Adolescent Theme:
Putting Research to Work
Valerie Dunn
October 10, 2013
Adolescent Theme
TC-17 Study (Transfer of Care at 17):
• Mental health of potentially vulnerable young people in transition:
care leavers (27) & CAMHS leavers (26)
• Clinical interviews plus service use, experiences, opinions at transition
& 12 months later
Why? Adolescence – high risk for emergence of MH problems
• Approx half lifetime mental disorders onset in mid-teens; 75% <25
• transition from child-centred services is at 16-18 (regional variation &
flexibility; CCC offers extended support)
• MH need in both groups which may compromise transition
What do we know ?
• CAMHS leavers: ); around 1/3 eligible for adult services –
don’t make it; transition most successful in the most severely
ill (eg inpatients or those with psychosis
• Care leavers: large unmet MH need, poor service uptake,
placement instability, poor outcomes on most indicators
(education, employment, social, criminality)
Research suggests need for improved support at
a difficult time
TC17 care leavers (n=27) results in brief:
* 74% lifetime MH diagnosis , often undetected/untreated
* 52% MH diagnosis as YP face transition ; 44% 12 months later
* 48% NEET (not in education, employment or training) at transition;
54% 12 months later
* 62% had not taken up at referrals
* Placement breakdown often associated with MH problems
18/27 (66%) – moved to independent living
Foster care
Accounts for around 75% of all care placements
Our survey of Cambs foster carers (LA & agency):
• Children’s behaviour & emotional ‘damage’ one of the biggest
challenges
• Around 40% ‘pushed to their limits’: aggression, violence,
destruction & complex MH problems (ADHD, self-harm,
overdoses).
– Difficulties had last 3 weeks – 10 years
– Often resulted in placement breakdown
FC (ours & national surveys) want better training, support & better
access to psychological services for those most in need
Next step …
By addressing MH problems early we could prevent escalation,
encourage stable placements & improve chances of successful
transition in young adulthood
‘Decisions at the outset of a care journey can set in motion a domino effect of
positive or negative outcomes, with costs accumulating over a lifetime’1
Our response:
Devise & evaluate CloseUp Training for foster carers
1 Hannon C, Wood C, Bazalgette L, In Loco Parentis, Demos. 2010
Challenges:
• To fully engage foster carers in the training
• To understand: What is it really like to be taken away from one’s
family and placed in local authority care?
Essential to involve young people
How can we actively & usefully involve young people in an
innovative, engaging & creative way?
Maverick approach required, surveys won’t do it
... but maybe a film could …
My name is Joe
- Partnership with Cambs Film Consortium – core team of
animator, composer, volunteers, Children’s Participation team,
workshop facilitator (YOS)
- Consultation & workshops for YP
- 4-day animation summer school, August 2012
- Premiere w Q&A, Cambridge Arts Picturehouse, Oct 2012
- YouTube with ‘Behind the Scenes’ http://youtu.be/ArBjWe3IWs0
Patient Public Involvement (PPI)
Principles of PPI
Active involvement
YP perspective
‘Feeling part of stuff’ (Action for Children)
Bottom-up approach
Everybody learns something
Gains for YP: views matter, new skills, confidence, CV
Form bond for future work
‘Joe’ Impact
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Foster carer training: fostering agencies, local authorities
National Agency – in discussions
NCAS website
YouTube – over 2,000 views
Social worker training
Youth Film Festival
Led to Finding My Way – launch October 15 – do come
Feedback
‘Well, we were talking about it without talking about it weren’t we. Yep,
it was good.’
Young person
‘This is a University isn’t it? I’m not clever enough to come here, but will
you show us round?’
Young person
‘I wanted to say how brilliant it was ... nice to be involved in a project
that was so well planned & supported, a great team I think! I was really
impressed with the young people, they were very courageous in sharing
their ideas & taking on so many new challenges.’
Lizzy,animator
‘That film says it all’
Foster carer
Aims of CloseUp Training:
- to capitalise on the unique position of foster carers to build a
bond with children & YP in their care
- to equip FC with skills & knowledge to identify symptoms (sx) of
common but severe emotional & behavioural problems in LAC
- to devise a method of monitoring & recording mental state for
mandatory review
- to improve access to appropriate, timely treatment when
necessary
CloseUp Training: content
• Common MH problems: attitudes & language, reassurances,
evidence not folklore, definitions, prevalence, causation,
bran development, services, impact, why it’s important
• How to identify core symptoms (sx) across the spectrum
• ‘Normal’ vs Common
• Association w attachment problems
• A-Z of Talking & Listening
• How to complete the Wellbeing Profile (FC & child versions –
design stage!)
CloseUp: delivery
- 2-day (or 3?) (4 hours per day) small groups
- Handbook, slides, expert video clips, My Name is Joe
- Mixture of direct instruction, discussion, case studies,
small group/pair exercises & ‘homework’
What words do YOU use?
Exercise 2: What words do you use? Why? Impact?
MI: what do we mean?
W e’r e
all different
~What’s normal? A myth?
~More helpful - normal range of almost everything from emotions
& behaviour to blood pressure, glucose levels, BMI …..
When does sadness/anxiety/behaviour become a clinical problem?
Reassurances
We’re NOT asking you to:
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Make clinical diagnoses
Provide psychological treatment
Label children & young people as mentally ill
Deal with mountains of extra paperwork
Medicalize ordinary child/teenage behaviour
Recording observations in the Well-P
• Core signs/symptoms common to multiple disorders:
mood
irritability
agitation/poor concentration
eating
sleep
fear/’red alert’
• When:
- daily for two weeks during first month in care in
your care (can be repeated annually or if concerned)
• Impairment
It’s not the individual days that are important but the
cumulative picture that emerges over the fortnight
Feasibility stage:
• Wisbech, December 2012, Cambridge March & Sept/Oct 2013
• 17 trained: 10 experienced carers (4 agency 6 LA) & 7 newlyapproved (2 agency, 5 LA)
• Experienced: largely unstructured – maximise FC input
• Overwhelmingly positive response:
*‘I wish I’d done this when I was a new carer’,
*‘It makes so much sense.’
*‘All new carers should do this. It’s so relevant’
*‘The training was a really, really good idea, it was
even helpful for me as a long time carer. The
WELL-P is a great idea and very forward thinking”.
The future:
CLAHRC EoE – 2-year pilot, agencies and LAs: test the
concept that FC can usefully identify & monitor MH
symptoms
Develop the child and teenage versions of the Well-P –
stickers, online, apps …
Data should help us understand the complex MH needs of
children and YP when they enter the care system and, in
turn, develop the appropriate services
Many thanks to
Cambridgeshire County Council
Peterborough City Council
Young people
Film makers
Foster carers
CPFT
Thank you for your time, interest & attention
Valerie Dunn
vjd20@cam.ac.uk, 01223 746053