Forensic Child Research Articles

Quantifying the experiences of Black and Dual Heritage young people in a forensic child and adolescent mental health service.

Young people from racialised backgrounds are overrepresented in justice services. This study explored differences in community support offered to young people from racialised groups referred to a forensic child and adolescent mental health service. We compared support offered to 427 young people, according to five ethnic groups. Over 20% of young people referred were Black (compared with 14% of the local population) and 15.8% were Dual White and Black Heritage (compared with 4% of the local population). Odds ratios showed that Black and Dual Heritage groups were more frequently involved with youth offending services (Black: 2.59, Dual Heritage: 2.88), gangs services (Black: 4.31, Dual Heritage: 7.13) and have a national referral mechanism (Black: 3.61, Dual Heritage: 4.01) than their White peers, but were less often in mainstream education compared with their Asian peers (Black: 0.26, Dual Heritage: 0.29). Black (odds ratio 0.35) and Dual Heritage (odds ratio 0.40) young people were less frequently diagnosed with a neurodevelopmental disorder than their White peers. Those from Black and Dual Heritage backgrounds were disproportionately disadvantaged.

Identifying studies examining the validity of instruments for use as outcome measures in child and adolescent forensic mental health services: a systematic review.

Outcome measurement in child and adolescent forensic mental health services can support service improvement, research, and patient progress evaluation. This systematic review aimed to identify studies which validate structured instruments available for use as outcome measures in the child and adolescent forensic mental health service cohort and assess the quality of these studies. A systematic review was conducted following PRISMA guidelines. Studies were identified by searching six online databases in November 2023. The quality and risk of bias of each study meeting inclusion criteria was independently assessed by two authors using the Crowe Critical Appraisal Tool. Results were synthesised narratively. A total of eight studies were identified which met inclusion criteria. These looked at six instruments which primarily focused on outcome measures in the areas of treatment motivation, level of functioning, psychiatric symptoms, care needs and response to social situations. Papers scored between 17/40 and 30/40 on the Crowe Critical Appraisal Tool. Studies were rated as low (n = 1), moderate (n = 6), high (n = 1) or very high quality (n = 0). Despite the large number of structured instruments potentially available, evidence for their use as outcome measures in child and adolescent forensic mental health services is limited. Future research should aim to validate current structured instruments for use in the forensic child and adolescent setting, with consideration of whether new instruments should be developed specifically for this group. Such instruments should be developed with both young people as service users and professionals who will be utilising the instrument in mind.

A descriptive evaluation of children presenting with Technology Assisted-Harmful Sexual Behaviour (TA-HSB) within a regional Forensic Child and Adolescent Mental Health Service (FCAMHS)

ABSTRACT Unsupervised technology use by children is increasing rapidly and with it, a common area of crime is emerging: Technology Assisted-Harmful Sexual Behaviour (TA-HSB). Previous research has demonstrated that there are significant differences between adult offenders displaying TA-HSB, offline Harmful Sexual Behaviour (offline HSB) and those displaying both (dual HSB). This study aimed to investigate these differences further within a community adolescent forensic population over a period of four years (1 April 2018 to 31 March 2022). The demographic characteristics and TA-HSB typologies of an adolescent forensic population who were displaying TA-HSB (n = 43), offline HSB (n = 116) and dual HSB (n = 130) were examined. The implications for future research are discussed. PRACTICE IMPACT STATEMENT This evaluation promotes a greater sense of awareness and knowledge of the characteristics of young people engaging in TA-HSB in a community adolescent forensic service and the incidence and types of TA-HSB they engage in. Findings help develop an understanding of risk formulation, differential needs and support of young people presenting with TA-HSB.

Adverse childhood experiences in a london-based forensic CAMHS population

Youth crime is a serious political and social issue, impacting significantly on the young person’s identity, and their community and societal integration and development (Rutter, 2010). Recently, London has experienced some of the highest recorded rates of crimes committed by youth resulting in many custodial settings being at full capacity. Significant attention has been attributed to formulating why some young people become involved in criminal behaviour and many recognise the role of early adversity, which may act as a vulnerability or precipitating factor for some. The association between Adverse Childhood Experiences (ACEs) and youth crime has been researched in many countries and helps to formulate why some young people may engage in crime. This paper investigates the ACEs in a sample of 164 London-based youth who were referred to Forensic Child and Mental Health Service (FCAMHS), by local services. Results indicated that all young people referred had experienced at least one ACE. Those presenting with eight or more ACEs were referred for engaging in serious community violence. While this does not predict or show causation, it is helpful in considering the level of vulnerability and adversity in this cohort of young people. These findings have important implications in the assessment and management of these young people, who may be seen as both victims of adversity and perpetrators of possible crime. Further, these findings can help promote a balanced way of thinking about the whole young person, not just the part that may have committed a crime.

“Containing the Network”: Referrers’ Experiences of the Community Forensic CAMHS Consultation and Liaison Model

Consultation between mental health professionals and other professionals working with young people can bring together multiple agencies to ensure young people are appropriately supported and referred to specialist care where needed. The aim of this research is to explore the consultation and liaison model of support for young people who are at high risk of engaging in harmful behaviors (e.g., harm to self and others), through the experiences of professionals liaising with specialist Community Forensic Child and Adolescent Mental Health Services (F:CAMHS). Interviews with referring professionals (N = 34, from 34 services) were analyzed thematically, themes focused on referrer experiences; impact on the network; and impact on young people and their parents/carers. The combination of forensic mental health expertise in risk assessment and management, with the ability to provide overarching and indirect support to the network is fundamental to the model. Community F:CAMHS’ capacity to manage anxiety in the professional network is likely helped by the one-step-removed position afforded in the consultative role. Adopting a position of authority led to clearer, more co-ordinated and more robust risk management plans. Consideration could be given to adopting the model when working with referrals involving multiple agencies and high levels of anxiety within the network.

The Profile and Characteristics of Young People Accessing Recently Implemented Community Forensic Child and Adolescent Mental Health Services (F:CAMHS) in Northern Ireland

Children under the age of 18 who are known to forensic child and adolescent mental health services often present with complex psychosocial and behavioural needs that are elevated compared with those in the general youth population. The Forensic Child and Adolescent Mental Health Service for Northern Ireland (FCAMHSNI) was commissioned in 2014 to support these children. Despite almost a decade of implementation, the profile and characteristics in the service remain under-analysed, impeding service improvement and making international comparisons more difficult. The primary aim of the current study was to address the regional gaps in how the needs of those accessing FCAMHSNI are understood. A secondary aim was to capture comparable data. Data on 107 accepted referrals are included in the analyses. The majority of cases within this time period were male (81.1%, n = 86) and the majority of presenting behaviours were related to violence and aggression 62.3% (n = 48). However, some forms of violence, such as harmful sexual behaviour, was relatively low when compared with other jurisdictions. Specific demographic characteristics such as gender and religious background appeared to be significant risk factors for referral to the service. Almost all of the sample are known to have experienced at least one potentially traumatic event (95.2%) and in more than one-third of cases, service users presented with co-morbid issues (35.6%, n = 37). These observations are discussed. This study adds to the growing international literature around the needs of forensically involved youth and helps to inform future service development and provision.

Forensic adolescent psychiatry: the care situation in Austria

In Austria there is alack of registered experts in the field of forensic child and adolescent psychiatry. Their tasks include the assessment of young people in various legal issues, but there is also alack of child and adolescent psychiatrists for treatment and care for mentally ill adolescents in prison. This lack means that child psychiatric questions are often answered by psychologists or adult psychiatrists.In the group of incarcerated young people, there is an increased proportion of mental illnesses. However, it is also known that young people with-primarily externalizing-mental illnesses also show asignificantly increased risk of becoming delinquent. Specialized youth psychiatric treatment can also have a(relapse) preventive effect.To ascertain the exact requirement in Austria, the figures are lacking. These numbers should be collected urgently.Furthermore, astructured training for forensic child and adolescent psychiatrists should be expanded and aplatform for exchange and supervision of child psychiatrists working in forensic topics would be desirable. If it is possible to cover the need in this area, the goal that children and adolescents are only examined by specially trained child and adolescent psychiatrists, can be achieved.

An Audit Cycle Highlighting the Rate of Chlamydia Screening in a Forensic Child and Adolescent Mental Health Unit in Birmingham

AimsChlamydia, a sexually transmitted bacterial infection caused by Chlamydia Trachomatis can result in long-term complications for affected individuals. The National chlamydia screening programme recommends screening at-risk young persons, however for the vulnerable patients at the Forensic Child and Adolescent Mental Health Service (FCAMHS), there has been no audit to determine the completion rate. This audit aim to (1) Determine the demographics of young persons on admission (2) To determine the rate of chlamydia screening as well as the percentage of patients who qualified for a Chlamydia screening(3) To determine the rate of documentation for completed tests.MethodsThis was a retrospective study. The medical electronic records of patients who met the inclusion criteria was searched. All the three mixed-sex adolescent forensic wards (2 medium secure units and one low secure unit) at FCAMHS Ardenleigh, Birmingham were sampled.All patients that were on admission aged above 15 years of age were recruited.A total sample size of 19 was obtained for the initial audit and 12 for the re-audit.Data collectionData were collected by the author for the initial-audit and re-audit by searching the clinical progress notes, the investigation results and the physical health rethink forms. An excel software was used for analysis.ResultsDemographicsThere were 11 males (57.9%) and 8 females (42.1%) in the initial auditIn the re-audit, there were 7 males (58.3) and 5 females (41.7). Some of the patients were still on admission at the time of the re-audit, hence the percentages were calculated differently. The mean age and average length of admission was also calculated.Chlamydia screeningIn the initial audit, the percentage of patients tested for Chlamydia was 11.5%, even though 36.8% of patients met the criteria for Chlamydia screening. In the re-audit, 25.0% were tested, and 41.7% met the criteria for Chlamydia screening.Physical health (Rethink) formsThe physical health form was completed for majority of patients 73.7% in the initial audit although, this was not compatible with screening rates. Before the re-audit was concluded, the physical health forms were no longer in use.ConclusionThe audit highlighted an overall improvement in the rate of screening following recommendations from initial audit. The inclusion of Chlamydia screening in admission processes could be useful in improving sexual health.

Forensic Child and Adolescent Mental Health: Looking back, looking around, looking to the future

Criminal Behaviour and Mental HealthVolume 32, Issue 3 p. 154-158 EDITORIAL Forensic Child and Adolescent Mental Health: Looking back, looking around, looking to the future Susan Bailey, Corresponding Author Susan Bailey sbailey@kooth.com Centre for Mental Health, London, UK Correspondence Susan Bailey, Centre for Mental Health, London, UK. Email: sbailey@kooth.comSearch for more papers by this author Susan Bailey, Corresponding Author Susan Bailey sbailey@kooth.com Centre for Mental Health, London, UK Correspondence Susan Bailey, Centre for Mental Health, London, UK. Email: sbailey@kooth.comSearch for more papers by this author First published: 13 August 2022 https://doi.org/10.1002/cbm.2243Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume32, Issue3June 2022Pages 154-158 RelatedInformation

Barriers and gaps within services which affect Black, Asian and Minority Ethnic access to community Forensic CAMHS

PurposeThis paper aims to determine any barriers and gaps within one community Forensic Child and Adolescent Mental Health Service (FCAMHS) provision for young people presenting with risk of harm to others or involvement with the youth justice system, from Black, Asian and Minority Ethnic (BAME) backgrounds.Design/methodology/approachThis study presents a systematic review of literature into the barriers and gaps within community FCAMHS, which showed little research in the area. Because of this, referral numbers for five major cities within the Yorkshire and Humber community FCAMHS region were compared to population statistics and youth justice caution and sentencing data.FindingsComparison suggests that BAME young people are under-represented across referrals to community FCAMHS. Also, there were differences in the representation of BAME young people when compared to youth justice data across the five major cities.Research limitations/implicationsThe lack of literature, combined with disparities in proportional representation of BAME young people within the Yorkshire and Humber FCAMHS, shows the need for a detailed study and analysis within national community FCAMHS.Practical implicationsMore needs to be done within community FCAMHS to ensure that services are meeting the needs of young people at risk of criminalisation.Originality/valueTo the best of the author’s knowledge, there is currently no published literature that explores ethnic representation and access to community-based FCAMH services. Exploration within one regional service suggests that young people from BAME backgrounds may be under-represented within such services, whilst at the same time being over-represented within formal criminal justice.

“If I Didn’t Have Them, I’m Not Sure How I Would Have Coped with Everything Myself”: Empowering and Supporting Parents/Carers of High-Risk Young People Assisted by Community Forensic CAMHS

Parent/carer involvement in their child’s support for mental health difficulties is a critical component of effective care. 13 Community Forensic Child and Adolescent Mental Health Services (F:CAMHS) across England were developed to provide specialist support to young people at high risk of harm to self and in particular others, and their families. The aim of this study is to explore parent/carer experiences of Community F:CAMHS. Thematic analysis of interviews (N = 18, from 5 sites) was conducted. Superordinate themes generated focused on 1) facilitators; and 2) barriers to support. Subthemes generated relate primarily to facilitators, particularly empowering parents/carers through the co-production of strategies to help, “holding” cases (taking ownership), and acting on behalf of and supporting parents/carers. Managing clear, joined-up communication across multi-agencies is also of key importance. Barriers to effective support are a lack of joined-up communication at the beginning of the implementation of the services, awareness of Community F:CAMHS, and limited contact. Implications, including the need to further embed the Community F:CAMHS offering in the overall provision of support for this population are discussed. Areas for future research are identified, including the exploration of how young people's characteristics and outcomes may impact parents/carers’ experiences of interacting with services.

Nuances of Forensic Child psychiatry - A special focus on child custody, corporal punishment, and the relevance of the Mental Health-Care Act for children and adolescents.

Nuances of Forensic Child psychiatry - A special focus on child custody, corporal punishment, and the relevance of the Mental Health-Care Act for children and adolescents.

A Mixed-Methods Realist Evaluation of the Implementation and Impact of Community Forensic CAMHS to Manage Risk for Young People With Forensic and Mental Health Needs: Study Protocol.

Introduction: Young people in contact with forensic child and adolescent mental health services present with more complex needs than young people in the general population. Recent policy has led to the implementation of new workstreams and programmes to improve service provision for this cohort. This paper aims to present the protocol for a national study examining the impact and implementation of Community Forensic Child and Adolescent Mental Health Services (F:CAMHS).Methods and analysis: The study will use a mixed-methods Realist Evaluation design. Quantitative service activity and feedback data will be collected from all 13 sites, as well as questionnaires from staff. Non-participant observations and qualitative interviews will be conducted with staff, young people and parents/guardians from four focus study sites. An economic evaluation will examine whether Community F:CAMHS provides good value for money. The results will be triangulated to gain an in-depth understanding of young people's, parents/guardians' and staff experiences of the service.Ethics and dissemination: Ethical approval was granted by the Health Research Association and UCL Ethics. The results will be disseminated via project reports, feedback to sites, peer-reviewed journal publications and conference presentations.

FRIEND OR FOE? THE VIRTUAL WORLD AND COMMERCIAL SEXUAL EXPLOITATION OF CHILDREN IN THE ERA OF COVID-19

This presentation will explore commercial sexual exploitation of children (CSEC) and its evolution in the COVID-19 era. We will review risk factors, signs, and symptoms of CSEC and the role of social media and the internet on CSEC. We will delineate prevention and intervention strategies, especially related to the virtual world. We will also review sexual health intervention for CSE-impacted youth. Suzan Song, MPH, PhD, will review the public health literature, case examples, the impact of public health measures and school closures on the propagation of CSEC domestically and globally, and risk factors, signs, and symptoms. Jessa Crisp, a lived experience expert and mental health professional for CSE youth, will use case-based examples of social media’s use in luring trafficking victims, its use by these youth for support, and its influence on social norms that facilitate trafficking. Dawn Bounds, PhD, will explore user and predator characteristics and associated risks, the online grooming process, and evidence-based strategies for prevention. Sarah Godoy will discuss a health promotion intervention developed with the expertise of lived experience experts to better address their sexual health needs. Jordan Greenbaum, MD, a forensic pathologist/child abuse physician in Atlanta, and Eraka Bath, MD, a forensic child and adolescent psychiatrist in Los Angeles, will serve as our discussants, providing their unique perspectives on the material presented and facilitating engagement with our audience. The virtual world has played an important role in the propagation of CSEC during the COVID-19 epidemic. This presentation will arm child and adolescent psychiatrists with critical knowledge about the online grooming process, recognition of youth at risk, and intervention strategies to support children and families in prevention and early intervention. Participants will also acquire knowledge in sexual health mitigation strategies for CSE-involved youth. Psychiatrists have a unique role to play in prevention, early intervention, and harm reduction around CSEC. It is critical to gain a deeper understanding of the role of virtual technologies, such as internet, social media, and mobile health (m-health) technologies, in the propagation, prevention, and intervention with youth at risk for CSE and impacted by CSE.

Characteristics of young people accessing recently implemented Community Forensic Child and Adolescent Mental Health Services (F:CAMHS) in England: insights from national service activity data

Children and young people in contact with forensic child and adolescent mental health services present with more complex needs than young people in the general population. Recent policy in child and adolescent mental health has led to the implementation of new workstreams and programmes to improve service provision. This research examines the characteristics of children and young people referred to recently commissioned Community Forensic Child and Adolescent Services (F:CAMHS) and service activity during the first 24 months of service. The study is a national cohort study to describe the population and investigate service provision and access across England. Secondary data on 1311 advice cases and 1406 referrals are included in analysis. Findings show that 71.9% of the sample had accessed mainstream CAMHS before their referral, 50.9% had experienced/witnessed multiple traumatic events and 58.4% of young people presented with multiple difficulties. The results of the study highlight the complexity of the cohort and a need for interagency trauma-informed working. This is the first study to describe the characteristics of children and young people referred to Community F:CAMHS and provides valuable information on pathways and needs to inform service policy and provision.

Reducing aggression and improving offending outcomes in youth with conduct disorder, results of a systematic review

AimsThe aim of this literature review was to determine what interventions are effective in reducing aggression and offending behaviour in under 18's with conduct disorder.Null hypothesis: There is no difference in aggression or offending behaviour in under 18's with conduct problems in spite of interventions offeredBackgroundMental health services for children and adolescents who are aggressive or who have come into contact with the Youth Justice System are sparse and often under resourced. Conduct disorder (CD) is one of the most frequently diagnosed conditions in adolescents, particularly in young offenders (Kenny et al 2007). The most effective prevention programs for youth at risk of persistent delinquency has previously been found to be a multi model program focussing on the family context. However, this has not taken in to consideration the extent and prevalence of mental disorder, including conduct disorder, within the target population.MethodA systematic literature search was undertaken on medline and psychoinfo between January and December 2018. Identified papers were then screened by two independent researchers against pre-agreed inclusion and exclusion criteria. Relevant papers were assessed for bias and results summarised.ResultFrom an initial data set of 526 papers, 9 were included for review. 4 focussed on psychopharmacology (1 aripiprazole, 1 risperidone, 1 risperidone vs clozapine, 1 clozapine), 1 family centred feedback, 1 Mode Deactivation Therapy and 3 were multi modal (combinations of Mode Deactivation Therapy, Stop Now and Act Programme, CBT, Didactic sessions, 1:1 counselling). None of the multi-modal interventions were standardised or comparable to each other. End points varied from 8 weeks (aripiprazole) to 15 months (multimodal SNAP programme). Settings varied from community programmes to secure inpatient settings. Whilst one risperidone study reported it to be effective in reducing aggression, it was not significant. One SNAP (multimodal) programme failed to show significant effect. All other 7 interventions, across various methods, demonstrated significant reductions in aggression, violence or other antisocial behaviour.ConclusionFew papers were identified that assessed interventions for youth with conduct disorder. The papers that were identified were significantly heterogeneous in their intervention, sample selection, methodology and outcome measures. Unfortunately, this leads to an inability to compare any interventions for this demographic. Despite the rise in Forensic Child and Adolescent Mental Health Services, there is a weak and poorly understood evidence base for supporting and managing young people with conduct disorder.

Forensic Child and Mental Health in Europe

Forensic Child and Mental Health in Europe

Child Interviewing in Legal Cases : A European Perspective

Child interviewing in legal cases is a multidisciplinary, multiprofessional topic that has been addressed as a following realisation, that accurate and eligible oral evidence, information or confession from children can only be obtained by a specific genre of interviews. Child development experts and researchers have advocated for specialised techniques for forensic child interviewing since the 80s and 90s, along with specialised police training and practice. In the European Union the last decade could rightly be called the decade of child-friendly justice. During these ten years several legal instruments were implemented about children’s involvement in legal proceedings and their special needs and rights as a vulnerable group. This shift is reflected in national legislations, however, there is still room for improvement, especially in the everyday practices within the interrogation rooms.

Supporting youth workers: A reflective group consultation approach

Forensic child and adolescent mental health services (FCAMHS) became a service within the Tavistock and Portman NHS Foundation Trust in 2018, and since then has become a multidisciplinary expansion of the Portman Clinic’s consultation and assessment work. FCAMHS provides specialised consultation, assessment and brief interventions to professionals, families, and young people across 13 boroughs in Central, North, and East London. As a service provider we aim to support third sector service users who are working directly with some of the most vulnerable, at risk, and risky young people in our area. Through an existing contact in a local youth organisation we began to discuss the idea of creating a space where professionals could come together as a group to reflect on experiences and identify areas of difficulty in their work. Reflective practice groups offered by the Portman Clinic are often psychoanalytically-informed consultation groups which offer a way of working with professionals and young people by reflecting on the meaning, communication and experience of the young person’s behaviour, and our own responses to this. Therefore, we decided to offer a reflective practice group to third sector professionals known to FCAMHS from local youth services and other local agencies, who work with some of the most vulnerable, challenging and high risk young people in this location of London. This reflective practice group has now been running for almost two years and provides a valuable space for youth workers to process and make sense of their work with this challenging forensic population.

Forensic interviewers’ experiences of interviewing children of different ages

ABSTRACT Increased knowledge about practitioners’ experiences of conducting forensic child interviews may provide valuable insights into the perceived challenges they encounter when questioning children. This mixed-methods study examined Swedish practitioners’ views on different interviewing components (ground rules, rapport building, practice narratives, question types), props, strategies for adapting their methods for preschool-aged children, and perceptions of challenges interviewing children of differing ages. Eighty-eight specialized forensic child interviewers responded to a national survey. The data was analyzed using quantitative and qualitative approaches. Attitudes regarding different interviewing components were mainly in line with current research recommendations. Prop use was primarily limited to drawings, photographs, and stress-reduction tools. A variety of strategies were used to adapt the existing protocol for questioning young children, indicating a potential need for additional standardized guidelines for this age group. Furthermore, the perceived barriers for children to disclose and the demands placed on the interviewer varied across age groups. Since all children should have the right to be questioned with age appropriate methods, we need to continue to develop ways of adapting practitioners’ interviewing strategies to match children’s developmental levels. To reach this aim, researchers may benefit from taking into account the concerns raised by forensic child interviewers.