Accommodating Complexity: The Need for Evidence-Informed Mental Health Assessments for Children in Out-of-Home Care

Hiller, Rachel; Lehmann, Stine; Lewis, Stephanie J.; Minnis, Helen; Shelton, Katherine Helen; Tarren‐Sweeney, Michael; Taussig, Heather N.

doi:10.1016/j.jaac.2022.06.021

Cited by 3 publications

(3 citation statements)

References 8 publications

(14 reference statements)

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“…In addition to the wide variety of concerns there were also notable changes in concerns over time, and this would likely pose problems for services offering post-adoption support, not least because there was no evidence that either child age nor time in the family home predicted the type of concern. To cover all possibilities, services would need to offer a wide range of assessments and treatments, but also be responsive to different concerns at different times, and thus open to longitudinal assessment and review, an approach that has been recommended for nearly two decades as best practice for assessing children with maltreatment histories (e.g., Chaffin et al, 2006; Hiller et al, 2023). The challenges for service delivery to adequately meet the changing needs of this complex set of young people may be driving some of the dissatisfaction with services, but this needs further exploration.…”

Section: Discussionmentioning

confidence: 99%

Adoptive parents’ satisfaction with child and adolescent mental services and their mental health concerns over time: A question of fit?

Woolgar,

Pinto,

González

2023

Developmental Child Welfare

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Little is known about adoptive parents’ experiences of and satisfaction with statutory child and adolescent mental services (CAMHS) in the UK, nor of parental concerns about their adopted children’s mental health and well-being. Ninety-eight adoptive parents completed an online survey about their satisfaction with services as well as their mental health concerns for their child currently and retrospectively at the point of adoption. Parental concerns were diverse, and many overlapped with issues that CAMHS could normally help with. Attachment was the primary concern initially, but this decreased over time in placement; while challenging behaviour was the highest rated current concern, along with aspects of general functioning such as peer relations, social skills and education. Unexpectedly, trauma was a relatively low concern at both timepoints. There were very high levels of dissatisfaction with CAMHS, evident across questions of access, engagement and quality of services, all at levels much higher than typically reported by general samples. Adoptive parents’ substantial dissatisfaction with CAMHS occurred despite an apparent fit between many parental concerns and the kinds of services typically offered in CAMHS. There remains a significant challenge to develop a shared understanding between parents and services of adopted children’s needs, especially given the absence of data about adopted children’s mental health and wellbeing problems.

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Section: Discussionmentioning

confidence: 99%

Adoptive parents’ satisfaction with child and adolescent mental services and their mental health concerns over time: A question of fit?

Woolgar,

Pinto,

González

2023

Developmental Child Welfare

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“…The review findings highlight the importance of routine and comprehensive mental health screening. Assessment of children's mental health whilst living in residential care should not be considered in isolation from wider social challenges (Hiller et al, 2022). In addition to carer report, where possible, the perspectives of children, social workers and teachers should be included in mental health assessments (Luke et al, 2014).…”

Section: Recommendations For Practicementioning

confidence: 99%

A systematic review and meta-analysis of the type and prevalence of mental health disorders and symptoms among children living in residential care

Westlake,

Hillman,

Kerr-Davis

et al. 2023

Developmental Child Welfare

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Research suggests that among all children living in social care, those in residential care have the highest mental health need. This systematic review and meta-analysis is the first to establish the type and prevalence of mental health disorders and symptoms among children in residential care. A systematic search of PsycINFO, MEDLINE, Scopus, Web of Science Core Collection, ASSIA, IBSS and grey literature databases from January 1989 to July 2022 was conducted ( N = 11, 246). Articles were eligible for inclusion where they: (1) included a sample living in residential provision similar to that provided in the UK, (2) used standardised screening tools or psychiatric assessments, using diagnostic classification systems, and (3) reported prevalence estimates. Pooled prevalence estimates were calculated using random-effects meta-analysis. 21 articles with prevalence rates for a total of 4287 children, adolescents and young adults were included. Almost half the children had symptoms indicative of a probable mental health disorder (46%; 95% confidence interval (CI) 35–58). Externalising problems (49%; 95% CI 34–65), were more common than internalising problems (39%; 95% CI 26–53) and prevalence rates for conduct disorder (34%; 95% CI 17–55), depression (26%; 95% CI 18–35), emotional symptoms (17%; 95% CI 8–28), and somatic symptoms (14%; 95% CI 8–20) were estimated. The findings provide evidence that the prevalence of mental health disorders and symptoms are particularly high among children in residential care. These pooled estimates should be interpreted with caution due to high heterogeneity and further epidemiological research is needed to guide policy in different countries.

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“…The evidence to date highlights the importance that high‐quality caregiving, with added evidence informed interventions targeted either directly at the child or indirectly (through the carer or those around the child), providing support where necessary, has the potential to effect positive change in children's well‐being. Additionally, these young people share more commonalities than differences with their peers who are not in care, and it is important to recognize that in spite of some specific adverse experiences, many of the mental health and well‐being interventions that are seen as effective with the general child population are also likely to be successful with this group (e.g., Hiller, Lehmann, et al, 2023 ). Similarly, there is a growing evidence of the efficacy of particular universal and selective interventions in promoting young people's positive mental health (de Pablo et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

An agenda for future research regarding the mental health of young people with care experience

Devaney

Power

Jacobs

et al. 2023

Child & Family Social Work

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Young people who are currently or were previously in state care have consistently been found to have much higher rates of mental health and neurodevelopmental difficulties than the general youth population. While a number of high‐quality reviews highlight what research has been undertaken in relation to the mental health of young people with care experience and the gaps in our knowledge and understanding, there is, until now, no consensus, so far as we aware, as to where our collective research efforts should be directed with this important group. Through a series of UK wide workshops, we undertook a consultative process to identify an agreed research agenda between those with lived experience of being in care (n = 15), practitioners, policy makers and researchers (n = 59), for future research regarding the mental health of young people with care experience, including those who are neurodiverse/have a neurodevelopmental difficulty. This consensus statement identified 21 foci within four broad categories: how we conceptualize mental health; under‐studied populations; under‐studied topics; and underused methodologies. We hope that those who commission, fund and undertake research will engage in this discussion about the future agenda for research regarding the mental health of young people with care experience.

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Accommodating Complexity: The Need for Evidence-Informed Mental Health Assessments for Children in Out-of-Home Care

Cited by 3 publications

References 8 publications

Adoptive parents’ satisfaction with child and adolescent mental services and their mental health concerns over time: A question of fit?

Adoptive parents’ satisfaction with child and adolescent mental services and their mental health concerns over time: A question of fit?

A systematic review and meta-analysis of the type and prevalence of mental health disorders and symptoms among children living in residential care

An agenda for future research regarding the mental health of young people with care experience

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