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Increasing rates of mental health difficulties for young people in the UK are often described, though seldom from young people's perspective or viewpoint. The Schools NorthEast Healthy MindED Commission works towards supporting schools to understand and mitigate the factors affecting young people's mental health, and through doing so enable better resilience. This research extends from the work of the commission. Utilising the World Health Organisation mental health definition, we supported schools to have conversations with young people about the factors that affect their mental health. Staff from regional schools were trained and supported to carry out focus group discussions and complete initial data analysis. Meta-analyses of findings were carried out to identify illuminative themes. Findings were fed back to establish face validity and so allow further action planning – not reported here. Themes are considered against established theory and the wider literature. In addition to illustrating the usefulness of listening to young people in order to understand mental health in school contexts, crosscutting themes of relationships, agency, and rest and recovery were concluded as key to enabling mental health within school contexts. [ABSTRACT FROM AUTHOR]

The study examined whether caregiver worry of COVID-19 infection and co-existence difficulty differentially predicted child mental health and wellbeing during the lockdown in two culturally different countries that were severely affected by the pandemic: the UK and Turkey. Co-existence difficulty is the hardship experienced by family members living all together in the same house at the same time during the lockdown period. Participants were 1849 caregivers of children between 5- and 12-years old living in the UK ( n = 995) and Turkey ( n = 854), who completed an electronic survey distributed via social networks during the initial phase of the COVID-19 lockdown (July and August 2020). Caregivers completed a set of questionnaires on child and family wellbeing and on whether the child's internalizing and externalizing symptoms changed during the lockdown as compared to before. Worry of COVID-19 infection was higher amongst caregivers in the Turkish sample and was associated with higher levels of child internalizing symptoms during the lockdown in the Turkish sample, however there were no statistically significant differences in the size of the impact of worry of infection on the children's internalizing symptoms between the two countries. Co-existence difficulty independently predicted increase in children's internalizing and externalizing symptoms during the lockdown in both samples. Families in the UK experienced a higher level of difficulty with co-existence compared to the families living in Turkey but the magnitude of the impact of co-existence difficulty on children's outcomes between the two samples was not significantly different.The findings suggest that public health strategies should aim to reduce social anxiety and invest in the development of programs aimed at supporting families to overcome the challenges of co-existence during times of public health crisis., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

A large body of literature has demonstrated that there are developmental differences in mental health problems. However, less is known about the development of mental health problems in ethnic minority children, particularly at the population level. Using a detailed ethnic classification and nationally representative data from the UK Millennium Cohort Study (n = 18, 521, 49% female, 18% ethnic minority), this study examines ethnic differences in children's mental health problems and trajectories of mental health from ages 3 to 14 years. Growth curve modeling revealed that ethnic minority children followed different developmental trajectories of internalizing and externalizing problems than white children, either in terms of the mean-level and/or rate of change across age. These differences were not explained by child sex, socioeconomic status, maternal depressive symptoms, and maternal immigrant status, highlighting the need for further research exploring the factors that underpin ethnic inequalities in child mental health. [ABSTRACT FROM AUTHOR]

Background: Parental domestic violence and abuse (DVA), mental ill-health (MH), and substance misuse (SU) can have a negative impact on both parents and children. However, it remains unclear if and how parental DVA, MH, and SU cluster and the impacts this clustering might have. We examined how parental DVA, MH, and SU cluster during early childhood, the demographic/contextual profiles of these clusters, and how these clusters relate to child MH trajectories., Methods: We examined data from 15,377 families in the UK Millennium Cohort Study. We used: (1) latent class analysis to create groups differentially exposed to parental DVA, MH, and SU at age three; (2) latent growth curve modelling to create latent trajectories of child MH from ages 3-17; and (3) a case-weight approach to relate latent classes to child MH trajectories., Results: We identified three latent classes: high-frequency alcohol use (11.9%), elevated adversity (3.5%), and low-level adversity (84.6%). Children in the elevated adversity class had higher probabilities of being from low-socioeconomic backgrounds and having White, younger parents. Children exposed to elevated adversity displayed worse MH at age three (intercept = 2.274; p < 0.001) compared the low-level adversity (intercept = 2.228; p < 0.001) and high-frequency alcohol use class (intercept = 2.068; p < 0.001). However, latent growth factors (linear and quadratic terms) of child MH did not differ by latent class., Conclusions: Parental DVA, MH, and SU cluster during early childhood and this has a negative impact on children's MH at age three, leading to similar levels of poor MH across time. Intervening early to prevent the initial deterioration, using a syndemic-approach is essential., (© 2024. The Author(s).)

We conducted a mixed-methods, formative evaluation of a peer-led parenting intervention for homeless families. Participants were parents living in temporary accommodation with self-identified difficulties related to parenting an index child aged 2–11 years. An evidence-based programme ('Empowering Parents, Empowering Communities') was adapted for delivery with the target population in London, UK. We assessed feasibility in terms of session attendance rate, intervention completion rate and potential for impact on a range of parent-reported outcomes measures. Acceptability and appropriateness were examined by a user satisfaction measure and qualitative interviews. The intervention was delivered across three group cohorts (N = 15). Thirteen parents completed the programme (including one parent who required two attempts). We found improvements in child behavioural difficulties, parenting knowledge and practices, while parental well-being and social support were unchanged. Participants were highly satisfied overall, with indications that the peer-led model mitigated negative expectancies of services and normalized experiences of parenting in challenging conditions. Parental self-care and 'the good enough parent' were strongly endorsed topics, although some content (e.g. timeout) was deemed impractical. These promising findings warrant further testing under controlled conditions. [ABSTRACT FROM AUTHOR]

Socioeconomic disadvantage has been linked to mental health difficulties in children and adolescents, although many children appear to do well despite exposure to financial adversity in childhood. Our study looked at the effects of family financial difficulty on children's mental health outcomes (n = 636) at 4–5 years in a multi-ethnic UK cohort, the Born in Bradford cohort. We considered potential parent and child variables promoting resilience in this population. Univariate linear regression was used to identify associations between family financial difficulty measured antenatally and child mental health difficulties measured by teacher-rated Strengths and Difficulties (SDQ) scores at 4–5 years. Hierarchical multivariate regression was used to test for potential moderating effects of parent and child factors. Mothers completed the General Health Questionnaire-28, Kessler-6 Questionnaire and questions related to parenting warmth, hostility and confidence. Parent-rated Infant Characteristic Questionnaires and teacher-rated Early Years Foundation Stage scores provided information on child temperament, literacy and physical development as potential moderators. Financial difficulty was associated with worse mental health outcomes in children. High parent warmth, high child literacy scores and physical development scores were all associated with positive child mental health outcomes at 4–5 years. In terms of protective effects, only maternal warmth was found to significantly moderate the relationship between financial difficulty and child mental health difficulties. The current study demonstrates that family financial difficulty is associated with poorer child mental health outcomes in a UK cohort of mothers and their school-aged children. It provides evidence of the positive relationships between warm parenting, child literacy and child physical development with mental health in young children. The study supports the finding that warm parenting moderates the relationship between family financial difficulty and interventions supporting this aspect of parenting may therefore provide particular benefit to children growing up in this context. [ABSTRACT FROM AUTHOR]

Abstract Background Children in out-of-home care are consistently found to have poor mental health compared to children in the general population. However, UK research has so far failed to disentangle the impact of the care system on children's mental health outcomes from the effects of the adverse circumstances that led to their admission to care. Objective This research investigated the association between care placement and the presence of child mental health problems after controlling for children's pre-care experiences. It also identified factors associated with mental health problems among children in care. Participants and Setting The sample comprised three groups of children involved with child welfare services due to maltreatment, including children in out-of-home care (n = 122), reunified children (n = 82) and those who had never been in care (n = 159). Methods The mental health of the children in the three groups was compared, using information collected from their parents/foster carers and social workers. Results The odds of a child in out-of-home care having a mental health problem were not significantly higher than those of a child who had never been in care (AOR = 1.24; p = 0.462). However, the odds of a child in out-of-home care having reactive attachment disorder (RAD) were significantly higher than those of a child who had never been in care (AOR=1.92; p = 0.032). Conclusions These findings make an important contribution to international debates about whether placing children in care is beneficial or detrimental to their wellbeing, and highlight a range of inter-linking factors associated with the mental health of children in out-of-home care. [ABSTRACT FROM AUTHOR]

Background: Having good access to information is crucial when attending an appointment with a health professional; for 5% of the world’s population, who have some degree of hearing loss, this is challenging. With the introduction of acts against discrimination in the U.K., there is a responsibility to provide equitable access to services; best practice states that professionals should work with a registered British Sign Language Interpreter. In child and adolescent mental health services, practitioners may work with the deaf child/young person and their families; this presents many challenges. Previous models of interpreting do not lend themselves to this setting; interpreters need to have high levels of language and two-way interpreting skills, imparting detailed information about language and communication demands they face. Method: The role of the interpreter in the team was audited at two time points using an activity recording sheet; this is integrated with available literature and our clinical expertise. Results: Based on iterative audits and expert panels to discuss good practice, we have formulated a helpful way of working with interpreters. To enable robust assessments and therapeutic interventions, clinicians and interpreters are required to co-work. We discuss our experiences of helpful practices when working with interpreters including the importance of pre-appointment meetings, co-working during sessions, and debriefing. Conclusion: We make recommendations for working with deaf children/young people, improving communication with them and their families, and their experience of services, all of which could potentially improve outcomes. [ABSTRACT FROM AUTHOR]

There are substantial health disparities between children from low and higher income families. The study aimed to test changes in child mental health inequalities across three large UK population cohorts of 11-year-old children assessed in 1999, 2004 and 2012 as part of the British Child and Adolescent Mental Health Surveys and Millennium Cohort Study. Child mental health was assessed using parent and teacher versions of the Strengths and Difficulties Questionnaire. There were substantial differences in parent and teacher reported symptom scores between children from low and higher income families in each cohort. Differences in parent-reported symptoms increased over time (ES 0.35 [95% CI 0.20, 0.49] in 1999, ES 0.39 [95% CI 0.17, 0.61] in 2004, ES 0.54 [95% CI 0.49, 0.58] in 2012); cohort interaction: p = 0.01). This study found that marked child mental health inequalities exist. The mental health gap between advantaged and disadvantaged children has not reduced over the last 20 years and may be getting worse. [ABSTRACT FROM AUTHOR]

Objectives: To explore the implementation of shared decision making (SDM) in Child and Adolescent Mental Health Services (CAMHS), and identify clinician-determined facilitators to SDM. Methods: Professionals from four UK CAMHS tried a range of tools to support SDM. They reflected on their experiences using plan-do-study-act log books. A total of 23 professionals completed 307 logs, which were transcribed and analysed using Framework Analysis in Atlas.Ti. Results: Three states of implementation (apprehension, feeling clunky, and integration) and three aspects of clinician behavior or approach (effort, trust, and flexibility) were identified. Conclusions: Implementation of SDM in CAMHS requires key positive clinician behaviors, including preparedness to put in effort, trust in young people, and use of the approach flexibly. Practice implications: Implementation of SDM in CAMHS is effortful, and while tools may help support SDM, clinicians need to be allowed to use the tools flexibly to allow them to move from a state of apprehension through a sense of feeling “clunky” to integration in practice. [ABSTRACT FROM AUTHOR]

A large body of literature suggests that children living with two married, biological parents on average have fewer behavior problems than those who do not. What is less clear is why this occurs. Competing theories suggest that resource deficiencies and parental selectivity play a part. We suggest that examining different contexts can help adjudicate among different theoretical explanations as to how family structure relates to child behavior problems. In this paper, we use data from the Growing Up in Australia: Longitudinal Study of Australian Children (LSAC), the UK Millennium Cohort Study (MCS), and the US Early Childhood Longitudinal Study (ECLS-K) to examine the relationship between family structure and child behavior problems. Specifically, we look at how living in several configurations of biological and social parents may relate to child behavior problems. Findings suggest both similarities and differences across the three settings, with explanations in the UK results favoring selectivity theories, US patterns suggesting that there is a unique quality to family structure that can explain outcomes, and the Australian results favoring resource theories.

Emotional and behavioural difficulties (EBD) are common in children, and forecasting their prevalence in schools is of interest to both academic researchers and local authorities. Percentage of pupils eligible for free school meals is one measure often used for this purpose. The article presents the first independent validation of a simple numerical score, the Ford score, which predicts the level of EBD within schools using routinely collected school variables on eligibility for free school meals, special educational needs, unauthorised absences and permanent exclusions. The research tested the predictive utility of the Ford score in the English sub-sample of the British Child and Adolescent Mental Health Survey, 2004. This gave a sample of 6,379 children aged 5–16 in 3,117 schools, with mental health being assessed through clinician-assigned psychiatric diagnoses and through brief questionnaires filled in by parents, teachers and young people. The Ford score was found to be highly predictive of the level of EBD by all four of these measures, with a linear effect across the whole range. The estimated prevalence of mental disorder rose from about 5 per cent in schools with low Ford scores to around 14 per cent in high-scoring schools. The Ford score was more highly correlated with all measures of EBD than percent-age of free school meals alone. The Ford score's predictive utility did not seem to be further enhanced, however, by adding in an additional measure of local area deprivation. It was concluded that the Ford score represents a simple and up-to-date school EBD predictor which is more accurate than percentage free school meals alone and which is not notably improved by taking account of a schools' area deprivation. [ABSTRACT FROM AUTHOR]

Past studies have documented rising levels of conduct problems among UK adolescents in the last quarter of the twentieth century, and increased rates of emotional difficulties between the 1980s and 1990s. We used parent, teacher and youth ratings from two large scale, nationally representative studies of 5–15 year-old carried out in 1999 and 2004 to assess whether these increases continued into the early years of the new millennium. Ratings on most “problem” sub-scales remained stable or showed small declines over this period, and parent and teacher reports suggested small increases in levels of prosocial behaviours. The upward trends in rates of UK child adjustment problems noted since the 1970s and 1980s may have plateaued, and possibly begun to be reversed. [ABSTRACT FROM AUTHOR]

Background: Whilst the correlates of child mental health problems are well understood, less is known about factors that operate to maintain healthy or unhealthy functioning, or that contribute to change in functioning. A range of factors may be of interest here, including relatively stable characteristics of children or their environment, that may have long-lasting and enduring consequences for their mental health, along with events that prompt changes in a child's mental state.Methods: Children were followed up 3 years after the original survey for a sub-sample of the 1999 British Child and Adolescent Mental Health Survey (N = 2,587 children). Latent mental health ratings drew on data provided by parent, teacher, and youth versions of the Strengths and Difficulties Questionnaire at baseline, and at follow-up. A residual scores method was used to assess change in functioning over time.Results and Conclusions: Latent mental health scores showed strong stability over time (r = 0.71) indicating the need for effective intervention with children who have impairing psychopathology, since they are unlikely to get better spontaneously. A poorer outcome was associated with: externalizing as opposed to emotional symptoms, reading difficulties; living in a single-parent or reconstituted family at baseline; and after exposure between Time 1 and Time 2 to parental separation, parental mental illness, child illness, and loss of a close friendship. All these factors could be targeted in public health or clinical interventions, particularly as predictors of change in child mental health were closely comparable across the range of initial SDQ scores, suggesting that they operated in a similar manner regardless of the initial level of (mal)adjustment. [ABSTRACT FROM AUTHOR]

Background: The Children Service Interview was designed as a brief measure of service use related to mental health problems in Great Britain.Method: We validated the Children's Services Interview against medical records from a sample of 87 children, and assessed test-retest reliability from 25 parents completing two interviews. We examined criterion validity by looking at the service use patterns of children attending clinics for different types of disorders.Results: The Children's Services Interview showed high levels of face validity and moderate or better concordance with medical records as far as contacts were recorded in the case notes. Test-retest reliability was moderate or better apart from contacts with the voluntary sector, teachers, and the number and duration of appointments with some professionals.Conclusion: The study suggests the Children's Services Interview can extract moderately valid and reliable data on service use.Declaration Of Interest: Tamsin Ford was supported by a Wellcome Clinical Training Fellowship in Health Services Research while completing this work. [ABSTRACT FROM AUTHOR]

This paper focuses on contemporary British public policy and how social policies and feminist-informed family therapy are influencing and challenging each other. The concept and practice of family support is evaluated in terms of the central political role it fulfils in replicating stereotyped gender roles and normative family constructs, It is argued that family support and family therapy are morphing as government policies encourage more voluntary sector services, presenting feminist family therapists with both challenges and opportunities to influence social policy. [ABSTRACT FROM AUTHOR]

This article uses the recent controversies over 'Parental Alienation Syndrome' as a springboard for a discussion of the relationship between mental health knowledge and expertise, and the legal system. Autopoietic theory is a sociological account of social communication systems and the relations between these systems. Law as a social communication system and child mental health as a sub-system of science are observed as distinct and selfreferential, each relating to its environment and to one another in very different ways, predetermined by their coding and programmes. Recent developments in the rules of admissibility for expert evidence raise questions over the precise status in law of knowledge from clinical child psychiatric and child psychological experts. Through the autopoietic observation of law and child mental health this article explains why the legal system needs to show that it is capable of distinguishing between 'reliable' and 'unreliable' mental health knowledge and court experts. As a result of these observations, some fundamental questions arise about the role of experts in advising courts and in offering therapeutic intervention for children and families. Finally, the article examines the existence within child mental health of law as an instrument for therapy. [ABSTRACT FROM AUTHOR]

Avril Calder, The Future of Youth Justice: The Government's Legislative Proposals , p.135 Claire Sturge, The Contribution of Child and Adolescent Mental Health Specialists to Care Planning in Child Care Proceedings , p.137. [ABSTRACT FROM AUTHOR]

The National Health Service (UK) offers initial screening appointments for children referred to child and adolescent mental health services to determine clinical need and assess risk. Conversation analysis was utilized on 28 video recordings of these assessments, lasting approximately 90 minutes each with a multidisciplinary team. This article focuses on the agenda setting strategies used to establish relevant goals with children and adolescents; specifically, the technique of offering 'three wishes'. For example, ' if you had three wishes, what would you like to make happen?' In cases where children initially volunteered an assessment-relevant wish, they tended not to articulate further wishes. Non-assessment-relevant wishes (i.e. fantasy wishes, such as being 'rich') were treated as insufficient, with many approaches used to realign establishing assessment relevant goals. Where responses were not institutionally relevant, practitioners undertook considerable discursive work to realign the focus of the three wishes task to assessment relevance. In these cases, the wish responses were treated as irrelevant and tended to be dismissed, rather than explored for further detail. Such work with the children's contributions has implications for engaging children and child-centred practices.

The article presents a study which shows the effectiveness of behavioral outreach worker (BOW) system that is consistent with similar systems in the literature, such as primary mental health workers or advice workers in Great Britain. It emphasizes that the BOW system functions well in shortening the waiting time involved in further mental health service referral. It also notes that children usually take more than one month to visit referred mental health services.