Care-experienced Young People Research Articles

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.

Conceptual meanings of permanency: Photovoice with care-experienced youth

ABSTRACT Children in out-of-home care have a developmental need for safe and secure relationships to meet their long-term social, emotional and physical needs. Permanency has been a guiding principle in child protection since the mid-1970s, with the focus on creating legal and residential certainty. Permanency is a complex felt and lived experience for children and young people that cannot be reduced to a single dimension, such as legal permanency. A critical gap exists in understanding the perspective of young people and using research methods such as Photovoice that facilitate expression of intangible concepts. Eleven care-experienced young people aged 16 to 25 years took part in participatory research in New South Wales. Participants used photography to explore literal and metaphorical experiences of permanency and thematic analysis was used to interpret visual and textual data. The results present a more nuanced picture of permanency as an internal state and reveal that young people actively cultivate the felt sense of security and belonging in their lives through connection with nature, people and culture. Photovoice empowers participants as co-creators of knowledge and presents new insights to inform public discourse and policy and practice developments.

‘Family doesn’t have to be mom and dad’: an exploration of the meaning of family for care-experienced young people

Young people who experience out-of-home care have typically encountered difficult and/or disrupted family relationships. This article reports on a survey undertaken in the US with 215 young adults (aged 18–22) who experienced out-of-home care starting in pre-adolescence. The article examines responses to an open-ended interview question, ‘How do you define family?’ The analysis highlighted that few young people define family as confined to blood relations. More commonly, young people adopted more flexible definitions, prioritising the ‘doing’ and reflecting on their conceptions of family; attempting to ‘do family’ differently from what they had experienced was also evident. The findings encourage consideration of the utility of family as an important concept for child welfare practice, as positive and flexible understandings of family were imbued with a sense of agency, identity, belonging and overall wellbeing.

'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.

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.

Exploring online experiences, cyberbullying and wellbeing for young people looked after in Wales: An analysis of the school health research network 2017/18 survey

For young people the online world affords creative, entertainment and socialisation opportunities but also poses risks including cyberbullying, grooming and harmful content. Little is known about online experiences of care-experienced young people, a vulnerable group who may benefit from online experiences but may be at increased risk online. This cross-sectional study used data from 11- to 16-year-olds in Wales from the School Health Research Network (SHRN) Student Health and Wellbeing Survey 2017/18 ( n = 103,971). Cyberbullying, face-to-face bullying and other online experiences were analysed. The prevalence of these experiences and associated mean wellbeing scores were compared for young people in care ( n = 1,921) and not in care ( n = 83,551), controlling for socio-demographic variables gender, ethnicity and year group. Higher numbers of young people in care were involved in cyberbullying, bullying, sharing explicit images, problematic social media use and regular contact with online only friends. These online experiences were associated with lower mean wellbeing scores. Lower numbers of young people in care had access to smartphones and social networking sites from age 12, and lower numbers were regularly in online contact with close friends and a wider peer group. These online experiences were associated with higher mean wellbeing scores. Young people in care appear to be less involved with online experiences that positively impact wellbeing and more involved in online experiences that negatively impact wellbeing. Promoting positive online experiences and education around problematic social media use may be particularly valuable in helping young people living in care develop healthy, safe and positive online lives.

Interventions targeting the mental health and wellbeing of care-experienced children and young people in higher-income countries: Evidence map and systematic review

BackgroundThe mental health and wellbeing of care-experienced children and young people (i.e. foster care, kinship care, residential care) is poorer than non-care-experienced populations. The Care-experienced cHildren and young people’s Interventions to improve Mental health and wEll-being outcomes Systematic review (CHIMES) aimed to synthesise the international evidence base for interventions targeting subjective wellbeing, mental health and suicide amongst care-experienced young people aged ≤ 25 years.MethodsFor the first phase of the review, we constructed an evidence map identifying key clusters and gaps in interventions and evaluations. Studies were identified through 16 electronic databases and 22 health and social care websites, in addition to expert recommendations, citation tracking and screening of relevant systematic reviews. We charted interventions and evaluations with a summary narrative, tables and infographics.ResultsIn total, 64 interventions with 124 associated study reports were eligible. The majority of study reports were from the USA (n = 77). Interventions primarily targeted children and young people’s skills and competencies (n = 9 interventions), the parental functioning and practices of carers (n = 26), or a combination of the two (n = 15). While theoretically under-specified, interventions were largely informed by theories of Attachment, Positive Youth Development, and Social Learning Theory. Current evaluations prioritised outcomes (n = 86) and processes (n = 50), with a paucity of study reports including theoretical descriptions (n = 24) or economic evaluations (n = 1). Interventions most frequently targeted outcomes related to mental, behavioural or neurodevelopmental disorders, notably total social, emotional and behavioural problems (n = 48 interventions) and externalising problem behaviours (n = 26). There were a limited number of interventions targeting subjective wellbeing or suicide-related outcomes.ConclusionsFuture intervention development might focus on structural-level intervention theories and components, and target outcomes related to subjective wellbeing and suicide. In accordance with current methodological guidance for intervention development and evaluation, research needs to integrate theoretical, outcome, process and economic evaluation in order to strengthen the evidence base.Systematic review registrationPROSPERO CRD42020177478.

Communities of Support for Care-Experienced Mothers

Abstract A genuinely supportive social network is crucial to health and well-being in motherhood. Feeling supported during challenging times can help to shield the impact of adversity and distress. Mutual support networks resulting from authentic, caring connections with others can be particularly beneficial to people with histories of fractured family relationships and/or out-of-home care (OOHC). As three women with lived experience of OOHC, we describe how we have built communities of support to sustain us as we raise our families, reflect on our childhoods, and strive to provide loving environments for our children. Our narratives highlight the value of informal support during the joys and challenges of motherhood, and the need for strength-based and trauma-informed practices within health and social work. Drawing on the theory of social support, we argue that professionals should aim to support care-experienced young people to empower themselves by building autonomous and authentic social connections to promote their well-being, particularly during life transitions such as exiting care and becoming parents.