Exploring trauma symptomatology complexity among children and adolescents in care attending a tertiary level specialist mental health service

A 15-year outcome study of children and young people in care attending a tertiary level specialist mental health service.

Listen to Our Voices! Hearing Children and Young People Living in the Care of the State

Limited evaluation research has been conducted on the effectiveness of mental health services and intervention provided to Indigenous children and young people (C&YP) in care. The primary objective of the study was to examine the difference in functioning and mental health outcomes of C&YP in care at a specialist mental health service for Indigenous and non-Indigenous C&YP. Of the total 259 C&YP included in this study, 38.2% (N = 99) were Indigenous. Two measures were used to examine C&YP’s mental health and functioning. Indigenous consumers showed a significantly greater improvement in antisocial behaviour, emotional symptoms, and peer relationships compared to non-Indigenous consumers at discharge from the program. The findings of this study provide support for the program’s therapeutic intent to be a culturally supportive tertiary level mental health service for vulnerable C&YP in care. IMPLICATIONS Equivalent outcomes for Indigenous and non-Indigenous consumers provide support for the program’s intent to be a culturally supportive and safe tertiary level mental health service for vulnerable children and young people in care. Further research is needed to determine the key components of cultural consultation that are advantageous for consumers, care providers, and their families.

There is evidence that engagement with the arts can engender transformative effects on young people’s views of themselves and their futures, this can be particularly useful for children and young people in care. This paper draws on a case study of an arts-based programme delivered in Wales, UK. Field observations of the arts-based sessions were conducted, and the participant sample included young people in foster care (n = 8), foster carers (n = 7) and project facilitators (n = 3). The study employed interviews, observations, reflexive diaries, and metaphor work to explore the subjective accounts of these different stakeholders. This provided an insight into their experience of being involved with the arts-based programme, the impacts of this involvement, and what steps they felt could be taken to improve the model. The paper argues that arts and cultural engagement can be transformative in improving the confidence and social connectedness of young people in foster care, but that attention needs to be given to how programmes are delivered. The paper documents the often overlooked mundane, yet important, aspects of planning arts-based programmes, exploring the involvement of foster carers, interpersonal relationships, and the provision of refreshments. It calls for investment in developing carefully designed extracurricular opportunities for young people in care, where they can experience ‘becoming more confident in being themselves’.

BackgroundEmerging evidence suggests that distant placements and multiple moves may be detrimental to young people in care settings. Less is known about the characteristics of young people in secure care most affected by these processes.AimsThis study examined distance from home and number of previous placements in English young people detained in secure care and their relationships with organisational and individual characteristics.MethodsData were derived from the (2016) cross‐sectional National Adolescent Study census of English young people in secure care, which included 1322 young people across secure mental health, welfare and Youth Justice establishments. Associations were described with odds ratios/95% confidence intervals (OR/CI).ResultsOverall, 285 young people (26.4%) were in secure placements over 100 miles from their family/local authority while 54 (5.6%) had 10 or more previous placements. These rates were higher in secure welfare than other settings (73.8%; OR (CI) = 9.62 (5.72, 16.18), 12.7%; OR (CI) = 2.76 (1.29, 5.91) respectively), and there was significant overlap between long‐distance placement and multiple placements (n = 22; OR (CI) = 2.26 (1.27, 4.04)). Younger age and presence of neurodevelopmental disorder were also associated with long‐distance placements while psychiatric diagnosis, previous secure placement, and previous service contact were linked to multiple placements.ConclusionsDistant and/or multiple placements in young people in secure care appear common, particularly for those who are placed in secure welfare and who are younger and/or present with a psychiatric disorder. Multi‐agency evaluations that capture the longitudinal experience of these vulnerable young people are needed to understand how undesirable patterns of placement in secure care occur and prevent future instances.

Workforce participation has many positive effects on quality of life. However, as young people in care have generally below-average levels of educational participation and attainment, they may be ill-equipped for the transition to further education and work. A mixed-method study conducted in Australia about career development for young people in care investigated how this population develops ideas about future work: the social and cognitive variables that influence career decision-making; practices for preparing young people in care for the transition to work or further education; and factors that support or impede the transition. Findings from the qualitative study are reported in this paper. Interview data were obtained from the multiple perspectives of young people in care, foster carers, caseworkers and school personnel. The overall picture was one of young people in care lacking the encouragement, resources and capacity to realistically plan for the job they want. Specific interventions are required to enhance career development and employment outcomes for this population.

How young people in State care decide upon future careers, and the support offered for this process by carers and child protection caseworkers, has received little research attention. This qualitative study sought the views of young people in care, foster and kinship carers, and child protection caseworkers about career development for in-care youth. We found young people were thinking about career options but encountered a safety driven, acute casework approach, which sidelined education and work planning. Career development was not viewed as a caseworker responsibility, and, by default, was primarily developed by carers. The study highlights the need for a greater focus on the transition to adulthood and the inclusion of career development in policy and practice development.

BackgroundPodcasting is a form of arts-based research. It uses sound to create a space of emotional engagement with research participants, allowing listeners to hear and respond to research findings and...

PurposeStudying mental wellbeing requires the use of reliable, valid, and practical assessment tools, such as the Short version of the Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS). Research on the mental wellbeing of children in care is sparse. The current study aims to: (1) examine the unidimensionality of SWEMWBS; (2) assess measurement invariance of SWEMWBS across children and young people in care compared to their peers not in care; and (3) investigate the latent factor mean differences between care status groups.MethodsWe used data from the 2017 School Health Research Network Student Health and Wellbeing (SHW) survey, completed by 103,971 students in years 7 to 11 from 193 secondary schools in Wales. The final data include a total of 2,795 participants (46% boys), which includes all children in care and a sub-sample of children not in care who completed the SWEMWBS scale fully and answered questions about their living situation.ResultsConfirmatory factor analysis supported the unidimensionality of SWEMWBS. The SWEMWBS is invariant across groups of young people in foster, residential and kinship care compared to children and young people not in care at configural, metric and scalar levels. Findings from latent mean comparisons showed that young people in care reported lower mental wellbeing than their peers, with those in residential care reporting the lowest scores.ConclusionsFindings suggest that SWEMWBS is a valid scale for measuring differences in mental wellbeing for young people in care similar to the population.

Background: Existing literature indicates that young people in state care have particular sexual health needs that include addressing their social and emotional well-being, yet little has been published as to how these components of sex education are actually delivered by service-providers. Objective: The aim of this study was to analyse the processes involved in delivering relationship and sexuality education to young people in state care from the perspectives of a sample of service-providers with a role in sexual health-care delivery. Design: Qualitative methodological strategy. Setting: Service-delivery sites at urban and rural locations in Ireland. Method: A total of 22 service-providers were interviewed in depth, and data were analysed using a qualitative analytical strategy resembling modified analytical induction. Findings: Participants proffered their perceptions and examples of their practices of sex education in relation to the following themes: (1) acknowledging the multi-dimensional nature of sexual health in the case of young people in care; (2) personal and emotional development education to address poor self-esteem, emotional disconnectedness and an inability to recognise and express emotions; (3) social skills’ education as part of a repertoire of competencies needed to negotiate relationships and safer sex; (4) the application of positive social skills embedded in everyday social situations; and (5) factual sexuality education. Conclusion: Insights into service-providers’ perceptions of the multi-dimensional nature of the sexual health needs of young people in state care, and the ways in which these service-providers justified their practice make visible the complex character of sex education and the degree of skill required to deliver it to those in state care.

Introduction: Children and young people in care are a key client group for child and youth mental health services. A collaborative approach to addressing the complex and long-term needs of children or young people in care is essential and carers who support these children or young people are vital team members of this collaboration. Method: This research surveyed carers over a 4-year period to gather feedback about a specialist mental health service. 277 carers responded to the Carer Perceptions Survey. Participants were mainly foster (65%) and kinship (17%) carers. However, residential workers (13%) and biological parents (5%) also responded to the survey. A thematic analysis was undertaken with responses to open-ended questions about most liked aspects of the service and ideas for service improvement. Results: Themes included support for carers, communication between carers and staff, personal attributes of staff, working in collaboration, accessibility to the service, and carer training. Carers expressed their appreciation of staff who provided support in collaborative and respectful ways and valued staff who listened to their experiences and ideas. In addition, carers expressed interest in receiving more information and training about how best to support the mental health of children and young people in their care. Conclusion: Effective mental health services for children and young people in care require clinical staff that foster respectful engagement and facilitate collaboration with carers in all aspects of care.

This study by Alison Beck explores the views of young people in the care of Lambeth local authority, and those of their carers, about the young people's mental health and their access to and experience of mental health services. It is associated with a separate study which used a quantitative design to clarify mental health needs in the same population (Beck, forthcoming) and which identified two particularly disadvantaged subgroups: young people living out of the borough and young people who moved their placements frequently. Their views are considered separately, where relevant, in this paper. The main methodology was a postal questionnaire survey comprising open-ended questions. The results highlighted a number of themes: young people tended to identify internal emotional problems while their carers predominantly focused on externally visible problem behaviours; young people generally valued contact with social workers but reported this lacking; both groups of respondents described barriers to accessing mental health services. These included physical obstacles, such as distance to travel, as well as psychological barriers such as the belief that only ‘mad’ people use such services. A two-limbed service model is proposed to address the needs of young people in local authority care incorporating: provision by mental health professionals of information about mental health services and liaison between all parties to secure appropriate services; and mental health interventions aimed at engaging young people with local CAMHS.

Ensuring that young people in foster care receive the support they need at the right time, is a pressing issue across health- and social services. In this study, we aim to broaden the knowledge base on what constitutes appropriate help and support from the perspective of young people in long-term foster care in Norway. As part of a larger survey, young people in foster care (N = 178) aged eleven to eighteen years provided written accounts on the open-ended question: ‘What advice would you give adults who help young people living in foster care?’. We conducted a systematic content analysis to identify themes and categories across the data. Four main themes were identified: enable participation; build trusting relationships; ensure appropriate follow-up; and cultivate belonging. Participation served as a pivoting point across the themes, as a prerequisite for young people in care to receive the services they need and develop a positive self-relationship. Our findings indicate that services must be tailored to recognise how the strengths and needs of young people in foster care change over time and differ across individuals. Developing practice tools that enhance young people’s participation is therefore paramount, as social workers, foster parents and other adults are crucial to processes of well-being and belonging.

The National Strategic Framework for Aboriginal and Torres Strait Islander Peoples’ Mental Health and Social and Emotional Wellbeing identifies building a strong Aboriginal and Torres Strait Islander led evidence-base to inform care as a key priority. Aboriginal and/or Torres Strait Islander adolescents in contact with the criminal justice system are a highly vulnerable group of Australians, with substantial unmet needs. There is limited evidence to inform culturally appropriate models of care that meet the social and emotional wellbeing needs of justice-involved Aboriginal and/or Torres Strait Islander adolescents. This project aims to develop, implement and evaluate an in-reach and community transitional model of social and emotional wellbeing care for Aboriginal and/or Torres Strait Islander adolescents (10–17 years old) who experience detention through close engagement with Aboriginal and/or Torres Strait Islander youth, Elders, researchers, practitioners and community members, and by drawing on culturally informed practice and knowledge systems. The project is based on a multi-level mixed methods design, with a strong focus on ongoing project evaluation (based on the Ngaa-bi-nya framework) and co-design. Co-design is facilitated through culturally safe and trauma informed participatory processes based on development of strong partnerships from project initiative, design, implementation and evaluation. Application of the landscape domain of the Ngaa-bi-nya framework for Aboriginal and Torres Strait Islander program evaluation will be explored in Phase one. Aboriginal and Torres Strait Islander adolescents with experience in detention will be engaged through one-on-one interviews with data collection through the Growth and Empowerment Measure (GEM) Youth (which will be adapted from the adult version and validated as part of this study), the Kessler Psychological Distress Scale (K-10), questions around alcohol and drug use, and narrative interviews exploring experience. Qualitative data will be analyzed using an inductive thematic approach, structured within the framework of the Ngaa-bi-nya landscape prompts. Quantitative data will be analyzed using descriptive statistics to provide a profile of the cohort. Findings from Phase one will be used to inform the development of a model of social and emotional wellbeing care that will be implemented and evaluated in Phase two.

Influencing policy and practice for young people in foster care: Learning from a model of collective participation