Aims and Objectives:
Looked after children and young people have consistently been found to have much higher rates of mental health difficulties than the general population, with almost half of them meeting the criteria for a psychiatric disorder (Ford et al., 2007). There are many reasons for this, including the experiences they have had in their birth families before coming into the care system. Children’s experiences once they enter care are also linked to their well-being, and can further contribute to both the causes and the nature of any difficulties.
This presentation will draw out some key themes from the Rees Centre’s review, commissioned by the National Society for the Prevention of Cruelty to Children (NSPCC), of strategies for the prevention and treatment of mental health difficulties among children in the care system (Luke et al., 2014). We will outline key messages from research regarding best practice in ‘ordinary care’ in terms of reducing the likelihood of mental health difficulties, as well as the principles that appear to be most important for the effectiveness of mental health interventions. The presentation for EUSARF 2016 will also update the review to include research published since 2014.
Methods:
Our review focused on identifying and bringing together existing evidence, including 106 individual studies of interventions identified from searching the literature and suggestions made by an international panel of experts in the field. Our literature search on specific interventions covered any programmes that were listed as targeting behavioural, emotional or hyperkinetic outcomes for looked after children and young people.
The review distinguishes between the effects of ‘add-on’ interventions (for example therapeutic services or mentoring), and the effects of variations in the quality of ‘ordinary care’ provided (such as whether the foster placement is a good one).
Key findings:
This review of mental health and well-being interventions for looked after children suggests that differences within ordinary care can be a powerful influence on well-being for children in residential and foster care, as well as providing the context for any additional interventions. We conclude that interventions for behavioural and emotional issues are more likely to be effective when they include some focus on developing relationships and understanding of self and others. In addition, the review shows that one approach does not fit all. For example, some interventions benefit highly antisocial young people but might be the wrong fit for others.
The review highlights issues that are relevant for practitioners and policy makers, because of the importance of improving earlier decision making about care placements, as well as the consequent resource allocation for assessments and interventions. The evidence reviewed supports the position that high-quality caregiving, with added interventions targeted either directly at the child or indirectly (through the caregiver or those around the child), providing support where necessary, might effect positive change in children’s well-being.
References
Ford, T., Vostanis, P., Meltzer, H., & Goodman, R. (2007). Psychiatric disorder among British children looked after by local authorities: Comparison with children living in private households. The British Journal of Psychiatry, 190(4), 319–325.
Luke, N., Sinclair, I., Woolgar, M., & Sebba, J. (2014). What works in preventing and treating poor mental health in looked after children? London: NSPCC/Oxford: Rees Centre.
Mental health of children and young people in care , Program evaluation and quality in child welfare
