Preparing young people with complex needs and their families for transition to adult services

© RCN Publishing Company Limited 2018Improving survival rates for children and young people with complex health needs requires a robust system for transition to adult services. Effective planning is essential to ensure a smooth transition process that is in the best interests of the young person and their family. This article discusses the needs and requirements for planned and purposeful transition processes to support young people with complex healthcare needs and their families. It considers the preparation of adult services, the team, the young person and their parents in line with an integrated approach and the nurse’s role. Recommendations for practice include the necessity for an integrated approach to ensure optimum outcomes and ascertaining the potential value of a nurse-led service in delivering the transition process. A carefully tailored planning strategy should be developed to prepare and support young people with complex health needs through transition

Implementing the United Kingdom's ten-year teenage pregnancy strategy for England (1999-2010): how was this done and what did it achieve?

In 1999, the UK Labour Government launched a 10-year Teenage Pregnancy Strategy for England to address the country's historically high rates and reduce social exclusion. The goal was to halve the under-18 conception rate. This study explores how the strategy was designed and implemented, and the features that contributed to its success. This study was informed by examination of the detailed documentation of the strategy, published throughout its 10-year implementation. The strategy involved a comprehensive programme of action across four themes: joined up action at national and local level; better prevention through improved sex and relationships education and access to effective contraception; a communications campaign to reach young people and parents; and coordinated support for young parents (The support programme for young parents was an important contribution to the strategy. In the short term by helping young parents prevent further unplanned pregnancies and, in the long term, by breaking intergenerational cycles of disadvantage and lowering the risk of teenage pregnancy.). It was implemented through national, regional and local structures with dedicated funding for the 10-year duration. The under-18 conception rate reduced steadily over the strategy's lifespan. The 2014 under-18 conception rate was 51% lower than the 1998 baseline and there have been significant reductions in areas of high deprivation. One leading social commentator described the strategy as 'The success story of our time' (Toynbee, The drop in teenage pregnancies is the success story of our time, 2013). As rates of teenage pregnancy are influenced by a web of inter-connected factors, the strategy was necessarily multi-faceted in its approach. As such, it is not possible to identify causative pathways or estimate the relative contributions of each constituent part. However, we conclude that six key features contributed to the success: creating an opportunity for action; developing an evidence based strategy; effective implementation; regularly reviewing progress; embedding the strategy in wider government programmes; and providing leadership throughout the programme. The learning remains relevant for the UK as England's teenage birth rate remains higher than in other Western European countries. It also provides important lessons for governments and policy makers in other countries seeking to reduce teenage pregnancy rates. BACKGROUND METHODS RESULTS CONCLUSION

Risk and teenage parenthood: an early sexual health intervention

Purpose - This paper outlines the development of a resource designed to support practitioners, who were not sexual health specialists, but who worked with young people who may be at risk of teenage pregnancy or parenthood. Its aim was to enable practitioners to carry out an assessment using a screening tool, and to use educational interventions designed to reduce risk-taking behaviour or refer to a sexual health specialist. We report a research project to examine the perceptions of practitioners who had used the resource. Design/methodology/approach – The resource was based on a local needs assessment and developed by a multi-agency working group. The research utilised an on-line questionnaire and telephone interviews with practitioners. Findings - Practitioners reported using the screening tool with young people with an average age of 13.1 years. They thought the educational interventions provided knowledge and helped with communication, self-awareness, reflection, confidence, attitudes and values clarification. Research limitations/implications - The project was based in one county in England. A sample of seventeen per cent of the practitioners responded to the questionnaire, and they might be those who had engaged most, or most positively, with the resource. Three practitioners undertook interviews. The views and behaviours of young people are yet to be evaluated. Originality/value - Within a climate of limited resources, the findings suggest that the project was providing an acceptable proportionate universalist, early sexual health intervention for young people

A critical analysis of Child and Adolescent Mental Health Services policy in England

Policy in Child and Adolescent Mental Health (CAMH) in England has undergone radical changes in the last 15 years, with far reaching implications for funding models, access to services and service delivery. Using corpus analysis and critical discourse analysis, we explore how childhood, mental health, and CAMHS are constituted in 15 policy documents, 9 pre-2010, and 6 post 2010. We trace how these constructions have changed over time, and consider the practice implications of these changes. We identify how children’s distress is individualised, through medicalising discourses and shifting understandings of the relationship between socioeconomic context and mental health. This is evidenced in a shift from seeing children’s mental health challenges as produced by social and economic inequities, to a view that children’s mental health must be addressed early to prevent future socio-economic burden. We consider the implications CAMHS policies for the relationship between children, families, mental health services and the state. The paper concludes by exploring how concepts of ‘parity of esteem’ and ‘stigma reduction’ may inadvertently exacerbate the individualisation of children’s mental health

Fundamental Movement Skills of Preschool Children in Northwest England

-This cross-sectional study examined fundamental movement skill competency among deprived preschool children in Northwest England and explored sex differences. A total of 168 preschool children (ages 3-5 yr.) were included in the study. Twelve skills were assessed using the Children's Activity and Movement in Preschool Motor Skills Protocol and video analysis. Sex differences were explored at the subtest, skill, and component levels. Overall competence was found to be low among both sexes, although it was higher for locomotor skills than for object-control skills. Similar patterns were observed at the component level. Boys had significantly better object-control skills than girls, with greater competence observed for the kick and overarm throw, while girls were more competent at the run, hop, and gallop. The findings of low competency suggest that developmentally appropriate interventions should be implemented in preschool settings to promote movement skills, with targeted activities for boys and girls

Engaging fathers: : acknowledging the barriers

Engaging fathers has the potential to benefit the entire family through 1. promoting fathers’ wellbeing directly, 2. building on fathers’ vital capacity to support mothers’ psychological wellbeing, 3. maternal health behaviours, and 4. promoting children’s mental health and development. Benefits to a child’s development include positive impacts on cognitive development, educational attainment, social competence, positive self-esteem and reduced incidence of emotional and behavioural problems. However, the barriers to father-inclusive practice are real and numerous and include personal, organisational, strategic and societal factors. This article reviews the need to work more closely and fruitfully with fathers, and acknowledges some of the barriers

Neuroscience and family policy:what becomes of the parent?

This article discusses the findings of a study tracing the incorporation of claims about infant brain development into English family policy as part of the longer term development of a ‘parent training’, early intervention agenda. The main focus is on the ways in which the deployment of neuroscientific discourse in family policy creates the basis for a new governmental oversight of parents. We argue that advocacy of ‘early intervention’, in particular that which deploys the authority of ‘the neuroscience’, places parents at the centre of the policy stage but simultaneously demotes and marginalises them. So we ask, what becomes of the parent when politically and culturally, the child is spoken of as infinitely and permanently neurologically vulnerable to parental influence? In particular, the policy focus on parental emotions and their impact on infant brain development indicates that this represents a biologisation of ‘therapeutic’ governance

Choice and caring : the experiences of parents supporting young people with Autistic Spectrum Conditions as they move into adulthood

This paper reports findings about parents' experiences of caring for young people with Autistic Spectrum Conditions (ASCs) moving into adulthood. In-depth interviews were conducted with 38 parents of young people (15-21 years) with ASCs. Data were analysed thematically. In the perceived absence of service support, parents acted as 'care-coordinators' and 'life-supporters' for their child as they moved into adulthood. These roles came with little choice, emotional demands and personal restrictions. Being supported was important for parents, but preferences differed regarding what this should look like. Implications for policy are discussed

Factors associated with high and low levels of school exclusions:Comparing the English and wider UK experience

This article draws on findings from the first cross-national study of school exclusions in the four jurisdictions of the UK. It sketches factors associated with the past research with reductions in exclusions. It then reports interview data gathered in England in 2018 from five specialist officers working in two Local Authorities and a senior officer working for a national voluntary organisation. The officers describe good practice but also national, local and school level developments contributing to a deteriorating situation. These developments include unhelpful government guidance and regulations; school accountability frameworks affecting curriculum and leading to the neglect of Special Educational Needs; loss of Local Authority powers and funding resulting in reductions in support services. Data gathered for this study in other UK jurisdictions suggests that in Scotland and Northern Ireland, and to a lesser extent in Wales, a practice that avoids school exclusions has persisted more than in England

National survey of the injury prevention activities of children's centres

Children's centres were established across England to provide a range of services including early education, social care and health to pre-school children and their families. We surveyed children's centres to ascertain the activities they were undertaking to prevent unintentional injuries in the under fives. A postal questionnaire was sent to a sample of children's centre managers (n = 694). It included questions on current activities, knowledge and attitudes to injury prevention, health priorities and partnership working. Responses were received from 384 (56%) children's centres. Overall, 58% considered unintentional injury prevention to be one of the three main child health priorities for their centre. Over half the respondents (59%) did not know if there was an injury prevention group in their area, and 21% did not know if there was a home safety equipment scheme. Knowledge of how child injury deaths occur in the home was poor. Only 11% knew the major cause of injury deaths in children under five. Lack of both staff time and funding were seen as important barriers by children's centre staff to undertake injury prevention activities. Nearly all stated that training (97%) and assistance with planning injury prevention (94%) would be helpful to their centres. Children's centres need further support if they are to effectively tackle this important public health area