Scoping review:Improving the emotional and behavioural health of looked after children by Phil Ayres

VULNERABLE CHILDREN SCOPING REVIEW 2

Improving the emotional and behavioural health of looked-after children and young people (LACYP)

Centre for Excellence and Outcomes in Children and Young People’s Services The Centre for Excellence and Outcomes in Children and Young People’s Services (C4EO) identifies and coordinates local, regional and national evidence of ‘what works’, to create a single and comprehensive picture of effective practice in delivering children’s services. Using this information, C4EO offers support to local authorities and their Children’s Trust partners, working with them to improve outcomes for children, young people and their families. It is focusing its work on seven national themes identified in Every Child Matters. The seven themes are: • Early Years • Disability • Vulnerable Children (particularly children in care) • Child Poverty • Schools and Communities • Youth • Parents, Carers and Families. C4EO works with a consortium of leading national organisations: the National Children’s Bureau, the National Foundation for Educational Research, Research in Practice and the Social Care Institute for Excellence. The Centre is also supported by a number of strategic partners, including the Improvement and Development Agency, the Family and Parenting Institute, the National Youth Agency and the Institute of Education. There is close and ongoing cooperation with the Association of Directors of Children’s Services, the Local Government Association, the NHS Confederation, the Children’s Services Network, the Society of Local Authority Chief Executives, Ofsted and the regional Government Offices. C4EO is funded by the Department for Children, Schools and Families.

Improving the emotional and behavioural health of looked-after children and young people (LACYP) Sheila Fish Mike Fisher Deborah Rutter Janet Clapton Lisa Bostock Isabelle Brodie

First published in Great Britain in May 2009 by the Centre for Excellence and Outcomes in Children and Young People’s Services (C4EO) © Centre for Excellence and Outcomes in Children and Young People’s Services (C4EO) All rights reserved Written by Sheila Fish, Mike Fisher, Deborah Rutter, Janet Clapton, Lisa Bostock and Isabelle Brodie

This report is available in online www.scie.org.uk Centre for Excellence and Outcomes in Children and Young People’s Services (C4EO) 8 Wakley Street London EC1V 7QE Tel 020 7843 6358 www.c4eo.org.uk

Contents Acknowledgements Summary

Purpose and scope of the study

Scoping study methods

Assessment of the evidence base

Design of the main review

Data annexe

References

Appendix 1: Relevant national indicators and data sources

Appendix 2: Search parameters

Appendix 3: Scoping study process

Appendix 4: Studies in each of the main categories of study in the scoping review

Acknowledgements The team would like to thank the Theme Advisory Group for its advice. We would also like to thank Maxine Wrigley at A National Voice, Englandâ&#x20AC;&#x2122;s only national organisation run by and for care-experienced children and young people for providing additional advice and support regarding the inclusion of the perspectives of people who use services.

Improving the emotional and behavioural health of looked-after children and young people

Summary This scoping study assesses the nature and extent of the evidence base in relation to improving the emotional and behavioural health (EBH) of looked-after children and young people (LACYP). The study was carried out between November 2008 and February 2009 by the Social Care Institute for Excellence on behalf of the Centre for Excellence and Outcomes in Children and Young People’s Services (C4EO). The scoping study’s prime purpose is to establish the key review questions and search parameters for later review work, assess the nature and strength of the evidence base and provide an initial overview of trends in the literature. The scope does not report on the findings of the literature on the following, which are the subject of separate scoping studies. •

improving the educational outcomes of looked-after children and young people

•

increasing the number of care leavers (young people) in ‘settled, safe accommodation’.

The scoping studies are the first publications in the C4EO review sequence. Their publication will be followed by main knowledge reviews, which will analyse the content of the best available literature in relation to the review areas. A review on safeguarding and child protection will also be published at a later date.

Aims This study aims to identify the scale and scope of the evidence base in the literature for three key review questions: 1.

What are LACYP’s views on what constitutes EBH and how do they compare with those of policy makers, children’s services personnel and independent sector providers?

What do we know about the accessibility, acceptability and effectiveness of policies, services and interventions to improve EBH initiated by central, regional and local government and the independent sector for LACYP?

What do we know about the contribution made to improved EBH of LACYP by the attitudes, skills and abilities of foster, residential and kinship carers and birth families and interventions to support this contribution?

Nature of the evidence base The systematic search identified over 5,000 papers and books potentially relevant to the scoping review. These went through a two-staged screening process, initially based only on title and abstract and subsequently based on the full text. This narrowed the number of relevant papers down to 104, which were fully coded for relevance to the scoping review questions, study type, main methods, population and location.

Improving the emotional and behavioural health of looked-after children and young people

Question 1: views of LACYP on what constitutes EBH and what would help to promote it Research in this area breaks down into three main categories of study, moving progressively from a very tight focus on emotional and behavioural difficulties (EBD) out to more general views of LACYP about their experiences of being in care. Out of a total of 41 studies relevant to this review question, the majority (37) are UK-based studies. Most (37) are empirical non-experimental studies, mainly based on interviews and/or focus groups (31). The scope indicates a significant research gap in relation to the views of LACYP with direct experience of EBD and related services. The two (non-systematic) review articles in the 41 items relevant to this review question suggest even more specific gaps related to LAC of primary school age or younger, and those who experience a poor outcome from therapy. Question 2: accessibility, acceptability and effectiveness of interventions There are three main groups among the thirty-two studies on interventions addressing LACYP with EBD: enhanced foster care (12), multi-systemic therapy (MST) and similar interventions (6) and mentoring (4). There is a further group of mixed â&#x20AC;&#x2DC;otherâ&#x20AC;&#x2122; studies (11). (Note that the total is 33 because one study falls into two categories.) Studies of approaches that are less exclusively targeted at LACYP with EBD but that may, nevertheless, have the potential to improve outcomes for LACYP with EBD are also available. These include advocacy (2) and family group conferences (1). Those included in this scope, however, do not evidence a specific link between such approaches and the prevention of EBD that disadvantage LACYP. Out of a total of 32 studies relevant to this review question, approximately a quarter (9) are UK-based and a half (17) are based on research in the USA. Only five are identified as having an experimental design with some control or comparison. There are ten reviews, three of which are systematic. The scope results indicate that material with which to answer questions about the accessibility, acceptability and effectiveness of interventions is sparse. Question 3: contribution of attitudes, skills, abilities and behaviours of carers and birth families, and interventions to support this contribution Research in this area focuses on adult participants in the fostering situation. The scope identified an inadequate amount of material on residential workers (1) and on birth families (3) and their perspectives. Much of the literature identified is about foster carers, their support, and particularly training programmes (13). It tends to focus on outcomes for carers â&#x20AC;&#x201C; not directly for children and young people themselves. The material included in this scope seems to suggest that the efficacy of training for foster carers is unproven.

Improving the emotional and behavioural health of looked-after children and young people

Fifteen of the 39 papers relevant to this research question are UK-based and 20 are based on studies in the US. The majority (27) are empirical non-experimental studies, using mainly interviews and focus groups (13) but also surveys (9). Ten are empirical studies with some control or comparison, of which eight are controlled trials. There is one systematic review. Limitations The following limitations should be noted. Abstracts were often missing from the database searches or were too brief to assess the relevance of the material, making precise searching and screening difficult. The lack of clarity within articles also made it difficult to identify relevance to LAC. The timescale of the scoping study meant that only studies since 2000 were included. The timescale also meant that there was some variation in the papers identified, and those retrieved in time to be integrated into the analysis. Similarly, the timescale allowed very little time for authors of the three vulnerable children scopes to collaborate in analysis and reflection, in order to identify, discuss and synthesise crosscutting themes. Also, 90 per cent of the coding decisions were not subject to independent checks.

Implications for the main review Key points: •

The studies included in this topic area, both within and between questions, are so disparate that it cannot plausibly be subject to a single review.

•

At a general level, across all three questions, attempting to incorporate a focus on both the positive, rounded notion of emotional wellbeing and the specific issues of EBD did not prove feasible.

•

There are increasing numbers of studies of the general views and experiences of LACYP but relatively few framed specifically in terms of EBH. There is a notable lack of studies of views of LACYP with direct experience of EBD and related services, especially younger children and those with less successful outcomes following therapeutic interventions.

•

The material on residential workers and birth families identified in the scope is inadequate to support a full review. Similarly, the few studies of kinship and non-kin carers do not tend to link attitudes, skills and abilities to EBH issues (let alone outcomes) for children and young people in care. The majority focus on training for foster carers but tend to highlight problems with attendance and the lack or no evidence of efficacy.

•

There are three sets of interventions focused on EBD that disadvantage LACYP: enhanced foster care, MST and similar interventions, and mentoring. These are different kinds of interventions that could not be subject to single review. In addition, the scope indicates a high degree of heterogeneity within the three categories of intervention.

Improving the emotional and behavioural health of looked-after children and young people

As a general point, this scoping study suggests that the evidence relevant to the priority of improving the EBH of LACYP is not conducive to detailed synthesis through a single systematic review.

Review Question 2 What do we know about the accessibility, acceptability and effectiveness of policies, services and interventions to improve EBH initiated by central, regional and local government and the independent sector for LACYP? The scope suggests that research on broad interventions, at a societal level, to enhance EBH (implementation of LAC, reduction in child poverty) is not yet sufficiently linked to specific EBD to support useful synthesis. Neither does the scope support investing in the systematic review of broad interventions such as advocacy or family group conferences, as these do not appear to demonstrate specific links to outcomes for LACYP with EBD. This may, of course, be a product of how the scope was constructed; further time and searching could reveal useful evidence of such a link. The main recommendation for further review work concerns the three categories of interventions identified: enhanced foster care, MST and similar interventions, and mentoring. The scope indicates that these are three distinct groups, with very different intervention characteristics, suggesting that a separate review might be required for each kind of intervention. The scope has identified existing reviews, some systematic, that could be re-examined and updated. The work would initially take the form of a first-level review of reviews, which should take account of ‘translation’ issues that arise from the disjunction between the findings of systematic reviews about effectiveness at a general level and the need to take specific populations and local contexts into account (see Sundell et al 2006; Anttila and Fish 2008).

Improving the emotional and behavioural health of looked-after children and young people

Review Question 3 What do we know about the contribution made to improved EBH of LACYP by the attitudes, skills and abilities of foster, residential and kinship carers and birth families and interventions to support this contribution? On the basis of material in this scope, it appears that the efficacy of training for foster carers is insufficiently supported to warrant a full review. Furthermore, it is not clear from the scope that there is sufficient material on more varied and sustained packages of interventions to support foster carers that could be more usefully explored instead. Other avenues of potential inquiry would require new searches (e.g. to identify the relevant literature on contact with birth parents for LACYP; or the UK literature on the prevalence, needs and services/support available to kinship carers), which are outside the parameters of the present scope.

Improving the emotional and behavioural health of looked-after children and young people

Purpose and scope of the study This section focuses on the rationale for scoping studies in general, the review questions to be answered in this particular study, the rationale and policy context for this focus, key definitions and cross-cutting issues.

C4EO scoping studies The C4EO has the principal aim of identifying, coordinating and disseminating ‘what works’, in order to significantly improve the outcomes of children, young people and their families – realising the full potential of Every Child Matters (ECM). Its work programme is focused on seven themes, covering the early years, disability, child poverty, parents, carers and families, youth, schools and communities as well vulnerable children. The evidence base for each priority is provided by a knowledge review, which involves a sequence of activity, rather than being a one-off event. Each knowledge review will bring together a unique, quality-assured blend of: •

the best research evidence from the UK – and where relevant from abroad – on what works in improving services and outcomes for children and young people

•

the best quantitative data on a thematic priority with which to establish baselines and assess progress in improving outcomes

•

the best validated local experience and practice on strategies, levers and interventions that have already proved to be the most powerful in helping services improve outcomes, and why this is so.

The prime purpose of the scoping study, which initiates the C4EO review sequence for each theme priority, is to establish the key review questions and search parameters for the later review work, assess the nature and strength of the evidence base and provide an initial overview of trends in the literature.

Review questions for this study This scoping study is one of three under the vulnerable children theme. The other two focus on the priorities of (a) improving the educational outcomes of looked-after children and young people and (b) increasing the number of care leavers in ‘settled, safe accommodation’ respectively. This scoping study considers the literature and data available to examine the priority of improving the emotional and behavioural health (EBH) of looked-after children and young people (LACYP). The scope team considered three questions: 1.

What are LACYP’s views on what constitutes EBH and how do they compare with those of policy makers, children’s services personnel and independent sector providers?

Improving the emotional and behavioural health of looked-after children and young people

Rationale and policy context Improving the EBH of LACYP is a Department for Children, Schools and Families (DCSF) strategic delivery objective. Improving the EBH of LACYP has occupied a prominent position in policy in recent years and the National Indicator Set will create a baseline in 2008/09. Key current initiatives have stemmed, in the main, from the White Paper Care matters: time for change (GB. Parliament. HoC 2007) as well as The childrenâ&#x20AC;&#x2122;s plan: building brighter futures (DCSF 2007) (overlapping with the National service framework on children, young people and maternity services (DH and DfES 2004). They encompass a whole range of responses (see Table 1 below). These include those targeted exclusively at children and young people in care and specific groups of children in care (such as unaccompanied asylum seekers) as well as ones that identify LACYP as a particular subgroup of the larger population of children and young people. Initiatives include new performance indicators, the development of new guidelines and updating of existing ones, new strategies, as well as pilots of various promising interventions and accompanying evaluations. To a certain extent therefore this means that to review the evidence in this area is to work with the sand perpetually shifting under oneâ&#x20AC;&#x2122;s feet.

Improving the emotional and behavioural health of looked-after children and young people

Table 1. of LACYP

Summary of recent policy developments relevant to improving the EBH

1. Selective review of what is known about the effectiveness of interventions for children whose conduct disorders place them at risk of developing persistent and intractable patterns of problem behaviour in later life, commissioned by the Department of Health and the Prime Minister’s Strategy Unit, to inform policy discussions preceding publication of the government’s Action Plan on Social Exclusion (August, 2006). Published in Utting et al (2007). 2. Better outcomes: the way forward. Improving the care of unaccompanied asylum seeking children (BIA 2008), January. 3. Introduction of National Indicator 58: emotional and behavioural health of looked-after children (HM Government 2008), May. 4, CAMHS review: children and young people in mind: the final report of the national CAMHS review (CAMHS 2008), November. 5. Healthier lives, healthier futures: the strategy for children and young people’s health (DCSF 2009b), February. 6. NICE/SCIE public health guidance development on ‘The physical and emotional health and well-being of looked-after children and young people’ (in progress). See see Final Scope document at www.nice.org.uk/nicemedia/pdf/LACFinalScope.pdf 7. Revising and reissuing Promoting the health of looked after children (DH 2002); being led by the DCSF. To contain a strengthened section on mental health. Consultation spring 2009; publication autumn 2009. 8. Healthy Care Programme. See www.ncb.org.uk/Page.asp?originx3175wn_2979939062545q18z5431395204 9. Roll-out of the Fostering Change Programme of parent training for carers, to improve their parenting skills, as well as ensure that the emotional wellbeing of children in care is considered more routinely.

Definitions Emotional and behavioural health Defining this key term was not straightforward in this scope. We began with a broad, rounded notion of ‘emotional and behavioural health’. The focus was on the non-physical aspects of health, often categorised as ‘mental’ or ‘social’. We used the World Health Organization’s (WHO’s) definition of health, incorporating mental and social wellbeing and not merely the absence of problems, difficulties or clinically defined disorders. Our search terms included ‘happiness’ and ‘quality of life’, as well as specific conditions such as ‘conduct disorder’. This was particularly important given our interest in establishing how LACYP themselves constitute EBH.

Improving the emotional and behavioural health of looked-after children and young people

However, this broad definition proved an unwieldy instrument for identifying relevant literature. Using it left us with many more records than we could possibly manage within the time/resource constraints we had – almost three times the numbers of the other two priorities in the vulnerable children theme. As a result, we were forced to rethink our definition of EBH. This led to somewhat different definitions being used in the different subquestions of the scope. In view of the importance of the views of LACYP, we decided to remain with this broad definition for Review Question 1 on LACYP’s views. However, for Review Question 2 (accessibility, acceptability and effectiveness of interventions), we tightened the focus to include only studies that reported specific interventions aimed at improving the EBH of LACYP. This had a knock-on effect for our definition of EBH because interventions tend to focus more narrowly on emotional and behavioural difficulties (EBD) of LACYP to the exclusion of promoting wellbeing in the broader sense. This has the benefit of mirroring more closely the formulation of National Indicator 58: emotional and behavioural health of looked-after children (HM Government 2008). By this means, we intended to ensure that we identified the studies most likely to address the specific problems identified for example by Ward and Holmes (2008), who showed that the child welfare system was least likely to have good outcomes for ‘troubled children with emotional or behavioural difficulties’. The narrower definition of EBH for Review Question 2 is therefore different from that used in Review Questions 1 and 3. This means that the questions of accessibility and acceptability are answerable only in relation to this more specific kind of intervention. We are not able to say anything about the acceptability and accessibility of more general service provision (such as schemes to improve inter-agency liaison). Interventions We defined interventions as a specific activity with specified outcomes that included evaluation of any design. The rationale for this was that the scope should identify practices that are sufficiently well defined to be subject to synthesis at review. As indicated above, beyond this, definitions varied somewhat between sub-questions of the review. Specifically for Review Question 2, the term ‘intervention’ was defined as a specific therapeutic practice aimed at improving the EBH of LACYP. It therefore focused on what practitioners do, rather than the organisation of services. We did not include studies where the target population included LACYP and others, but measured outcomes for LACYP were not disaggregated within the results. This was intended to narrow the focus and to exclude system-wide approaches (such as an account of introducing LACYP into a child welfare system). While system-wide approaches may concern the EBD of LACYP, they are not always linked directly to outcomes addressing EBD and usually have a wide remit to improve the overall performance and accountability of the child welfare system. Thus, the scope for Review Question 2 was constructed to exclude broad societal approaches to valuing and respecting LACYP as citizens, and approaches directed at improving child welfare for all children in order to improve outcomes for the most disadvantaged (a preventive or trickle-down effect). While there may be merit in this

Improving the emotional and behavioural health of looked-after children and young people

societal approach in the long run, it is unlikely to deliver outcomes in a three- to four-year horizon, which is emphasised by the C4EO. This restriction of the definition of ‘intervention’ to activities aimed specifically at the EBH of LACYP was not continued for Review Question 3. As will be discussed in the assessment of the evidence base below, literature available on training for carers and birth families is rarely linked to outcomes for LACYP, let alone specific outcomes related to EBH.

Definitions generic across the vulnerable children theme Looked-after children and young people (LACYP) For the purposes of this study, we have defined the following groups as ‘looked-after children and young people: •

0–25-year-olds in medium- or long-term care (more than six months) – wherever they are looked after (for example, in residential care, in foster care, in a young offenders’ institution) – and their families

•

0–25-year-olds who undergo several short-term (up to six months) periods in local authority care (either under a care order, or on a voluntary basis)

•

0–25-year-olds preparing to leave medium-term or long-term local authority care.

In practice, the literature rarely specifies this level of detail, largely describing children as in care or looked after. Acceptability and accessibility of interventions The ‘acceptability of interventions’ refers to how acceptable interventions are to service users and carers, and to other people (e.g. staff) involved in delivering them. The ‘accessibility of interventions’ refers to how easy to access services or interventions are. Effectiveness of interventions The ‘effectiveness of interventions’ refers to how effective interventions are (in a practice setting), usually assessed by measuring outcomes in various dimensions. For example, a service designed to help LACYP achieve better educational outcomes might be assessed by direct long-term outcomes (e.g. number of GCSE passes) or by indirect shorter-term indicators (e.g. attendance at school). Further definitions are provided in the Data annexe.

Improving the emotional and behavioural health of looked-after children and young people

Cross-cutting issues The scoping study identified two cross-cutting issues â&#x20AC;&#x201C; child poverty and safeguarding. These issues have been identified by C4EO as of central importance to improving outcomes to children and will be subject to future reviews that cover all the themes. While it is arguable that all the material on LACYP concerns child poverty and safeguarding (within the wider understanding of social capital), the material included in this scoping study has been coded to reflect these cross-cutting themes only where they are directly addressed or confirmed within each study. The governmentâ&#x20AC;&#x2122;s definition of safeguarding is: the process of protecting children from abuse or neglect, preventing impairment of their health and development, and ensuring they are growing up in circumstances consistent with the provision of safe and effective care that enables children to have optimum life chances and enter adulthood (for more information, please visit www.everychildmatters.gov.uk/socialcare/safeguarding/workingtogether/).

Improving the emotional and behavioural health of looked-after children and young people

Scoping study methods The study began with the Theme Advisory Group (TAG) – a group of experts in the policy, research and practice field of vulnerable (looked after) children – establishing the key questions to be addressed and the parameters for the search (see Appendix 1). The scoping study used a broad range of methods to identify relevant material: •

searches of bibliographic databases

•

searches of research projects

•

searches of databases

•

browsing relevant organisations’ websites

•

recommendations from the TAG.

The research team undertook an initial screening process of the search results, using record titles and abstracts (where available) to ensure that the search results conformed to the search parameters (see Appendix 1) and were relevant for answering the scoping study questions. Items were excluded if: •

they were not about LAC or care leavers (up to 25 years old)

•

they were published before 2000

•

they did not relate to a study in the UK, Ireland, the USA, Canada, Australia or New Zealand

•

they did not answer the scoping study questions

•

a fuller report was published elsewhere

•

duplicate records were found.

Records from the searches that were thus screened as relevant were then loaded into the Evidence for Policy and Practice Information (EPPI)-Reviewer database. At the second stage of screening, the team considered that scoping required the use of full text, and so all records screened for inclusion were obtained. Information from the full document was used to assess the relevance of the item (i.e. each piece of literature) to the study. Further items were excluded if they: •

could not be retrieved in full text within the scoping study deadline

•

contained insufficient detail to determine relevance.

As noted above, for Review Question 2 specifically, this secondary screening included an additional exclusion criterion – it excluded studies that did not report on an intervention in the stricter sense described above, aimed specifically at improving the EBH of LACYP.

Improving the emotional and behavioural health of looked-after children and young people

The content of the rejected records included those that focused on: •

adopted children

•

policy

•

overviews or briefings of the topic

•

descriptive survey material (and not LACYP views)

•

LACYP as part of a broader sample, with no attempt to disaggregate information on LACYP.

The research team then assessed the remaining items and coded them in relation to the following: •

relevance to the research question

•

country (the UK, Ireland, the USA, Canada, Australia or New Zealand)

•

study type (including experimental study with comparison/control, non-experimental study, systematic review etc.)

•

main methods (including survey, interviews and focus groups, control trial, literature review etc.)

•

intervention setting (including foster care, residential care, school, housing services, floating support etc.)

•

study population (including LACYP, care leavers, health, education, housing and education staff etc.)

•

cross-cutting issues (child poverty and safeguarding).

Please see Appendix 2 for a full copy of the exclusion criteria and coding tool. Having completed the coding, it was clear that ‘intervention setting’ is an ambiguous term. It can capture either the environmental space in which an intervention takes place (e.g. a school meeting room) or the context in which the child(ren) are placed. Many studies do not report this and, therefore, the scoping review did not analyse the responses checked on this section of the coding form. An agreed part of the scoping study was to undertake independent coding quality assurance checks on 10 per cent of the coded papers. In addition, all studies excluded on reading of the full text were independently checked. (Further information on the scoping process and details of the search strategy can be found in Appendix 2.) Table 2 provides a summary of the different stages of the scoping study methods.

Improving the emotional and behavioural health of looked-after children and young people

Table 2. 1. 2. 3. 4. 5. 6. 7. 8.

Summary of the different stages

Question setting Searching to identify relevant material Initial screening against inclusion/exclusion criteria Included studies entered into EPPI-Reviewer database Second-stage screening Coding of the final included studies Quality assurance on 10% of coded papers Assessment of content and scope of included papers

Title and abstract

Full paper Full paper Full paper Full paper

Limitations of the study methods The following limitations should be noted: •

Abstracts were often missing from the database searches or were too brief to assess the relevance of the material, making precise searching and screening difficult.

•

The lack of clarity of reporting within some articles also made it difficult to identify whether the sample focused exclusively on LAC or included LAC at all.

•

The tight timescale of the scoping study meant that only studies since 2000 were included.

•

The timescale meant that there was some variation in the papers identified, and those retrieved in time to be integrated into the analysis.

•

The timescale, and especially the late arrival of papers, did not permit adequate quality assurance of the coding of papers included in the scope. A final check was carried out on the papers included in 3.2 (the studies detailed in Tables 1-3 of Appendix 3) to ensure that they were consistently coded. The results have informed the final version of this scoping study. However, discrepant entries on Eppi Reviewer were not altered, although the audit trail will enable this work to take place.

•

The timescale allowed very little time for the authors of the three vulnerable children scopes to collaborate in analysis and reflection in order to identify, discuss and synthesise cross-cutting themes.

The timescale for this review required that analysis of the content of papers was undertaken alongside retrieval. In the event, the content analysis had to be finalised before all the papers were available as full text. Consequently, for this review, the tables analysing resource types (location, design and methodology), and those detailing the topic of papers (Appendix 3) do not include the following nine items:

Improving the emotional and behavioural health of looked-after children and young people

•

Ahrens, K.R., DuBois, D.L., Richardson, L.P., Fan, M.Y. and Lozano, P. (2008) ‘Youth in foster care with adult mentors during adolescence have improved adult outcomes’, Pediatrics, vol 121, no 2, pp e246–52.

•

Biehal, N. and Wade, J. (2002) Children who go missing: research, policy and practice, London: Department of Health.

•

Cassen, R., Feinstein, L. and Graham, P. (2008) ‘Educational outcomes: adversity and resilience’, Social policy and society, vol 8, no 1, pp 73–85.

•

Coakley, T.M. (2008) ‘Examining African American fathers’ involvement in permanency planning: an effort to reduce racial disproportionality in the child welfare system’, Children and youth services review, vol 30, no 4, pp 407–417.

•

Connelly, G., Siebelt, L. and Furnivall, J. (2008) Supporting looked after children and young people at school: a Scottish case study, Strathclyde: University of Strathclyde.

•

Coulling, N. (2000) ‘Definitions of successful education for the “looked after” child: a multi-agency perspective’, Support for Learning, vol 15, no 1, pp 30–35.

•

Courtney, M. E. and Dworsky, A. (2006) ‘Early outcomes for young adults transitioning from out-of-home care in the USA’, Child & family social work, vol 11, no 3, pp 209– 219.

•

Courtney, M.E., Piliavin, I., Grogan-Kaylor, A. and Nesmith A. (2001) ‘Foster youth transitions to adulthood: a longitudinal view of youth leaving care’, Child welfare journal, vol 80, no 6, pp 685–717.

•

Iglehart, A.P. (ed) (2004) ‘Special issue. Kinship foster care: filling the gaps in theory, practice and research’, Children and youth services review, vol 26, no 7, pp 613–686.

These items can be made available to authors of any reviews arising from the scoping studies. The totals are consistent (104 plus 9) with the flowchart shown at Appendix 2.

Improving the emotional and behavioural health of looked-after children and young people

Assessment of the evidence base Overview: coding results A total of 104 items were assessed as relevant to the review questions. Table 3 shows the number relevant to each of the three review questions. Please note that items may be assessed as relevant to more than one question. Table 3.

Review question relevance

Review question relevance Number Review Question 1: LACYP views 41 Review Question 2: Intervention and services 32 Review Question 3: Carers and birth families 39 Total number of papers (taking into account 8 papers relevant to more 104 than one sub-question) These totals are consistent with Tables 1â&#x20AC;&#x201C;3 (detailing included studies) in Appendix 3, given that one study (Utting et al, 2007) in review question 2 is included in two sections of the table 2 (Appendix 3); one study (Coakley et al, 2007) in review question 3 is included in two sections of table 3 (Appendix 3). A further eight papers were included in more than one sub-question.

Scope of evidence for Review Question 1 on views of LACYP The search strategy and screening identified 41 papers relevant to the views of LACYP on what constitutes EBH. The majority (37) are UK-based studies and 3 are American. The majority (37) of studies reporting views of LACYP are empirical non-experimental studies, with two classified as arising from papers with an experimental design with some control or comparison, and two from review articles. In relation to methods reported in the 41 papers, 29 studies are based on interviews and/or focus groups, nine use survey methodologies, while three use a case study methodology. 8 papers report two or more methods. This body of work can be broken down into three main categories of study, moving progressively from those with a very tight focus on EBD out to those with more general views of LACYP about their experience of being in care (see Table 4; the studies in each category are presented in Table 1 in Appendix 3). The first category includes studies that focus specifically on EBD. The second category focuses on studies related to views about general health and wellbeing in its broadest, including its positive, sense and not focused specifically on problems and difficulties. The third category focuses on views and experiences of LACYP more generally that are not related either to issues of health and wellbeing or to EBD, but to the general experience of being in care.

Improving the emotional and behavioural health of looked-after children and young people

Table 4.

Summary of main categories (content) of studies of LACYP’s views

Summary of main categories of ‘views’ studies 1. Views on EBD including mental health problems. Grand total: (a) views of LAC with EBD or receiving mental health services (b) views about EBD or mental health problems/services but LACYP with EBD/mental health problems not distinguished, including unaccompanied asylum seekers (c) views about specific EBDs or specific interventions e.g. conduct disorder, sexual abuse 2. Views on ‘health and ‘wellbeing’ in the broadest sense, not on serious difficulties/problems 3. Views on the experience of being looked after more broadly and/or the basic principles of good practice 4. Other Total included papers

Number 17 (7) (4)

(6) 10 13 1 41

It can be seen from Table 4 that the first category of studies – on EBD including mental health problems – has three subsets. It is important to distinguish between studies concerned with the direct experiences of LACYP with EBD or receiving mental health services (7), and those relating LACYP’s views about EBD or mental health problems and services but in which LACYP with direct experience of EBD/mental health problems are not explicitly distinguished (4). We have included papers on unaccompanied asylum seekers (2) in the latter. A third subset of studies relates to specific interventions concerned with EBDs either generally e.g. advocacy (5) or in relation to specific clinically defined problems e.g. conduct disorder or sexual abusers (1). This is an important subset if we seek to ascertain the acceptability and accessibility of studies relevant to Review Question 2. Views on EBD including mental health problems (Table 1, Appendix 3) There were seven studies of views of LACYP with EBD or receiving mental health services, including one review (Davies and Wright 2008). The majority focus on mental health issues and services provision (5), including in relation to homelessness (Vasillou and Ryrie 2006) and secure accommodation (Lerpiniere et al 2006). Other issues include bereavement (Penny 2007) and post-traumatic growth (Sutton et al 2006). The title of the review (Davies and Wright 2008) of literature ‘pertinent to looked-after children’s views of mental health services’ (emphasis added) underscores the paucity of research on the views of LACYP with direct experience of EBH or related services. The authors indicate even more specific gaps related to LAC of primary school age or younger and those who experience a poor outcome from therapy. This is borne out in those studies included in this scope, which focus on older children and young people, in the main. The studies of views about EBD or mental health problems/services in which LACYP with EBD/mental health problems are not distinguished, continues this focus on mental health

Improving the emotional and behavioural health of looked-after children and young people

(Beck 2006; Ellermann 2007). Otherwise, they are concerned with unaccompanied asylum-seeking children and young people (Stanley 2001; Chase et al 2008). Research on views about specific EBDs or specific interventions includes studies of advocacy programmes (Hartnett 2002; Barnes 2007), mentoring (Clayden and Stein 2005), a therapeutic residential facility for sexually abusive young men (Boswell and Wedge 2003) and a residential unit/school (Smith et al 2004). Views on health and wellbeing Included in this category are general studies of health and wellbeing needs (Fleming et al 2005) and resilience (Dearden 2004), but also more focused issues such as health information needs (Bundle 2002), play opportunities (Milligan and Stevens 2006; McGuinness and Robinson 2007) and the particular views and experiences of young people related to their sexual orientation (Mallon et al 2002). A subset of studies focuses specifically on care leavers (Goddard and Barrett 2007), particularly when going to university (Jackson et al 2003, 2005) or looking for accommodation and work (Wade and Dixon 2006). General studies of the views of LACYP Studies in this group focus neither on EBD nor on health and wellbeing more broadly. Instead, they focus on LACYPâ&#x20AC;&#x2122;s views of their in-care experience generally (Sinclair et al 2001; McAuley 2005; Ward et al 2005; Enlighten Peer Research Project 2007) or on particular aspects of the experience of being in care, such as being looked after by family members as opposed to strangers (Broad et al 2001). This group also includes studies concerned with the experience of leaving care for disabled young people (Priestley et al 2003) and young people from different black and minority ethnic groups (Barn et al 2005). Some studies are routine collections by government bodies about LACYPâ&#x20AC;&#x2122;s views (Timms and Thoburn 2003; Morgan 2006, 2007). Others focus on how participation can be improved (Munro 2001; Cashmore 2002). Theorising about how best to understand such views is often lacking, although it is the availability of some studies (McLeod 2006; Ward et al 2005) thats alert us to the greater absence.

Scope of evidence for Review Question 2 on interventions (Table 2, Appendix 3) Thirty-two studies were identified as relevant to the question about the acceptability, accessibility and effectiveness of interventions to improve the EBH of LACYP. These are discussed in this analysis and presented in Table 2 in Appendix 3. Nine of the thirty-two studies are UK-based and seventeen are based on research in the USA. There is only one from Australia/New Zealand, while 5 studies derive from material from more than one country (including UK, USA and Canada).

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Seventeen are empirical non-experimental studies, while five are identified as having an experimental design with some control or comparison. There are three systematic reviews and seven other review articles. In relation to methods, the largest group of studies (10) is based on interviews and focus groups, while four use controlled trial methodology (including structured measures), seven are based on literature reviews, eight use survey data, and five case study material. The three systematic reviews are classified as secondary analysis. Six studies used ‘other’ methods, including observational techniques. More than one method (maximum of two recorded) were reported by 11 studies. On examination (Table 2, Appendix 3), this body of research falls into three broad categories: enhanced foster care (12), MST and similar interventions (6) and mentoring (4) (with one study, Utting et al, 2007, falling into two categories). A fourth group captures ‘other’ studies (11). Within this broad classification, there are a wide variety of interventions (as is apparent from the term ‘MST and similar interventions’ that we are using). We emphasise that this classification is designed to serve scoping and that a subsequent systematic review would need to reduce the variation in the included studies in order to deliver useful information on effectiveness. Enhanced foster care The term ‘foster care’ has different meanings in North America (any out-of-home care) and the UK (family placement) and it is not always possible to identify in the North American studies the extent to which the focus is on enhancing family placement. In this group of studies, there are three reviews and two systematic reviews (Craven and Lee 2006; Hahn et al 2005). Specifically, the studies focus on: • early intervention foster care (EIFC) (Fisher et al 2000) •

treatment foster care (McGuinness and Dyer 2007; review by Redding et al 2000; review by Utting et al 2007)

•

multidimensional treatment foster care (Moore et al 2001)

•

enhancing school readiness (Pears et al 2007)

•

preventive intervention in foster care (Taussig et al 2007)

•

day treatment (Whitemore et al 2003)

•

school-based group therapy (Williams et al 2001).

MST and similar interventions What unites studies in this group is that they are aimed at the most challenging behaviour and use a mixture of systemic and cognitive approaches.

Improving the emotional and behavioural health of looked-after children and young people

There are three systematically conducted reviews: the main Campbell 1 systematic review of MST (Littell et al 2005), the Utting et al (2007) review that includes a review of MST, and a review of treatments for conduct disorder (Henggeler and Sheidow 2003). In accordance with usual scoping practice, we have not examined the included studies as would have to be undertaken in the full review. Other studies included are: •

multimodal treatment for ADHD (dosReis et al 2004)

•

crisis intervention to reduce aggression in residential care (Nunno et al 2003)

•

cognitive behavioural intervention (Stevens 2004).

Mentoring Included in this category are mentoring, both as a naturally occurring feature of children and young people’s social network (Ahrens et al 2007) and as a constructed intervention. The latter includes interventions using trained mentors, such as a befriending project (McBriar et al 2001), special projects for care leavers (Clayden and Stein 2005), and culturally competent mentoring (Utsey et al 2003). As the inclusion of a befriending study indicates, mentoring draws on the theoretical framework of resilience (which is enhanced by having a confidant) and role modelling. Mentoring is a common intervention for many groups of children and young people and is not exclusively studied in relation to LACYP.

A Campbell Review is a review conducted according to the guidelines of the international systematic reviews organisation for social interventions – the Campbell Collaboration.

Improving the emotional and behavioural health of looked-after children and young people

Other interventions We noted in the subsection on the definition of interventions that our distinction between broad societal approaches and more specifically targeted activities aimed at improving the EBH of LACYP was in fact not neat. This is because work that has the potential to address the EBD of LACYP may also operate at a system-wide level. For example, advocacy may be directed at improving outcomes for specific groups of LACYP while also addressing the lack of participation by many LACYP in decision making. Similarly, family group conferences may have specific, measurable outcomes for LACYP with EBD while also demonstrating a transformed relationship between the state and the families of disadvantaged children and young people. We therefore examined those studies where such system-wide work had the potential to improve outcomes for LACYP with EBD. These are included in the final ‘other’ category and include interventions related to: •

mental health (Kurtz and James 2003)

•

advocacy (Boylan and Ing 2005; Barnes 2007)

•

family group conferences (Connolly 2007)

•

cultural competence (Alford 2003)

•

strengthened residential care (Armour and Schwab 2005)

•

strengthened post-abuse service (Barker and Place 2005)

•

mental health/secure units (Lerpiniere et al 2006)

•

trauma therapy for unaccompanied asylum seeking children (USAC) (Ehntholt and Yule 2006)

•

concurrent planning (Monck et al 2004)

•

kinship care (Strozier et al 2005).

If, at review stage, these interventions are to be included, papers will need to be screened to identify the extent to which these approaches directly address EBD in LACYP. It is worth noting that the US material on cultural competence (Alford 2003) seems unlikely to be simply applicable to the UK.

Scope of evidence for Review Question 3 on carers and birth families (Table 3, Appendix 3) Thirty-nine (39) studies were identified as relevant to the question of the contribution made to the improved EBH of LACYP by the attitudes, skills, abilities and behaviours of foster, residential and kinship carers and birth families, and interventions to support their contribution. These are included in the analysis summarised in Table 3 in Appendix 3 (which totals 40 because Coakley et al, 2007, is counted in two sections).

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Twenty papers are based on studies in the US and fifteen are UK-based, while one is from Australia/New Zealand and two are from Canada. An additional paper (a systematic review by Turner et al, 2007) uses data from more than one country. The majority (27) are empirical non-experimental in design, and a further ten are empirical with some control or comparison. There is one systematic review and four other review articles. Two are classified as background information and two are categorised as other/inadequate information on their design. In relation to methodology, thirteen are based on interviews and focus groups, nine are based on surveys while eight were controlled trials (using structured measures). Secondary analysis of data accounted for four studies. One used a case study approach, while fourteen are classified as ‘other’ or had inadequate information on methodology. 10 studies used two methodologies. Research in this area focuses on adult participants in the fostering situation. Table 3 in Appendix 3 shows that studies can be divided into four categories, covering material on: •

birth families (3)

•

kinship carers, including grandparents (7)

•

residential workers (1)

•

non-kinship foster carers ¾ training of foster carers (13) ¾ other studies concerning foster carers (16).

As the figures above indicate, the scope identified insufficient material on residential workers (1) and birth families (3) and their perspectives. Much of the literature identified is about foster carers, their support, and particularly training programmes (13). Birth families Although many LACYP return to live with parents, we found very little material on the birth parents of children in care. The scope only found two papers that deal with this issue (Haight et al 2002; Moyers et al 2006), the latter being UK-based. Where papers mentioning contact with birth parents were accessed, this was through search terms relating to foster carers. Kinship carers, including grandparents Almost all the literature identified as referring to kinship carers derived from the USA. Grandparents are most commonly involved in studies referring to kinship care, with two studies focusing directly on issues for grandparents (Smith and Dannison 2003; Dowdell 2004). Whether these arrangements were formal or informal was often unclear in the US studies, and some studies combined both categories. They commonly focus on the level of support

Improving the emotional and behavioural health of looked-after children and young people

(financial, educational) offered to kinship carers. Much of this material is observational and focuses on outcomes for carers rather than for LACYP. One study (Johnson-Garner and Meyers 2003) explores the characteristics of resilient kinship caregiving for African-American young people from the perspective of caregivers, many of whom are grandparents. Two studies focus on interventions to support kinship carers. Strozier et al’s (2005) study deals with the evaluation of a small intervention (Kinship Care Connection) delivered through school to 34 caregivers and Smith and Dannison’s (2003) study discusses a similar programme for ‘custodial grandparents’ and their grandchildren. Residential workers Only one study focuses on residential workers (Furnivall et al 2007). This is a UK-based survey that focuses on the experiences and perspectives of residential childcare practitioners in dealing with children’s mental health difficulties. Training of foster carers Studies involving foster carers do not all include interventions, but where they do, the intervention is, with few exceptions, training for foster carers (see Table 3 in Appendix 3). This includes one systematic review (Turner et al 2007). Training described or evaluated is almost universally informed by attachment theory and/or deals with challenging behaviour or the consequences of abuse. Outcomes for the studies evaluating foster carer training usually include assessment of the behaviour of LACYP themselves, but in many cases these are reported by foster carers and lack objectivity. Common measures of impact include: time to placement breakdown, stated satisfaction of foster carers, and the foster carer informant version of the Strengths and Difficulties Questionnaire and Child Development Checklist. Other The final, ‘other’ category includes the following topic areas: • support for foster carers (Golding 2002, 2004; MacGregor et al 2006; Cole and Eamon 2007), specifically related to emotional and behavioural problems (Bruns and Burchard 2000; Sargent and O’Brien 2004) and complex needs (Lauver 2008) • foster carer roles related to specific areas, including placement stability and/or breakdown (Gilbertson and Barber 2004; Brown and Bednar 2006) • attachment (Cole 2005), reactions to disclosure of sexual abuse (Gries et al 2000), continuity of activities (Fong et al 2006), life skills (Nollan et al 2002) and long-term fostering (Schofield and Beek 2005) • characteristics and needs of LACYP (Fleming et al 2005; Lowe and Pithouse 2005).

Improving the emotional and behavioural health of looked-after children and young people

New and ongoing studies A number of new and ongoing policy research studies may be relevant for future C4EO reviews within this priority: •

evidence reviews to inform the National Institute for Health and Clinical Excellence (NICE)/Social Care Institute for Excellence (SCIE) guidance development

•

evaluation of pilot projects of multidimensional treatment foster care for adolescents with complex needs and challenging behaviour

•

randomised controlled trials of MST pilot projects

•

evaluation of pilot projects of social pedagogy in residential care

•

a report on the comparative costs of multidimensional treatment foster care.

Useful updates can be found at http://livegroup.co.uk/investinginchildren/index.php?view=agenda (accessed 10 April 2009).

Gaps in the evidence base Key gaps in the evidence base related to improving the EBH of LACYP include: •

evaluated pilots of broader support packages for foster carers that go beyond training

•

studies of the contribution made by attitudes, skills and abilities of birth parents to the EBH of LACYP and how to support this contribution

•

studies of the contribution made by attitudes, skills and abilities of residential workers to the EBH of LACYP and how to support this contribution

•

incorporation of the views of LACYP into effectiveness studies of interventions to address EBD

•

studies of the views of LACYP with direct experience of EBD and related services, particularly younger children and those with unsuccessful outcomes of therapeutic interventions.

Improving the emotional and behavioural health of looked-after children and young people

Design of the main review This section focuses on the implications of the assessment of the evidence base for the main review. It considers the type of review to be adopted, the range of evidence to be used and refinements to the review questions.

C4EO and systems change The C4EO, working with partners, aims to improve outcomes for children and young people by supporting and sharing what works, focusing on the model of whole-system change proposed by Every Child Matters (ECM). This will be secured through improved: •

inter-agency governance, leading to the development of robust inter-agency governance and accountability and the establishment of local safeguarding children boards

•

integrated strategy, resulting in joint needs assessments of children, young people and parents

•

integrated processes, with the introduction of the common assessment framework and better information sharing

•

integrated frontline delivery, with the development of multidisciplinary teams and common core of knowledge and understanding about children’s needs.

This model of change, with outcomes for children, young people and their families at its heart, is referred to as the ‘onion’ diagram.

Improving the emotional and behavioural health of looked-after children and young people

Diagram 1. The ‘onion’ diagram

Source: DCSF 2008d (For more information on whole-systems change, and the ‘onion’ diagram, please visit www.everychildmatters.gov.uk/aims/strategicoverview/). The main review will need to consider how the available evidence can support system change in order to improve outcomes for children and young people. The impression is that there are significant limits to the extent to which the literature speaks to systems-level changes.

Improving the emotional and behavioural health of looked-after children and young people

Implications for the main review As a general point, this scoping study suggests that the evidence relevant to the priority of improving the EBH of LACYP is not conducive to detailed synthesis through a single systematic review.

Review Question 1 What are LACYP’s views on what constitutes EBH and how do they compare with those of policy makers, children’s services personnel and independent sector providers? The scope findings suggest that studies of LACYP’s views are not yet sufficiently linked to EBH to support useful synthesis. This is especially the case given the apparent underdevelopment of conceptual and theoretical frameworks through which to understand LACYP’s experiences. Pertinent too is the indicated lack of studies of views of LACYP with direct experience of EBD and related services, especially younger children and those with less successful outcomes following therapeutic interventions. If, as this scope suggests, a review of interventions targeted at EBD that disadvantage LACYP is commissioned, it should include an emphasis on identifying the views of LACYP on the relevance of these interventions to their perception of their EBH.

Review Question 2 What do we know about the acceptability, accessibility and effectiveness of policies, services and interventions to improve EBH initiated by central, regional and local government and the independent sector for LACYP? Research on broad interventions, at a societal level, to enhance EBH (implementation of LAC, reduction in child poverty) is not yet sufficiently linked to specific EBD to support useful synthesis. Neither does the scope support investing in the systematic review of broad interventions such as advocacy or family group conferences. While these may have beneficial effects on outcomes for LACYP with EBD, this scope does not demonstrate specific links. This may, of course, be a product of how the scope was constructed; further time and searching could reveal useful evidence of such a link. Further work on such interventions would require exploring whether, for example, available outcomes-based research on family group conferences (e.g. Sundell and Vinnerljung 2004; Walsh and Marsh 2005) has measured EBH outcomes for children who have been subject to family group conference decision making or whether family group conferences have specific value in relation to LACYP with EBD. It appears from this scope that research on advocacy has also not specifically explored its impact on the EBD of LACYP. The main recommendation for further review work concerns the three categories of interventions identified: enhanced foster care, MST and similar interventions, and

Improving the emotional and behavioural health of looked-after children and young people

mentoring. The scope indicates that these are three distinct groups, with very different intervention characteristics. In addition, the scope indicates a high degree of heterogeneity within the three categories of intervention. A separate review is therefore required for each kind of intervention. The scope has identified existing reviews, some systematic, that could be re-examined and updated. The work would initially take the form of a first-level review of reviews. The reviews identified in the scope may be supplemented by specific searches for reviews and by reference harvesting from included studies (e.g. Clayden and Stein 2005 refer to DuBois et al 2002). Examining the systematic reviews more closely will allow the scope for updating to be identified. For example, Littell et al (2005) refer to several studies of MST that were under way but had not reported. (Littell will report on the updating of her main MST review at the May 2009 Campbell Colloquium.) Any further work will also need to take account of the UK MST pilots. As noted above, it would also need to pay particular attention to studies of user views included within the intervention studies identified. Material on the perspectives of foster carers would also need to be identified in order to highlight any evidence on how participants, including LACYP and foster carers, can best be motivated to engage with the intervention. Lastly, we would suggest that a review of reviews should take account of â&#x20AC;&#x2DC;translationâ&#x20AC;&#x2122; issues that arise from the disjunction between the findings of systematic reviews about effectiveness at a general level and the need to take specific populations and local contexts into account (see Sundell et al 2006; Anttila and Fish 2008).

Review Question 3 What do we know about the contribution made to improved EBH of LACYP by the attitudes, skills and abilities of foster, residential and kinship carers and birth families and interventions to support this contribution? On the basis of material in this scope, the efficacy of training for foster carers appears to be insufficiently supported to warrant a full review. Furthermore, it is not clear from the scope that there is sufficient material on more varied and sustained packages of interventions to support foster carers that could be more usefully explored instead. Other avenues of potential inquiry would require new searches (e.g. to identify the relevant literature on contact with birth parents for LACYP; or the UK literature on the prevalence, needs and services/support available to kinship carers), which are outside the parameters of the scope.

Data annexe

Improving the emotional and behavioural health of looked-after children and young people

Introduction and availability of data The main focus of this priority is improving the EBH of LACYP. At present, there is no extant and comprehensive database on the EBH of young people as a whole (other than some information on the social and emotional development of children in the early years that is recorded as teacher-assessed scores in the Foundation Stage Profile). Information on the EBH of LACYP is now being gathered through the use of the Strengths and Difficulties Questionnaire (SDQ) administered in local authorities to all young people aged four to 16 who are looked after (see section ‘Nature and scope of the data’ later in this data annexe). The extent to which this data will be published at aggregate level or prove accessible for further analysis (under special licence or by approved users) is not yet clear. Under the European Union Directive (95/46/EC), health data about individuals (including mental health data) is seen as ‘sensitive’ and access to information that might lead to the identification of any individual is strictly controlled. This data annexe presents further discussion about the data currently available on the EBH of LACYP. It provides: •

a summary of the search strategy for identifying data

•

an overview of the nature and scope of the data that was found, with a brief commentary on the quality of this data, and any gaps that have been identified

•

some examples of the type of charts and diagrams that could be produced, showing, for example, comparisons between outcomes for looked-after children and all children.

A summary table of the data sources of readily available, published data for LAC at a national, regional and/or local authority level is produced in Data annexe appendix 1.

Search strategy There are a number of archival databases in the UK, such as the National Digital Archive of Datasets (NDAD) and the UK data archive, some of which have services that facilitate searching or access to macro- and micro-datasets (including ESDS International). Even so, searching for current and recently published data cannot yet be conducted in the same way as searching for published research findings. Access to newly published data is not supported by comprehensive searchable databases in the same way that literature searches are supported, although the DCSF and the Department for Innovation, Universities and Skills (DIUS) produce a publications schedule for Statistical First Releases and Statistical Volumes. Data for this data annexe was obtained by a combination of search methods but primarily by obtaining online access to known government publications (such as the Statistical First Releases and Statistical Volumes from the DCSF) and access to data published by the Department of Health and Office of National Statistics, other government departments, the National Health Service and other national, regional and local bodies. It should be noted that links to statistical sources that were live at the time of searching may not remain live at the time of publication.

Improving the emotional and behavioural health of looked-after children and young people

Nature and scope of the data Current data on the EBH of individuals, is, as we have seen, relatively limited and the exemplars included in this annexe need to be viewed as indicative and illustrative rather than as a national picture of the emotional and behavioural wellbeing of LAC. It is likely that we will know more about this area in the future, once current changes to the data collection, collation and reporting strategies for LAC become fully embedded. Even though data on LAC has been collated for at least seven years via local authority OC2 statistical returns, it is important to recognise that these returns have always been on an aggregate basis at local authority level, providing, for example, information on the number of children who are looked after, the ethnicity of children who are looked after, and their educational status (mainstream or other education, including home schooling), attainment levels and physical health (including access to dentistry) of the various cohorts of children and young people. Until recently, however, comprehensive data was not recorded at an individual child level so that one could assess (for instance) the average health of 10-year-old white boys in local authority care. Outcomes and trends in outcomes that are currently presented in published statistics are primarily from cross-tabulated data and do not allow for more illuminative multivariate analysis. More recently, a new data collection form – the SSDA903 (DCSF 2009a) – has been introduced, which moves away from the collection of aggregated cohort data. 2 This form collects data on individual children (including those as yet unborn, but known to the local authority) using a unique local authority generated identifier that follows the child through the care system. Alongside this form, local authorities are required to use the Strengths and Difficulties Questionnaire’ (SDQ – a short behavioural screening questionnaire) to obtain data on emotional symptoms, conduct problems, hyperactivity or inattention; friendships and peer problems; ‘plus an “impact supplement” to assist in the prediction of emotional health problems’ (DCSF 2008b p 2). It is completed by the child’s carer (or, if they are living independently, by their social worker or other responsible adult – although not a teacher) with the consent of the child. The SDQ score (based on the scores for four of the listed measures), considered alongside matched SSDA903 data and National Pupil Database information, 3 should provide a rich source of data for future statistical and research analysis, although whether or not this data becomes accessible, as anonymised data at individual level (that is, presented in a non-disclosive way), is yet to be established, as is the likelihood that it might be matched to other administrative data, such as the matched SSDA903/National

Data for the year 2008/09 is to be collected on every child who was looked after by the local authority at any time during the year ending 31 March and children who were being looked after by the local authority on 1 April 2006 under any legal status other than those accommodated under a series of short-term breaks for respite care and whose date of birth fell between 1 April 1989 and 31 March 1990.

Work is under way to match data from the SSDA903 to the National Pupil Database. That work is being evaluated and for the year 2008/09, therefore, two data collection systems are still in place. OC2 returns for 2008/09 will still be required to ensure that the existing indicators for attainment data can be replicated. The DCSF hopes that the OC2 data collection can cease ‘after the 2009/10 Statistical First Release subject to satisfactory matching to the NPD using UPNs’ (Britton 2008).

Improving the emotional and behavioural health of looked-after children and young people

Pupil Database. The extent to which the data itself will be in the public domain may be limited, since it will be highly sensitive data. Data on all LAC from age four to 16 is collected, but is only submitted in the SSDA903 for those who have been in care for at least 12 months on 31 March of the relevant data collection year. Providing reasons for non-submission of data scores for individual children is mandatory, so that the eventual dataset should be relatively complete. No data has yet been submitted with the SSDA903 returns as the first full collection will take place in April 2009. Some further issues for this data scoping study relate to the ways in which certain types of data are recorded. While work has taken place to ensure that information on ethnicity is consistent and comparable between OC2 and SSDA903 returns, the School Census (which feeds into the National Pupil Database) and the Children in Needs Census, data on disability, for instance, is still fraught with difficulties. Indeed, no disability data for individual children will be recorded on the SSDA903 returns for 2008/09, although there are plans in place to include it in future annual returns. Data on the mental and emotional health of young people looked after by local authorities in England has been identified from only one source, a survey conducted in 2002 by the Social Survey Division of Office of National Statistics on behalf of the Department of Health. While the report on this provides data on young people aged five to 17, it was based on a relatively small sample (just over 1,000) and has not been followed up in subsequent studies, so does not provide any trend data (Meltzer et al 2003).

Examples of charts showing trends and regional data Findings from the Centre for Longitudinal Studies (Jackson et al 2002) suggest that there is a stronger association between LAC and disturbed behaviour than is found in the wider population (NI 58) 4: data from a cohort study indicated that some 8 per cent of the LAC population had been referred to Pupil Referral Units (PRUs) compared with only 0.1 per cent of non-LAC children and young people. What do we know about the demographics of LAC and how many of them may have some form of emotional or behavioural difficulty? Data on the demographics of LAC and their educational outcomes at Key Stage 1 to 4 have been identified from the DCSF. Data for the National Indicator (NI 58) is limited, although some data has been identified in relation to substance misuse (NI 115) 5, which may provide some indicator data on behaviour. In both 2006 and 2007, the proportion of children and young people in care who were identified as having at least one episode of substance misuse was similar (3 per cent). Data on all children is not collected in the same way, so comparative analysis is difficult.

NI 58 is the emotional and behavioural health of LAC.

NI 115 is to reduce the proportion of young people frequently using illicit drugs, alcohol or volatile substances.

Improving the emotional and behavioural health of looked-after children and young people

Exemplar 1. LAC: demographic information Of the 60,000 or so children and young people who were recorded as looked after as at 31 March in each year from 2004 to 2008, over half in each year were male (see Figure 1) and over 40 per cent were aged between 10 and 15 (see Figure 2). These figures do not include those who were looked after on a series of short-term placements. There was little observable change in the proportion of each age group who were looked after, except in the age group five to nine (where there was a four percentage point decrease from 21 per cent to 17 per cent) and in the proportion of over 16-year-olds, which increased by four percentage points from 17 to 21 per cent. Figure 1.

LAC 2004 to 2008: by sex

Source: DCSF 2008a

Improving the emotional and behavioural health of looked-after children and young people

Figure 2.

LAC 2004 to 2008: by age

Source: DCSF 2008a

The highest proportion of LAC was from a white ethnic background: over three-quarters of all LAC in each year came from this group. Of those from different minority ethnic groups, the greatest percentage came from Black or mixed-race backgrounds (around 8 per cent in each case). Although the proportions of children from each of the minority ethnic groups who were looked after remained relatively stable between 2004 and 2008, there appeared to be some minor increases in the number of Pakistani, ‘other’ Asian and ‘other’ ethnic group children becoming the responsibility of the local authority (see Figure 3). The reasons for children and young people becoming looked after appear, predominantly, to be related to abuse and neglect. This was the category of need that was identified for over 60 per cent of LAC at the time when they were taken into care (see Figure 4); it may not be the sole reason for which they remained in care. Family dysfunction, family in acute distress and absent parenting were the other main reasons for children being looked after; although low income was recorded as the primary reason in about 100 cases in each year from 2004 to 2008, the proportion of such cases was less than 0.2 per cent of the total and so does not appear in Figure 4.

Improving the emotional and behavioural health of looked-after children and young people

Figure 3.

LAC 2004 to 2008: by ethnicity

Source: DCSF 2008a

Improving the emotional and behavioural health of looked-after children and young people

Figure 4.

LAC 2004 to 2008: by reason for being taken into care

Source: DCSF 2008a

Exemplar 2. LAC: mental health disorders Data on the mental health of just over 1,000 children and young people aged five to 18 was collected by the Social Survey Division of the Office for National Statistics on behalf of the Department of Health in 2001/02. It was collected from carers (foster carers, parents and residential care workers), teachers and the young people themselves (if over the age of 11). The data presented in the following figures was taken from published figures for that survey and it is worth noting that children could present with more than one emotional disorder. As such, therefore, the figures presented here should be seen as an indication of prevalence across the age range, rather than a measure of occurrence from which improvements or decline in EBH could be assessed. As can be seen from Figure 5, conduct disorders are by far the most prevalent across all of the age groups, exceeding the proportion demonstrating emotional or anxiety disorders. Although the percentage of LAC demonstrating anxiety disorders is fairly constant at around 11 per cent of the study participants across each of the age bands, depression and depressive disorders appear more prevalent among 16- to 18-year-olds.

Improving the emotional and behavioural health of looked-after children and young people

Figure 5.

Percentage of children with emotional disorders: by age group

Source: Meltzer et al 2003

Further analysis by type of disorder suggests that hyperkinetic disorders are less evident among older children than younger children (see Figure 6) and, indeed, they appear to be the second commonest disorder among younger children, aged five to 10 (Figure 5).

Improving the emotional and behavioural health of looked-after children and young people

Figure 6.

Percentage of children with emotional disorders: by type of disorder and age

Source: Meltzer et al 2003

Differences in type of disorder are also evident by sex. Although boys and girls are more or less equally represented among those with no disorder, boys dominate the population of those with hyperkinetic disorders, while proportionately more girls demonstrate an emotional disorder (see Figure 7).

Figure 7.

Percentage of children with emotional disorders: by type of disorder and sex

Source: Meltzer et al 2003

Improving the emotional and behavioural health of looked-after children and young people

Figure 8 provides an overview of disorders by ethnic group. Children from any one ethnic group may have been diagnosed with more than one disorder, so comparative analysis is complex. Nonetheless, the data suggests that, among those with emotional disorders and hyperkinetic disorders, a higher proportion appear to be of white ethnic origin, while among those with conduct disorders, those from white and black ethnic origins seem to be equally represented.

Figure 8.

Percentage of children with emotional disorders: by type of disorder and ethnicity

Source: Meltzer et al 2003 Note that the number of children with any mental disorder is less than the sum of the numbers of children with each disorder because children could have been assessed as having more than one type of disorder

By comparison with children with no disorder, a higher proportion of children with mental health disorders appear to be placed in residential care. This is particularly evident for those with less common disorders (see Figure 9).

Improving the emotional and behavioural health of looked-after children and young people

Figure 9.

Percentage of children with emotional disorders: by type of placement

Source: Meltzer et al 2003

Exemplar 3. Outcome data By comparison with all children, a far higher proportion of LAC have been subject to permanent exclusion from school (see Figure 10) or have been convicted of an offence or subject to a final warning or reprimand during the year (Figure 11). Figure 10.

Permanent exclusion from school: by status

Source: DCSF 2008c

Improving the emotional and behavioural health of looked-after children and young people

Figure 11. Offending by children looked after continuously for at least 12 month

Source: DCSF 2008c

The proportion of children and young people in care who were identified as having at least one episode of substance misuse were similar (3 per cent in both 2006 and 2007).

In summary To date, no comprehensive source of existing national data on the emotional and/or behavioural health of children and young people who are looked after has been identified, although data collected on the SDQ should, in the future, provide a more general picture than the single (though detailed) Office for National Statistics survey of just over 1,000 children aged five to 17 can afford.

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Nunno, M.A., Holden, M.J. and Leidy, B. (2003) ‘Evaluating and monitoring the impact of a crisis intervention system on a residential child care facility’, Children and youth services review, vol 25, no 4, pp 295–315. Ogilvie, K., Kirton, D. and Beecham, J. (2006) ‘Foster carer training: resources, payment and support’, Adoption and fostering, vol 30, no 3, pp 6–16. Pacifici, C., Delaney, R., White, L., Nelson, C. and Cummings, K. (2006) ‘Web-based training for foster, adoptive and kinship parents’, Children and youth services review, vol 28, no 11, pp 1329–1343. Pears, K.C., Fisher, P.A. and Bronz, K.D. (2007) ‘An intervention to promote social emotional school readiness in foster children: preliminary outcomes from a pilot study’, School psychology review, vol 36, no 4, pp 665–673. Penny, A. (2007) Grief matters for children: support for children and young people in public care experiencing bereavement and loss, London: National Children’s Bureau. Pithouse, A., Hill-Tout, J. and Lowe, K. (2002) ‘Training foster carers in challenging behaviour: a case study in disappointment?’, Child & family social work, vol 7, no 3, pp 203–214. Priestley, M., Rabiee, P. and Harris, J. (2003) ‘Young disabled people and the “new arrangements” for leaving care in England and Wales’, Children and youth services review, vol 25, no 11, pp 863–890. Pughe, B. and Philpot, T. (2006) Living alongside a child’s recovery, London: Jessica Kingsley Publishers. Redding, R.E., Fried, C. and Britner, P.A. (2000) ‘Predictors of placement outcomes in treatment foster care: implications for foster parent selection and service delivery’, Journal of child and family studies, vol 9, no 4, pp 425–447. Sargent, K. and O’Brien, K. (2004) ‘The emotional and behavioural difficulties of looked after children: foster carers’ perspectives and an indirect model of placement support’, Adoption & fostering, vol 28, no 2, pp 31–37. Schofield, G. and Beek, M. (2005) ‘Providing a secure base: parenting children in longterm foster family care’, Attachment & human development, vol 7, no 1, pp 3–25. Scott, J. and Hill, M. (2006) The health needs of looked after and accommodated children and young people in Scotland: messages from research, Edinburgh: Scottish Executive. Sinclair, I., Wilson, K. and Gibbs, I. (2001) ‘“A life more ordinary”: what children want from foster placement’, Adoption & fostering, vol 25, no 4, pp 17–26.

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Smith, A.B. and Dannison, L.L. (2003) ‘Grandparent-headed families in the United States: programming to meet unique needs’, Journal of intergenerational relationships, vol 3, pp 35–47. Smith, M., McKay, E. and Chakrabarti, M. (2004) ‘What works for us: boys’ views of their experiences in a former List D school’, British journal of special education, vol 31, no 2, pp 89–93. Stanley, K. (2001) Cold comfort: young separated refugees in England, London: Save the Children. Stevens, I. (2004) ‘Cognitive-behavioural interventions for adolescents in residential child care in Scotland: an examination of practice and lessons from research’, Child & family social work, vol 9, no 3, pp 237–246. Strozier, A., McGrew, L., Krisman, K. and Smith, A. (2005) ‘Kinship care connection: a school-based intervention for kinship caregivers and the children in their care’, Children and youth services review, vol 27, no 9, pp 1011–1029. Strozier, A.L. and Krisman, K. (2007) ‘Capturing caregiver data: an examination of kinship care custodial arrangements’, Children and youth services review, vol 29, no 2, pp 226– 246. Sundell, K. and Vinnerljung, B. (2004) ‘Outcomes of family group conferencing in Sweden: a 3-year follow-up’, Child abuse & neglect, vol 28, no 3, pp 267–287. Sundell, K., Hansson, K., Andrée Löfholm, C., Olsson, T., Gustle, L.-H. and Kadesjö, C. (2006) Multisystemic therapy and traditional services for antisocial adolescents in Sweden: results from a randomized controlled trial after six months, Stockholm: Socialstyrelsen. Sutton, V., Robbins, I., Vicky, S. and Gordon, S. (2006) ‘A qualitative study exploring refugee minors’ personal accounts of post-traumatic growth and positive change processes in adapting to life in the UK’, Diversity in health and social care, vol 3, no 2, pp 77–88. Taussig, H.N., Culhane, S.E. and Hettleman, D. (2007) ‘Fostering healthy futures: an innovative preventive intervention for preadolescent youth in out-of-home care’, Child welfare, vol 86, no 5, pp 113–131. Timmer, S.G., Urquiza, A.J. and Zebell, N. (2006) ‘Challenging foster caregiver–maltreated child relationships: the effectiveness of parent–child interaction therapy’, Children and youth services review, vol 28, no 1, pp 1–19. Timms, J.E. and Thoburn, J. (2003) Your shout!: a survey of the views of 706 children and young people in public care, London: National Society for the Prevention of Cruelty to Children.

Improving the emotional and behavioural health of looked-after children and young people

Turner, W., Macdonald, G.M. and Dennis, J. (2007) ‘Behavioural and cognitive behavioural training interventions for assisting foster carers in the management of difficult behaviour’, Cochrane database of systematic reviews, vol 1. Utsey, S.O., Howard, A. and Williams, O. (2003) ‘Therapeutic group mentoring with African American male adolescents’, Journal of mental health counselling, vol 25, no 2, pp 126– 139. Utting, D., Monteiro, H. and Ghate, D. (2007) Interventions for children at risk of developing antisocial personality disorder, London: Policy Research Bureau. Vasillou, C. and Ryrie, I. (2006) ‘Someone there to talk to’, Mental health today, October, pp 23–26. Wade, J. and Dixon, J. (2006) ‘Making a home, finding a job: investigating early housing and employment outcomes for young people leaving care’, Child & family social work, vol 11, no 3, pp 199–208. Walsh, D. and Marsh, P. (2005) Family Group Conference Plans: a study of planning and outcomes in Kent Family Group Conference Service (Families and welfare findings series number 8), Maidstone: Kent County Council, Family Group Conference Service (available at www.petermarsh.staff.shef.ac.uk/documents/FGCPlansinKent.doc, accessed 18 March 2009). Ward, A. (2003) Therapeutic approaches in work with traumatised children and young people, London: Jessica Kingsley Publishers. Ward, H. and Holmes, L. (2008) ‘Calculating the costs of local authority care for children with contrasting needs’, Child & family social work, vol 13, no 1, pp 80–90. Ward, H., Skuse, T. and Munro, E.R. (2005) ‘The best of times, the worst of times: young people’s views of care and accommodation’, Adoption & fostering, vol 29, no 1, pp 8–17. Warman, A., Pallett, C. and Scott, S. (2006) ‘Learning from each other: process and outcomes in the Fostering Changes training programme’, Adoption & fostering, vol 30, no 3, pp 17–28. Whitemore, E., Ford, M. and Sack, W.H. (2003) ‘Effectiveness of day treatment with Proctor Care for Young Children: a four-year follow-up’, Journal of community psychology, vol 31, no 5, pp 459–468. Who Cares? Trust (2008) Who cares? About feeling good?, London: Who Cares? Trust. Williams, S.C., Fanolis, V. and Schamess, G. (2001) ‘Adapting the Pynoos School Based Group Therapy Model for use with foster children: theoretical and process considerations’, Journal of child & adolescent group therapy, vol 11, nos 2-3, pp 57–76.

Improving the emotional and behavioural health of looked-after children and young people

Appendix 1: Relevant national indicators and data sources ECM outcome

National indicator (NI)

NI detail

Data source (published information)

Scale (published information)

Links to data source

Be healthy

NI 50

Emotional health of children

National (UK and country level)

www.statistics.gov.uk/statbase/Product.a sp?vlnk=10432

Make a positive contribution

NI 58

DCSF: Emotional health of LAC

NI 111

First-time entrants to the Youth Justice System, aged 10â&#x20AC;&#x201C;17: numbers of LAC cautioned/convict ed within past 12 months, compared with other 10- to 17-

DCSF: Outcome Indicators for LAC, 12 months to 30 September 2007 â&#x20AC;&#x201C; England

www.dh.gov.uk/en/Publicationsandstatist ics/Publications/PublicationsStatistics/DH _4019442

(not yet published, currently being collected) National, regional and local authority

www.dcsf.gov.uk/datastats1/guidelines/c hildren/pdf/SDQ%20guidance%20update %20Dec%202008.pdf www.dcsf.gov.uk/rsgateway/DB/SFR/s00 0785/index.shtml

Improving the emotional and behavioural health of looked-after children and young people

ECM outcome

National indicator (NI) NI 115 (PSA 14/DSO 6)

Population

NI detail

year-old children Reduce the proportion of young people frequently using illicit drugs, alcohol or volatile substances Population characteristics

Data source (published information)

Scale (published information)

Links to data source

DCSF: Outcome Indicators for LAC, 12 months to 30 September 2007 â&#x20AC;&#x201C; England

National, regional and local authority

www.dcsf.gov.uk/rsgateway/DB/SFR/s00 0785/index.shtml

DCSF: LAC in England (including adoption and care leavers) year ending 31 March 2008

National, regional and local authority

www.dcsf.gov.uk/rsgateway/DB/SFR/s00 0810/index.shtml

Improving the emotional and behavioural health of looked-after children and young people

Appendix 2: Search parameters Copy of parameters document agreed by NFER and TAG for the scoping study.)

Centre for Excellence and Outcomes Specification Parameters for Scoping Studies 1. C4EO Theme 3 Vulnerable Children 2. Priority 3.2. Improving the emotional and behavioural health of looked-after children and young people (LACYP). 3. Context for this priority Improving the emotional and behavioural health of LACYP is a Department for Children, schools and families (DCSF) strategic delivery objective. Using DCSF data, the National Indicator Set will create a baseline in 2008/09. We have not identified any trend data for looked-after children, but one Office for National Statistics (ONS) survey showed that mental health problems among LACYP is four times that for all children, with conduct disorder the most prevalent diagnosis(Meltzer et al 2003). Emotional health is a keystone building block needed to achieve other outcomes throughout the childâ&#x20AC;&#x2122;s life and challenging behaviour is one of the main factors in placement breakdown for looked-after children. Problematic emotional health and behaviour are likely to be a consequence of pre-care experiences and can be exacerbated by instability of placements. LACYP mention low self-esteem and self-concept as barriers to educational and other outcomes and emphasise promoting resilience as well as targeted interventions as an important means to improve emotional health (Bostock 2004; A National Voice 2007; Who Cares? Trust 2008). This means that interventions to assess and improve emotional and behavioural health are likely to entail systems-level change as they concern interfaces between childrenâ&#x20AC;&#x2122;s health, schools, social care and housing. DCSF and the Department of Health (DH) are issuing revised statutory guidance on promoting the health of LACYP. The National Institute for Clinical Excellence (NICE) and the Social Care Institute for Excellence (SCIE) will be producing joint guidelines on improving the physical and emotional health of LACYP.

Improving the emotional and behavioural health of looked-after children and young people

4. Main review questions 6 to be addressed in this scoping study (no more than five; preferably fewer) What do we know about how to improve the emotional and behavioural health of LACYP? Sub-questions: 1. What are LACYP’s views on what constitutes emotional and behavioural health and do they compare with policy makers, children’s services personnel and independent sector providers? 2. What do we know about the accessibility, acceptability and effectiveness of policies, services and interventions to improve emotional and behavioural health initiated by central, regional and local government and the independent sector for LACYP? 3. What do we know about the contribution made to improved emotional and behavioural health of LACYP by the attitudes, skills and abilities of foster, residential and kinship carers and birth families and interventions to support this contribution? 5. Which cross-cutting issues should be included? (Child poverty; safeguarding; equality and diversity; disability; workforce development; change management; leadership; learning organisations)? Please specify the review questions for crosscutting issues in this. Child poverty Safeguarding Equality and diversity 6. Definitions for any terms used in the review questions Population of children: •

looked-after children and young people in medium- and long-term care (more than six months) – wherever they are looked after (e.g. residential care, foster care, young offenders institution) – up to age 25, and their families

•

children and young people who have several short-term (up to six months) periods in local authority care (either under a care order, or on a voluntary basis)

•

children and young people preparing to leave medium-term or long-term local authority care.

See guidance note on setting review questions at the end of this form.

Improving the emotional and behavioural health of looked-after children and young people

Definition of health: Health is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity (www.who.int/about/definition/en/print.html). DH’s definition of wellbeing: ‘Wellbeing is a general term encompassing the total universe of human life domains including physical, mental and social aspects, that make up what can be called a “good life”. Health domains are a subset of domains that make up the total universe of human life.’ Outcomes: ECM Outcomes: •

Be healthy.

•

Stay safe.

•

Enjoy and achieve.

•

Make a positive contribution.

•

Achieve economic wellbeing.

National Indicator 58: Emotional and behavioural health of looked-after children. Specific LACYP defined outcomes to be identified during the scope. 7. What will be the likely geographical scope of the searches? (Work conducted in/including the following countries) England only UK only Europe only Europe and other countries (English language) NB: UK, USA, Canada, Australia and New Zealand. 8. Age range for CYP: Up to 25. 9. Literature search dates Start year 2000. 10. Suggestions for key words to be used for searching the literature. See scoping summary document for complete list of search terms.

Improving the emotional and behavioural health of looked-after children and young people

11. Suggestions for websites, databases, networks and experts to be searched or included as key sources. •

A National Voice www.anationalvoice.org/

•

BAAF www.baaf.org.uk/

•

CAMHS www.camhs.org.uk/

•

Children’s Rights Directors www.rights4me.org/reports.cfm

•

Fostering Network www.fostering.net/

•

Healthy Care, NCB resources www.ncb.org.uk/

•

National Asylum Support Service (NASS) www.asylumsupport.info/specialfeatures/children.htm

•

National Centre for Excellence in Residential Child Care www.ncb.org.uk/page.asp?sve=934

•

References from NICE/SCIE scope on physical and emotional health and wellbeing of LACYP

•

Scottish Institute for Residential Child Care www.sircc.org.uk/

•

Teaching and Learning Scotland www.ltscotland.org.uk/lookedafterchildren/index.asp

•

Therapeutic Communities www.therapeuticcommunities.org/

•

Voice www.voiceyp.org/ngen_public/default.asp

•

Voices from Care Cymru www.voicesfromcarecymru.org.uk/main.htm

•

Young Minds www.youngminds.org.uk/

12. Any key texts/books/seminal works that you wish to see included? •

SCIE’s review on challenging behaviours

•

SCIE/NICE guidance on conduct disorders

•

Department of Health (2002) Promoting the health of looked-after children www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidan ce/DH_4005321

•

Action for Children (2007) A review of the promotion of children’s emotional wellbeing by Action for Children services www.actionforchildren.org.uk/uploads/media/29/331.pdf

•

Margo, J. and Sodha, S. (2007) Get happy: children and young people’s emotional wellbeing www.actionforchildren.org.uk/uploads/media/36/1581.pdf

Improving the emotional and behavioural health of looked-after children and young people

•

Cox, A. and Cox, C. (2004): Mental health and care leavers (Rainer policy briefing) www.leavingcare.org/data/tmp/3191-6781.pdf

•

Who Cares? Trust (2008) Who cares? Feeling good? www.whocaresxtra.org.uk/lifewcx/article.cfm?ticketid=4750

•

Cafcass (2008) Health and wellbeing review: the experiences of young people in care www.cafcass.gov.uk/idoc.ashx?docid=20cc062c-2fd0-4574-a544b338c1e46c7b&version=-1%20–

•

Mental Health Foundation (1999) Bright futures: promoting children and young people’s mental health

•

Young Minds (2006) Looking after looked after children: sharing emerging practice

•

Pughe and Philpot (2006) Living alongside a child’s recovery

•

Ward (2003) Therapeutic approaches in work with traumatised children and young people

•

Davies, J. and Wright J.(2008) ‘Children’s voices: a review of the literature pertinent to looked-after children’s views of mental health services’, Child and adolescent mental health, vol 13, no 1, pp 26–31 http://www3.interscience.wiley.com/cgi-bin/fulltext/119421669/PDFSTART

•

Wade and Dixon (2006) Making a home, finding a job: investigating early housing and employment outcomes for young people leaving care http://eprints.whiterose.ac.uk/4160/1/CFSWMar06.pdf

•

Scott and Hill (2006) The health needs of looked after and accommodated children and young people in Scotland: messages from research www.swia.gov.uk/swia/files/Health%20of%20Looked%20After%20and%20Accommod ated%20Children%20in%20Scotland.pdf

•

Leavingcare.org (2006) What makes the difference for care leavers? Project (WMTD) Peer research project http://www.leavingcare.org/data/tmp/3975-8241.pdf

13. Anything else that should be included or taken into account? •

concept of resilience

•

relationships and attachment

•

importance of housing to wellbeing (Wade and Dixon 2006)

•

mental health of children in secure settings, 300 held for welfare reasons – HM Government (2007) Promoting mental health for children held in secure settings: A framework for commissioning services, London: Department of Health (available at www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidan ce/DH_073414).

Improving the emotional and behavioural health of looked-after children and young people

Note on setting review questions The review questions are important because the scoping team will use these to assess the available literature. Review question need to be clear, specific and answerable. For example, the questions addressed in a scoping study on diversity in the early years might identify the following questions: 1. What is the evidence of different outcomes for children from diverse backgrounds and with different characteristics? 2. In what ways do early learning environments impact on children’s sense of identity and understating of diversity? 3. What is the evidence to support specific strategies that help children from all backgrounds and with diverse characteristics to access the curriculum and make good progress in the early years? In addition to suggesting review questions, it is important to provide definitions of key teams and concepts (for example, for ‘outcomes’, ‘diversity’, ‘early learning environment’ and ‘early years’ in the above example).

Improving the emotional and behavioural health of looked-after children and young people

Appendix 3: Scoping study process The study began with the Theme Advisory Group (TAG) – a group of experts in the policy, research and practice field of vulnerable (looked after) children – establishing the key questions to be addressed and the parameters for the search (see Appendix 1). The scoping study used a broad range of sources to identify relevant material: •

searches of bibliographic databases

•

searches of research project databases

•

browsing relevant organisations’ websites

•

recommendations from the TAG.

See ‘Search strategy’ section below for the sources and strategy used. The research team undertook an initial screening process of the search results, using record titles and abstracts (where available) to ensure that the search results conformed to the search parameters and were relevant for answering the scoping study questions. Items were excluded if: •

they were not about LAC or care leavers, aged up to 25

•

they were published before 2000

•

they were not from a peer-reviewed journal or report or not a key text

•

they were not empirical research

•

they did not relate to a study in the UK, Ireland, USA, Canada, Australia or New Zealand

•

they did not answer the scoping study questions

•

a fuller report was published elsewhere

•

they could not be obtained in full text, either at all, or within the scoping study deadline

•

they were a duplicate record.

The inclusion/exclusion criteria are shown in Table 1.

Improving the emotional and behavioural health of looked-after children and young people

Table 1.

Inclusion/exclusion criteria

The following criteria were applied sequentially from top down Inclusion/exclusion criteria 1 EXCLUDE Date of publication before 2000 2

EXCLUDE Publication type not peerreviewed journal or report EXCLUDE Location not UK, Ireland, USA, Canada, Australia, NZ EXCLUDE Population Not about LAC or care leavers, or their care EXCLUDE Research type Not empirical research EXCLUDE Scope EXCLUDE insufficient details to identify reference EXCLUDE unable to retrieve EXCLUDE full study already reported INCLUDE

EXTRA

EXCLUDE

6 7

Guidance Published before 2000

Exclude books, dissertation abstracts, trade magazines, policy (unless evaluated), guidance (unless evaluated) Include relevant reports, evaluated policy

Upper age limit 25

Exclude case study, vignette, opinion piece, commentary, briefing

Use if not excluded above but does not answer one of the review questions

Covers records for which full text could not be obtained at all or not in time for this piece of work For studies where identical methodology and findings are reported in more than one record Not excluded by above Intervention is defined as a named,

Improving the emotional and behavioural health of looked-after children and young people

EXCLUSION CRITERION for Review Questions 2 and 3 where intervention involved

Not intervention

bounded, activity or set of activities with specific objectives that are assessed/evaluated in some way

Additional criteria were applied in relation to Review Questions 2 and 3 and the records rescreened. This served to define interventions more strictly as a specific activity with specified outcomes that concerned the EBH of LACYP. The papers included in Review Questions 2 and 3 were also required to include some evaluation of outcomes, whether related to acceptability, accessibility or effectiveness: descriptive accounts were excluded as it was felt that they did not contribute to our understanding of interventions. These measures were intended to narrow the focus and to exclude system-wide approaches (such as an account of introducing LAC into a child welfare system). While system-wide approaches may concern the EBH of LACYP, they are not always linked directly to outcomes addressing EBD and usually have a wide remit to improve the overall performance and accountability of the child welfare system. Policy was excluded unless evaluated. A proportion of records of doubtful relevance according to the available abstract/title were parked for later examination. Records from the searches that were screened as relevant according to title or abstract were then loaded into the Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI)-Reviewer database. Full texts were retrieved for the second stage of screening, since the team considered that scoping required the use of full texts. All records screened for inclusion were sought. Inclusion/exclusion criteria were then applied to the full text articles. Approximately onethird of retrieved items were excluded using full texts (see exclusion criteria above; see Figure 1 below). Thirty-eight items could not be retrieved in full text within the scoping study deadline.

Improving the emotional and behavioural health of looked-after children and young people

Figure 1.

Literature flow chart

Note: removal of duplicate references took place throughout; referral between priorities took place at second screening. Output from searching 15 bibliographic databases using population terms 19,992 Output from searching population database using specific question terms 4,375

Output from scoping and expert suggestions 336

Combined output from searches and suggestions 4,709 Plus 2 duplicates Exclude Output from first screen (on title and abstracts) 536 Breakdown: Education question: 137 Well-being question: 372 Accommodation question: 79

Exclude date of publication 1,373 Exclude publication type 670 Exclude location 263 Exclude population 795 Exclude research type 490 Exclude scope 403 Exclude insufficient details 25 Duplicate 38 Full study already reported 3 Queried relevance and parked 113

Exclude

Output from second screen (on full text) 219 Breakdown*: Education question: 68 Wellbeing question***: 113 Accommodation question: 83

Exclude date of publication 4 Exclude publication type 13 Exclude location 1 Exclude population 34 Exclude research type 52 Exclude scope 120 Exclude insufficient details 1 Exclude unable to retrieve** 38 Duplicate 7 Full study already reported 11

Improving the emotional and behavioural health of looked-after children and young people

Notes: * includes material that could not be obtained at all as well as records that could not be obtained in time for inclusion. ** includes referrals from other priorities *** Includes nine papers cited in methodology section, not yet analysed (in addition to 104 analysed). The content of the rejected records included those that focused on: •

adopted children

•

policy

•

overviews or briefings of the topic

•

descriptions of interventions with no indication of outcomes.

The research team then assessed the remaining items and coded them in relation to the following: •

relevance to the review question or questions

•

country (UK, Ireland, Canada, the USA, Australia or New Zealand)

•

study type (including experimental study with comparison/control, non-experimental study, systematic review etc.)

•

main methods (including survey, interviews and focus groups, control trial, literature review etc.)

•

intervention setting (including foster care, residential care, school, housing services or floating support etc.)

•

study population (including LACYP, care leavers, health, education, housing and education staff etc.)

•

cross-cutting issues (child poverty and safeguarding).

It was subsequently agreed that the term ‘intervention setting’ is an ambiguous, and therefore unhelpful, term. It can capture, for example, either the environmental space in which an intervention happens (e.g. a school meeting room) or the context in which the child(ren) are placed. Many studies do not report either and, therefore, the scoping review does not analyse the responses checked on this section of the coding form. An agreed part of the scoping methodology was to undertake independent coding quality assurance checks on 10 per cent of the references. References were selected randomly from Endnote listings of papers allocated to each sub-question. In addition, all studies excluded on reading the full text were checked (i.e. reviewed by at least two people). The checks on coding demonstrated a high degree of consistency and reliability in the use of the coding tool. With minor exceptions (e.g. varied understanding of ‘intervention setting’: see above), the result of double coding was principally to add to the recording of methodological detail.

Improving the emotional and behavioural health of looked-after children and young people

The check on exclusions at full text again demonstrated the consistent and reliable use of scoping criteria, and did not reveal any systematic bias in the decisions. In three cases, an exclusion decision was subject to further discussion before being resolved. The process is summarised in Table 2. Table 2.

1. 2. 3. 4. 5. 6. 7. 8.

Summary of different stages

Stage Question setting Searching, browsing and recommendations to identify relevant material Initial screening using inclusion/exclusion criteria Entering included studies into EPPI-Reviewer database Second-stage screening Coding of final included studies Quality assurance on 10% of coded papers Assessment of content and scope of included papers

Material used

Using title and abstract

Using full paper Using full paper Full paper Full paper

Please see Table 3 for a full copy of the coding tool.

Improving the emotional and behavioural health of looked-after children and young people

Table 3.

Coding tool: vulnerable children keywording guideline

Section A: A.1 On reading full text, is this paper now excluded?

A.1.1 No

(Date, publication type, location, population not LACs, research type, doesn’t address scope questions)

A.1.2 Yes (add reason for exclusion)

A.2 Research question relevance

A.2.1 Relevant 3.1 Improving educational outcomes

Code all priorities that apply. Code for sub-questions (all that apply) also as far as possible.

(add reason for exclusion)

A.2.2 Relevant 3.1.1 LACYP’s views A.2.3 Relevant 3.1.2 Services/interventions (effectiveness, acceptable, accessible) A.2.4 Relevant 3.1.3 Attitudes and skills of carers and families A.2.5 Relevant 3.2 Emotional/behavioural health A.2.6 Relevant 3.2.1 LACYP’s views A.2.7 Relevant 3.2.2 Services/interventions (effectiveness, acceptable, accessible) A.2.8 Relevant 3.2.3 Attitudes and skills of carers and families A.2.9 Relevant 3.3 Care leavers in settled safe accommodation A.2.10 Relevant 3.3.1 LACYP’s views A.2.11 Relevant 3.3.2 Services/interventions (effectiveness, acceptable, accessible) A.2.12 Relevant 3.3.3 Attitudes and skills of carers and families A.2.13 Relevant 3.3.4 What is known about those not in SSA at 19? A.2.14 concept, theory or policy paper (important background)

A.3 Country (Tick all that apply)

A.3.1 UK A.3.2 Ireland

Improving the emotional and behavioural health of looked-after children and young people

A.3.3 Canada A.3.4 USA A.3.5 Australia or New Zealand A.3.6 Not specified

A.4 Study type

A.4.1 Systematic review

(Tick one)

(QA of papers and transparent methodology)

A.4.2 Empirical experimental study with comparison/control (controlled trials, before/after designs, matched/waiting list control)

A.4.3 Empirical non-experimental study (includes qualitative studies of the views of people who use services, their carers and supporters, case studies, survey reports, testing of assessment tools, surveys & cohort studies)

A.4.4 Review article (expert, consensus, literature: NOT systematic or unbiased)

A.4.5 Background critical account of policy, concepts, definitions, models A.4.6 Inadequate information A.4.7 Other (specify)

A.5 Main methods

A.5.1 Not research

(Tick all that apply)

(opinion, policy,etc)

A.5.2 Survey A.5.3 Interviews and focus groups A.5.4 Observation A.5.5 Ethnographic study A.5.6 Secondary analysis A.5.7 Controlled trial (+/- randomisation)

A.5.8 Case study/case studies A.5.9 Literature review A.5.10 Inadequate information A.5.11 Other (specify)

A.6 Intervention setting (tick all that apply)

A.6.1 No intervention in study

Improving the emotional and behavioural health of looked-after children and young people

NOTES: 1. Primarily this is where intervention is delivered, or with/to whom, though if thatâ&#x20AC;&#x2122;s not important, may relate to who delivers (eg housing workers). 2. This data is important to accessibility and acceptability of interventions. 3. If study evaluates different care settings, such as family vs residential placement, that is, the intervention.

A.6.2 Foster care placement A.6.3 Residential care A.6.4 Secure settings A.6.5 Relatives/friends (kinship) placement A.6.6 Birth family A.6.7 School or school-related service A.6.8 Healthcare settings A.6.9 Childrenâ&#x20AC;&#x2122;s or youth centres A.6.10 Housing services or floating support A.6.11 Unspecified A.6.12 Other (specify)

A.7 Study population

A.7.1 LACYPs

(tick all that apply)

(specify age range if given)

A.7.2 Male LACYP only A.7.3 Female LACYP only A.7.4 Disabled LACs or those with LTCs (incl. with learning difficulties and SENs)

A.7.5 Care leavers A.7.6 LACYP of BME background (incl. Travellers, Irish, any ethnic minority)

A.7.7 Unaccompanied asylum seekers in care A.7.8 LACs in secure accommodation (inc. YOI, psychiatric)

A.7.9 Sibling groups of LACYPs A.7.10 Birth families A.7.11 Family and relatives of LACYP A.7.12 Frontline paid carers (foster, kinship carers, residential workers)

A.7.13 Other health, social care and housing staff (not covered in above, e.g. managers)

A.7.14 Other (specify)

Improving the emotional and behavioural health of looked-after children and young people

A.8 Identify as key item in relation to one of the topics?

A.8.1 NO: Definitely not a key item

Is this one of the 10–20 most relevant items for the VC theme? Complete the following, all that apply

A.8.2 YES: Suggest a reason if you wish

(scores nil)

A.8.3 Key item for 3.1 Educational outcomes (enter all that apply)

A.8.4 Key item for 3.2 Emotional health and wellbeing (enter all that apply)

A.8.5 Key item for 3.3 Accommodation (enter all that apply)

A.9 Cross-cutting issues

A.9.1 Child poverty A.9.2 Safeguarding children (Government definition: the process of protecting children from abuse or neglect, preventing impairment of their health and development, and ensuring they are growing up in circumstances consistent with the provision of safe and effective care that enables children to have optimum life chances and enter adulthood successfully.)

The numbers of items found by the initial search, and subsequently selected, can be found in Table 4. The three columns represent: •

items found in the initial searches

•

items selected at first screening for further consideration (i.e. those complying with the search parameters after the removal of duplicates)

•

items considered relevant to the study at second screening by a researcher who had read the abstract and/or accessed the full document.

Table 4.

Overview of searches for all topics

Items found Source

Items selected for consideration

Items identified as relevant to this theme

Databases Applied Social Sciences Index and Abstracts (ASSIA)

3,508

128

Australian Society and Family

Improving the emotional and behavioural health of looked-after children and young people

Abstracts British Education Index (BEI)

443

291

ChildData

8576

977

Cinahl

3889

576

2,929

277

n/a

HMIC

2,615

154

IBSS

900

Medline

3,325

235

PsycInfo

4,539

908

Social Care Online

7,673

490

Social Services Abstracts

3114

257

Social Work Abstracts

2,044

187

Zetoc

1,159

Barnardos

n/a

British Library Welfare Reform on the Web

n/a

CERUKplus

INTUTE

n/a

INVOLVE

n/a

JSTOR

n/a

Cochrane Library EMBASE Google

Internet databases/portals (also see ‘Search strategy’ section)

Research Register for Social Care Reference harvest ‘Taking care of education’

Incorporated in Social Care Online search n/a

Improving the emotional and behavioural health of looked-after children and young people

TAG recommendations (including texts and organisations)

n/a

Notes: Where n/a is indicated, this is because these resources were browsed rather than searched. Initial output was publication date from beginning of 1990, this was restricted to the start of 2000 at first screening. Duplicate removal was ongoing throughout the process.

Total number of relevant records by review question: Whole priority: Emotional/behavioural health: 113 By question: Services/interventions (acceptability, accessibility, effectiveness): 40 LACYPâ&#x20AC;&#x2122;s views: 45 Attitudes and skills of carers and families: 48.

Note: studies may be coded as relevant to more than one priority.

Improving the emotional and behavioural health of looked-after children and young people

Table 5: Overview of search output for EBH Items identified as relevant to this priority Source Databases Applied Social Sciences Index and Abstracts (ASSIA)

Australian Society and Family Abstracts

British Education Index (BEI)

ChildData

Cinahl

Cochrane Library

EMBASE

HMIC

Google

IBSS

Medline

PsycInfo

Social Care Online

Social Services Abstracts

Social Work Abstracts

Zetoc

Reference harvest: â&#x20AC;&#x2DC;Taking care of educationâ&#x20AC;&#x2122;

TAG recommendations (including texts and organisations)

Note: as this was derived from aggregated output of all searches, no columns are given for initial output.

Improving the emotional and behavioural health of looked-after children and young people

Search strategy This section provides information on the keywords and search strategy for each database and web source searched as part of the scoping study. Searching was carried out by the SCIE social care information specialist. The list of databases and sources to be searched included the databases recommended for systematic reviews, 40 organisations’ databases and subject portals identified by a SCIE scope and recommendations from TAG members. The general approach was as follows. •

A detailed search on LAC population-relevant terms was carried out across 15 databases. The search strategy was translated for each database and the output was de-duplicated, creating a database of approximately 19,000 records.

•

Topic-specific searches were carried out on this combined population database, to create a second database.

•

References obtained by recommendation and browsing were added to these records, creating a database of approximately 5,000 records.

•

All these records were screened for relevance to all the questions. This approach dealt with significant overlap in topic relevance between the priorities.

All searches were limited to publication years 2000-08, in English language only. The keywords used in the searches, together with a brief description of each of the databases searched, are outlined below. The following conventions have been used: (ft) denotes that free-text search terms were used and * denotes a truncation of terms. (+NT) denotes that narrower subject terms have been included (where available).

Improving the emotional and behavioural health of looked-after children and young people

Stage 1: Compiling the LAC population set Applied Social Sciences Index and Abstracts (ASSIA) (searched via CSA Illumina 27/08/08) ASSIA is an index of articles from over 500 international English language social science journals. #1 #2 #3 #4 #5 #6

looked after child* (ft) child* in care (ft) foster care (+NT) adoption (+NT) kinship care (ft) children (+NT) or adolescents (+NT) or young people (+NT) #7 residential care (+NT) #8 #6 and #7 #9 group homes (+NT) #10 #6 and #9

#11 #12 #13 #14 #15 #16

care orders special guardianship (ft) leaving care (ft) care leaver* secure accommodation unaccompanied asylum seeking child* (ft) #17 placement (ft) and #6 #18 #1 or #2 or #3 or #4 or #5 or #8 or #10 or #11 or #12 or #13 or #14 or #14 or #15 or #16 or #17

Australian Family and Society Abstracts (searched via Informit 13/11/08) #1 #2 #3

child* (ft) adopt* (ft) or foster* (ft) #1 and #2

#4 #5 #6

residential childcare looked after children #3 or #4 or #5

British Education Index (BEI) (searched via Dialog 11/11/08) BEI provides information on research, policy and practice in education and training in the UK. Sources include over 300 journals, mostly published in the UK, plus other material including reports, series and conference papers. #1 #2 #3 #4 #5 #6 #7 #8 #9 #10

looked after children (ft) child* looked after (ft) child* in care (ft) orphan* (ft) orphans adopted children foster (ft) foster care or foster children residential child care (ft) residential care and (child* (ft) or children)

#11 #12 #13 #14 #15 #16

care order* (ft) special guardian* (ft) care leav* (ft) leav* care (ft) secure accommodation (ft) unaccompanied asylum seeking child* (ft) #17 placement* (ft) and (child* (ft) or children) #18 #1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #9 or #10 or #11 or

Improving the emotional and behavioural health of looked-after children and young people

#12 or #13 or #14 or #15 or #16

or #17

Campbell Collaboration C2 Library (searched 14/10/08)

The Campbell Collaboration Library of Systematic Reviews contains systematic reviews and review protocols in the areas of education, criminal justice and social welfare. The Education and Social Welfare sections were browsed but no relevant records were found.

CERUK Plus (searched 11/11/08) The CERUK Plus database provides access to information about current and recently completed research, PhD-level work and practitioner research in the field of education and children’s services. #1

(looked after children) or (care leavers)

ChildData (searched via NCB Inmagic interface, 01/09/08) ChildData is the National Children’s Bureau database, containing details of around 35,000 books, reports and journal articles about children and young people.

#1 #2 #3 #4 #5

children in care looked after child* (ft) child* looked after (ft) orphans foster care or foster carers or foster children #6 kinship care #7 adoption or adopted children #8 residential care or residential care staff #9 group home* (ft) #10 children’s homes

#11 #12 #13 #16 #17

care orders special guardianship leaving care care leaver* (ft) unaccompanied asylum seeking child* (ft) #18 placement #19 #1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #9 or #10 or #11 or #12 or #13 or #14 or #15 or #16 or #17 or #18

Improving the emotional and behavioural health of looked-after children and young people

Cochrane Library (searched via Wiley Interscience 09/09/08) #1 #2 #3 #4 #5 #6 #7 #8 #9 #10

child, institutionalized (+NT) looked after child* (ft) child* in care (ft) child, orphaned orphanages foster home care kinship care (ft) adoption (+NT) residential child care (ft) group homes (+NT)

#11 #12 #13 #14 #15

care order* (ft) special guardianship (ft) care leaver* (ft) secure accommodation (ft) unaccompanied asylum seeking child* (ft) #16 #1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #9 or #10 or #11 or #12 or #13 or #14 or #15

Cumulative Index to Nursing and Allied Health Literature (Cinahl Plus) (searched via EBSCO Host 29/08/08) Cinahl Plus provides indexing for 3,802 journals from the fields of nursing and allied health. #1 #2 #3 #4 #5 #6 #7 #8

looked after child* (ft) child* in care (ft) ‘orphans and orphanages’ (+NT) foster home care (+NT) kinship care (ft) adoption residential child care (ft) special guardianship (ft)

#9 #10 #11 #12

leaving care (ft) care leaver* (ft) secure accommodation (ft) unaccompanied asylum seeking child* (ft) #13 #1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #9 or #10 or #11 or #12

EMBASE (searched via Ovid SP 05/09/08) The Excerpta Medica database (EMBASE) is a major biomedical and pharmaceutical database. There is selective coverage for nursing, dentistry, veterinary medicine, psychology, and alternative medicine. #1 #2 #3 #4 #5 #6 #7 #8

looked after child* (ft) child* in care (ft) orphanage (+NT) foster care (+NT) adoption (+NT) or adopted child (+NT) residential home (+NT) and (child* or adolescen* (ft)) group homes (ft) and (child* or adolescen* (ft)) children’s homes (ft)

#9 #10 #11 #12 #13 #14

care orders (ft) special guardianship (ft) leaving care (ft) care leaver* (ft) secure accommodation (ft) unaccompanied asylum seeking child* (ft) #15 #1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #9 or #10 or #11 or #12 or #13 or #14

Improving the emotional and behavioural health of looked-after children and young people

Health Management Information Consortium (HMIC) (searched via Ovid SP 03/09/08) The HMIC database is a compilation of data from two sources – the Department of Health’s Library and Information Services and King’s Fund Information and Library Service. Topic coverage is on health services. #1 #2 #3 #4 #5 #6

looked after child* (ft) child* in care (ft) children in care orphans disabilities (+NT) (foster care or foster children or foster parents) (+NT) #7 kinship care (ft) #8 (adoption or adopted children or adoptive parents) (+NT) #9 residential child care (+NT) #10 children’s homes (ft)

#11 care orders #12 special guardianship (ft) #13 former children in care or care leavers #14 secure accommodation #15 unaccompanied asylum seeking child* (ft) #16 placement (ft) and children (+NT) #17 #1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #9 or #10 or #11 or #12 or #13 or #14 or #15 or #16

International Bibliography of the Social Sciences (IBSS) (searched via EBSCO Host, 05/09/08)

#1 #2 #3 #4 #5 #6 #7 #8 #9

looked after child* (ft) children in care orphanages orphans (foster care or foster child* or foster parent) (ft) kinship care (ft) adopted children residential child care (ft) children’s homes (ft)

#10 #11 #12 #13 #14 #15

care order* (ft) special guardianship (ft) leaving care (ft) care leaver* (ft) secure accommodation unaccompanied asylum seeking child* (ft) #16 #1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #9 or #10 or #11 or #12 or #13 or #14 or #15

JSTOR (searched 14/11/08) JSTOR is an international archive of journal articles and grey literature. #1

children in care (ft)

Improving the emotional and behavioural health of looked-after children and young people

Medline (searched via Ovid SP 27/08/08) Medline is the primary source of international literature on biomedicine and healthcare.

#1 #2 #3 #4 #5 #6 #7 #8 #9 #10 #11

looked after children (ft) child* in care (ft) looked after child* (ft) child, orphaned (+NT) orphanages (+NT) foster home care (+NT) kinship care (ft) adoption (+NT) residential child care (ft) special guardianship (ft) leaving care (ft)

#12 secure accommodation (ft) #13 unaccompanied asylum seeking child* (ft) #14 #1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #9 or #10 or #11 or #12 or #13 #15 child (+NT) or adolescent #16 group homes (+NT) #17 #15 and #16 #18 #14 or #17

PsycInfo (searched via Ovid SP 05/09/08) PsycInfo contains more than 2.5 million records on psychological and behavioural science. #1 #2 #3 #4 #5

looked after child* (ft) child* in care (ft) orphans (+NT) orphanages (+NT) foster children (+NT) or foster care (+NT) or foster parents (+NT) #6 kinship care (ft) #7 adoption (child) (+NT) #8 adopted children (+NT) #9 residential child care (ft) #10 care orders (ft) #11 special guardianship (ft)

#12 #13 #14 #15 #16

#17 #18 #19 #20

leaving care (ft) care leaver* (ft) secure accommodation (ft) unaccompanied asylum seeking child* (ft) #1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #9 or #10 or #11 or #12 or #13 or #14 or #15 child (+NT) or adolescent group homes (+NT) #17 and #18 #16 or #19

Improving the emotional and behavioural health of looked-after children and young people

Social Care Online (searched 21/08/08)

Social Care Online is the Social Care Institute for Excellence’s (SCIE’s) database covering an extensive range of information and research on all aspects of social care. Content is drawn from a range of sources including journal articles, websites, research reviews, legislation and government documents and service user knowledge. #1 #2 #3 #4 #5 #6 #7 #8 #9 #10 #11

looked after children children looked after (ft) child* in care (ft) foster care (+NT) foster children adoption (+NT) adopted children residential child care care orders special guardianship leaving care

#12 care leaver* (ft) #13 secure accommodation and (children or young people) #14 unaccompanied asylum seeking child* (ft) #15 placement and (children or young people) #16 #1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #9 or #10 or #11 or #12 or #13 or #14 or #15

Social Services Abstracts (searched via CSA Illumina 02/09/08) Social Services Abstracts is an international database covering social work, social welfare and social policy. #1 #2 #3 #4 #5 #6 #7 #8 #9

looked after child* (ft) child* in care (ft) orphans foster care or foster children adoption (+NT) adopted children (+NT) residential care (ft) and (children (+NT)) children’s homes (ft) special guardianship (ft)

#10 care leaver* (ft) #11 secure accommodation (ft) #12 unaccompanied asylum seeking child* (ft) #13 placement and (child (+NT)) #14 #1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #9 or #10 or #11 or #12 or #13

Improving the emotional and behavioural health of looked-after children and young people

Social Work Abstracts (searched via Ovid SP 03/09/08) Social Work Abstracts covers material published in primarily US-based journals with social work relevance. #1 #2 #3 #4 #5 #6 #7 #8 #9 #10

looked after child* (ft) child* in care (ft) orphan* (ft) foster* (ft) kinship care (ft) adoption (ft) residential child care (ft) children’s homes (ft) care orders (ft) special guardianship (ft)

#11 #12 #13 #14

care leaver* (ft) leaving care(ft) secure accommodation (ft) unaccompanied asylum seeking child* (ft) #15 placement and (child* (ft) ) #16 #1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #9 or #10 or #11 or #12 or #13 or #14 or #15

Zetoc (searched via British Library 03/09/08) Zetoc provides access to the British Library’s electronic table of contents of journals and conference proceedings. This search interface has quite limited functionality. #1 #2 #3 #4 #5 #6 #7

looked after children (ft) foster care (ft) and health (ft) adopted children (ft) and health (ft) residential child care (ft) children’s homes (ft) special guardianship (ft) care leaver (ft)

#8 care leavers (ft) #9 secure accommodation (ft) #10 placement (ft) and children (ft) and care (ft) #11 #1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #9 or #10

Search output from each database was combined (using OR) in an EndNote library, which was subsequently searched for each priority. The EndNote library was produced from the above references on 05/12/08.

Improving the emotional and behavioural health of looked-after children and young people

Stage 2 Topic-specific searches (All later aggregated for screening for all priorities, due to overlap in relevance.) Education priority #1 #2 #3

school* (ft) education* (ft) learning (ft)

#4 #5

pupil* (ft) #1 or #2 or #3 or #4

The output from this set was searched using the following terms: Educational outcomes and positive school experiences set #1 #2 #3 #4 #5 #6 #7 #8 #9 #10 #11 #12 #13

achievement* (ft) qualification* (ft) examin* (ft) key stage* (ft) college* (ft) university (ft) degree* (ft) attendance (ft) truan* (ft) stability (ft) dropout* (ft) expulsion* (ft) exclu* (ft)

#14 friend* (ft) #15 career* (ft) #16 occupation* (ft) #17 job* (ft) #18 employ* (ft) #19 citizen* (ft) #20 school refusal (ft) #21 school phobia (ft) #22 #1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #9 or #10 or #11 or #12 or #13 or #14 or #15 or #16 or #17 or #18 or #19 or #20 or #21

virtual school head* (ft) education support (ft) out of school hours learning (ft) specialist* (ft) designated teacher* (ft) club* (ft) personal education plan* (ft) mentor* (ft)

#9 #10 #11 #12 #13 #14 #15 #16

education at home (ft) guidance (ft) policy green paper* (ft) white paper* (ft) Every Child Matters (ft) Childrenâ&#x20AC;&#x2122;s Act Care Matters (ft)

Improving the emotional and behavioural health of looked-after children and young people

#17 #18 #19 #20

educational psychologist* (ft) mental health professional* (ft) camhs (ft) achievement ceremon* (ft)

#21 #1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #9 or #10 or #11 or #12 or #13 or #14 or #15 or #16 or #17 or #18 or #19 or #20

The output from this set was searched using the following terms: Acceptability, accessibility and effectiveness set #1 acceptab* (ft) #11 outcomes (ft) #2 accessib* (ft) #12 evaluat* (ft) #3 satisfaction (ft) #13 making a difference (ft) #4 service uptake (ft) #14 success* (ft) #5 service use (ft) #15 improvement (ft) #6 engage* (ft) #16 implementation (ft) #7 involv* (ft) #17 #1 or #2 or #3 or #4 or #5 or #6 or #8 participat* (ft) #7 or #8 or #9 or #10 or #11 or #12 #9 effective* (ft) or #13 or #14 or #15 or #16 #10 What works (ft) This output was used to answer the question on the accessibility, acceptability and effectiveness of policies, services and interventions. The education set was searched using the following terms: Foster, residential and kinship carers and birth families #1 #2 #3 #4 #5

carer* (ft) worker* (ft) assistant* (ft) guardian* (ft) family (ft)

#6 mother* (ft) #7 father* (ft) #8 parent* (ft) #9 #1 or #2 or #3 or #4 or #5 or #6 or #7 or #8

The output from this set was searched using the following terms: Attitudes, skills, aptitudes and behaviours set #1 #2 #3 #4 #5 #6 #7 #8 #9

attitude* (ft) skill* (ft) abilit* (ft) behaviour* (ft) behavior* (ft) encourage* (ft) supportive (ft) supporting (ft) empathy (ft)

#10 promote (ft) #11 help* (ft) #12 assist* (ft) #13 facilitate (ft) #14 value (ft) #15 engage* (ft) #16 #1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #9 or #10 or #11 or #12 or #13 or #14 or #15

The output from this set was searched using the following terms: Training and support for above behaviours set #1 #2

training (ft) support* (ft)

#3 #4

competen* (ft) regist* (ft)

Improving the emotional and behavioural health of looked-after children and young people

#5 #6

counselling (ft) assess* (ft)

#1 or #2 or #3 or #4 or #5 or #6

#2 #3 #4 #5 #6 #7 #8 #9 #10 #11 #12 #13 #14 #15 #16 #17 #18 #19 #20 #21 #22 #23 #24

childrenâ&#x20AC;&#x2122;s centre* (ft) family centre* (ft) confiden* (ft) esteem (ft) grie* (ft) happy (ft) happiness (ft) emotion* (ft) self control (ft) mental* (ft) qaly (ft) quality of life (ft) resilen* (ft) respect (ft) wellbeing (ft) antisocial (ft) anxi* (ft) attach* (ft) behav* (ft) bereav* (ft) bully* (ft) conduct (ft) cortisol (ft) depress* (ft)

#25 hyperactiv* (ft) #26 relationship* (ft) #27 risk taking (ft) #28 self harm (ft) #29 stress (ft) #30 suicide (ft) #31 personality disorder* (ft) #32 ADHD (ft) #33 buddy (ft) #34 mentor* (ft) #35 counsellor* (ft) #36 psych* (ft) #37 advoca* (ft) #38 therap* (ft) #39 support worker* (ft) #40 key worker* (ft) #41 #1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #9 or #10 or #11 or #12 or #13 or #14 or #15 or #16 or #17 or #18 or #19 or #20# or #21 or #22 or #23 or #24 or #25 or #26 or #27 or #28 or #29 or #30 or #31 or #32 or #33 or #34 or #35 or #36 or #37 or #38 or #39 or #40

The output from this set was searched using the following terms: Positive emotional and behavioural health set #1

confiden* (ft)

esteem (ft)

Improving the emotional and behavioural health of looked-after children and young people

#6 #7 #9 #11 #12 #13 #14

happy (ft) happiness (ft) self control (ft) qaly (ft) quality of life (ft) resilen* (ft) respect (ft)

#15 wellbeing (ft) #16 feeling good (ft) #17 feel good (ft) #18 #1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #9 or #10 or #11 or #12 or #13 or #14 or #15 or #16 or #17

The output from this set was searched using the following terms: Views set #1 #2 #3

opinion* (ft) view* (ft) feedback (ft)

#4 #5 #6

listen* (ft) voice* (ft) #1 or #2 or #3 or #4 or #5

This output was used to answer the question on LACYPâ&#x20AC;&#x2122;s views on emotional and behavioural health The emotional/behavioural health set was searched using the following terms: Emotional/behavioural health policy and interventions set #1 #2 #3 #4 #5 #6 #7 #8 #9 #10 #11 #12 #13

advoca* (ft) mentor* (ft) counsell* (ft) therap* (ft) dedicated (ft) specialist (ft) policy (ft) legislation (ft) green paper (ft) white paper (ft) Every Child Matters (ft) Childrenâ&#x20AC;&#x2122;s Act secure attachment (ft)

#14 Healthy Care (ft) #15 mental health professional* (ft) #19 camhs (ft) #20 achievement ceremon* (ft) #21 guidance (ft) #22 educational psychologist* (ft) #23 psychiatrist* (ft) #24 #1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #9 or #10 or #11 or #12 or #13 or #14 or #15 or #16 or #17 or #18 or #19 or #20 or #21 or #22 or #23

The output from this set was searched using the following terms: Acceptability, accessibility and effectiveness set #1 #2 #3 #4 #5 #6 #7 #8 #9 #10

acceptab* (ft) accessib* (ft) satisfaction (ft) service uptake (ft) service use (ft) engage* (ft) involv* (ft) participat* (ft) effective* (ft) What works (ft)

#11 outcomes (ft) #12 evaluat* (ft) #13 making a difference (ft) #14 success* (ft) #15 improvement (ft) #16 implementation (ft) #17 #1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #9 or #10 or #11 or #12 or #13 or #14 or #15 or #16

Improving the emotional and behavioural health of looked-after children and young people

This output was used to answer the question on the accessibility, acceptability and effectiveness of policies, services and interventions. The emotional/behavioural health set was searched using the following terms: Foster, residential and kinship carers and birth families set #1 #2 #3 #4 #5

carer* (ft) worker* (ft) assistant* (ft) guardian* (ft) family (ft)

#6 mother* (ft) #7 father* (ft) #8 parent* (ft) #9 #1 or #2 or #3 or #4 or #5 or #6 or #7 or #8

The output from this set was searched using the following terms: Attitudes, skills, aptitudes and behaviours set #1 #2 #3 #4 #5 #6 #7 #8 #9 #10 #11 #12

attitude* (ft) skill* (ft) abilit* (ft) behaviour* (ft) behavior* (ft) encourage* (ft) supportive (ft) supporting (ft) empathy (ft) promote (ft) help* (ft) assist* (ft)

#13 facilitate (ft) #14 value (ft) #15 engage* (ft) #16 bond (ft) #17 sympath* (ft) #18 warmth (ft) #19 love (ft) #20 belonging (ft) #21 #1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #9 or #10 or #11 or #12 or #13 or #14 or #15 or #16 or #17 or #18 or #19 or #20

The output from this set was searched using the following terms: Training and support for above behaviours set #1 #2 #3 #4

training (ft) support* (ft) competen* (ft) regist* (ft)

#5 #6 #7

counselling (ft) assess* (ft) #1 or #2 or #3 or #4 or #5 or #6

Improving the emotional and behavioural health of looked-after children and young people

Safe, settled accommodation priority Population terms EndNote library above was searched using the following terms: Accommodation set #1 #2 #3 #4 #5 #6 #7

accommodation (ft) housing (ft) homeless* (ft) flat* (ft) bedsit* (ft) lodging* (ft) hostel* (ft)

#8 independent living (ft) #9 floating support (ft) #10 tenan* (ft) #11 B&B (ft) #12 bed and breakfast (ft) #13 #1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #9 or #10 or #11 or #12

The output from this set was searched using the following terms: Safe, settled set #1 #2 #3

safe* (ft) settled (ft) secur* (ft)

#4 #5

permanen* (ft) #1 or #2 or #3 or #4

The output from this set was searched using the following terms: Views set #1 opinion* (ft) #4 listen* (ft) #2 view* (ft) #5 voice* (ft) #3 feedback (ft) #6 #1 or #2 or #3 or #4 or #5 This output was used to answer the question on LACYPâ&#x20AC;&#x2122;s views on emotional and behavioural health The accommodation set was searched using the following terms: Not in settled accommodation set #1 unsafe (ft) #7 lost (ft) #2 unsettled (ft) #8 rough sleep* (ft) #3 temporary (ft) #9 on the street* (ft) #4 homeless* (ft) #10 #1 or #2 or #3 or #4 or #5 or #6 or #5 out of touch (ft) #7 or #8 or #9 #6 not in contact (ft) This output was used to answer the question on those not in suitable accommodation by age 19. The accommodation set was searched using the following terms: Accommodation policy and interventions set #1 #2

floating support (ft) housing support (ft)

#3 #4

housing service* (ft) housing officer* (ft)

Improving the emotional and behavioural health of looked-after children and young people

#5 #6 #7 #8 #9 #10 #11 #12 #13 #14

benefit* (ft) credit* (ft) grant* (ft) fund* (ft) dedicated specialist* (ft) policy legislation green paper (ft) white paper (ft)

#15 Children (Leaving Care) Act (ft) #16 affordable (ft) #17 low cost (ft) #18 guidance (ft) #19 joint working (ft) #20 Homelessness Act (ft) #21 #1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #9 or #10 or #11 or #12 or #13 or #14 or #15 or #16 or #17 or #18 or #19 or #20

The output from this set was searched using the following terms: Acceptability, accessibility and effectiveness set #1 acceptab* (ft) #11 outcomes (ft) #2 accessib* (ft) #12 evaluat* (ft) #3 satisfaction (ft) #13 making a difference (ft) #4 service uptake (ft) #14 success* (ft) #5 service use (ft) #15 improvement (ft) #6 engage* (ft) #16 implementation (ft) #7 involv* (ft) #17 #1 or #2 or #3 or #4 or #5 or #6 or #8 participat* (ft) #7 or #8 or #9 or #10 or #11 or #12 #9 effective* (ft) or #13 or #14 or #15 or #16 #10 What works (ft) This output was used to answer the question on the accessibility, acceptability and effectiveness of policies, services and interventions The emotional/behavioural health set was searched using the following terms: Foster, residential and kinship carers and birth families #1 #2 #3 #4 #5

carer* (ft) worker* (ft) assistant* (ft) guardian* (ft) family (ft)

#6 mother* (ft) #7 father* (ft) #8 parent* (ft) #9 #1 or #2 or #3 or #4 or #5 or #6 or #7 or #8

The output from this set was searched using the following terms: Attitudes, skills, aptitudes and behaviours set #1 #2 #3 #4 #5 #6 #7 #8 #9

attitude* (ft) skill* (ft) abilit* (ft) behaviour* (ft) behavior* (ft) encourage* (ft) supportive (ft) supporting (ft) empathy (ft)

#10 #11 #12 #13 #14 #15 #16 #17

promote (ft) help* (ft) assist* (ft) facilitate (ft) value (ft) engage* (ft) financ* (ft) fund* (ft)

Improving the emotional and behavioural health of looked-after children and young people

#18 #1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #9 or #10 or #11 or #12

or #13 or #14 or #15 or #16 or #17

The output from this set was searched using the following terms: Training and support for above behaviours set #1 #2 #3 #4

training (ft) support* (ft) competen* (ft) regist* (ft)

#5 #6 #7

counselling (ft) assess* (ft) #1 or #2 or #3 or #4 or #5 or #6

The output from this set was searched using the following terms: Quantitative, correlate set #1 quantitative (ft) #6 percentage (ft) #2 correlate* (ft) #7 significant difference (ft) #3 effective* (ft) #8 #1 or #2 or #3 or #4 or #5 or #6 or #4 statistic* (ft) #7 #5 cohort* (ft) This output was used to answer the question on the contribution of carers and birth families, and interventions to support them. For all priorities Literature suggestions from Theme Advisory Group and other experts These were incorporated into the pool of references that were screened. Policy, government agencies, academic and third sector websites The following websites were browsed and searched for each priority, and relevant documents incorporated in the screening EndNote libraries. These websites included government departments and agencies, academic centres and third-sector organisations. Output figures were not compiled for each website because this work was carried out during background preparation for this project. Organisation

URL

4 Nations Child Policy Network A National Voice Barnardoâ&#x20AC;&#x2DC;s British Association for Adoption & Fostering Care Services Improvement Partnership Knowledge Community Caspari Foundation Centre for Policy Studies Connexions Direct

www.childpolicy.org.uk/ www.anationalvoice.org/ www.barnardos.org.uk/ www.baaf.org.uk/

http://kc.csip.org.uk/

www.caspari.org.uk/ www.cps.org.uk/ www.connexions-direct.com/

Improving the emotional and behavioural health of looked-after children and young people

DEMOS Department for Children, Schools and Families Department of Health Evidence Network Government Social Research Howard League for Penal Reform Intute INVOLVE Institute for Public Policy Research Joseph Rowntree Foundation Kingsâ&#x20AC;&#x2122; Fund Local Government Analysis and Research Mental Health Foundation Nacro National Centre for Excellence in Residential Child Care National Centre for Social Research (NATCEN) National Childrenâ&#x20AC;&#x2122;s Bureau National Library for Health Office for National Statistics NCVCCO (Children England) National Foundation for Educational Research National Youth Agency Northern Ireland Commissioner for Children and Young People Personal Social Services Research Unit Prison Reform Trust Promising Practices Network Research in Practice Restorative Justice Consortium Rethink What Works for Children York Systematic Reviews in Social Policy and Social Care Young Minds

www.demos.co.uk/ www.dcsf.gov.uk/ www.dh.gov.uk/en/index.htm www.kcl.ac.uk/schools/sspp/interdisciplinary/evidence www.gsr.gov.uk/ www.howardleague.org/ www.intute.ac.uk/ www.invo.org.uk/ www.ippr.org.uk/ www.jrf.org.uk/ www.kingsfund.org.uk/ www.lga.gov.uk/lga/core/page.do?pageId=1036233 www.mentalhealth.org.uk/ www.nacro.org.uk/ www.ncb.org.uk/Page.asp?sve=934 www.natcen.ac.uk/ www.ncb.org.uk/Page.asp www.library.nhs.uk/ www.statistics.gov.uk/default.asp www.ncvcco.org/ www.nfer.ac.uk/index.cfm www.nya.org.uk/ www.niccy.org/ www.pssru.ac.uk/ www.prisonreformtrust.org.uk/ www.promisingpractices.net/ www.rip.org.uk/ www.restorativejustice.org.uk/ www.rethink.org/ www.whatworksforchildren.org.uk/ www.york.ac.uk/inst/chp/srspsc/index.htm www.youngminds.org.uk/

Improving the emotional and behavioural health of looked-after children and young people

Appendix 4: Studies in each of the main categories of study in the scoping review Table 1: Main categories of ‘views’ studies Category 1

EBD including mental health problems

Views of LAC with EBD or receiving mental health services

Views about EBD or mental health problems/services but LACYP with EBD/mental health problems not distinguished

Views on specific interventions related to EBD e.g. advocacy or specific EBD e.g. conduct disorder,sexual abuse

Study

No. 17

Davies, J.A. and Wright, J. (2008) ‘Children’s voices: a review of the literature pertinent to looked-after children’s views of mental health services’, Child and adolescent mental health, vol 13, no 1, pp 26–31.

Lee, B.R., Munson, M.R., Ware, N.C., Ollie, M.T., Scott, L.D. and McMillen, J.C. (2006) ‘Experiences of and attitudes toward mental health services among older youths in foster care’, Psychiatric services, vol 57, no 4, pp 487–482.

Penny, A. (2007) Grief matters for children: support for children and young people in public care experiencing bereavement and loss, London: National Children’s Bureau.

Sutton, V., Robbins, I., Vicky, S. and Gordon, S. (2006) ‘A qualitative study exploring refugee minors’ personal accounts of post-traumatic growth and positive change processes in adapting to life in the UK’, Diversity in health and social care, vol 3, no 2, pp 77–88.

Kurtz, Z. and James, C. (2003) What’s new: learning from the CAMHS innovation projects: summary, London: Department of Health.

Lerpiniere, J., Paul, S., Milligan, I. and Kendrick, A. (2006) Evaluation of the REP project: the Rossie-Elms mental health and well-being project, Glasgow: University of Strathclyde, Scottish Institute for Residential Child Care (available at www.sircc.org.uk/sites/default/files/REP_Evaluation_Report_final.pdf, accessed 12 March 2009).

Vasillou, C. and Ryrie, I. (2006) ‘Someone there to talk to’, Mental health today, October, pp 23–26.

Beck, A. (2006) ‘Users’ views of looked after children’s mental health services’, Adoption & fostering, vol 30, no 2, pp 53–63.

Chase, E., Knight, A. and Statham, J. (2008) The emotional well-being of young people seeking asylum in the UK, London: British Association for Adoption and Fostering.

Ellermann, C.R. (2007) ‘Influences on the mental health of children placed in foster care’, Family & community health, vol 30, no 2, pp S23–S32.

Stanley, K. (2001) Cold comfort: young separated refugees in England, London: Save the Children.

Barnes, V. (2007) ‘Young people’s views of children’s rights and advocacy services: a case for “caring” advocacy?’, Child abuse review, vol 16, no 3, pp 140–152.

Boswell, G. and Wedge, P. (2003) ‘A pilot evaluation of a therapeutic community for adolescent male sexual abusers’, Therapeutic communities, vol 24, no 4, pp 259– 276.

Carlile, A.C. (2006) The Carlile Inquiry: an independent inquiry into the use of physical restraint, solitary confinement and forcible strip searching of children in prisons, secure training centres and local authority secure children’s homes, London: The Howard League for Penal Reform.

Smith, M., McKay, E. and Chakrabarti, M. (2004) ‘What works for us: boys’ views of their experiences in a former List D school’, British journal of special education, vol

Improving the emotional and behavioural health of looked-after children and young people