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 Some of the most highly cited literature in this area is becoming increasingly outdated, however, and as the gap between mental health service availability and provision is steadily growing, it is imperative that we understand the scale and nature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 sampled young people (aged 0-18 years) with care experience 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 1-82%. 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 need

Unlocking the facts: young people referred to secure children's homes

Secure Children’s Homes (SCHs) in the UK are licensed to deprive young people referred to them by court of their liberty.  Young people placed in SCHs are either sentenced or on remand through the justice system or placed due to local authority concerns that a young person is a serious risk to themselves or others.  At present SCHs lack sufficient capacity to provide a place for all young people referred to them for welfare reasons. When this happens, local authorities must provide an alternative accommodation that meets the young person’s needs and keeps them safe. With little knowledge of the experiences of young people from England who receive a secure order for welfare reasons, this study set out to explore and compare similarities and differences between the journeys and outcomes of young people placed in SCHs and those housed in an alternative accommodation

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

‘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

The strengths and challenges of online services and interventions to support the mental health and wellbeing of care-experienced children and young people: A study exploring the views of young people, carers, and social care professionals in Wales during the Coronavirus pandemic

The Coronavirus pandemic and its associated lockdowns and restrictions prompted a move from face-to-face interactions to remote forms of engagement that relied on telephone or online contact. This had consequences for the type and frequency of mental health and wellbeing services and interventions that were available to care-experienced children and young people and their foster and kinship carers. This report presents the views and experiences of online mental health and wellbeing provision among young people, carers, and health and social care professionals in Wales during the Coronavirus pandemic. Data were produced in online qualitative interviews with 23 participants, including care-experienced young people (n=3), the biological child of a foster carer (n=1), health and social care professionals (n=9), and foster and kinship carers (n=10). The participants discussed the strengths and challenges of online and in-person services and offered recommendations for future practice and interventions. Once the interview data was generated and analysed the project team met with three advisory groups to discuss the findings of the study and refine the recommendations for policy and practice. These meetings involved foster and kinship carers (n=10) who were members of The Fostering Network’s All Wales Foster Carers’ Advisory Forum, which is facilitated by The Fostering Network in Wales, care-experienced young people (n=4) who were part of CASCADE Voices, and young people (n=4) who were members of The Fostering Network in Wales Young People’s Care Forum. The findings from the study noted some benefits of online mental health and wellbeing services and interventions for care-experienced children and young people, including accessibility, privacy and being able to engage or disengage remotely without the pressures of face-to-face interactions. However, accessibility, a lack of privacy and the format of online interactions were also cited as some of the challenges of remote forms of contact. Therefore, the advantages and disadvantages of online versus in-person contact were complex and intertwined. This complexity reflects the important point that care-experienced children and young people are not a uniform group. Rather, care-experienced young people need to be seen as individuals and to be afforded a choice about the provision of health and wellbeing interventions that best support their particular needs and requirements. The report offers recommendations in six key areas, research; training; awareness and access; resources; choices and flexibility; safety, and protection and risk. The findings of this report aim to support improvement of both remote and face-to-face services and interventions to support the mental health and wellbeing of care-experienced children and young people as we move beyond the restrictions of the Coronavirus pandemic

Maintenance Cognitive Stimulation Therapy: An Economic Evaluation Within a Randomized Controlled Trial

Background Cognitive Stimulation Therapy (CST) is effective and cost-effective for people with mild-to-moderate dementia when delivered biweekly over 7 weeks. Aims To examine whether longer-term (maintenance) CST is cost-effective when added to usual care. Methods Cost-effectiveness analysis within multicenter, single-blind, pragmatic randomized controlled trial; subgroup analysis for people taking acetylcholinesterase inhibitors (ACHEIs). A total of 236 participants with mild-to-moderate dementia received CST for 7 weeks. They were randomized to either weekly maintenance CST added to usual care or usual care alone for 24 weeks. Results Although outcome gains were modest over 6 months, maintenance CST appeared cost-effective when looking at self-rated quality of life as primary outcome, and cognition (MMSE) and proxy-rated quality-adjusted life years as secondary outcomes. CST in combination with ACHEIs offered cost-effectiveness gains when outcome was measured as cognition. Conclusions Continuation of CST is likely to be cost-effective for people with mild-to-moderate dementia

Cognitive behavioural therapy (CBT) for anxiety in people with dementia: study protocol for a randomised controlled trial

Background Many people with dementia experience anxiety, which can lead to decreased independence, relationship difficulties and increased admittance to care homes. Anxiety is often treated with antipsychotic medication, which has limited efficacy and serious side effects. Cognitive behavioural therapy (CBT) is widely used to treat anxiety in a range of populations, yet no RCTs on CBT for anxiety in dementia exist. This study aims to develop a CBT for anxiety in dementia manual and to determine its feasibility in a pilot RCT. Methods/design Phase I involves the development of a CBT for anxiety in dementia manual, through a process of (1) focus groups, (2) comprehensive literature reviews, (3) expert consultation, (4) a consensus conference and (5) field testing. Phase II involves the evaluation of the manual with 50 participants with mild to moderate dementia and anxiety (and their carers) in a pilot, two-armed RCT. Participants will receive either ten sessions of CBT or treatment as usual. Primary outcome measures are anxiety and costs. Secondary outcome measures are participant quality of life, behavioural disturbance, cognition, depression, mood and perceived relationship with the carer, and carer mood and perceived relationship with the person with dementia. Measures will be administered at baseline, 15 weeks and 6 months. Approximately 12 qualitative interviews will be used to gather service-users' perspectives on the intervention. Discussion This study aims to determine the feasibility of CBT for people with anxiety and dementia and provide data on the effect size of the intervention in order to conduct a power analysis for a definitive RCT. The manual will be revised according to qualitative and quantitative findings. Its publication will enable its availability throughout the NHS and beyond. Trial registration ISRCTN6480685