Differences in the diagnosis and treatment decisions for children in care compared to their peers: An experimental study on <scp>post‐traumatic</scp> stress disorder

McGuire, Rosie; Halligan, Sarah L.; Meiser‐Stedman, Richard; Durbin, Lucy; Hiller, Rachel

doi:10.1111/bjc.12379

Cited by 13 publications

(8 citation statements)

References 25 publications

(37 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A host of factors may act as barriers to the delivery of evidence-based interventions to individuals with PTSD, with therapist factors such as fears regarding delivering trauma-focused therapy and lack of training being widely reported. 27 Recent studies [28][29][30] point to increasing therapist reluctance to utilise evidence-based therapies with children exposed to multiple trauma. These findings may be used in training to highlight the body of knowledge that supports the efficacy of psychological therapieswith by far most accumulated evidence for TF-CBTfor youth who have experienced multiple traumas (including sexual violence and war).…”

Section: Implications For Clinical Practice Training and Treatmentmentioning

confidence: 99%

Efficacy of psychological interventions for post-traumatic stress disorder in children and adolescents exposed to single versus multiple traumas: meta-analysis of randomised controlled trials

et al. 2023

View full text Add to dashboard Cite

Background Previous meta-analyses of psychotherapies for children and adolescents with post-traumatic stress disorder (PTSD) did not investigate whether treatment efficacy is diminished when patients report multiple (versus single) traumas. Aims To examine whether efficacy of psychological interventions for paediatric PTSD is diminished when patients report multiple (versus single) traumas. Method We systematically searched PsycInfo, MEDLINE, Web of Science and PTSDpubs on 21 April 2022 and included randomised controlled trials (RCTs) meeting the following criteria: (a) random allocation; (b) all participants presented with partial or full PTSD; (c) PTSD is the primary treatment focus; (d) sample mean age <19 years; (e) sample size n ≥ 20. Trauma frequency was analysed as a dichotomous (single versus ≥2 traumas) and continuous (mean number of exposures) potential moderator of efficacy. Results Of the 57 eligible RCTs (n = 4295), 51 RCTs were included in quantitative analyses. Relative to passive control conditions, interventions were found effective for single-trauma-related PTSD (Hedges’ g = 1.09; 95% CI 0.70–1.48; k = 8 trials) and multiple-trauma-related PTSD (g = 1.11; 95% CI 0.74–1.47; k = 12). Psychotherapies were also more effective than active control conditions in reducing multiple-trauma-related PTSD. Comparison with active control conditions regarding single-event PTSD was not possible owing to scarcity (k = 1) of available trials. Efficacy did not differ with trauma exposure frequency irrespective of its operationalisation and subgroup analyses (e.g. trauma-focused cognitive–behavioural therapy only). Conclusions The current evidence base suggests that psychological interventions for paediatric PTSD can effectively treat PTSD in populations reporting single and multiple traumas. Future trials for PTSD following single-event trauma need to involve active control conditions.

show abstract

Section: Implications For Clinical Practice Training and Treatmentmentioning

confidence: 99%

Efficacy of psychological interventions for post-traumatic stress disorder in children and adolescents exposed to single versus multiple traumas: meta-analysis of randomised controlled trials

et al. 2023

View full text Add to dashboard Cite

show abstract

“…There should be streamlined processes, without extensive wait times, for children who require access to further specialist mental health input. Mental health practitioners need training to accurately diagnose mental health difficulties and make decisions about appropriate evidence-based treatment for children living in residential care (McGuire et al, 2022).…”

Section: Discussionmentioning

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

View full text Add to dashboard Cite

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.

show abstract

“…The treatments which were recommended were diverse, but given the limited information found within records, it is difficult to establish the type of support was delivered to the young people in practice (e.g., descriptions such as “general psychotherapy”). However, there is some evidence to suggest that children in care may have difficulties accessing evidence‐based mental health support for certain mental health conditions, and this requires further direct investigaiton (McGuire et al., 2022 ). What this also does raise is potential issues with record keeping within children's social care files.…”

Section: Discussionmentioning

confidence: 99%

“…Changes in mental health were not associated with access to mental health support. One reason for this may be the high rates of treatment breakdown (30% of the sample), or that young people in care can struggle to access evidence‐based treatments (McGuire et al., 2022 ). This may also reflect challenges with treating the mental health needs of children in care, given their complex mental health needs which could impact treatment response time (Lorenc et al., 2020 ).…”

Section: Discussionmentioning

confidence: 99%

Secondary data analysis of social care records to examine the provision of mental health support for young people in care

et al. 2023

Self Cite

View full text Add to dashboard Cite

Background: Young people in care are much more likely to experience mental health difficulties than the general population, yet little is known about the provision of mental health support for this group in the United Kingdom. Methods:Using routinely collected social care data, we explored the provision of mental health support for 112 young people in care in the UK. We identified young people experiencing elevated internalising or externalising difficulties in their first year in care (based on strengths and difficulties questionnaire scores) and extracted data on mental health referrals and provision. We generated descriptive statistics relating to provision of mental health support and used regressions to examine predictors of mental health provision, and associations between support and mental health outcomes one and 2 years later.Results: Eighty-one percent of the children (n = 79) were referred to mental health services in their first year of being in care. Referrals were usually for emotional or conduct problems. Those with higher externalising symptoms were more likely to be referred than those with higher internalising symptoms (OR = 1.2, (95% confidence interval (CI): 1.01, 1.38)). Females were more likely to access support than males (OR = 3.82 (95% CI: 1.2, 13.3)). Sixty-eight percent of children (n = 66) accessed mental health services in their first year of being in care. Of those who accessed services, support ended prematurely for 29 (44%) of them, often due to placement instability or disengagement. Accessing support in the first year of care was not associated with changes in mental health 1 year (OR: 2.14 (95% CI: 0.62,7.29)), or 2 years after entering care (OR: 0.72-8.57, (95% CI: 0.72, 8.57)), although methodological limitations are noted. Conclusions:Mental health difficulties for children in care are recognised quickly, but mental health support may be difficult to access, with issues evident in retention and engagement.

show abstract

Differences in the diagnosis and treatment decisions for children in care compared to their peers: An experimental study on post‐traumatic stress disorder

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 13 publications

References 25 publications

Efficacy of psychological interventions for post-traumatic stress disorder in children and adolescents exposed to single versus multiple traumas: meta-analysis of randomised controlled trials

Efficacy of psychological interventions for post-traumatic stress disorder in children and adolescents exposed to single versus multiple traumas: meta-analysis of randomised controlled trials

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

Secondary data analysis of social care records to examine the provision of mental health support for young people in care

Contact Info

Product

Resources

About