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Hiller RM, Meiser-Stedman R, Elliott E, Banting R, Halligan SL. A longitudinal study of cognitive predictors of (complex) post-traumatic stress in young people in out-of-home care. J Child Psychol Psychiatry 2021; 62:48-57. [PMID: 32196661 DOI: 10.1111/jcpp.13232] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Young people in out-of-home care are substantially more likely to meet criteria for PTSD than their peers, while their early maltreatment exposure may also place them at greater risk of developing the newly proposed complex PTSD. Yet, there remains limited empirical evidence for the mechanisms that might drive either PTSD or complex features in this group, and ongoing debate about the suitability of existing cognitive behavioural models and their related NICE-recommended treatments. In a prospective study of young people in out-of-home care, we sought to identify demographic and cognitive processes that may contribute to the maintenance of both PTSD symptom and complex features. METHODS We assessed 120 10- to 18-year-olds in out-of-home care and their primary carer at two assessments: an initial assessment and 12-month follow-up. Participants completed questionnaires on trauma history, PTSD symptoms and complex features, while young people only also self-reported on trauma-related (a) maladaptive appraisals, (b) memory quality and (c) coping. Social workers reported on maltreatment severity. RESULTS Young people's maltreatment severity was not a robust predictor of either PTSD symptoms or complex features. All three cognitive processes were moderately-to-strongly correlated with baseline and 12-month PTSD symptoms and complex features, with maladaptive appraisals the most robust unique driver of both, even when controlling for initial PTSD symptom severity. CONCLUSIONS Existing cognitive models of PTSD are applicable in this more complex sample of young people. The model was also found to be applicable to the additional features of complex PTSD, with the same processes driving both outcomes at both time points. Clinical implications are discussed.
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Affiliation(s)
| | - Richard Meiser-Stedman
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Rosie Banting
- Department of Psychology, University of Bath, Bath, UK
| | - Sarah L Halligan
- Department of Psychology, University of Bath, Bath, UK.,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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2
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Holland J, Sayal K, Berry A, Sawyer C, Majumder P, Vostanis P, Armstrong M, Harroe C, Clarke D, Townsend E. What do young people who self-harm find helpful? A comparative study of young people with and without experience of being looked after in care. Child Adolesc Ment Health 2020; 25:157-164. [PMID: 32542877 DOI: 10.1111/camh.12384] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 02/18/2020] [Accepted: 02/28/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Self-harm amongst young people is an increasing problem, with looked-after young people at higher risk. Despite this, little research exists on what young people who self-harm find helpful. METHOD One hundred and twenty-six 11-21 year olds (53 who had experience of the care system and 73 who did not) were recruited from the community and NHS. All participants had self-harmed in the past 6 months. Participants completed an Audio Computer-Assisted Self-interview (ACASI) regarding their views about the support they had received, how helpful it was, and what further help they felt they needed. RESULTS Looked-after young people reported the three most helpful sources of support were Child and Adolescent Mental Health Services (CAMHS), friends and pets and the least helpful were CAMHS, Accident and Emergency (A&E) and Social services. For non-looked-after young people, CAMHS, counselling and Harmless (user-led support service for self-harm) were most helpful and CAMHS, cognitive behavioural therapy (CBT) and general practitioner (GP) were the least. Compared with the other group, more looked-after young people had received help from A&E and CAMHS, whereas more non-looked-after young people had accessed GPs, parents, psychological therapies, self-help books and websites. More looked-after young people found support groups helpful, and more non-looked-after young people reported that distraction techniques, medication and their siblings were helpful. CONCLUSION Young people who self-harm have mixed views about CAMHS. Differences in the pattern of access and preferences for support between looked-after and non-looked-after young people should be reflected in service availability and commissioning. KEY PRACTITIONER MESSAGE Little is known about what young people who self-harm find helpful, particularly for looked-after young people. CAMHS was named amongst the most helpful and the least helpful services by both looked-after and non-looked-after young people. Social services and A&E were frequently cited amongst the least helpful sources of support. Young people report finding informal support helpful, including family and friends. There appears to be a need for explorations of the reasons behind the apparent negative perception of statutory services in young people, and what is required to shift that.
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Affiliation(s)
- Josephine Holland
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK.,CANDAL (Centre for ADHD and Neurodevelopmental Disorders across the Lifespan), Institute of Mental Health, Nottingham, UK
| | - Kapil Sayal
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK.,CANDAL (Centre for ADHD and Neurodevelopmental Disorders across the Lifespan), Institute of Mental Health, Nottingham, UK
| | - Alexandra Berry
- Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham, UK
| | - Chelsea Sawyer
- Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham, UK
| | - Pallab Majumder
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Panos Vostanis
- Department of Neurosciences, Psychology and Behaviour, University of Leicester, Leicester, UK
| | - Marie Armstrong
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | | | - David Clarke
- Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham, UK
| | - Ellen Townsend
- Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham, UK
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3
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Hillman S, Cross R, Anderson K. Exploring Attachment and Internal Representations in Looked-After Children. Front Psychol 2020; 11:464. [PMID: 32265787 PMCID: PMC7096589 DOI: 10.3389/fpsyg.2020.00464] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 02/27/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This article explores the Story Stem Assessment Profile (SSAP), a narrative-based measure, for the assessment of internal representations in children between the ages of 4 and 11 years old. METHODS The findings draw upon two samples of children comprising of a sample of looked-after children at Five Rivers Child Care (FR) (n = 42) and a community-based population (n = 42). The FR group identified were suggested to have a higher level of need, as defined by scores obtained from the Strengths and Difficulties Questionnaire (SDQ) and Relationship Problems Questionnaire (RPQ). RESULTS Using the SSAP, the findings indicate the instrument's discriminant validity with strong differences being displayed between the two populations. Consistently children in the FR sample displayed more disorganized, avoidant and negative representations, whilst at the same time having significantly fewer representations characteristic of 'secure' attachment. CONCLUSION The SSAP is successful in differentiating between 'low' and 'high' cohorts of children aged 4-11 years. The study provides strong support for the measure as a way of capturing internal and attachment representations, with further research to explore possible changes in these representations at follow-up being promising and intriguing. Continued research efforts at FR will allow for improved clinical formulations, increased understanding and therefore positive outcomes relating to the children in their care.
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Affiliation(s)
- Saul Hillman
- The Anna Freud National Centre for Children and Families, Kantor Centre of Excellence, London, United Kingdom
| | - Richard Cross
- Assessment and Therapy, Five Rivers Child Care Limited, Salisbury, United Kingdom
| | - Katharine Anderson
- Assessment and Therapy, Five Rivers Child Care Limited, Salisbury, United Kingdom
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4
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Said G, King D. Implementing Narrative Exposure Therapy for unaccompanied asylum-seeking minors with post-traumatic stress disorder: A pilot feasibility report. Clin Child Psychol Psychiatry 2020; 25:213-226. [PMID: 31315450 DOI: 10.1177/1359104519864123] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There are high rates of post-traumatic stress disorder (PTSD) in unaccompanied asylum-seeking minors (UAM) and there is a requirement for feasible, acceptable and evidence-based treatments. Narrative Exposure Therapy (NET) is a short-term treatment for PTSD following multiple traumatic events. This article aims to examine the applicability of NET for UAM in routine clinical practice and to provide preliminary feasibility, acceptability and effectiveness data. The participants were four UAM receiving NET within a dedicated child and adolescent mental health service for refugee children. Semi-structured interviews were conducted to understand the acceptability of this approach and standardised measures of PTSD were used to provide preliminary data regarding the effectiveness of NET for these clients. The clients attended NET consistently with few missed appointments. At post-treatment, two clients' symptom scores were below the clinical cut-off for PTSD and all three clients who completed NET met reliable improvement criteria. The clients reported improvements in functional outcomes and mentioned that they would encourage other young people with similar difficulties to engage in NET. This study was limited by the small sample size and naturalistic time limitations in clinicians' contracts. This article highlights that it is possible to implement NET within routine clinical practice and observed improvements in PTSD symptoms and functional outcomes for UAM.
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Affiliation(s)
- Glorianne Said
- Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Dorothy King
- Berkshire Traumatic Stress Service, Berkshire Healthcare NHS Foundation Trust, UK
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5
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Nixon C, Elliott L, Henderson M. Providing sex and relationships education for looked-after children: a qualitative exploration of how personal and institutional factors promote or limit the experience of role ambiguity, conflict and overload among caregivers. BMJ Open 2019; 9:e025075. [PMID: 30975674 PMCID: PMC6500194 DOI: 10.1136/bmjopen-2018-025075] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 02/05/2019] [Accepted: 03/05/2019] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To explore how personal and institutional factors promote or limit caregivers promoting sexual health and relationships (SHR) among looked-after children (LAC). In so doing, develop existing research dominated by atheoretical accounts of the facilitators and barriers of SHR promotion in care settings. DESIGN Qualitative semistructured interview study. SETTING UK social services, residential children's homes and foster care. PARTICIPANTS 22 caregivers of LAC, including 9 foster carers, 8 residential carers and 5 social workers; half of whom had received SHR training. METHODS In-depth interviews explored barriers/facilitators to SHR discussions, and how these shaped caregivers' experiences of discussing SHR with LAC. Data were systematically analysed using predetermined research questions and themes identified from reading transcripts. Role theory was used to explore caregivers' understanding of their role. RESULTS SHR policies clarified role expectations and increased acceptability of discussing SHR. Training increased knowledge and confidence, and supported caregivers to reflect on how personally held values impacted practice. Identified training gaps were how to: (1) Discuss SHR with LAC demonstrating problematic sexual behaviours. (2) Record the SHR discussions that had occurred in LAC's health plans. Contrary to previous findings, caregivers regularly discussed SHR with LAC. Competing demands on time resulted in prioritisation of discussions for sexually active LAC and those 'at risk' of sexual exploitation/harm. Interagency working addressed gaps in SHR provision. SHR discussions placed emotional burdens on caregivers. Caregivers worried about allegations being made against them by LAC. Managerial/pastoral support and 'safe care' procedures minimised these harms. CONCLUSIONS While acknowledging the existing level of SHR promotion for LAC there is scope to more firmly embed this into the role of caregivers. Care needs to be taken to avoid role ambiguity and tension when doing so. Providing SHR policies and training, promoting interagency working and providing pastoral support are important steps towards achieving this.
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Affiliation(s)
- Catherine Nixon
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Lawrie Elliott
- Department of Nursing and Community Health, Glasgow Caledonian University, Glasgow, UK
| | - Marion Henderson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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6
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Raman S, Ruston S, Irwin S, Tran P, Hotton P, Thorne S. Taking culture seriously: Can we improve the developmental health and well-being of Australian Aboriginal children in out-of-home care? Child Care Health Dev 2017; 43:899-905. [PMID: 28736897 DOI: 10.1111/cch.12488] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 06/19/2017] [Accepted: 06/22/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Children in out-of-home care have well-documented health and developmental needs. Research suggests that Aboriginal children in care have unmet health and intervention needs. In metropolitan Sydney, Kari Aboriginal Resources Inc. (KARI), an Aboriginal organization, provides support to indigenous children in care, including clinical assessment and intervention. We wanted to determine the health and developmental needs of a subset of children in out-of-home care with KARI, who had been in stable care for at least a year. We wanted to identify child, carer, and intervention characteristics that contributed to children doing well. We also wanted to identify enablers and barriers to providing culturally competent intervention. METHODS We used mixed methods. From the KARI clinic database over the past 3 years, we identified children who had been in stable care with KARI for >12 months. We compared clinical measures and outcomes for these children with results from previous audits. We carried out a group discussion and key informant interviews with therapists and caseworkers to identify risk and resilience factors for each child, as well as enablers and barriers to culturally competent intervention. RESULTS The health and developmental profile of the 26 children identified as being in stable care was similar to that of previous audits. Most (88%) were getting speech pathology intervention; one third were getting occupational therapy and psychological intervention; most children and their carers attended cultural programmes. The majority of children (25/26) improved in their developmental health. Caseworkers and therapists identified risk and resilience factors related to child, carer, and home characteristics. They also identified elements of good practice; systemic issues prevented some interventions from being carried out. CONCLUSIONS There are challenges delivering a trauma-informed, culturally respectful service to Aboriginal children in out-of-home care in an urban setting, but it can be done if attention is paid to culture and the enablers and barriers are identified.
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Affiliation(s)
- S Raman
- Department of Community Paediatrics, South Western Sydney Local Health District, Liverpool, NSW, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, NSW, Australia
| | - S Ruston
- Kari Aboriginal Resources Inc., Liverpool, NSW, Australia.,Allied Health Department, Liverpool Hospital, Liverpool, NSW, Australia
| | - S Irwin
- Kari Aboriginal Resources Inc., Liverpool, NSW, Australia
| | - P Tran
- Kari Aboriginal Resources Inc., Liverpool, NSW, Australia.,Allied Health Department, Liverpool Hospital, Liverpool, NSW, Australia
| | - P Hotton
- Child Protection Unit, Sydney Children's Hospital, Randwick, NSW, Australia
| | - S Thorne
- Kari Aboriginal Resources Inc., Liverpool, NSW, Australia
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7
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Butterworth S, Singh SP, Birchwood M, Islam Z, Munro ER, Vostanis P, Paul M, Khan A, Simkiss D. Transitioning care-leavers with mental health needs: 'they set you up to fail!'. Child Adolesc Ment Health 2017; 22:138-147. [PMID: 32680381 DOI: 10.1111/camh.12171] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/14/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Children in the UK care system often face multiple disadvantages in terms of health, education and future employment. This is especially true of mental health where they present with greater mental health needs than other children. Although transition from care - the process of leaving the local authority as a child-in-care to independence - is a key juncture for young people, it is often experienced negatively with inconsistency in care and exacerbation of existing mental illness. Those receiving support from child and adolescent mental health services (CAMHS), often experience an additional, concurrent transfer to adult services (AMHS), which are guided by different service models which can create a care gap between services. METHOD This qualitative study explored care-leavers' experiences of mental illness, and transition in social care and mental health services. Twelve care-leavers with mental health needs were interviewed and data analysed using framework analysis. RESULTS Sixteen individual themes were grouped into four superordinate themes: overarching attitudes towards the care journey, experience of social care, experience of mental health services and recommendations. CONCLUSIONS Existing social care and mental health teams can improve the care of care-leavers navigating multiple personal, practical and service transitions. Recommendations include effective Pathway Planning, multiagency coordination, and stating who is responsible for mental health care and its coordination. Participants asked that youth mental health services span the social care transition; and provide continuity of mental health provision when care-leavers are at risk of feeling abandoned and isolated, suffering deteriorating mental health and struggling to establish new relationships with professionals. Young people say that the key to successful transition and achieving independence is maintaining trust and support from services.
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Affiliation(s)
- Sarah Butterworth
- Research and Innovation, Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK
| | - Swaran P Singh
- Research and Innovation, Birmingham and Solihull Mental Health Foundation Trust, Birmingham, UK.,Department of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Max Birchwood
- Department of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Zoebia Islam
- Department of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK.,LOROS, Hospice Care for Leicestershire and Rutland, Groby Road, Leicester, UK
| | - Emily R Munro
- Thomas Coram Research Unit, UCL Institute of Education, University College London, London, UK
| | - Panos Vostanis
- Leicester Medical School, University of Leicester, Leicester, UK
| | - Moli Paul
- Department of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Alia Khan
- Children in Care Council, Birmingham City Council, Birmingham, UK
| | - Douglas Simkiss
- Department of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK.,Children and Families Division, Moseley Hall Hospital, Alcester Road, Moseley, Birmingham, UK
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8
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Wadman R, Clarke D, Sayal K, Armstrong M, Harroe C, Majumder P, Vostanis P, Townsend E. A sequence analysis of patterns in self-harm in young people with and without experience of being looked after in care. Br J Clin Psychol 2017; 56:388-407. [PMID: 28593633 DOI: 10.1111/bjc.12145] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 05/05/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Young people in the public care system ('looked-after' young people) have high levels of self-harm. DESIGN This paper reports the first detailed study of factors leading to self-harm over time in looked-after young people in England, using sequence analyses of the Card Sort Task for Self-harm (CaTS). METHODS Young people in care (looked-after group: n = 24; 14-21 years) and young people who had never been in care (contrast group: n = 21; 13-21 years) completed the CaTS, describing sequences of factors leading to their first and most recent episodes of self-harm. Lag sequential analysis determined patterns of significant transitions between factors (thoughts, feelings, behaviours, events) leading to self-harm across 6 months. RESULTS Young people in care reported feeling better immediately following their first episode of self-harm. However, fearlessness of death, impulsivity, and access to means were reported most proximal to recent self-harm. Although difficult negative emotions were salient to self-harm sequences in both groups, young people with no experience of being in care reported a greater range of negative emotions and transitions between them. For the contrast group, feelings of depression and sadness were a significant starting point of the self-harm sequence 6 months prior to most recent self-harm. CONCLUSIONS Sequences of factors leading to self-harm can change and evolve over time, so regular monitoring and assessment of each self-harm episode are needed. Support around easing and dealing with emotional distress is required. Restricting access to means to carry out potentially fatal self-harm attempts, particularly for the young persons with experience of being in care, is recommended. PRACTITIONER POINTS Self-harm (and factors associated with self-harm) can change and evolve over time; assessments need to reflect this. Looked-after young people reported feeling better after first self-harm; fearlessness of death, access to means, and impulsivity were reported as key in recent self-harm. Underlying emotional distress, particularly depression and self-hatred were important in both first and most recent self-harm. Looked-after young people should undergo regular monitoring and assessment of each self-harm episode and access to potentially fatal means should be restricted. The CaTS would have clinical utility as an assessment tool Recruiting participants can be a significant challenge in studies with looked-after children and young people. Future research with larger clinical samples would be valuable.
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Affiliation(s)
- Ruth Wadman
- School of Psychology, The University of Nottingham, UK
| | - David Clarke
- School of Psychology, The University of Nottingham, UK
| | - Kapil Sayal
- Division of Psychiatry & Applied Psychology, School of Medicine, University of Nottingham, UK
| | - Marie Armstrong
- Child and Adolescent Mental Health Service, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | | | - Pallab Majumder
- Child and Adolescent Mental Health Service, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
| | - Panos Vostanis
- School of Neuroscience, Psychology and Behavior, Centre for Medicine, University of Leicester, UK
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9
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Liabo K, McKenna C, Ingold A, Roberts H. Leaving foster or residential care: a participatory study of care leavers' experiences of health and social care transitions. Child Care Health Dev 2017; 43:182-191. [PMID: 27896832 DOI: 10.1111/cch.12426] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 09/05/2016] [Accepted: 10/10/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Young people in residential or foster care experience multiple transitions around their 18th birthday without the long term and consistent support from their family of origin that most of their peers can expect. We report a mixed methods qualitative study of transitions across health and social care services for children leaving care, providing narratives of what young people described as positive, and what they and professionals think might be improved. METHODS Data were collected in participatory meetings and individual interviews between young people and researchers (n = 24) and individual interviews with practitioners (n = 11). In addition to discussion and interview techniques, we used pictorial and other participatory methods. Interviews were coded by three members of the team and differences resolved with a fourth. Our analysis draws on thematic and framework approaches. RESULTS Health was rarely at the top of any young person's agenda, although gaps in health care and exceptional care were both described. Housing, financial support and education took priority. Young people and professionals alike emphasized the importance of workers prepared to go the extra mile; of young people being able to contact professionals; and professionals being able to contact one another. CONCLUSIONS Policy and practice aspirations for care leavers recommend gradual change but transfer rather than transition continues to be described by care leavers. Our data support the need for transition as a long-term process, with children and young people having early opportunities to prepare for citizenship.
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Affiliation(s)
- K Liabo
- University of Exeter Medical School, Exeter, UK
| | - C McKenna
- Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, London, UK
| | | | - H Roberts
- Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health, London, UK
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10
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O'Hare L, Santin O, Winter K, McGuinness C. The reliability and validity of a child and adolescent participation in decision-making questionnaire. Child Care Health Dev 2016; 42:692-8. [PMID: 27345443 DOI: 10.1111/cch.12369] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 05/22/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is a growing impetus across the research, policy and practice communities for children and young people to participate in decisions that affect their lives. Furthermore, there is a dearth of general instruments that measure children and young people's views on their participation in decision-making. This paper presents the reliability and validity of the Child and Adolescent Participation in Decision-Making Questionnaire (CAP-DMQ) and specifically looks at a population of looked-after children, where a lack of participation in decision-making is an acute issue. METHODS The participants were 151 looked after children and adolescents between 10-23 years of age who completed the 10 item CAP-DMQ. Of the participants 113 were in receipt of an advocacy service that had an aim of increasing participation in decision-making with the remaining participants not having received this service. RESULTS The results showed that the CAP-DMQ had good reliability (Cronbach's alpha = 0.94) and showed promising uni-dimensional construct validity through an exploratory factor analysis. The items in the CAP-DMQ also demonstrated good content validity by overlapping with prominent models of child and adolescent participation (Lundy 2007) and decision-making (Halpern 2014). A regression analysis showed that age and gender were not significant predictors of CAP-DMQ scores but receipt of advocacy was a significant predictor of scores (effect size d = 0.88), thus showing appropriate discriminant criterion validity. CONCLUSION Overall, the CAP-DMQ showed good reliability and validity. Therefore, the measure has excellent promise for theoretical investigation in the area of child and adolescent participation in decision-making and equally shows empirical promise for use as a measure in evaluating services, which have increasing the participation of children and adolescents in decision-making as an intended outcome.
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Affiliation(s)
- L O'Hare
- School of Education, Queen's University Belfast, Belfast, Northern Ireland
| | - O Santin
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland
| | - K Winter
- School of Sociology, Social Policy and Social Work, Queen's University Belfast, Belfast, Northern Ireland
| | - C McGuinness
- School of Education, Queen's University Belfast, Belfast, Northern Ireland
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11
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Huddlestone L, Pritchard C, Ratschen E. Smoking and Looked-After Children: A Mixed-Methods Study of Policy, Practice, and Perceptions Relating to Tobacco Use in Residential Units. Int J Environ Res Public Health 2016; 13:ijerph13060593. [PMID: 27314373 PMCID: PMC4924050 DOI: 10.3390/ijerph13060593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 06/06/2016] [Accepted: 06/07/2016] [Indexed: 11/30/2022]
Abstract
Despite the implementation of smoke-free policies by local authorities and a statutory requirement to promote the health and well-being of looked-after children and young people in England, rates of tobacco use by this population are substantially higher than in the general youth population. A mixed-methods study, comprising a survey of residential care officers in 15 local authority-operated residential units and semi-structured, face-to-face interviews with residential carers in three local authority-operated residential units, was conducted in the East Midlands. Survey data were descriptively analysed; and interview data were transcribed and analysed using thematic framework analysis. Forty-two care officers (18% response rate) completed the survey, and 14 participated in the interviews. Despite reporting substantial awareness of smoke-free policies, a lack of adherence and enforcement became apparent, and levels of reported training in relation to smoking and smoking cessation were low (21%). Potential problems relating to wider tobacco-related harms, such as exploitative relationships; a reliance on tacit knowledge; and pessimistic attitudes towards LAC quitting smoking, were indicated. The findings highlight the need for the development of comprehensive strategies to promote adherence to and enforcement of local smoke-free policy within residential units for looked-after children and young people, and to ensure appropriate support pathways are in place for this population.
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Affiliation(s)
- Lisa Huddlestone
- UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology & Public Health, University of Nottingham, Nottingham NG5 1PB, UK.
| | - Catherine Pritchard
- UK Centre for Tobacco and Alcohol Studies, Division of Epidemiology & Public Health, University of Nottingham, Nottingham NG5 1PB, UK.
| | - Elena Ratschen
- Department of Health Sciences, University of York, York YO10 5DD, UK.
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Memarzia J, St Clair MC, Owens M, Goodyer IM, Dunn VJ. Adolescents leaving mental health or social care services: predictors of mental health and psychosocial outcomes one year later. BMC Health Serv Res 2015; 15:185. [PMID: 25934411 PMCID: PMC4494644 DOI: 10.1186/s12913-015-0853-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Accepted: 04/27/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND UK service structure necessitates a transition out of youth services at a time of increased risk for the development and onset of mental disorders. Little is currently known about the mental health and psychosocial outcomes of leaving services at this time. The aim of this study was to determine predictors of mental health and social adjustment in adolescents leaving mental health or social care services. METHODS A cohort (n = 53) of 17 year olds were interviewed and assessed when preparing to leave adolescent services and again 12 months later. Their mental health and psychosocial characteristics were compared to a same-age community sample group (n = 1074). RESULTS At discharge 34 (64%) met DSM IV criteria for a current psychiatric diagnosis and only 3 (6%) participants met operational criteria for successful outcomes at follow-up. Impairments in mental health, lack of employment, education or training and low preparedness were associated with poor outcomes. CONCLUSIONS The findings suggest the current organisation of mental health and care services may not be fit for purpose and even unwittingly contribute to persistent mental illness and poor psychosocial outcomes. A redesign of services should consider a model where the timing of transition does not fall at the most hazardous time for young people, but is sufficiently flexible to allow young people to move on when they are personally, socially and psychologically most able to succeed. Assessment of a young person's readiness to transition might also be useful. A youth focused service across the adolescent and early adult years may be better placed to avoid young people falling through the service gap created by poor transitional management.
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Affiliation(s)
- Jessica Memarzia
- Developmental Lifecourse Research Group, Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, Cambridge, CB2 8AH, England.
- NIHR CLAHRC East of England (EoE), Douglas House, 18b Trumpington Road, Cambridge, CB2 8AH, England.
| | - Michelle C St Clair
- Developmental Lifecourse Research Group, Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, Cambridge, CB2 8AH, England.
- Department of Psychology, University of Bath, Bath, BA2 7AY, England.
| | - Matt Owens
- Developmental Lifecourse Research Group, Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, Cambridge, CB2 8AH, England.
- Mood Disorders Centre, Psychology, University of Exeter, Exeter, UK.
| | - Ian M Goodyer
- Developmental Lifecourse Research Group, Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, Cambridge, CB2 8AH, England.
| | - Valerie J Dunn
- Developmental Lifecourse Research Group, Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, Cambridge, CB2 8AH, England.
- NIHR CLAHRC East of England (EoE), Douglas House, 18b Trumpington Road, Cambridge, CB2 8AH, England.
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Ingley-Cook G, Dobel-Ober D. Innovations in Practice: group work with children who are in care or who are adopted: lessons learnt. Child Adolesc Ment Health 2013; 18:251-254. [PMID: 32847300 DOI: 10.1111/j.1475-3588.2012.00683.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/11/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is limited evidence on effective group interventions for looked-after and adopted children. A specialist Children and Adolescent Mental Health Service (CAMHS) developed and evaluated a group intervention based on Mentalisation-based therapy (MBT). METHOD Data was collected through semi-structured interviews with all young people before and after the programme. Additional information was collected from the facilitators' reflective diaries. The study aimed to evaluate the impact and applicability of a Mentalisation-based group programme on looked-after and adopted children. RESULTS Feedback from the young people indicated that the intervention had a positive impact on the young people. CONCLUSIONS Having a chance to meet other young people in similar circumstances, sharing experiences and making connections were the greatest benefits gained from the group.
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Affiliation(s)
- Germaine Ingley-Cook
- Sustain, Ground Floor Suite 6, Anson Court, Horninglow Street, Burton-on-Trent, Staffordshire, DE14 1NH, UK
| | - David Dobel-Ober
- Research and Development, South Staffordshire and Shropshire NHS Foundation Trust, Trust Headquarters, St. Georges Hospital, Corporation Street, Stafford, Staffordshire, ST16 3SR, UK
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Abstract
BACKGROUND AND SCOPE The focus of this review is on institutionalized children, one of the most inequitably and severely treated groups of children. Although institutions vary, many share some common characteristics, including large groups, high children: caregiver ratios, many and changing caregivers, and caregiver-child interactions that lack warm, sensitive, contingently-responsive, and child-directed behaviors. Resident children develop poorly physically, mentally, and social-emotionally, but those adopted from institutions display substantial catch-up growth in many domains of development. If they are adopted at an early age, there have been no long-term consequences of institutionalization yet measured; but if institutionalization is prolonged, they display higher rates of long-term deficiencies and problems in many domains. METHODS This review is based on a database search of the literature, focusing on the development of children while residents, and the development of post-institutionalized children who have been transitioned from institutions to family care. It also draws on the reports and findings of the St. Petersburg-USA Orphanage Intervention. FINDINGS A combination of theories pertaining to attachment (especially caregiver attachment to the infant/toddler), chronic stress, and genetics may explain these outcomes. It appears that caregiver-child interactions are a major contributor to children's outcomes, and interventions in institutions that improve such interactions produce substantial increases in children's physical, mental, and social-emotional development, including for children with disabilities. CONCLUSIONS Deinstitutionalization and the creation of comprehensive professional child welfare systems emphasizing family care alternatives is a preferred goal, but this is likely to take many low-resource countries decades to develop. If substantial numbers of children remain in institutions despite best efforts to find families for them, improving the institutions might help to provide all the children with the best care possible under the circumstances.
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Affiliation(s)
- Robert B. McCall
- University of Pittsburgh, Office of Child Development, 400 Lexington Avenue, Pittsburgh, PN 15108, USA
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