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By 2025, over eight million UK households will be receiving Universal Credit (UC). Introduced in 2013 to simplify the benefit system and improve work incentives for working age adults, UC has been criticised for causing hardship and exacerbating inequalities. There is limited research on children and young people’s (CYP) views of UC, as well as its health and social impacts. In this pilot qualitative study, creative methods were used to understand the views of UC among CYP (n = 40) aged 12–16 years in North East England. Findings showed diverse and nuanced understanding of UC as well as contested views about conditionality, sanctions, lower UC rates for under-25s and the two-child limit alongside recognition of the stigma and shame associated with benefits. While CYP value paid employment, they stressed the importance of minimum income standards and tailored employment support for UC claimants, taking account of their personal, health and family circumstances. Findings suggest CYP are aware when parents and carers are struggling financially and may try to ease pressures on parents. Debates about principles of equality, fairness, social justice and deservingness were present in young people’s accounts. We conclude by exploring future directions for a CYP-centred approach to social policy.
At a time of increased demand for specialist mental health services, a more nuanced understanding of how adolescents navigate systems of care and support is essential. We mapped ‘networks of care’ to explore patterns of mental health help-seeking alongside the perceived helpfulness of support accessed.
Methods
We examined data from 23 927 adolescents aged 11–18 years who participated in the 2023 OxWell Student Survey, an English school-based, repeated cross-sectional survey of mental health and wellbeing. Students self-reported past-year access to 18 types of support across informal (e.g. friends and family), semi-formal (e.g. school and charities), and formal (e.g. health and social care) domains, alongside how helpful they found the support. We used a network approach to explore interconnections between sources of support accessed and perceived helpfulness.
Results
One in four (27.0%, 6449/23927) adolescents reported past-year access to mental health support, of which 56.7% (3658/6449) reported accessing multiple types. Informal networks were the most commonly accessed (23.1%, 5523/23927), followed by semi-formal (9.7%, 2317/23927) and formal (6.8%, 1623/23927) supports. Informal sources had high acceptability, with around 80–90% reporting them as helpful, whereas child and adolescent mental health services (CAMHS), helplines, and online supports were perceived to be the least helpful. The networks also identified groups who might not be optimally served by current systems, including gender diverse adolescents and adolescents who found mental health support from their parents unhelpful.
Conclusions
Adolescents are accessing mental health support across informal, semi-formal, and formal sources of care. Services can no longer be developed, delivered, or evaluated in isolation from these networks.
Community-based organisations continue to take on a greater role in supporting children and young people in the UK with their mental health. However, little evidence exists on the capacity and capability of these settings to effectively implement evidence-based interventions (EBIs).
Aims
To identify barriers and facilitators of the implementation of EBIs within community settings in the UK, for children and young people's mental health promotion, prevention and treatment.
Method
A PRISMA-guided, rapid scoping review was conducted, using predefined criteria and a relevant search strategy on eight databases: Ovid EMBASE, Ovid Medline, Ovid PsycINFO, Ovid Global Health: Scopus, Web of Science All Databases, EBSCO CINAHL and EBSCO ERIC. Study characteristics and data on barriers and facilitators were extracted, with results narratively synthesised.
Results
Five out of 4899 studies met the inclusion criteria, addressing the barriers and facilitators of community-based implementation of EBIs for children and young people's mental health promotion, prevention and treatment. All of the studies that were identified focused on school settings, but we identified no studies that included data on barriers or facilitators of implementing EBIs in other community-based or voluntary sector settings.
Conclusions
There is a lack of available evidence on the capacity and capability of community settings in the UK to effectively implement EBIs and adhere to evidence-based practice. However, existing findings within schools have highlighted key barriers and facilitators to implementation, such as the importance of meaningful involvement of stakeholders throughout the research process, and greater allocation of resources to support evidence-based decision-making in these settings.
Optimising mental health literacy (MHL) at the individual and population level can be an effective mental health improvement and prevention tool. However, concepts of MHL are largely based on evidence from high-income countries. Little is known about the manifestation and role of MHL in countries where collectivist health and social cultures are dominant.
Aim
This study aimed to examine the MHL of Indonesian children and young people (CYP) with experience of common mental health problems and their parents.
Methods
Semi-structured interviews with 40 participants (19 CYP aged 11–15 with experience of common mental health problems and 21 parents) from three areas of Java, Indonesia. Data were analysed using framework analysis, informed by Jorm's 1997 Mental Health Literacy Framework.
Results
Parents and CYP demonstrated relatively low levels of MHL defined from a conventional perspective. Religiosity and spirituality were salient in participants' accounts, particularly parents, as were narratives about personal responsibility. These beliefs appeared to contribute to a high level of self-blame for mental illness, self-reliance for symptom management, the foregrounding of support from spiritual/traditional healers and a reduced propensity to access professional help. CYP were heavily reliant on family support, but parents often felt they were not best placed to communicate with their children about mental health. Providing trusted, technology-based sources of mental health information were advocated by CYP.
Conclusion
Robust efforts are needed to improve MHL in low- and middle-income countries drawing on culturally appropriate approaches to reduce stigma and optimise timely, effective help-seeking for CYP. Enhancing parental and family level literacy may be efficacious, especially when combined with mechanisms to facilitate open communication, as may the development of standalone interventions directly developed to reach younger generations. Future research may usefully establish the comparative efficacy and acceptability of these different approaches.
Depression prevalence among young people is increasing, with growing pressures on specialist mental health services. Manualised behavioural activation therapy may be effective for young people, and can be delivered by a range of mental health professionals (MHPs). This study explored clinician perspectives of barriers and facilitators to implementing behavioural activation with young people in routine practice.
Aims
We conducted a qualitative study with individual semi-structured interviews with MHPs, as part of a wider feasibility study.
Method
Participants were mental health professionals (therapists and supervisors) from two UK NHS sites delivering manualised behavioural activation for young people. Data were analysed with an inductive followed by deductive approach, applying the Theoretical Domains Framework (TDF) to understand key influences on practice change. Identified domains were mapped onto possible behaviour change techniques (BCTs) to support implementation, using the Theory and Techniques Tool (TTT).
Results
Nine MHPs were interviewed. Thirteen of fourteen TDF domains were relevant, including perceived professional identity, beliefs about own capabilities and perceived positive or negative consequences of using manualised behavioural activation, social influences, memory and attention, and environmental resources. Fourteen theory-linked BCTs were identified as possible strategies to help clinicians overcome barriers (e.g. integrating behavioural practice/rehearsal, prompts and persuasive communications within training, and supervision).
Conclusions
Behavioural science approaches (TDF, TTT) helped conceptualise key barriers and facilitators for MHPs delivering manualised behavioural activation with young people. Interventions using BCTs to address identified barriers could help the implementation of new therapies into routine practice, working to bridge the research–practice gap in clinical psychology.
We assessed the clinical utility of the parent-reported Strengths and Difficulties Questionnaire (SDQ) as a screen for emotional and behavioural difficulties in 626 children and young people with intellectual disability. Using the Developmental Behavior Checklist (DBC2-P) to determine clinical caseness, the area under the curve for the SDQ total difficulties score was 0.876 (95% CI 0.841–0.911), indicating that it is a good measure for identifying significant emotional and behavioural difficulties requiring further investigation. Analyses supported the use of the same SDQ cut-off for those with and without intellectual disability, which may assist with consistent and comparable assessment in clinical practice.
Children and young people with intellectual disability and/or Autism Spectrum Disorder (autism) experience higher rates of mental health problems, including depression, than their typically developing peers. Although international guidelines suggest psychological therapies as first-line intervention for children and young people, there is limited evidence for psychological therapy for depression in children and young people with intellectual disability and/or autism.
Aims
To evaluate the current evidence base for psychological interventions for depression in children and young people with intellectual disability and/or autism, and examine the experiences of children and young people with intellectual disability and/or autism, their families and therapists, in receiving and delivering psychological treatment for depression.
Method
Databases were searched up to 30 April 2020 using pre-defined search terms and criteria. Articles were independently screened and assessed for risk of bias. Data were synthesised and reported in a narrative review format.
Results
A total of 10 studies met the inclusion criteria. Four identified studies were clinical case reports and six were quasi-experimental or experimental studies. All studies were assessed as being of moderate or high risk of bias. Participants with intellectual disability were included in four studies. There was limited data on the experiences of young people, their families or therapists in receiving or delivering psychological treatment for depression.
Conclusions
Well-designed, randomised controlled trials are critical to develop an evidence base for psychological treatment for young people with intellectual disability and/or autism with depression. Future research should evaluate the treatment experiences of young people, their families and therapists.
This introductory chapter presents the goal of social justice for children and young people to ensure that children are served and protected within their countries and communities. Despite this important goal, children and young people are often overlooked as critical social justice stakeholders with adults and other country experiences prioritized instead. When social justice issues among young people are addressed, it is often through specific interventions rather than taking a comprehensive approach to social justice for children on a macro level. The chapter discusses the importance of children and young people’s involvement as critical stakeholders in systemic social justice reform. Prior models of social justice are critiqued and a call for a contemporary, global approach to social justice for children and young people is warranted. The chapter introduces the parameters of the volume that follows and how it takes an international approach that includes the presentation of case studies from low- and lower-middle-income countries, as well as upper-middle- and high-income countries as per the World Bank’s 2018–2019 new country classifications.
Non-alcoholic fatty liver disease (NAFLD) is the most common cause of paediatric liver disease, affecting 10% of school-aged children and 44–70% of obese children and young people (CYP) in the western world. Encompassing a spectrum from simple steatosis to steatohepatitis and progressive fibrosis, the disease is rapidly becoming the most common indication for liver transplantation. The molecular pathogenesis of NAFLD remains only partially understood. Development and progression of NAFLD is influenced by genetic and nutritional factors, insulin resistance, oxidative stress, gut microbiome, bile acid metabolism and lipid/glucose handling and is closely associated with overweight and obesity. Lifestyle change is the only proven effective treatment for paediatric NAFLD, however this is difficult to achieve in many. Given that moderate or severe fibrosis is already present in 30–50% of children with NAFLD at the time of presentation, progression in CYP may be more rapid, though adequate outcome data do not yet exist in this cohort. CYP with NAFLD are an excellent population in which to study underlying mechanisms and interventions to correct disease progression as they are largely unaffected by other environmental influences such as alcohol and may represent the more severe end of the spectrum in terms of early onset. Undoubtedly genetic and epigenetic mechanisms determine a large proportion of susceptibility to the disease and potentially, identification of individuals at risk may allow for targeted therapy. This review with give a clinical perspective of paediatric NAFLD focused on identifying those at risk of progressive disease and what to consider in attempting to modify risk.
This study evaluated Evolve Therapeutic Services, an innovative Queensland, Australian programme employing a trauma-informed collaborative wrap-round model of care in combination with a flexible intervention approach that is individually tailored to children and young people in out-of-home care who present with complex and extreme behavioural and mental health problems. The sample consisted of 768 children and young people. Three measures, the Children's Global Assessment Scale, Health of the Nation Outcome Scales for Children and Adolescents and the Strengths and Difficulties Questionnaire were used to assess functioning via a pre-post treatment design. Outcomes were assessed by comparing pre and post-treatment mean scores using repeated-measures t-tests. For estimates of differences in the proportion of children and young people in the clinical range between pre and post-treatment the McNemar test was used. In addition, surveys were completed by carers and stakeholders. Results provided a demographic profile, clinical profile and pre and post-treatment comparisons. Results revealed significant improvements across a range of problem areas: general functioning and adjustment; antisocial behaviour; overactivity and poor attention; non-accidental self-injury; problems with scholastic and language skills; emotional symptoms; peer and family relationships; self-care and independence; and school attendance. Survey data supported the outcomes from the stakeholder-rated and carer-rated measures. Findings provide ongoing evidence for the effectiveness of the therapeutic intervention programme.
Central to the success of therapeutic foster care (TFC) is the quality and stability of the relationship between the child and carer. This key relationship may, from a therapeutic perspective, facilitate healing by addressing the impact of complex developmental trauma experienced by the child who has been placed in care. Stability of the carer–child relationship is critical in this context. Therapeutic carers have been shown to be significantly more likely to remain in the role of carer than their counterparts in mainstream foster care. The research reported on in this paper draws upon findings from an evaluation of a TFC programme and gives voice to the Circle Carers, presenting the components of TFC which are important to them. The paper commences with the story of Ruby in TFC as told by a carer. The focus then becomes a detailed exploration of the experience of carers and their capacity to care. Implications for practice are identified.
A major challenge for researchers and urban planning practitioners is how to obtain meaningful and influential contributions on urban and environmental planning activities from children and young people within the constraints of adult policy and practice. The key elements of this challenge concern traditional methods of communication between ‘experts’ and children and young people in rationalist planning settings, versus emerging research in relation to children's and young people's views and agency around civic participation. This article will address the work of a number of researchers and practitioners who have grappled with the inherent tenions of making planning practice and urban design more inclusionary, while facilitating and respecting children and young people's civic participation. This article also advocates the advantages and strengths of their participation in planning and urban design processes.With a focus on two exploratory programs developed by the authors in the Australian states of New South Wales and Victoria, this article will demonstrate how the sharing of knowledge and skills between planning and design professionals and children and young people can lead to more meaningful and influential contributions from them. The programs examined were informed by leading practice both in Australia and internationally, and have assisted to develop children and young people's sense of spatial competence, and their confidence and efficacy in their local environment, contributing ultimately to their wellbeing. They have also supported the establishment of youth leadership groups with the confidence and skills to contribute to ongoing local government urban and environmental planning activities.
Parliamentary Inquiries into the adequacy of child protection services, as well as best practice care and service delivery in child protection, have been a dominant feature of contemporary Australia in recent times. The direct voices of children and young people in such inquiries are usually missing, despite them being at the very centre of the child protection system and a range of government policies. In this paper we reflect upon this issue and consider why these voices are absent and what factors and barriers limit their inclusion. A review of relevant literature and empirical data indicates that the structures, agendas and processes of such Inquiries are intrinsically adult-oriented endeavours in which the contributions and inclusion of children and young people are not easily accommodated. Through adopting a shift in perspective, orientation and practice, the voices and experiences of children and young people can be included in child protection Inquiries that have critical implications for the quality of their lives and their life chances. Such inclusions uphold the rights of children and young people and support the implementation of government policy in practice.
Each year a large number of children and adolescents develop significant posttraumatic symptoms after being involved in road traffic accidents (RTA). Consequently there is a need to develop effective interventions to prevent or minimize such reactions. The use of symptom monitoring with adults has found promising results. This pilot study explores the use of symptom monitoring with children and young people involved in RTAs. Twelve young people who met criteria on screening questionnaires for significant posttraumatic symptoms completed symptom monitoring diaries. Following completion of a diary once a day for 3 weeks, 3/12 children (25%) fell below criteria, suggesting significant posttraumatic symptoms. Feedback about self-monitoring was generally positive and suggests that symptom monitoring may be a helpful yet simple intervention for use with child trauma victims.
To examine the nature of the link between food advertising in UK magazines aimed at children and young people and Internet food marketing, to establish whether consideration should be given to tightening existing controls.
Design
A review and descriptive analysis of food advertising found in a sample of the top five magazine titles aimed at a range of ages of children and young people between November 2004 and August 2005 and of the Internet food marketing sites to which readers were directed.
Results
Food advertising appeared as ‘cover-mount’ free gifts and as part of the main bound issue. Children aged 6–10 years were the most frequent recipients of food-based free gifts, all of which were confectionery. No food advertising was found in magazines aimed at pre-school children and it formed a small percentage of total advertising in the magazines aimed at children of school age and above. Most food advertisements were for ‘less healthy’ foods, although advertisements for ‘healthier’ food products did appear infrequently. Almost half of food advertisements directed readers towards Internet food marketing sites. We found evidence that these sites are using at least some of the ‘marketing tricks’ which have been identified as a cause for concern.
Conclusions
Proposed restrictions on broadcast media may lead to more food advertising via other non-broadcast means. We suggest monitoring the effect of such changes in print and online advertising and that consideration be given to restricting marketing techniques used on websites aimed at children and young people.
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