Search

• Many mental health disorders first emerge during early childhood or adolescence. • Wait times for children's mental health services have been an international and widespread problem. • Long wait times prolong the emotional distress of children and/or adolescents and their caregivers which can exacerbate mental health difficulties. • The majority of research in this area has been conducted in the United Kingdom and Canada and focus on one waitlist strategy. • Common strategies include alternative service delivery models, increasing system capacity, and improving intake and assessment processes. Background: Although many mental health disorders first emerge during early childhood or adolescence, there is a significant gap between demand and availability of mental health resources, leading to long waitlists for services. Objective: The objective of this scoping review was to identify and characterize the research literature related to the range of waitlist management strategies that have been implemented in outpatient child and adolescent mental health care. Methods: Electronic databases reviewed included: Medline (Ovid), Embase (Ovid), PubMed, PsychINFO, SCOPUS, CINAHL, and ISI Web of Science. Grey literature databases included: OpenGrey, Conference Papers Index, and Proquest Digital Dissertations. Articles were screened by two reviewers in two steps: first by title and abstract, then full text level. Data were extracted using an a-priori developed data extraction framework, which was piloted and modified iteratively. Results: A total of 119 papers related to waitlist interventions in child and adolescent mental health were reviewed. Of these 119 papers, 11% were reviews, summary, or theoretical papers; 8% used a randomized control trial design and 2.5% were trial protocols. Most studies used less rigorous designs, such as uncontrolled before-and- after designs. The large majority focused on just one waitlist strategy each. The most commonly used approaches included: prioritization/triage and initial assessment; brief consultation and advice or brief therapy approaches; group-based models; interim services; increasing capacity; and strategies to decrease non-attendance. Most studies were conducted in the United Kingdom or Canada. Discussion: While mental health systems are complex, most studies examining waitlist initiatives explored the implementation of single initiatives. It is unlikely that a single waitlist strategy can be effective in managing wait times for children's mental health. Rather, consistent and systemic approaches to address wait times that consider the impact of the reduction approach on the patient, the program, and the community are needed. [ABSTRACT FROM AUTHOR]

• This study reviewed the prevalence of mental health disorders among Looked After Children in the UK. • Prevalence rates varied across studies. • The Strengths and Difficulties Questionnaire (SDQ) was the most frequently used tool to assess mental health. • There is still uncertainty about the scale and nature of mental health difficulties in this group. 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. [ABSTRACT FROM AUTHOR]

Abstract For many local authority children and family services in the UK faced with the task of responding to children and families facing difficulties and with declining budgets, there is an increasing imperative on how services can respond more effectively to the diverse needs of families on the edge of care. At the same time policy and paradigm shifts have affected the way in which social workers engage with families. This paper is rooted in research commissioned by one local authority that used an innovative visual 'river of experience' co- production approach to understand better the experiences of children and families on their journeys to the edge of care and to inform how statutory services might respond 'better', and possibly earlier, to prevent children being taken into care. The research highlights the gap between assumptions and practices of child and family services and the realities and needs of children and families. The paper discusses these disjunctions and draws out questions to challenge statutory services. In particular, the paper asks why, in spite of serial involvement of professionals, do children still end up in the care system. The paper contributes to current discourses about rethinking child protection, arguing for a different approach to responding to families facing difficulties involving human centred, holistic family support and a more reflexive and relational approach to professional practice. Highlights • The continuing gap between services and the needs of children and families • Children's voices frequently go unheard in statutory professional interventions. • Insufficient attention to emotional/psychological legacy of early neglect • Reiterates the need for re-imagining child protection as family-centred practice • Need for Children and Family services to be flexible and adaptive learning systems [ABSTRACT FROM AUTHOR]

This paper presents a community based participatory research project, which adopted a photovoice approach with seven unaccompanied asylum-seeking children (UASC) living in foster care in the United Kingdom. The project also included a focus group with six foster carers to explore their perceptions of caring for UASCs. At the end of the focus group we then shared the young people's images from the photovoice project. The purpose of this was to better inform the carers understanding of this group's needs and the reality of their lived experiences, to see if this would have any impact on their perceptions or willingness to offer these children a placement in the future. The young people then developed the photographs into posters, which were shown at community events and exhibited in community spaces during refugee week. Findings from the focus group show that some of these carers had anxieties and held misconceptions around caring for UASCs. This highlights the need for practitioners to engage in open conversations with foster carers, to discuss their perceptions and challenge any misconceptions. Furthermore, the project identified that some of these carers were concerned about being able to meet the cultural needs of the young people. Foster carers also seemed unaware of the available support in place to help with this. Therefore, it would be beneficial for foster care services and practitioners to ensure that carers are fully informed of the support and training available to them to assist in meeting UASCs cultural, religious and linguistic needs. The project also presents important lessons for researchers committed to finding ways to engage UASCs meaningfully in the research process. The action orientated approach of photovoice led to a wide range of public engagement activities, that allowed us to show important aspects of the young people's lived realities growing up in foster care. [ABSTRACT FROM AUTHOR]

Schools provide the setting in which interventions aimed at preventing intimate partner violence and abuse (IPVA) are delivered to young people in the general population and a range of programmes have been designed and evaluated. To date, most rigorous studies have been undertaken in North America and the extent to which programmes are transferable to other settings and cultures is uncertain. This paper reports on a mixed methods review, aimed at informing UK practise and policy, which included a systematic review of the international literature, a review of the UK grey literature and consultation with young people as well as experts to address the question of what works for whom in what circumstances. The context in which an intervention was delivered was found to be crucial. Context included: the wider policy setting; the national or regional level, where the local culture shaped understandings of IPVA, and the readiness of an individual school. The programmes included in the systematic review provided stronger evidence for changing knowledge and attitudes than for behavioural change and those young people who were at higher risk at baseline may have exerted a strong influence on study outcomes. Shifting social norms in the peer group emerged as a key mechanism of change and the young people consulted emphasised the importance of authenticity which could be achieved through the use of drama and which required those delivering programmes to have relevant expertise. While the consultation identified increasing interest in targeting interventions on boys, there was an identified lack of materials designed for minority groups of young people, especially Lesbian, Gay, Bisexual and Transgender young people. Increased responsivity to the local context can be achieved by involving those who will deliver and receive these preventive programmes in their development. Schools need to be better prepared and supported in the task of delivering these interventions and this is particularly relevant for the management of disclosures of IPVA. Outcomes measured by evaluations should include those relevant to education. [ABSTRACT FROM AUTHOR]

Children who have been removed from their parents need stability and permanence; this is as true for disabled children as it is for others. Yet many children are subject to extended periods of uncertainty and instability. Growing attention has been paid to the need to achieve permanence within a timescale which meets children's needs. As disabled children are over-represented in looked after (in care) populations it is especially important that their needs are considered when formulating policy and practice in this area. This review of literature covers international material related to stability and permanence for disabled children, in particular permanence achieved through fostering and adoption. A scoping method was used to identify and analyse a broad range of material. Ninety texts were included in the review, including material from the US, the UK, Canada, Australia, China and the Netherlands. Empirical research included quantitative, mixed methods and qualitative studies. Other sources included literature reviews and a small number of research-based ‘think pieces’ and briefings. Disabled children often have permanence outcomes and experiences which differ from those of other children; most often they are disadvantaged by systematic features of services and by the latent disablism of decision-makers, professionals, carers and potential carers. The findings also show that disabled children are not a homogenous group and that characteristics such as age, gender, ethnicity and impairment type show complex relationships with permanence through adoption and foster care. Important gaps in current knowledge are identified, including disabled children's views and experiences in relation to achieving permanence. Several areas of policy and practice are highlighted where effort to improve permanence needs to be made. These range from tackling negative professional attitudes about the prospects of placing disabled children to further development of non-traditional approaches to the recruitment of foster carers and adopters. [ABSTRACT FROM AUTHOR]

• Over a third of children were reported missing on multiple occasions. • Children who were white and living in residential care were more likely to be reported missing repeatedly. • Repeat missing child reports happened in quick succession. There are around 200,000 reports of missing children each year in England and Wales, and around 65 per cent of these relate to repeat disappearances. Such repeat disappearances are a social care and policing concern due to the multiple risks that children are exposed to while they are missing from home, including exploitation, substance misuse, and violence. Understanding the characteristics of children who go missing repeatedly could help services protect them and meet their needs more effectively. This study uses police records to explore the characteristics of missing children (<18 years) from one Welsh local authority over a five-year period, and the prevalence, timing, and risk factors associated with repeat missing incidents. There were 1,434 children reported missing and 4,922 missing episodes in the city between 2014 and 2019. Thirty-nine per cent of children were reported missing more than once, and these children accounted for 82 per cent of all missing child reports. Logistic regression found that children who were White and living in residential care were more likely to be reported missing repeatedly. Over half (57 per cent) of the children who were reported as missing more than once were reported missing for a second time within two months of the first incident. This study highlights the volume and quick succession of repeat missing child reports. It provides evidence about some of the risk factors associated with repeat missing episodes. [ABSTRACT FROM AUTHOR]

• Rates of child welfare interventions rose in the year of an Ofsted inspection. • Spikes in intervention were greatest for local authorities judged inadequate. • Post-inspection, expenditure and agency workers rose steeply for inadequate LAs. • Good or outstanding LAs saw a fall in intervention rates, spend and agency workers. • These were unintended consequences and not linked to inspection recommendations. • The inspectorate is encouraged to study the impact of its own activities on provision. Children's social care services in England are inspected by a government agency, Ofsted. This paper reports on the impact of Ofsted inspections on rates of intervention and other performance measures, such as expenditure and workforce, drawing on a quantitative analysis of national datasets. Annual published returns from 150 English local authorities from 2009 to 19 were combined with results from Ofsted inspections under the Single Inspection Framework (2014–17), which covered all local authorities. Interrupted time series (ITS) analysis was undertaken to find out whether an inspection had a significant effect on performance in the context of trends pre- and post-inspection, and whether this effect varied according to the type of judgement. The results showed discontinuities in a range of indicators in the year of an inspection and the year afterwards. An increase in rates of child protection interventions occurred at the time of an inspection, which was most pronounced in local authorities receiving an inadequate judgement. An inadequate judgement led to a steep rise in spending and use of agency workers compared to other local authorities. The findings suggest that a short-term spike in intervention rates is an unintended consequence of inspections, which is sustained only in local authorities judged to be performing badly. Implications are discussed for performance in the sector and the purpose of inspection. [ABSTRACT FROM AUTHOR]

We conducted a scoping literature review based on a sample of 51 UK-based research articles published since 2004, focusing on children and young people aged 6–17 years. Taking the 2004 Office for National Statistics survey of child and adolescent mental health as a pivotal point in the development of the field, our aims were to identify the mental health difficulties featured in extant literature since the survey; uncover critical gaps; and propose avenues for advancing the field. Articles were critically reviewed, coded, and summarised. We found socioeconomic disadvantage, family instability and parental distress are cited as key contributing factors to mental distress. Following categorizations in the 2004 survey, emotional, conduct, and hyperactivity difficulties were the most commonly researched and reported topics. The needs of migrant, BAME, physically disabled, and LGBTQ children were severely underrepresented in the literature, as were those of looked after children. We also found a strong reliance on clinic-based convenience samples, which obfuscates the needs of children who are not able to access care. Further research using inclusive, population-based samples and diverse methods is needed going forward. [ABSTRACT FROM AUTHOR]