Suchergebnisse

The Foster Carers' Training Project was a three-year research project which examined the effect of training foster carers on the emotions and behaviour of the children they were looking after. The research produced useful quantitative findings, outlined in a paper recently published in Archives of Disease in Childhood (Minnis et al, in press), but the training itself also provided rich information about foster carers' communications and interactions with the children in their care. Helen Minnis and Clare Devine describe the training, the difficulties children presented, the communications which carers had to deal with and the empirical results of the research.

The publication of a new follow-up study of a transracial sample deserves special attention because the volume of longitudinal research in this field is fairly small. Alan Rushton and Helen Minnis provide a critical review of a recent North American paper by Brooks and Barth, and consider the quality of the evidence presented, the methodological limitations, what can be safely concluded from the study and the implications that can be drawn for practice in the UK. The reviewers conclude that the nature of these placements, the loss to follow-up and weakness of some of the measures inevitably restrict drawing firm conclusions, and readers should be aware that the researchers may have presented an over-optimistic view of placement outcome. However, the study broadly confirms the findings derived from other transracial samples that placement matching for race may not be the strongest predictor of outcome and that transracial placements do not necessarily preclude the achievement of a secure ethnic identity.

Two recent studies by Glasgow researchers have highlighted the high level of emotional and behavioural difficulties experienced by looked after children. One was a survey of children entering the care system (Dimigen et al, 1999) while the other was a randomised controlled trial of a training programme for foster carers. The survey was carried out in Glasgow, while the trial was carried out across another part of the Central Belt of Scotland. Despite their different designs and geographical areas, the two studies came up with complementary results. Helen Minnis and Christina Del Priore synthesise these results in this paper and use them to argue that practitioners need to take a fresh look at mental health services for looked after children and at the assessments which should determine what these children need.

In Scotland, the Children's Hearing system determines the placement of maltreated children. A locally tailored version of the New Orleans Intervention for such children is about to be introduced in Glasgow. As part of an evaluation of its impact, an exploration was conducted of decision-making by children's panel members, their possible role in the new intervention and their attitudes towards the changes. Interviews were held with focus groups and with members of the Children's Hearing system using vignettes and a topic guide to focus the discussions. Thematic analysis identified key themes about the decision-making process and how the new service might impact on this. It was found that making decisions about a child's eventual permanent placement is complex, but discussions generally focused on the parent rather than the child. Panel members highlighted how decision-making could be facilitated by a solid evidence base and knowing that a future care plan for the child is in place. Many of them were positive about the new intervention. Good, clear communication will be essential if they are to accept recommendations from a new service. Also, training will be crucial if they are to appreciate the validity of the reports that emerge.

Helen Minnis, Clare Devine and Tony Pelosi describe the qualitative pilot study of a new training programme for foster carers in Scotland. The study forms part of a larger research project which will examine the effect of the training on the emotions and behaviour of looked after children, due for completion in 1999. The aim of the training programme was to help foster carers develop their skills in communication and increase their confidence in their ability to cope with their foster children's feelings and behaviour. Carers felt that this aim was achieved but that, due to outside factors, the benefits were unlikely to be passed on to the children.

Exposure to war, conflict and forced migration puts children at risk of mental health problems. The present study examined the levels of psychological distress and resilience factors among 106 Palestinian refugee children aged 11 to 17 in the West Bank. In a cross-sectional, mixed method design along with qualitative interviews, three questionnaires were administered: the Strength and Difficulties Questionnaire and Patient Health Questionnaire-15, assessed the risk of mental health disorders and psychosomatic complaints, and the Child and Youth Resilience Measure assessed the availability of resilience-enhancing factors. Palestinian refugee children were found to be at greater risk for mental disorders and psychosomatic complaints than were children living in non-conflict affected settings. In addition, resilience-enhancing resources were significantly reduced and were negatively correlated with both symptom outcomes. Risk factors identified included poverty, violence and marginalisation. Key protective factors were youth education, supportive relationships and social participation. Our findings support interventions that address the identified protective factors, which may promote the mental health of this vulnerable population.

Background  Studies with children suggest that reactive attachment disorder (RAD) is associated with pathogenic early care. Little is known about RAD in adults with intellectual disabilities, many of whom experience adversity and abuse in early life. We investigated whether RAD symptoms occur in this population, and explored whether hypothesized risk factors are associated with higher RAD symptom scores.Method  Fifty adults with intellectual disabilities residing in long‐stay hospitals and their carers participated in a questionnaire survey of RAD symptoms, childhood experiences, and disabilities.Results  Reactive attachment disorder symptoms were present in this sample, and symptom scores were independently associated with early childhood adversity, diminished with age, but were not associated with cognitive ability, gender, other disabilities, nor number of childhood years in institutional care.Conclusions  As with children with RAD, it is possible that some maltreated adults with intellectual disabilities fail to develop stranger anxiety by the usual developmental age. Over decades, they may gradually learn.

This study aimed to investigate whether children with a history of maltreatment and current behaviour problems demonstrate greater sleep disruption than controls; and also whether sleep disturbances are associated with these behavioural problems using standardised carer report measures. Sixty-three participants were assessed using the Children's Sleep Habits Questionnaire (CSHQ) (Owens, Spirito and McGuinn, 2000) and the Strengths and Difficulties Questionnaire (SDQ) (Goodman, et al., 2003). Thirty-four participants aged 5–12 years were recruited via Adoption UK – Scotland. Inclusion criteria included a history of maltreatment (confirmed from social work documents) with associated social/behavioural problems. Twenty-nine controls with no psychiatric or maltreatment history, also aged 5–12 years, were recruited from two general practices. Mean CSHQ total sleep difficulty scores were significantly higher in maltreated children than in controls (48.9 vs 23.6, P < 0.001). Rates of clinically significant sleep problems (total sleep score>41) were also higher in the maltreatment group at 50% compared to 12% in controls (P = 0.002). There was a significant association between high scores on the CSHQ and the SDQ (P < 0.000). Overall, this study suggests that behaviourally disturbed children with a history of maltreatment experience significant sleep disruption, which is in turn associated with their behavioural disturbance. This has clear implications for both clinical assessment and intervention with this vulnerable group and is worthy of further research.

Children in care have experienced adversities, including maltreatment prior to contact with the system, negatively impacting on their mental health outcomes. The type of placement and length of time in care are thought to be important and the child welfare system aim is to achieve a permanent decision for children that best supports their needs by establishing a stable familial network. Permanency decisions can include reunification, foster care, kinship care, adoption, and residential placements. This review aims to establish to what extent permanent placement type, maltreatment experienced, length of time in care and age at which permanency is achieved impacts child mental health outcomes. Following PRISMA guidelines, five databases (ASSIA, CINAHL, PsycINFO, Scopus and SocINDEX) and two registers (CENTRAL and TRoPHI) were systematically searched yielding six articles for inclusion in the study. Data were extracted and articles critically appraised utilising the Crowe Critical Appraisal Tool (CCAT). Papers reported mixed findings for permanent placement type and child mental health outcomes with little or no significant overall differences reported. Type of maltreatment experienced moderated the type of mental health symptomology reported. Difficulties in attachment and social relationships were reported for children placed older than two years, although confounding factors such as type of maltreatment likely reduce the strength of the association. Typically, children in permanent placements had better outcomes compared with peers in short-term or unstable placements. A lack of suitable validated and age-appropriate outcome measures and the existence of confounding factors impair our understanding of the interaction between pre-care adversities, the child welfare system itself and permanent placement outcomes.