mental health problems for care-leavers. Following rigorous methods, we systematically searched three scientific databases spanning psychology and social care and identified 23 peer-reviewed studies for inclusion. This review highlights the heterogeneity of this research, in terms of methodology and topics investigated. Topics included are as follows: pre-care maltreatment, care-related experiences, psychological factors (emotion regulation), social support, education, and adult functioning (e.g., housing, finances, employment). We found mixed and inconsistent findings across research studies. The strongest evidence-base is around the influence of social support upon the mental health of recent care-leavers, though methodological problems are discussed. The field benefits from several large-scale observational and longitudinal research studies. However, there is an over-reliance upon retrospective reporting, and the use of unvalidated measures is common. It is apparent that there are significant gaps in our current understanding of the mental health of care-leavers, in particular around modifiable factors. We discuss potential directions for future empirical research, both in terms of methodology and factors investigated.
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Affiliation(s)
| | | | | | - John A. A. Macleod
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, UK
- The University of Bristol, UK
| | | | | | - Rachel M. Hiller
- University College London, UK
- Anna Freud Centre for Children and Families, London, UK
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Boonstra A, Leijdesdorff S, Street C, Holme I, van Bodegom L, Franić T, Appleton R, Tah P, Tuomainen H, Tomljenovic H, McNicholas F, van Amelsvoort T. Turning 18 in mental health services: a multicountry qualitative study of service user experiences and views. Ir J Psychol Med 2024:1-9. [PMID: 38562092 DOI: 10.1017/ipm.2024.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND Worldwide, the division between Child and Adolescent Mental Health Services (CAMHS) and Adult Mental Health Services (AMHS) has frequently resulted in fragmented care with an unprepared, non-gradual transition. To improve continuity of care and other service transition experiences, service user input is essential. However, such previous qualitative studies are from a decade ago or focused on one mental disorder or country. The aim of the present study was to learn from service users' transition experiences and suggested improvements. METHODS Semi-structured interviews were held with young people aged 18-24 and/or parents/caregivers in the United Kingdom, Ireland, the Netherlands and Croatia. Inclusion was based on the experience of specialist mental health care before and after turning 18. Thematic analysis of transcribed and translated interview transcripts was performed using ATLAS.ti 9. RESULTS Main themes of service user experiences included abrupt changes in responsibilities, various barriers and a lack of preparation, communication and ongoing care. Young people expressed a great need for continuity of care. Their suggestions to improve transitional care included early and adequate preparation, joint working, improved communication from and between services, overlapping services, staying at CAMHS for longer and designated youth mental health teams. CONCLUSIONS Young people who experienced care before and after turning 18 suggested either altering the age limits of services or ensuring early preparation and communication regarding the transition and finding AHMS. This communication should include general changes when turning 18. Further considerations include increasing collaboration and overlap between CAMHS and AMHS.
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Affiliation(s)
- Anouk Boonstra
- School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
| | - Sophie Leijdesdorff
- School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
| | - Cathy Street
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Ingrid Holme
- School of Political Science and Sociology, University of Galway, Galway, Ireland
| | - Larissa van Bodegom
- Yulius Mental Health Organization, Yulius Academy, Dordrecht, The Netherlands
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Tomislav Franić
- Department of Psychiatry, Clinical Hospital Center Split, Split, Croatia
| | - Rebecca Appleton
- Division of Psychiatry, NIHR Mental Health Policy Research Unit, University College London, London, UK
| | - Priya Tah
- Department of Education, University of Oxford, Oxford, UK
| | | | - Helena Tomljenovic
- Department of Psychiatry, Clinical Hospital Center Split, Split, Croatia
| | - Fiona McNicholas
- Department of Child & Adolescent Psychiatry, University College Dublin, Dublin, Ireland
| | - Thérèse van Amelsvoort
- School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
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Chen T, Reed H, Parra-Mujica F, Johnson EA, Johnson M, O'Flaherty M, Collins B, Kypridemos C. Quantifying the mental health and economic impacts of prospective Universal Basic Income schemes among young people in the UK: a microsimulation modelling study. BMJ Open 2023; 13:e075831. [PMID: 37793925 PMCID: PMC10551934 DOI: 10.1136/bmjopen-2023-075831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 09/14/2023] [Indexed: 10/06/2023] Open
Abstract
OBJECTIVE Universal Basic Income (UBI)-a largely unconditional, regular payment to all adults to support basic needs-has been proposed as a policy to increase the size and security of household incomes and promote mental health. We aimed to quantify its long-term impact on mental health among young people in England. METHODS We produced a discrete-time dynamic stochastic microsimulation that models a close-to-reality open cohort of synthetic individuals (2010-2030) based on data from Office for National Statistics and Understanding Society. Three UBI scheme scenarios were simulated: Scheme 1-Starter (per week): £41 per child; £63 per adult over 18 and under 65; £190 per adult aged 65+; Scheme 2-Intermediate (per week): £63 per child; £145 per adult under 65; £190 per adult aged 65+; Scheme 3-Minimum Income Standard level (per week): £95 per child; £230 per adult under 65; £230 per adult aged 65+. We reported cases of anxiety and depression prevented or postponed and cost savings. Estimates are rounded to the second significant digit. RESULTS Scheme 1 could prevent or postpone 200 000 (95% uncertainty interval: 180 000 to 210 000) cases of anxiety and depression from 2010 to 2030. This would increase to 420 000(400 000 to 440 000) for Scheme 2 and 550 000(520 000 to 570 000) for Scheme 3. Assuming that 50% of the cases are diagnosed and treated, Scheme 1 could save £330 million (£280 million to £390 million) to National Health Service (NHS) and personal social services (PSS), over the same period, with Scheme 2 (£710 million (£640 million to £790 million)) or Scheme 3 (£930 million (£850 million to £1000 million)) producing more considerable savings. Overall, total cost savings (including NHS, PSS and patients' related costs) would range from £1.5 billion (£1.2 billion to £1.8 billion) for Scheme 1 to £4.2 billion (£3.7 billion to £4.6 billion) for Scheme 3. CONCLUSION Our modelling suggests that UBI could substantially benefit young people's mental health, producing substantial health-related cost savings.
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Affiliation(s)
- Tao Chen
- Department of Public Health, Policy & Systems, University of Liverpool, Liverpool, UK
- Center for Health Economics, University of York, York, UK
| | - Howard Reed
- Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
- Landman Economics Ltd, Colchester, UK
| | - Fiorella Parra-Mujica
- School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Elliott Aidan Johnson
- Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | - Matthew Johnson
- Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | - Martin O'Flaherty
- Department of Public Health, Policy & Systems, University of Liverpool, Liverpool, UK
| | - Brendan Collins
- Department of Public Health, Policy & Systems, University of Liverpool, Liverpool, UK
| | - Chris Kypridemos
- Department of Public Health, Policy & Systems, University of Liverpool, Liverpool, UK
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Canaway A, Appleton R, van Bodegom L, Dieleman G, Franić T, Gerritsen S, de Girolamo G, Maras A, McNicholas F, Overbeek M, Paul M, Purper-Ouakil D, Santosh P, Schulze U, Singh SP, Street C, Tah P, Tremmery B, Tuomainen H, Verhulst FC, Wolke D, Madan J. Healthcare costs for young people transitioning the boundary between child/adolescent and adult mental health services in seven European countries: results from the MILESTONE study. BJPsych Open 2023; 9:e175. [PMID: 37749976 PMCID: PMC10617498 DOI: 10.1192/bjo.2023.559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 08/02/2023] [Accepted: 08/07/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND The boundary between services for children and adolescents and adults has been identified as problematic for young people with mental health problems. AIMS To examine the use and cost of healthcare for young people engaged in mental healthcare before and after the child/adolescent and adult service boundary. METHOD Data from 772 young people in seven European countries participating in the MILESTONE trial were analysed. We analysed and costed healthcare resources used in the 6-month period before and after the service boundary. RESULTS The proportion of young people engaging with healthcare services fell substantially after crossing the service boundary (associated costs €7761 pre-boundary v. €3376 post-boundary). Pre-boundary, the main cost driver was in-patient care (approximately 50%), whereas post-boundary costs were more evenly spread between services; cost reductions were correlated with pre-boundary in-patient care. Severity was associated with substantially higher costs pre- and post-boundary, and those who were engaged specifically with mental health services after the service boundary accrued the greatest healthcare costs post-service boundary. CONCLUSIONS Costs of healthcare are large in this population, but fall considerably after transition, particularly for those who were most severely ill. In part, this is likely to reflect improvement in the mental health of young people. However, qualitative evidence from the MILESTONE study suggests that lack of capacity in adult services and young people's disengagement with formal mental health services post-transition are contributing factors. Long-term data are needed to assess the adverse long-term effects on costs and health of this unmet need and disengagement.
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Affiliation(s)
- Alastair Canaway
- Centre for Health Economics at Warwick, Warwick Medical School, University of Warwick, UK
| | - Rebecca Appleton
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, UK
| | - Larissa van Bodegom
- Yulius Academy, Yulius Mental Health Organization, The Netherlands; and Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, The Netherlands
| | - Gwen Dieleman
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, The Netherlands
| | - Tomislav Franić
- Department of Psychiatry, University Hospital Split, Croatia; and School of Medicine, University of Split, Croatia
| | - Suzanne Gerritsen
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, The Netherlands
| | - Giovanni de Girolamo
- Unit of Epidemiological Psychiatry and Evaluation, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Italy
| | - Athanasios Maras
- Yulius Academy, Yulius Mental Health Organization, The Netherlands; and Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, The Netherlands
| | - Fiona McNicholas
- School of Medicine and Medical Science, University College Dublin, Republic of Ireland; and Lucena Child and Adolescent Mental Health Services, St. John of God Community Services, Republic of Ireland
| | - Mathilde Overbeek
- Yulius Academy, Yulius Mental Health Organization, The Netherlands and Clinical Child and Family Studies, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, The Netherlands
| | - Moli Paul
- Warwick Medical School, University of Warwick, UK and Children and Young People’s Mental Health Service, Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | - Diane Purper-Ouakil
- Child and Adolescent Psychiatry Unit, Centre Hospitalier Universitaire de Montpellier, Saint Eloi Hospital, France; and Team PsyDev, CESP U1018, INSERM, Université de Versailles Saint-Quentin-en-Yvelines, University Paris Saclay, France
| | - Paramala Santosh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, UK; and HealthTracker Ltd, UK
| | - Ulrike Schulze
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Germany
| | - Swaran P. Singh
- Warwick Medical School, University of Warwick, UK and Children and Young People’s Mental Health Service, Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | - Cathy Street
- Warwick Medical School, University of Warwick, UK
| | - Priya Tah
- Warwick Medical School, University of Warwick, UK
| | | | | | - Frank C. Verhulst
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, The Netherlands; and Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Dieter Wolke
- Department of Psychology, University of Warwick, UK
| | - Jason Madan
- Centre for Health Economics at Warwick, Warwick Medical School, University of Warwick, UK
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Markoulakis R, Cader H, Chan S, Kodeeswaran S, Addison T, Walsh C, Cheung A, Charles J, Sur D, Scarpitti M, Willis D, Levitt A. Transitions in mental health and addiction care for youth and their families: a scoping review of needs, barriers, and facilitators. BMC Health Serv Res 2023; 23:470. [PMID: 37165343 PMCID: PMC10171912 DOI: 10.1186/s12913-023-09430-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 04/20/2023] [Indexed: 05/12/2023] Open
Abstract
INTRODUCTION Transitional-aged youth (TAY) with mental health and/or addictions (MHA) concerns and their families experience significant challenges finding, accessing, and transitioning through needed MHA care. To develop appropriate supports that assist TAY and their families in navigating MHA care, their experiences of transitions in the MHA care system must be better understood. This scoping review identifies and explores the needs, barriers, and facilitators for TAY and their families when transitioning through MHA care. METHODS This scoping review commenced with a search of five relevant databases. Three research team members were involved in title, abstract, and full-text scanning and data extraction. Sources focusing on TAY anywhere between the ages of 12-29 years and meeting the study objectives were included. Extractions compiled background and narrative information about the nature and extent of the data. Analysis and synthesis of findings involved numerical description of the general information extracted (e.g., numbers of sources by country) and thematic analysis of narrative information extracted (e.g., family involvement in TAY help-seeking). RESULTS A total of 5894 sources were identified. Following title and abstract scanning, 1037 sources remained for full-text review. A total of 66 sources were extracted. Findings include background information about extracted sources, in addition to five themes that emerged pertaining to barriers and facilitators to access and transitions through care and the needs and roles of TAY and families in supporting help-seeking and care transitions: holistic supports, proactive preparation, empowering TAY and families, collaborative relationships, and systemic considerations. These five themes demonstrate approaches to care that can ensure TAY and families' needs are met, barriers are mitigated, and facilitators are enhanced. CONCLUSION This review provides essential contextual information regarding TAY with MHA concerns and their families' needs when seeking care. Such findings lend to an enhanced understanding of how MHA programs can support this population's needs, involve family members as appropriate, reduce the barriers experienced, and work to build upon existing facilitators.
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Affiliation(s)
- Roula Markoulakis
- Sunnybrook Research Institute, Toronto, ON, Canada.
- University of Toronto, Toronto, ON, Canada.
| | - Hinaya Cader
- Sunnybrook Research Institute, Toronto, ON, Canada
| | | | | | | | - Cathy Walsh
- Family Advisory Council, Family Navigation Project at Sunnybrook, Toronto, ON, Canada
| | - Amy Cheung
- Sunnybrook Research Institute, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Jocelyn Charles
- University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Deepy Sur
- Ontario Association of Social Work, Toronto, ON, Canada
| | | | - David Willis
- Keystone Child, Youth, and Family Services, Owen Sound, ON, Canada
| | - Anthony Levitt
- Sunnybrook Research Institute, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Eruyar S, Hunt S, O’Reilly M, Alowaybil R, Vostanis P. Responsiveness of support systems to address refugee young people’s mental health needs: Stakeholder perspectives from Turkey and the UK. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2022. [DOI: 10.1080/00207411.2022.2123697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2022]
Affiliation(s)
- Seyda Eruyar
- Department of Psychology, Necmettin Erbakan University, Konya, Turkey
| | - Sarah Hunt
- Department of Media, Communication and Sociology, University of Leicester, Leicester, UK
| | - Michelle O’Reilly
- Department of Media, Communication and Sociology, University of Leicester, Leicester, UK
| | - Reem Alowaybil
- Princess Nourah Bint Abdul Rahman University, Riyadh, Saudi Arabia
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - Panos Vostanis
- Department of Media, Communication and Sociology, University of Leicester, Leicester, UK
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Dickson KS, Sklar M, Chen SZ, Kim B. Characterization of multilevel influences of mental health care transitions: a comparative case study analysis. BMC Health Serv Res 2022; 22:437. [PMID: 35366865 PMCID: PMC8976965 DOI: 10.1186/s12913-022-07748-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 03/08/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Purpose
Mental health care transitions are increasingly prioritized given their potential to optimize care delivery and patient outcomes, especially those focused on the transition from inpatient to outpatient mental health care. However, limited efforts to date characterize such mental health transition practices, especially those spanning multiple service setting contexts. Examination of key influences of inpatient to outpatient mental health care transitions across care contexts is needed to inform ongoing and future efforts to improve mental health care transitions. The current work aims to characterize multilevel influences of mental health care transitions across three United States-based mental health system contexts.
Methods
A comparative multiple case study design was used to characterize transition practices within the literature examining children’s, non-VA adult, and VA adult service contexts. Andersen’s (1995) Behavioral Health Service Use Model was applied to identify and characterize relevant distinct and common domains of focus in care transitions across systems.
Results
Several key influences to mental health care transitions were identified spanning the environmental, individual, and health behavior domains, including: community capacity or availability, cross-system or agency collaboration, provider training and experience related to mental health care transitions, client care experience and expectations, and client clinical characteristics or complexity.
Conclusions
Synthesis illustrated several common factors across system contexts as well as unique factors for further consideration. Our findings inform key considerations and recommendations for ongoing and future efforts aiming to plan, expand, and better support mental health care transitions. These include timely information sharing, enhanced care coordination and cross setting and provider communication, continued provider/client education, and appropriate tailoring of services to improve mental health care transitions.
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Anderson JK, Newlove-Delgado T, Ford TJ. Annual Research Review: A systematic review of mental health services for emerging adults - moulding a precipice into a smooth passage. J Child Psychol Psychiatry 2022; 63:447-462. [PMID: 34939668 DOI: 10.1111/jcpp.13561] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/26/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND The transition between child and adult services should aim to support young people into the next stage of their life in a way that optimises their function. Yet financial, organisational and procedural barriers to continuity of care often hamper smooth transition between child and adult services. AIM AND METHOD We reviewed studies of transition from child to adult mental health services, focusing on: (a) rates of referrals and referral acceptance; (b) barriers and facilitators of successful transition; (c) continuity of care during and post-transition and (d) service users' experience of transition. Studies were identified through systematic searches of electronic databases: PsycINFO, Medline, Embase and Child Development and Adolescent Studies. FINDINGS Forty-seven papers describing 43 unique studies met inclusion criteria. Service provision is influenced by previous history and funding processes, and the presence or absence of strong primary care, specialist centres of excellence and coordination between specialist and primary care. Provision varies between and within countries, particularly whether services are restricted to 'core' mental health or broader needs. Unsupportive organisational culture, fragmentation of resources, skills and knowledge base undermine the collaborative working essential to optimise transition. Stigma and young people's concerns about peers' evaluation often prompt disengagement and discontinuation of care during transition, leading to worsening of symptoms and later, to service re-entry. Qualitative studies reveal that young people and families find the transition process frustrating and difficult, mainly because of lack of advanced planning and inadequate preparation. CONCLUSIONS Despite increasing research interest over the last decade, transition remains 'poorly planned, executed and experienced'. Closer collaboration between child and adult services is needed to improve the quality of provision for this vulnerable group at this sensitive period of development.
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Affiliation(s)
| | | | - Tamsin J Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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9
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Inclusive Leisure as a Resource for Socio-Educational Intervention during the COVID-19 Pandemic with Care Leavers. SUSTAINABILITY 2021. [DOI: 10.3390/su13168851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The COVID-19 pandemic has led to a reduction in leisure activities involving human contact. Social isolation has increased, particularly amongst vulnerable individuals with a fragile support network, as is the case with young people who have left care. The aim of the present research was to identify socio-educational proposals and interventions implemented during the pandemic pertaining to leisure as a form of promoting social inclusion of these young people. To this end, a qualitative study was carried out in which twenty semi-structured interviews were conducted with young people who had left care system, in addition to fifteen interviews with professionals working with this group when delivering socio-educational interventions. Discourse analysis revealed that isolation due to the health crisis had greater repercussions in normalised settings in which leisure activity was reduced with this increasing risk of social inclusion amongst these young people. Proposals and experiences emerging from this setting provide evidence that socio-educational interventions targeting leisure facilitate social inclusion. In this sense, future lines of research are suggested to optimise the outcomes of socio-educational interventions within this group.
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10
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"I'm just a long history of people rejecting referrals" experiences of young people who fell through the gap between child and adult mental health services. Eur Child Adolesc Psychiatry 2021; 30:401-413. [PMID: 32274589 PMCID: PMC8019413 DOI: 10.1007/s00787-020-01526-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 03/31/2020] [Indexed: 11/06/2022]
Abstract
The paediatric-adult split in mental health care necessitates young people to make a transition between services when they reach the upper end of child and adolescent mental health services (CAMHS). However, we know that this transition is often poor, and not all young people who require ongoing support are able to continue care in adult mental health services (AMHS). These young people are said to have fallen through the gap between services. This research aimed to explore the reasons why young people fall through the gap between CAMHS and AMHS, and what effect this has had on them and their families. Narrative interviews were conducted with 15 young people and 15 parents, representing 19 unique transition stories. Themes were identified collaboratively using thematic analysis. Reasons for falling through the gap were grouped into systemic problems and problems with the quality of care received. Effects of falling through the gap were grouped into separate themes for young people (feeling abandoned; struggling to manage without continued care; problems with medication) and parents (emotional impact of care ending; parents taking an active role in the young person's care). To our knowledge, this is the first qualitative study that has focused only on the experiences of young people who have fallen through the gap between services. This research adds novel findings to existing literature regarding barriers to transition and the effects of discontinuity of care.
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11
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Time Management by Young People in Social Difficulties: Suggestions for Improving Their Life Trajectories. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17239070. [PMID: 33291775 PMCID: PMC7729922 DOI: 10.3390/ijerph17239070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 11/27/2020] [Accepted: 12/02/2020] [Indexed: 12/29/2022]
Abstract
This article covers the responses provided by professional practitioners in socio-educational intervention who are responsible for young people in social difficulties, in other words those facing personal and social issues that stop them from leading a normal life. It considers their suggestions for helping young people to better their lives by becoming autonomous, as well as to manage and use their time in their transition to adulthood. A qualitative study was conducted that used an open, ad-hoc questionnaire administered to thirty participants (Madrid, Spain), in which the data analysis involved MAXQDA Analytics Pro 2020 software. The results identify suggestions at macrosocial level targeting the system, legal status, therapy, safety nets, education and the range and provision of social services. On another level, suggestions for improvement were identified in an immediate setting in which the young people interact with agencies, practitioners and counsellors. An initial level featured mostly statements of support for autonomy from the system and social services. The second level contained mainly suggestions for agencies, centres and social services. The conclusion is that there are implications at different levels of social ecology according to Bronfenbrenner’s model (1994). The practical suggestions for young people’s self-sufficiency in the use and management of their time should therefore be flexible, linked and cater for their more therapeutic needs through to their leisure time.
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12
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Almquist YB, Rojas Y, Vinnerljung B, Brännström L. Association of Child Placement in Out-of-Home Care With Trajectories of Hospitalization Because of Suicide Attempts From Early to Late Adulthood. JAMA Netw Open 2020; 3:e206639. [PMID: 32484554 PMCID: PMC7267851 DOI: 10.1001/jamanetworkopen.2020.6639] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 03/21/2020] [Indexed: 11/15/2022] Open
Abstract
Importance Children placed in out-of-home care (OHC) have higher rates of suicidal behaviors, including suicide attempts, compared with those who grow up in their family of origin. Several studies have shown that this elevated risk persists into young adulthood. Yet, our knowledge about any longer-term associations of OHC with suicide attempts is limited. Objective To examine how childhood experiences of placement in OHC are associated with trajectories of hospitalization because of suicide attempts (HSA) from early into late adulthood. Design, Setting, and Participants This prospective birth cohort study that was conducted in Stockholm, Sweden, and analyzed in March 2020 included 14 559 individuals born in 1953 who were living in the greater metropolitan of Stockholm in November 1963 and followed through registers up until December 2016. Exposures Childhood experiences of OHC based on information from the Social Register (age 0-19 years). Main Outcomes and Measures Hospitalization because of suicide attempts based on in-patient care data from the National Patient Register. Group-based trajectory modeling was used to cluster individuals according to their probabilities of HSA across adulthood (age 20-63 years). Results In this cohort of 14 559 individuals (7146 women [49.1%]), 1320 individuals (9.1%) had childhood experiences of OHC, whereas 525 individuals ( 3.6%) had HSA. A Cox regression analysis showed a substantially higher risk of HSA among those with childhood experiences of OHC (hazard ratio, 3.58; 95% CI, 2.93-4.36) and after adjusting for a range of adverse childhood living conditions (hazard ratio, 2.51; 95% CI, 2.00-3.15). Those with at least 1 HSA were grouped into 4 trajectories: (1) peak in middle adulthood (66 [12.6%]), (2) stable low across adulthood (167 [31.8%]), (3) peak in early adulthood (210 [40.0%]), and (4) peak in emerging adulthood (82 [15.6%]). A multinomial regression analysis suggested that those with experiences of OHC had higher risks of following any of these trajectories (trajectory 1: relative risk ratio [RRR], 2.91; 95% CI, 1.61-5.26; trajectory 2: RRR, 3.18; 95% CI, 2.21-4.59; trajectory 3: RRR, 4.32; 95% CI, 3.18-5.86; trajectory 4: RRR, 3.26; 95% CI, 1.94-5.46). The estimates were reduced after adjusting for adverse childhood living conditions. Conclusions and Relevance The findings suggest that the elevated risk of suicide attempts among former child welfare clients does not cease after young adulthood, indicating the necessity for clinical attention to childhood experiences of OHC as a risk marker for suicidal behavior across the life span.
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Affiliation(s)
- Ylva B. Almquist
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
| | - Yerko Rojas
- Södertörn University School of Social Sciences, Huddinge, Sweden
| | - Bo Vinnerljung
- Department of Social Work, Stockholm University, Stockholm, Sweden
| | - Lars Brännström
- Department of Social Work, Stockholm University, Stockholm, Sweden
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Mensah T, Hjern A, Håkanson K, Johansson P, Jonsson AK, Mattsson T, Tranæus S, Vinnerljung B, Östlund P, Klingberg G. Organisational models of health services for children and adolescents in out-of-home care: Health technology assessment. Acta Paediatr 2020; 109:250-257. [PMID: 31483896 PMCID: PMC7003841 DOI: 10.1111/apa.15002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 08/13/2019] [Accepted: 09/03/2019] [Indexed: 01/08/2023]
Abstract
AIM Decades of research confirm that children and adolescents in out-of-home care (foster family, residential care) have much greater health care needs than their peers. A systematic literature review was conducted to evaluate organisational health care models for this vulnerable group. METHODS A systematic literature search was undertaken of the following databases: Academic Search Elite, CENTRAL, Cochrane Database of Systematic Reviews, Cinahl, DARE, ERIC, HTA, PsycInfo, Psychology and Behavioural Sciences Collection, PubMed, SocIndex. Randomised and non-randomised controlled trials were to be included. Two pairs of reviewers independently assessed abstracts of the identified published papers. Abstracts meeting the inclusion criteria were ordered in full text. Each article was reviewed independently, by pairs of reviewers. A joint assessment was made based on the inclusion criteria and relevance. Cases of disagreement were resolved by consensus discussion. RESULTS No study with low or medium risk of bias was identified. CONCLUSION In the absence of studies of acceptable quality, it is not possible to assess the impact of organisational models intended to ensure adequate health and dental care for children and adolescents in out-of-home care. Therefore, well-designed follow-up studies should be conducted following the implementation of such models.
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Affiliation(s)
- Tita Mensah
- Faculty of OdontologyMalmö UniversityMalmöSweden
- The Clinic of Paediatric DentistryKarlstadSweden
| | - Anders Hjern
- Clinical EpidemiologyDepartment of MedicineKarolinska InstitutetStockholmSweden
- Centre for Health Equity Studies (CHESS)StockholmSweden
| | - Kickan Håkanson
- Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU)StockholmSweden
| | - Pia Johansson
- Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU)StockholmSweden
- Public Health & EconomicsHuddingeSweden
| | - Ann Kristine Jonsson
- Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU)StockholmSweden
| | - Titti Mattsson
- Faculty of LawHealth Law Research CentreLund UniversityLundSweden
| | - Sofia Tranæus
- Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU)StockholmSweden
- Health Technology Assessment–Odontology (HTA‐O)Faculty of OdontologyMalmö UniversityMalmöSweden
- Department of Dental MedicineKarolinska InstitutetStockholmSweden
| | - Bo Vinnerljung
- Department of Social WorkStockholm UniversityStockholmSweden
| | - Pernilla Östlund
- Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU)StockholmSweden
- Health Technology Assessment–Odontology (HTA‐O)Faculty of OdontologyMalmö UniversityMalmöSweden
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Eklund H, Findon J, Cadman T, Hayward H, Murphy D, Asherson P, Glaser K, Xenitidis K. Needs of Adolescents and Young Adults with Neurodevelopmental Disorders: Comparisons of Young People and Parent Perspectives. J Autism Dev Disord 2018; 48:83-91. [PMID: 28894999 PMCID: PMC5760588 DOI: 10.1007/s10803-017-3295-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
This study used the Camberwell Assessment of Need for adults with Developmental and Intellectual Disabilities (CANDID) to examine the social, physical health and mental health needs of 168 young people (aged 14-24 years) with neurodevelopmental disorders and compared young person and parent ratings of need. Agreement was poor in 21 out of 25 domains. Parents consistently reported higher levels of need than young people in the majority of domains although young people with ADHD reported significantly more needs in physical health, eyesight/hearing, seizures, other mental health problems and safety of others than their parents. Both parent and young person perspectives of needs are necessary to ensure that needs that are predictive of current or future poor outcomes are not missed.
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Affiliation(s)
- Hanna Eklund
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.
| | - James Findon
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Tim Cadman
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Hannah Hayward
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Declan Murphy
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Philip Asherson
- MRC Social Genetic and Developmental Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
| | - Karen Glaser
- Department of Social Sciences, Health and Medicine, Institute of Gerontology, King's College London, Strand, London, WC2R 2LS, UK
| | - Kiriakos Xenitidis
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK
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