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Young S. Debate: Involuntary treatment and detention are a necessary part of mental health care for children and young people - a perspective from an Independent Advocate in England, United Kingdom. Child Adolesc Ment Health 2024; 29:209-210. [PMID: 38487980 DOI: 10.1111/camh.12711] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 04/19/2024]
Abstract
This is a perspective from an Independent Advocate in England, United Kingdom on the importance of equality in the involuntary treatment of children and young people (CYP). The article highlights the need for safeguards when CYP require detention as part of their mental health care. The paper raises concern that CYP and their families who are less empowered to advocate for optimal care plans may be at risk of less satisfactory outcomes from mental health detention. It notes that CYP in the care system may be particularly vulnerable to such outcomes due to their lower levels empowerment. To mitigate this risk, services need to be proactive in reducing inequity arising from differential levels of empowerment among service users. This could be achieved by adopting strong participation and coproduction activities and ensuring access to Advocacy services for all CYP.
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Affiliation(s)
- Sam Young
- Independent Advocate, Real Advocacy, Manchester, UK
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Stabler L. 'I probably wouldn't want to talk about anything too personal': A qualitative exploration of how issues of privacy, confidentiality and surveillance in the home impact on access and engagement with online services and spaces for care-experienced young people. Adopt Foster 2023; 47:277-294. [PMID: 37873026 PMCID: PMC10590277 DOI: 10.1177/03085759231203019] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
This paper draws on a qualitative interview-based study that explored online mental health and wellbeing interventions and services for care-experienced young people. The study involved young people (n = 4), foster carers (n = 8), kinship carers (n = 2) and social care professionals (n = 9) in Wales, UK. The paper reflects on the complexities of online communication in the space of 'the home'. It documents the ways in which care-experienced young people's living arrangements can restrict access to services and complicate confidentiality within portals to the virtual world, creating an environment where young people and their carers 'wouldn't want to talk about anything too personal'. Drawing on data generated in a study focused on services and interventions to support the mental health and wellbeing of care-experienced children and young people, the paper considers privacy, confidentiality and surveillance in the home and reflects on how associated relational practices impact on care-experienced young people. While the data discussed in this paper was generated during the Covid-19 pandemic, its findings have implications for how care-experienced young people and their carers can be supported to engage with the digital world in the future.
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Copson R, Murphy AM, Cook L, Neil E, Sorensen P. Relationship-based practice and digital technology in child and family social work: Learning from practice during the COVID-19 pandemic. Dev Child Welf 2022; 4:3-19. [PMID: 38603085 PMCID: PMC8891247 DOI: 10.1177/25161032221079325] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Vital services provided by social workers to children in care or on the edge of care were largely delivered "online" during the COVID-19 pandemic. This paper explores the potential impact of these changes on vulnerable children and their families. Relationship-based practice is integral to social work and the shift to digital communication during the COVID-19 pandemic has led to accelerated practice changes and implications for relationship building both with and between service users. Going forward, social workers and other professionals are likely to move to an increasingly hybrid model of communication, combining both digital and face-to-face methods. This article identifies the impact of digital communication on relationships in professional practice, drawing on three studies of digital communication in the UK carried out at the University of East Anglia. The first considered how child protection social workers responded to the challenges of COVID-19, the second looked at how children in care were keeping in touch with their birth families and the third focused on the approaches being taken to moving children from foster care to adoptive families. Five themes related to relationships were identified across all three studies: the significance of the age and developmental stage of the child; the frequency of contact and communication; digital literacy/exclusion; the impact of the lack of sensory experience; and the importance of the relationship history. The article concludes with implications for utilising digital methods in building and maintaining relationships in practice and highlights the need to consider both the inner and outer worlds of those involved.
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Affiliation(s)
- Ruth Copson
- School of Social Work, University of East Anglia, UK
| | - Anne M Murphy
- School of Social Work, University of East Anglia, UK
| | - Laura Cook
- School of Social Work, University of East Anglia, UK
| | - Elsbeth Neil
- School of Social Work, University of East Anglia, UK
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Green Née Cox R, Bergmeier H, Chung A, Skouteris H. How are health, nutrition, and physical activity discussed in international guidelines and standards for children in care? A narrative review. Nutr Rev 2021; 80:919-930. [PMID: 34405883 DOI: 10.1093/nutrit/nuab056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Children in care (CiC) have often experienced trauma and, as a result, are at high risk for poor health outcomes. It is imperative that human-service stakeholders provide trauma-informed health services and interventions. However, little is known about how health promotion is addressed in the standards and guidelines for CiC. For this scoping review, the aim was to examine and compare how nutrition and physical activity are discussed in: 1) federal standards for CiC across the United Kingdom, the United States, New Zealand, and Australia; and 2) state and territory guidance in Australia. METHOD The grey literature was searched for documents outlining key child-welfare standards, guidelines, or policies for the provision of care across foster, kinship, or residential care. Documents were examined for the inclusion of recommendations and/or strategies focused on primary health and the promotion of nutrition and/or physical activity. RESULTS A total of 52 documents were included in this review: 28 outlining international federal guidance and 24 Australian documents. In the United States, New Zealand, and Australia, references to physical activity were often broad, with minimal direction, and nutrition was often neglected; the United Kingdom provided more detailed guidance to promote nutrition and physical activity among CiC. CONCLUSION There is a lack of consistency and specificity in guidelines supporting healthy lifestyle interventions for CiC both internationally and within Australia. It is recommended that 1) specific trauma-informed health promotion guidelines are developed for CiC; and 2) trauma-informed health promotion training is provided to carers. Doing so will ensure that care is provided in a manner in which stakeholders recognize the signs and consequences of trauma in order to determine the most appropriate health interventions to improve outcomes and prevent ongoing trauma for this population.
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Affiliation(s)
- Rachael Green Née Cox
- Health and Social Care Unit, School of Public Health and Preventative Medicine, Monash University, Clayton, Victoria, Australia
| | - Heidi Bergmeier
- Health and Social Care Unit, School of Public Health and Preventative Medicine, Monash University, Clayton, Victoria, Australia
| | - Alexandra Chung
- Health and Social Care Unit, School of Public Health and Preventative Medicine, Monash University, Clayton, Victoria, Australia.,Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventative Medicine, Monash University, Clayton, Victoria, Australia.,Warwick Business School, Warwick University, Coventry, United Kingdom
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Rouski C, Knowles SF, Sellwood W, Hodge S. The quest for genuine care: A qualitative study of the experiences of young people who self-harm in residential care. Clin Child Psychol Psychiatry 2021; 26:418-429. [PMID: 33307756 PMCID: PMC8041438 DOI: 10.1177/1359104520980037] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Levels of self-harm for young people in care are high, and even higher for those in residential care. Recent research highlights the importance of understanding self-harm relationally. Such an approach may be of particular value for understanding the self-harm of young people in care. The aim of this research was to understand the experiences of young people who self-harm whilst living in residential care, with a particular focus on the effect of the care setting on their self-harm. Five young people participated in semi-structured interviews which were analysed using Interpretive Phenomenological Analysis. Four themes emerged: 'The black hole of self-harm', 'Seeking genuine care and containment', 'The cry to be understood' and 'Loss of control to the system.' Young people recognised their need for support with their self-harm, but organisationally driven approaches to managing risk contributed to a perception that the care offered was not genuine, which led to an unwillingness to accept care. The findings highlight the need for a more compassionate, relational response to young people who self-harm in residential care.
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Alderson H, McGovern R, Copello A, McColl E, Kaner E, Smart D, McArdle P, Lingam R. Implementation Factors for the Delivery of Alcohol and Drug Interventions to Children in Care: Qualitative Findings from the SOLID Feasibility Trial. Int J Environ Res Public Health 2021; 18:ijerph18073461. [PMID: 33810478 PMCID: PMC8037471 DOI: 10.3390/ijerph18073461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/17/2021] [Accepted: 03/24/2021] [Indexed: 11/25/2022]
Abstract
Young people in care have a four-fold increased risk of drug and alcohol use compared to their peers. The SOLID study aimed to deliver two behaviour change interventions to reduce risky substance use (illicit drugs and alcohol) and improve mental health in young people in care. The study was carried out in 6 local authorities in the North East of England. Young people in care aged 12–20 years, who self-reported substance use within the previous 12 months were randomised to Motivational Enhancement Therapy, Social Behaviour and Network Therapy or control. In-depth 1:1 interviews and focus groups were used with young people in care, foster carers, residential workers, social workers and drug and alcohol practitioners to explore the key lessons from implementing the interventions. The Consolidated Framework of Implementation Research framed the analysis. Findings illustrated that the everyday interaction between individuals, service level dynamics and external policy related factors influenced the implementation of these new interventions at scale. We concluded that unless interventions are delivered in a way that can accommodate the often-complex lives of young people in care and align with the drug and alcohol practitioners’ and social workers priorities, it is unlikely to be successfully implemented and become part of routine practice.
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Affiliation(s)
- Hayley Alderson
- Population Health Sciences Institute, Newcastle University, Newcastle NE2 4AX, UK; (R.M.); (E.M.); (E.K.); (D.S.)
- Correspondence:
| | - Ruth McGovern
- Population Health Sciences Institute, Newcastle University, Newcastle NE2 4AX, UK; (R.M.); (E.M.); (E.K.); (D.S.)
| | - Alex Copello
- School of Psychology, The University of Birmingham, Birmingham B15 2TT, UK;
- Research Birmingham and Solihull Mental Health Foundation Trust, Birmingham B1 3RB, UK
| | - Elaine McColl
- Population Health Sciences Institute, Newcastle University, Newcastle NE2 4AX, UK; (R.M.); (E.M.); (E.K.); (D.S.)
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle NE2 4AX, UK; (R.M.); (E.M.); (E.K.); (D.S.)
| | - Deborah Smart
- Population Health Sciences Institute, Newcastle University, Newcastle NE2 4AX, UK; (R.M.); (E.M.); (E.K.); (D.S.)
| | - Paul McArdle
- CAMHS, Northgate Hospital, Morpeth, Northumberland NE61 3BP, UK;
| | - Raghu Lingam
- Population Child Health Research Group, School of Women and Children’s Health, Faculty of Medicine, University New South Wales, The Bright Alliance, High St & Avoca Street, Randwick, NSW 2031, Australia;
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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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Mc Grath-Lone L, Harron K, Dearden L, Nasim B, Gilbert R. Data Resource Profile: Children Looked After Return (CLA). Int J Epidemiol 2016; 45:716-717f. [PMID: 27413104 PMCID: PMC5005948 DOI: 10.1093/ije/dyw117] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2016] [Indexed: 11/16/2022] Open
Affiliation(s)
- Louise Mc Grath-Lone
- Administrative Data Research Centre for England, University College London Institute of Child Health,
| | | | - Lorraine Dearden
- Administrative Data Research Centre for England, UCL Institute of Education and Institute for Fiscal Studies, London, UK
| | - Bilal Nasim
- Administrative Data Research Centre for England, London School of Hygiene & Tropical Medicine
| | - Ruth Gilbert
- Administrative Data Research Centre for England, University College London Institute of Child Health
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Hardy C, Hackett E, Murphy E, Cooper B, Ford T, Conroy S. Mental health screening and early intervention: clinical research study for under 5-year-old children in care in an inner London borough. Clin Child Psychol Psychiatry 2015; 20:261-75. [PMID: 24370999 DOI: 10.1177/1359104513514066] [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] [Indexed: 11/16/2022]
Abstract
Typically the social-emotional development or mental health of under 5-year-old Children in Care (CiC) is not routinely assessed and there are few published data in the UK on the prevalence of difficulties for these children. Our hypothesis was that there could be a significant level of unidentified and unmet need within this group. A screening procedure was developed and piloted in a 12-month study assessing both child factors and the developing relationships between children and their caregivers. Previous screening studies have shown that recommendations for interventions are not reliably expedited. An intervention component was incorporated to address this and minimise delay in the children and their carers receiving support. Close inter-agency collaboration was integral to the establishment, implementation and high level of participation in the study. The screening proved acceptable to the majority of birth parents and caregivers, with 94% uptake of participants. In the year prior to screening only 10% of under-fives coming into care were identified as having difficulties in contrast to 67% of children in the screening cohort. The brief interventions offered were taken up in three-quarters of cases, leading to increased referrals on and access to mental health services for these children.
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Affiliation(s)
- Carol Hardy
- South London & Maudsley NHS Foundation Trust, London, UK
| | | | | | | | - Tamsin Ford
- Institute of Health Services Research, Exeter, UK
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