Care-experienced Young People Research Articles

What is Life Story Work? How defining approaches can bring clarity to research, training, and practice

Abstract Within health and social care settings, Life Story Work (LSW) for care-experienced children and young people is a social intervention that includes using a biographical or narrative approach. LSW is cited in policy, practice guidance and literature as important in helping young people develop their identity, increase placement stability and in supporting mental health and well-being. Despite an acknowledgement of the potential benefits of LSW, recent studies suggest that little is known about LSW effectiveness in practice, with a lack of qualitative studies available. In this article, we explore the potential benefits of LSW to care-experienced young people and the barriers to research, training, and practice, and suggest that clearly defined approaches could provide clarity for carers, practitioners and researchers. We introduce five defined approaches to LSW that are informed by literature and current practice. We provide examples of how they might be incorporated into research, training, and practice, then discuss how use of the five approaches could meet practice guidance requirements, and increase the emotional and psychological well-being of care-experienced young people. We conclude by suggesting how the approaches may be used within LSW research to develop an international evidence base for best practice.

The basic income for care leavers in Wales pilot evaluation: Protocol of a quasi-experimental evaluation.

This study will evaluate the Basic Income for Care Leavers in Wales pilot (BIP), which is the most generous basic income scheme in the world. A cohort of care-experienced young people who become aged 18 during a 12-month enrolment period (July 2022-June 2023) are receiving £1,600 (before tax) per month for two years, and the Welsh Government intends this to have a range of benefits. This evaluation will examine the impact of BIP, the implementation of the pilot and how it is experienced, and its value for money. The study is a theory-based quasi-experimental evaluation, and the design and methods are informed by ongoing co-production with care-experienced young people. We will estimate the impact of BIP on participants using self-reported survey data and routinely collected administrative data. This will include outcomes across a range of domains, including psychological wellbeing, physical and mental health, financial impact, education, training and volunteering. Comparisons between temporal (Welsh) and geographical (English, using administrative data) controls will be done using coarsened exact matching and difference in differences analysis. The process evaluation will examine how BIP is implemented and experienced, primarily through monitoring data (quantitative) and interview, observational, and focus group data (qualitative). The economic evaluation will take a public sector and a societal perspective to identify, measure and value the costs and outcomes of BIP, and to synthesise the evidence to inform a social cost-benefit analysis at 24 months post-intervention. BIP is unusual in that it targets a wide range of outcomes and is available to an entire national cohort of participants. The evaluation also has several practical constraints. Therefore, the study will use a range of methods and triangulate between different analyses to assess how successful it is. Findings will inform policy in relation to care leavers, social security and basic income studies worldwide.

Exploring care-experienced young people’s perceptions of the use of administrative data in research

Objective and ApproachData about people is generated every day and research based on administrative data, especially in the social care sector, is becoming more prevalent. This piece of work involves running a public engagement workshop alongside care-experienced young people with the aim to learn what young people understand when researchers say they will be using administrative data in their research. Results The following questions will be explored: What is understood by the terms ‘administrative data’ and ‘data linkage’? What are young people’s thoughts on how their data is used? What would they like to know about how their data is being used? Can they think of reasons why you would not want their data to be used? Do they think that the data that is collected (from a social worker, GP, etc.) accurately reflects their experiences? As well as this, important aspects of the collection of administrative data will be discussed. ConclusionsThe output of this piece of work will be an infographic. The aim is that this infographic will contain two facets. First, it will illustrate how administrative data is collected and used (including a life cycle of the data). Second, it will contain information that young people regard as pertinent to this topic and will contain quotes ‘for young people, for young people’. ImplicationsThe infographic from this work can be used by other researchers as part of their own public engagement work with young people.

A profile of the mental health needs of children in out-of-home care in Wales between 2019-2020

Objective and approachYoung people who have experience of being in out-of-home care are more likely to have poorer mental health when compared to those in the general population. However, some of the most highly cited literature around prevalence rates of different mental health conditions are becoming outdated. Data held in the Secure Anonymised Information Linkage (SAIL) Databank was used to better understand the mental health needs of this group. Health data from General Practitioner records, emergency department, and inpatient admissions were linked to the 2019/20 data from children’s social services. ResultsMental health was considered in relation to two facets: indicators and conditions. Indicators included incidents of self-harm, drug or alcohol use, while conditions included symptoms or diagnoses of five different mental health conditions (anxiety, depression, eating disorder, conduct disorder, and severe mental illnesses). Prevalence was looked at across general demographic characteristics, as well as those specific to the care experience. Logistic regression models examined if a young person’s care experience could predict the likelihood of mental health need. Conclusions The findings from this piece of work will inform current understanding of the vulnerabilities of this group. Future work will compare the needs of this group to others, including Children Receiving Care and Support, as well as the general population. ImplicationsThis work will provide an update to existing literature. The findings have the potential to contribute to discussions about how we best support this group and will inform approaches to meeting the health needs of care-experienced young people.

Care-experienced young people’s views and experiences of accessing general practice and dental services and attending health reviews in England: a qualitative study

BackgroundChildren in care and care leavers have worse health outcomes than their peers without care experience. This study addresses an evidence gap in exploring care-experienced young people’s views and experiences of accessing general practice and dental services and attending health reviews in England.MethodsWe conducted a qualitative study using podcasting as a creative medium. We recruited young people from two sites: one in South England (A) and one in greater London (B). We held two paired discussions in site A and two focus groups in site B, with 14 participants in total. Participants were aged between 13 and 22 years and were diverse in gender, ethnicity, and care experiences. Data were analysed thematically using candidacy theory as a theoretical framework.ResultsMental health was a prevailing concern for participants, but general practice was not considered a place to discuss it. Most participants reported distant relationships with primary healthcare professionals and considered opening-up to a professional to be risky, for example, it could result in an unknown/unwanted outcome. A lack of time and personal connection in appointments, and experiences of feeling judged, dismissed, or misunderstood, hindered young people’s ability to disclose mental health or relationship concerns. Participants reported variation in the timeliness and location of services, with salient examples of extensive waiting periods for braces. Participants perceived annual health reviews to be largely inconsequential.ConclusionsAny primary care presentation by a care-experienced young person should trigger additional professional curiosity. To build rapport and trust, professionals should not underestimate the power of active listening, being reliable and honest, and small acts of thoughtfulness, for example, ensuring medical letters are provided promptly. Carers and other trusted professionals should help care-experienced young people to understand the role of primary care and support them with access. Health reviews may not be of value to all young people in care. Further research is needed to examine primary healthcare access for care-experienced young people with significant safeguarding and healthcare needs.

Children’s rights in action: involving care-experienced individuals in academic lessons

ABSTRACT Focusing on children’s right to participate, as outlined in Article 12 of the 1989 Children’s Rights Convention, there is a growing body of research on involving children and young people in participatory practices in institutional meetings, everyday life, and peer research. However, fewer are the initiatives involving care-experienced young people in social work and educational professional training, as well as in academic education. Building on these considerations, this article describes the involvement of two care experienced young women coming from alternative care experiences within the Course of Work and Organizational Psychology, Social Work BA, Sapienza, University of Rome, Italy. Drawing on ethnographic notes taken during co-planning, co-delivering, and receiving feedback, I critically reflect on the methodological challenges and necessary psychological considerations of such initiatives, paving the way for future participatory training and academic opportunities for social workers.

Access to best-evidenced mental health support for care-experienced young people: Learnings from the implementation of cognitive therapy for PTSD.

Rates of PTSD are up to 12 times higher in care-experienced young people (CEYP) compared to their peers. Trauma-focused CBTs (tf-CBT) are the best-evidenced treatment for youth with PTSD, yet, in practice, CEYP often struggle to access this treatment. We worked alongside services to understand barriers and facilitators of the implementation of cognitive therapy for PTSD (a type of tf-CBT) to CEYP. This was an active, open implementation trial. We recruited 28 mental health teams across England, including general CAMHS, targeted CAMHS for CEYP and social care-based teams. From these teams, participants were 243 mental health professionals, from a wide variety of professional backgrounds. Following recruitment/intervention training, teams participated in rolling three monthly focus groups and individual interviews, to understand what helped and hindered implementation. Data were analysed using a framework analysis conducted using CFIR 2.0. Almost half of the teams were able to implement, but only approximately one quarter with CEYP, specifically. Universal barriers that were discussed by almost all teams particularly highlighted service structures and poor resourcing as major barriers to delivery to CEYP, as well as the complexities of the young person and their network. Unique factors that differentiated teams who did and did not implement included commissioning practices, the culture of the team, leadership engagement and style, and the development of supervision structures. Findings offer key considerations for mental health teams, service leads, commissioners and policy-makers to enhance delivery of best-evidenced mental health treatments like CT-PTSD, for CEYP.

Policy and Practice with Lesbian, Gay, Bisexual, Trans and Queer (LGBTQ+) Care-Experienced Young People—A National Survey of Local Authorities in England

Abstract There is scant research on the experiences and needs of lesbian, gay, bisexual, trans and queer/questioning young people growing up in care in the UK. This article reports on a national survey of local authorities (LAs) in England, which aimed to explore what data LAs collect relating to sexual orientation and gender identity, as well as exploring existing LA policies and practices in relation to LGBTQ+ young people growing up in out-of-home care. The survey asked about policy, recording, support and training. Respondents were senior managers in LAs with responsibility for looked after children. The survey response rate was 78 per cent (n = 118). The survey found a lack of specific policy relating to this population and little central recording of sexual orientation and gender identity (SOGI) data, although most LAs suggested information would be recorded in individual case records. LAs described a variety of ways in which they supported LGBTQ+ young people in practice at both individual and organisational levels but highlighted a lack of staff knowledge and confidence. Training provision was more likely to be provided for social workers than for foster carers or residential staff. Implications for practice are discussed.

Care-experienced students and equity support provision: an investigation of Australian university websites

ABSTRACT This paper investigates the presence of support information on university websites, with a specific focus on care-experienced young people. Engaging with extant research about the university and college choice process as it involves marketing of higher education internet sites, the paper is based on a national scan of equity support provision on Australian university websites. This paper posits that there is an extra element in the ‘phased decision-making’ for people with additional needs in universities that is yet to be recognised by higher education institutions in Australia. The website scan and analysis found significant gaps in essential information for care-experienced young people and highlights that current practices on institutional websites concentrate on marketing. The lack of information for applicants with additional needs arguably deepens disadvantage and the marketised nature of higher education information contradicts the tertiary goals of equitability of access.

"The bridge between school and uni, that's the bit that's missing": improving access to higher education for care-experienced students

International research has demonstrated that care-experienced young people achieve poorer educational and life course outcomes than their peers. Based on statistics from 2012, the Office for Fair Access (now the Office for Students, OfS) reported that while 60% of the general population of school leavers in the UK entered higher education (HE), only 6% of care leavers went to university. The latest data from the Department for Education (DfE) shows that this now stands at 14% of care leaversi, though growth remains slower than for the population as a whole. With rates of children taken into care increasing in Wales, there is value in understanding how best to support this group with their educational transitions. Growing from pan-Wales research into access to, and success in, HE for care-experienced young people, this paper reflects on how the experiences of care-experienced students gathered through research have been translated into action by developing a website centred around information, advice and guidance for this group and those who support them. In particular, there are reflections here on the value of collaboration between professional services and academic staff to further access and participation goals in a university setting.

A qualitative investigation into care-leavers' experiences of accessing mental health support.

People who grew up under the care of children's social services are a highly vulnerable group, with 50% of this population meeting the criteria for a mental health problem at any one time. Emerging evidence suggests that there is a disparity between the number of people who require support, and those that receive it, and that they face several barriers to accessing timely and effective mental health support. We have a limited understanding of how to support the mental health of this group as they 'age out' of children's social services, and the transition to independence, which occurs around the age of 18. We aimed to explore how care-leavers understand their experiences of help-seeking from formal mental health services. We used qualitative interviews, and Interpretative Phenomenological Analysis with 9 care-experienced young people aged between 18 and 25 years old. This work was co-produced by a team of care-experienced adults, from the conception of the study to write-up. Qualitative analysis revealed several themes which centred around: (1) taking reluctant steps towards recovery, (2) challenges with being understood and the importance of gaining an understanding of yourself, (3) navigating trust and (4) the legacy of not having your mental health needs met. We identified several important implications for health and social care practice, across primary and secondary health care settings. This work highlights ways to better support this highly vulnerable group in accessing evidence-based mental health support, and how to maintain engagement.

Call to action on care

Jen Downie and James Bury set out changes care-experienced young people need from policymakers

Care-experienced young people's views on what they want from mental health services.

This study explores what care-experienced young people want from mental health services. Six care-experienced young people were interviewed, and an interpretative phenomenological analysis applied. Three key themes emerged demonstrating that the way support is delivered, the people who deliver it, and the environment of mental health services are all important to care-experienced young people. Along with these findings, this study demonstrates that engaging vulnerable young people in research and service design is beneficial.

Corrigendum to “‘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”

Corrigendum to “‘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”

Investigating local policy responses to support care-experienced young people in China – A scoping review

An increasing amount of attention is being paid to young people with care experience on an international scale. They are often associated with negative outcomes after leaving care, such as low educational attainment, unstable housing, job instability and social exclusion. While many countries have prescribed social policies for supporting them for a more fruitful transition out of care, there is little information available in the context of China at local levels. Given this, this paper maps and examines existing local policies, exploring how local authorities support care-experienced young people in China. To achieve, it adopts a scoping review. The findings highlight (i) China’s local polices as a whole prescribe a variety of services, resources, and/or measures to support care-experienced young people, of which housing and employment are at the top of the list; (ii) current policy responses are insufficient, and opportunities of this group of people to access the stipulated support are quite limited. The findings of this study indicate that policymakers need to improve local policies in order to make them more operable, sophisticated, and comprehensive, so that care-experienced young people can reap the greatest benefits from them. Also, a national leaving-care policy that provides guidance to local authorities should be considered, adding consistency and clarity to relevant policies across the country. The limitations of this paper relate mainly to its review methods, which point to the need to expand data sources and conduct cross-reviews to enhance the findings’ credibility and robustness.

The prevalence of mental health disorders amongst care-experienced young people in the UK: A systematic review

Care-experienced children and young people are more likely to experience poorer mental health relative to the general population. Some of the most highly cited literature in this area is becoming increasingly outdated, however, and as the gap between mental health service availability and provision is steadily growing, it is imperative that we understand the scale and nature of the mental health needs of this group. A systematic review of all literature published from the UK was conducted in March 2022 using APA PsycINFO, ASSIA, Cochrane Library, Medline, PubMed, Scopus, Social Policy and Practice, Social Services Abstracts, and Web of Science. Papers were included if they 1) sampled young people (aged 0 to 18 years) with care experience and, 2) used either a standard or non-standardised measurement tool, or health records to assess mental health prevalence rates (reported as a percentage). Risk of bias assessed used the QuADS tool (Harrison et al., 2021) and data was extracted. Thirty-nine studies were included and summarised. The estimated prevalence of mental health disorders of young people in care ranged from 1 to 82 %. The most frequently used tool to assess mental health was the Strengths and Difficulties Questionnaire (Goodman, 1997) and, while over half of studies utilised prevalence information from a comparator group, this was most commonly young people in the general population. The results of the systematic review demonstrate that estimates of mental health disorders among care-experienced young people in the UK vary considerably. Further consideration should be given toward what measures are used to assess mental health in this population and how we can optimally assess and characterise their support needs.

Mentoring for care-experienced young people: A rapid review of program design

Background and objectivesIn Australia, out-of-home care (OoHC) is provided to safeguard children and young people unable to live with their families. Typically, this care stops at 18 years of age, leaving many young people without the relational support to find employment and stable accommodation. Mentoring is increasingly proposed as a way to support young people exiting care, though the types of mentoring and contextual factors vary considerably. This rapid review aims to identify key features of mentoring programs that support young people in OoHC. MethodsThis paper utilised a rapid review methodology to survey the academic literature on mentoring programs with young people in OoHC. The authors conducted literature searches in October 2022 using a search string designed to provide targeted exposure to the literature. Articles were limited by year and location, with the specific search string and limitations applied to the Scopus database, and Proquest and Informit platforms. ResultsUtilising literature, we identified five overlapping models for mentor–mentee relationships into a provisional typology of five categories based on varying levels of formality and familiarity in the relationships: ‘formal’, ‘natural’, ‘near-age’, ‘peer’, and ‘therapeutic’. In doing so, we identified seven important features of mentor–mentee relationships: shared experiences, relationship duration, boundaries and other relationships, identity and self-worth, educational contexts, power and participation, and role modelling. We identified four issues relating to mentoring in OoHC that are informed by the needs and barriers experienced by young people: training and support for mentors, unique challenges faced by young people in OoHC, transition out of care, and the matching process. Lastly, we established what might impact mentoring programs buy critically reflecting on the policy context and notions of empowerment. ConclusionThis rapid review of mentoring programs for care-experienced young people seeking employment offers valuable insights to inform future programs. The findings highlight diverse and unclassified mentoring relationship types, the absence of anticipated gender-specific findings, a lack of examination of the policy context, and a need for more robust conceptualisations of empowerment.

“I Don’t Feel Like There’s Enough Awareness about the Damage That Social Media Does”: A Thematic Analysis of the Relationships between Social Media Use, Mental Wellbeing, and Care Experience

Social media (SM) has become an unavoidable mode of communication for many young people today, leading to increasing importance in exploring its impact on mental wellbeing. This includes exploring the impact on those who may be more susceptible to developing mental health issues due to adverse childhood experiences, such as care-experienced young people. This study consisted of 22 semi-structured interviews with young people from the general population (n = 11) and care-experienced young people (n = 11). Thematic analysis revealed varying effects of SM, including positive effects such as entertainment, inspiration, and belongingness. However, other findings indicated that the design of SM is damaging for young people’s wellbeing. Age and developmental maturity appeared as key factors influencing the impact of SM on wellbeing, with the indication of further protective factors such as self-awareness, education, and certain SM design features. Specifically, care-experienced young people expressed how lived experiences of the care system can have both positive and negative effects on SM use while revealing the complex relationship between care experience, SM use, and wellbeing. These results can be used to inform SM design and policy and to provide suggestions for SM and wellbeing education among the general population and care-experienced young people.

Acceptability, feasibility and perceived effectiveness of online and remote mental health and wellbeing interventions during the COVID-19 pandemic: A qualitative study with care-experienced young people, carers and professionals

The COVID-19 pandemic, and associated lockdowns, saw numerous services move to online and remote delivery. This included mental health and wellbeing interventions for care-experienced young people. To date there has been limited consideration of how different stakeholders experienced the receipt or delivery of remote provision during this period. We conducted online one-to-one and small group interviews with: young people with experience of care (n = 3); a young person whose biological parents were foster carers (n = 1); foster and kinship carers (n = 10); and social care and affiliated professionals (n = 9). We further engaged with relevant stakeholder consultation groups to refine and confirm study findings. Five central themes were generated, that reflected participants’ experience of a range of services, while also serving as recommendations for the future development and optimisation of provision: 1) Awareness: there is a lack of general awareness of mental health provision and understanding of what is available to support care-experienced young people, and a specific lack of knowledge regarding online support; 2) Choice and tailoring: young people need choice and flexibility in identifying provision that best suits their needs, and this includes the decision to receive online, blended or in-person services; 3) Training: carers and professionals need training on how to foster relationships with young people online and how to ensure safety and child protection; 4) Safety, protection and risk: young people need to have safe and private spaces when accessing online services; and 5) Access and resources: care-experienced young people don’t always have access to online support, and need appropriate technological devices that don’t have prohibitive restrictions. Taken together, the study findings offer insight into how interventions and services may be developed and optimised moving forward to ensure that they are meeting the needs of young people in care, and maximize likely effectiveness.

Mental health and wellbeing interventions for care-experienced children and young people: Systematic review and synthesis of process evaluations

BackgroundThe mental health and well-being of care-experienced children and young people remains a concern. Despite a range of interventions, the existing evidence base is limited in scope, with a reliance on standalone outcome evaluations which limits understanding of how contextual factors influence implementation and acceptability. The Care-experienced cHildren and young people’s Interventions to improve Mental health and wEll-being outcomes Systematic review (CHIMES) aimed to synthesise evidence of intervention theory, outcome, process and economic effectiveness. This paper reports the process evaluation synthesis, exploring how system factors facilitate and inhibit implementation and acceptability of mental health and wellbeing interventions for care-experienced children and young people. MethodsSixteen databases and 22 websites were searched between 2020 and 2022 for studies published from 1990 and May 2022. This was supplemented with contacting experts in the field, citation tracking, screening of relevant systematic reviews and stakeholder consultations. We drew on framework synthesis of qualitative data and incorporated a systems lens, taking account of contextual influences across socio-ecological domains. Quality appraisal assessed reliability and usefulness. Confidence in synthesised findings was assessed with the GRADE-CERQual tool. We report the review in accordance with relevant elements of both the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), and the Enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) checklist. ResultsSearches retrieved 15,068 unique study reports, and 23 of these were eligible for process evaluation synthesis, reporting on sixteen interventions. Studies were published between 2003 and 2021. Nine interventions were from the UK and Ireland, six interventions were from the USA, and one was from Australia. They were largely classified as interpersonal, where the aim was to modify carer-child relationships. Five key context factors were identified that supported and prohibited intervention delivery: (1) lack of system resources; (2) intervention burden, which encompasses the time, cognitive, and emotional burden associated with implementation and participation; (3) interprofessional relationships between health and social care professionals; (4) care-experienced young people’s identity; and (5) carer identity. ConclusionWe identified several supportive and restrictive factors across social and health care systems that may impact intervention implementation and acceptability. Key implications include: the importance of involving diverse stakeholders in intervention development and delivery; the need to better resource and support those involved in interventions, particularly training and support for carers; and ensuring future evaluations integrate process evaluations in order to optimise interventions.