Mental health screening for children in care using the Strengths and Difficulties Questionnaire and the Brief Assessment Checklists: Guidance from three national studies.

Although children residing in statutory out-of-home care and those adopted from care are more likely than not to have mental health difficulties requiring clinical intervention or support, their difficulties often remain undetected. Children’s agencies have a duty of care to identify those child clients who require therapeutic and other support services, without regard to the availability of such services. The present article proposes a first-stage mental health screening procedure (calibrated for high sensitivity) for children and adolescents (ages 4–17) in alternative care, which children’s agencies can implement without clinical oversight using the Strengths and Difficulties Questionnaire (SDQ) and Brief Assessment Checklists (BAC). The screening procedure was derived from analyses of BAC, SDQ, and “proxy SDQ” scores obtained in three national studies of children and adolescents residing in alternative care (Australia, the Netherlands, and England). The SDQ and BAC demonstrated moderate to high screening accuracy across a range of clinical case criteria—the SDQ being slightly better at predicting general mental health problems and the BAC slightly better at predicting attachment- and trauma-related problems. Accurate first-stage screening is achieved using either the SDQ or the BAC alone, with recommended cut points of 10 (i.e., positive screen is 10 or higher) for the SDQ and 7 for the BAC. Greater accuracy is gained from using the SDQ and BAC in parallel, with positive screens defined by an SDQ score of 11 or higher or a BAC score of 8 or higher. Agencies and post-adoption support services should refer positive screens for comprehensive mental health assessment by clinical services.Development Psychopathology in context: famil

Mental health screening for children in care using the Strengths and Difficulties Questionnaire and the Brief Assessment Checklists: Guidance from three national studies

Although children residing in statutory out-of-home care and those adopted from care are more likely than not to have mental health difficulties requiring clinical intervention or support, their difficulties often remain undetected. Children’s agencies have a duty of care to identify those child clients who require therapeutic and other support services, without regard to the availability of such services. The present article proposes a first-stage mental health screening procedure (calibrated for high sensitivity) for children and adolescents (ages 4–17) in alternative care, which children’s agencies can implement without clinical oversight using the Strengths and Difficulties Questionnaire (SDQ) and Brief Assessment Checklists (BAC). The screening procedure was derived from analyses of BAC, SDQ, and “proxy SDQ” scores obtained in three national studies of children and adolescents residing in alternative care (Australia, the Netherlands, and England). The SDQ and BAC demonstrated moderate to high screening accuracy across a range of clinical case criteria—the SDQ being slightly better at predicting general mental health problems and the BAC slightly better at predicting attachment- and trauma-related problems. Accurate first-stage screening is achieved using either the SDQ or the BAC alone, with recommended cut points of 10 (i.e., positive screen is 10 or higher) for the SDQ and 7 for the BAC. Greater accuracy is gained from using the SDQ and BAC in parallel, with positive screens defined by an SDQ score of 11 or higher or a BAC score of 8 or higher. Agencies and post-adoption support services should refer positive screens for comprehensive mental health assessment by clinical services

Effects of maltreatment and parental schizophrenia spectrum disorders on early childhood social-emotional functioning: a population record linkage study

Published online: 04 August 2016Aims. Childhood maltreatment and a family history of a schizophrenia spectrum disorder (SSD) are each associated with social-emotional dysfunction in childhood. Both are also strong risk factors for adult SSDs, and social-emotional dysfunction in childhood may be an antecedent of these disorders. We used data from a large Australian population cohort to determine the independent and moderating effects of maltreatment and parental SSDs on early childhood social-emotional functioning. Methods. The New South Wales Child Development Study combines intergenerational multi-agency data using record linkage methods. Multiple measures of social-emotional functioning (social competency, prosocial/helping behaviour, anxious/fearful behaviour; aggressive behaviour, and hyperactivity/inattention) on 69 116 kindergarten children (age ~5 years) were linked with government records of child maltreatment and parental presentations to health services for SSD. Multivariable analyses investigated the association between maltreatment and social-emotional functioning, adjusting for demographic variables and parental SSD history, in the population sample and in sub-cohorts exposed and not exposed to parental SSD history. We also examined the association of parental SSD history and social-emotional functioning, adjusting for demographic variables and maltreatment. Results. Medium-sized associations were identified between maltreatment and poor social competency, aggressive behaviour and hyperactivity/inattention; small associations were revealed between maltreatment and poor prosocial/helping and anxious/fearful behaviours. These associations did not differ greatly when adjusted for parental SSD, and were greater in magnitude among children with no history of parental SSD. Small associations between parental SSD and poor social-emotional functioning remained after adjusting for demographic variables and maltreatment. Conclusions. Childhood maltreatment and history of parental SSD are associated independently with poor early childhood social-emotional functioning, with the impact of exposure to maltreatment on social-emotional functioning in early childhood of greater magnitude than that observed for parental SSDs. The impact of maltreatment was reduced in the context of parental SSDs. The influence of parental SSDs on later outcomes of maltreated children may become more apparent during adolescence and young adulthood when overt symptoms of SSD are likely to emerge. Early intervention to strengthen childhood social-emotional functioning might mitigate the impact of maltreatment, and potentially also avert future psychopathology.S. L. Matheson, M. Kariuki, M. J. Green, K. Dean, F. Harris, S. Tzoumakis, M. Tarren-Sweeney, S. Brinkman, M. Chilvers, T. Sprague, V. J. Carr, and K. R. Lauren

The Herts and Minds study: Evaluating the effectiveness of Mentalization-Based Treatment (MBT) as an intervention for children in foster care with emotional and/or behavioural problems: a phase II, feasibility, randomised controlled trial.

Trial registration at https://doi.org/10.1186/ISRCTN90349442 © The Authors 2017. Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Nick Midgley, Sarah Jane Besser, Helen Dye, Pasco Fearon, tim Gale, Kiri Jefferies-Sewell, Karen Irvine, Joyce Robinson, Solange Wyatt, David Wellsted and Sally Wood, 'The Herts and minds study: evaluating the effectiveness of mentalization-based treatment (MBT) as an intervention for children in foster care with emotional and/or behavioural problems: a phase II, feasibility, randomised controlled trial', Pilot and Feasibility Studies, Vol. 3(12, February 2017. The published version is available online at doi: 10.1186/s40814-017-0127-xBackground A significant proportion of children in the social care system in England present with mental health problems, with the majority experiencing some form of emotional and behavioural difficulties. The most effective treatments for these children are currently unknown, partly due to a lack of robust, controlled studies. Researchers have identified a number of obstacles to conducting well-designed research with this population, making the need to test the feasibility of a randomised controlled trial especially important. Methods/design This protocol outlines a two-arm, randomised control feasibility trial to explore the acceptability and credibility of mentalization-based treatment (MBT) as a treatment for reducing emotional and behavioural difficulties in looked after children and to test the possibility of addressing a number of methodological challenges to conducting high-quality research with this population. MBT is a relatively new intervention which, in the adaptation of the model tested here, includes many of the features of therapy identified in NICE guidelines as necessary to support children in care. The two arms are MBT and usual clinical care (UCC). The study will take place in Hertfordshire Partnership University NHS Foundation Trust with follow-up at 12 and 24 weeks. Discussion This study will aim to ascertain whether it is worthwhile and feasible to progress to testing the intervention in a full-scale definitive randomised controlled trial (RCT). This study therefore has the potential to improve our understanding of the obstacles to conducting high-quality research with this very vulnerable population, and in the medium term, could help to improve the stability of foster placements and the emotional well-being of children in care. Trial registration ISRCTN90349442Peer reviewe

Supporting the education and wellbeing of children looked-after: what is the role of the virtual school?

The Children and Families Act (2014) placed a statutory responsibility on local authorities in the United Kingdom to establish a Virtual School Headteacher with the role of championing the education of all children looked-after within that authority. The current research was designed to illuminate how Virtual Schools are currently supporting educational outcomes for children looked-after, not only through educational interventions, but also through supporting broader psychological factors that might impact on attainment such as attachment, relationships and mental health. Virtual School Head Teachers from 29 local authorities completed an online survey about the services they provided to three target groups – children looked-after, foster carers and schools – with a particular focus on the transition years from primary to secondary school, which have been identified as being a difficult time for children looked-after. Using inductive thematic analysis four overarching themes to service provision were identified: Enhanced learning opportunities; Specific Transition Support; Wellbeing and Relationships, and Raising Awareness. Direct work, interprofessional working and the development of supportive environments, particularly guided by attachment theory, were identified as important areas of practice. Practice is discussed in relation to resilience and ecological systems theory and suggestions for future research are identified

A narrative review of stability and change in the mental health of children who grow up in family-based out-of-home care

The present review sought to address the following questions: What evidence is there that long-term, family-based out-of-home care (OOHC) has a general, population-wide effect on children’s mental health such that it is generally reparative or generally harmful? Does entry into long-term OOHC affect children’s mental health, as evidenced by prospective changes over the first years in care? And, is the reparative potential of long-term, family-based OOHC moderated by children’s age at entry into care? Fourteen studies were identified for review. We found no consistent evidence that family-based OOHC exerts a general, population-wide effect on the mental health of children in care; or that entry into care has an initial effect on children’s mental health; or that children’s age at entry into care moderates their subsequent mental health trajectories. Instead, several longitudinal studies have found that sizable proportions of children in care manifest meaningful improvement in their mental health over both short- and long-term time frames and that similarly sizable proportions experience meaningful deterioration in their mental health. Rather than asking whether long-term, family-based care is generally reparative or harmful for the development of previously maltreated children, future investigations should instead focus on identifying the systemic and interpersonal characteristics of care that promote and sustain children’s psychological development throughout childhood—and those characteristics that are developmentally harmful (i.e., for which children is the experience of care beneficial, and for which children is it not?). The review concludes with recommendations for the design of improved cohort studies that can address these questions.Development Psychopathology in context: famil