Purpose Attachment theory and associated terms are drawn upon widely in clinical and social work practice with families. There is a notable gap in research exploring how the use of these concepts and terms influences care. Research Design This article describes a critical discourse analysis of child and adolescent mental health service (CAMHS) clinical notes exploring the use of attachment related discourses for a sample of 30 cases. The case notes typically documented intensive professional activity (meetings; correspondence; assessment; therapy) and cross service discussions about children who were at serious risk of harm due to social and psychological difficulties. Results We identified the following themes: 1) Lack of Assessment; 2) Conceptual Confusion; 3) Care Pathways; 4) Conversations with Children and Parents. Attachment related language was used for multiple reasons: an attempt by professionals to call for action from another service (e.g. change of placement), giving more power to professionals who might not otherwise have access to terminology that describes their concerns from a “clinical” perspective; offering an explanation for chronic issues resistant to the interventions offered by services; a means of locating the cause of problems within actors not currently involved in the child’s life; a shorthand way of describing complex presentations not easily described within a diagnostic framework. Conclusion The study identified concerns about how these terms are used in practice and the impact on care provided to children and families. We make recommendations for policy changes, further research, and for practitioners and academics to work collaboratively.
The importance of trauma-informed care has recently been recognised more greatly across the United Kingdom and has led to increased efforts to provide training to staff across a range of public sectors. Evaluation of training interventions is often limited to outcomes of staff knowledge and confidence. The current study aimed to evaluate the impact of an attachment- and trauma-informed training intervention for social work professionals on how they understand the young people they work with. 29 social work professionals attended training online and face-to-face. A pre-post design was utilised, with intervention and waiting-for-training groups, evaluating outcomes of professionals’ expressed emotion (EE), reflective functioning (RF), and attachment-informed stance using 5 Minute Speech Samples (FMSS), alongside attitudes towards trauma-informed care (ARTIC) and knowledge, confidence and worries regarding trauma-informed care. A novel Attachment-Informed FMSS coding system was developed and piloted showing good inter-rater and code-recode reliability. Significant interaction effects were found for knowledge (η p 2 = .623, p = <.001), confidence (η p 2 = .281, p = .003) and EE Warmth (η p 2 = .172, p = .025), significant increases were seen pre-to post-intervention for training group compared to waiting-for-training group, and training group had a significant increase in ARTIC scores pre-to post-intervention ( r = .412, p = .02). Significant effects of time were found for RF and attachment-informed stance but no interaction effect was found. Training outcomes may not have the intended effect of increasing professionals’ ability to be reflective or attachment-informed but still provide positive changes in knowledge, confidence and self-reported attitudes.
Children in care have significantly poorer behavioural and emotional wellbeing (BEW) compared to those not in care (in the community). Experiences precipitating and within care systems contribute to this. Many children enter the system having been abused or neglected and experience placement instability (PI) while in care. As such, there is a need for studies which examine the relationship between BEW and PI. This study used BERRI to explore the (1) BEW of participants living in residential settings, foster care, and the community (2) effects of PI on BEW and (3) differences in relationships between PI and BEW based on placement type. The primary carers of 2,001 children and adolescents in residential settings, 267 in foster care, and 191 in the community completed BERRI. The “community” group was a self-selected sample with potential concerns. An independent samples t-test and a series of one-way and mixed-methods ANOVAs were used to analyse the data. (1) Participants from residential settings had greater BEW difficulties than those from foster care and the community (η 2 = .07); (2) those with PI reported greater scores on the BEW subscales of BERRI (η 2 = .03); and (3) a significant relationship between level of PI and BEW total scores was only seen in the residential settings subgroup (η 2 = .14 for behaviour scores, η 2 = .002 for emotional wellbeing scores). It is crucial to reduce PI and its BEW causes and consequences, with a specific focus on residential settings. Recommendations are proposed.
Adopted children are likely to present with a wide range of common mental health issues requiring assessment and therapeutic support. In England the commissioning of therapeutic support is usually conducted by non-mental health professionals. The current study compares the mental health concerns raised in 153 consecutive referral letters from post-adoption social workers against the diagnoses subsequently identified by a specialist mental health clinic for adopted and fostered children. The social workers referred appropriate cases for specialist assessment, with an average of just over two psychiatric diagnoses per child identified in clinic, but there was low agreement between the mental health issues raised in the referral letters and the corresponding clinic diagnoses, particularly in relation to attachment and trauma issues. Most common amongst a wide range of conditions identified ( N = 16) in the clinic were behavioural problems (66.0%), ADHD (61.4%), autism (26.1%) and anxiety diagnoses (23.5%). A minority of children received either post-traumatic stress (12.4%) or attachment-related (0.6%) diagnoses. Notably, when free to choose referral issues for further assessment, social workers also rarely identified issues with attachment (21.6%) or trauma (8.5%). Discussion considers the barriers to a shared understanding between social workers and clinicians regarding mental health issues in adopted children. These challenges are especially important in England where the study was conducted because contrary to the evidence base adoption support has since been restricted to address only issues of attachment and trauma, which were both minority issues in social workers’ referrals, rarely diagnosed and indicated little shared understanding between professionals.
Background: During the COVID-19 pandemic, risk factors for child sexual abuse (CSA) increased, yet no study has examined its impact on primary health care (PHC) attendance in Brazil. Purpose: This study assessed how the pandemic affected consultations for sexually abused children in PHC services. Research Design, Study Sample, and Data Collection: We conducted a cross-sectional ecological analysis using data from the Primary Care Health Information System, evaluating monthly consultations for children aged 0–9 from 2017-2020. Analysis: Consultation rates per 100,000 children during April–December 2020 were compared with pre-pandemic period using the Mann–Whitney U test. Month by month rates during the pandemic were compared with the historical limits using 95% confidence intervals. Results: 5,097 consultations of sexually abused children were studied – 25.1% during the pandemic, 79.8% girls and 58.4% 5–9 years old. Considering the first 9 months of the pandemic (overall), the monthly consultation rates fell among boys aged five to nine (35.1%; p < .05). However, considering each of the months included in the study, monthly consultations for abuse exceeded the historical upper limits among younger girls in the fifth and sixth months, among older girls in the seventh and ninth months, and among younger boys in the sixth month. Overall, during the first nine months of the pandemic, consultation rates for CSA decreased significantly among boys aged 5–9 years, while month-specific increases above historical upper limits were observed among girls and younger boys. Conclusions: Measures to mitigate barriers to accessing PHC for CSA need to be considered in preparation for future pandemics.
Purpose: This study examined sleep problems in Flemish (Dutch speaking part of Belgium) school-aged children (4–12 years) placed in family foster care. Research design: Foster parents ( n = 197) completed an online questionnaire consisting of: (1) characteristics of foster child, foster family and foster placement, (2) behavioural problems of foster child, and (3) sleep problems of foster child using the Dutch version of the ‘Children’s Sleep Habits Questionnaire (CSHQ)’. Higher scores indicate more sleep problems. Results: Based on a cut-off value used in an American sample, 71.1% of the foster children in our sample screened positive for clinically significant sleep problems. In general, foster children scored significantly higher than children from different community samples and significantly lower than children from different sleep-disordered samples. Multiple regression analysis showed that sleep problems were significantly associated with internalizing problem behaviour, externalizing problem behaviour, and household composition. The likelihood of experiencing/perceiving sleep problems in foster children was higher in case of more internalizing or externalizing problem behaviour and in case of single parenthood. Conclusion: These results highlight the importance of screening, assessment and intervention in foster children with sleep problems by health professionals.
This study aimed to investigate the demographic, clinical, and placement factors associated with psychotropic medication prescribed to youth in foster care presenting with a request for a psychotropic medication. Additionally, this study explored placement instability after the initial prescription of psychotropic medication since entering foster care. Insight into specific factors that may influence the number of placement changes of youth in care prescribed psychotropic medication within a medication oversight program can help provide proactive support and timely mental health interventions. Psychotropic medication data were obtained for youth in the oversight program ages 0 to 18 who entered foster care from 2015 to 2021 ( N = 480) and merged with placement data from an integrated administrative database. Regression analyses examined demographics, clinical factors, and placement instability predicting antipsychotic or polypharmacy prescription following an initial psychotropic medication review. The number of placements and hospitalizations in the following two years was analyzed by medication types. After controlling for covariates, entering care on no medication predicted the prescription of an antipsychotic, and polypharmacy of youth in care prescribed at least one psychotropic medication. Additionally, among youth with a psychotropic referral, being initially prescribed an antidepressant or an antipsychotic and a disruptive behavior diagnosis predicted the number of subsequent placements and hospitalizations. These factors can help identify youth at high risk for placement instability and psychiatric hospitalization at the point of referral for psychotropic medication, allowing for targeted intensive mental health treatment and casework.
This scoping review aimed to explore the qualitative research on the educational experiences of youth in care. The initial search yielded 9913 sources. Following multiple exclusion steps, 18 sources remained, half of which were unpublished theses with eight journal articles and one report. There were 397 participants included in this review, most of whom were young women from the same female-only public charter school for court-involved youth in the United States. Participant characteristics were inconsistently reported, particularly race/ethnicity which was unknown for 45% of participants. One-off interviews and focus groups were the predominant data collection methods used in the qualitative research. None of the 18 studies utilised participatory or co-design methods. The poor demographic reporting and traditional research methods make it difficult to determine whose experiences the research is capturing, and produce doubt that the experiences of those most impacted by the care system are being understood in meaningful ways.
Several studies have explored trauma symptomatology in children and young people (C/YP) in foster and kinship care. The current study explored the mental health difficulties for a cohort of C/YP in care with complex needs in Queensland, Australia at commencement of treatment at a tertiary level specialist mental health service, with a focus on gender and Aboriginal and/or Torres Strait Islander background. The short form of the Assessment Checklist measures were completed by carers for 100 children aged 5–10 years and 96 adolescents aged 11–17 years. The findings reinforced that the service was providing treatment to the intended cohort of C/YP in care with severe and/or complex mental health and/or social and emotional wellbeing concerns. As a measure of total mental health problems for children and adolescents, over 80% of the sample were in the clinical range. Female children displayed greater over-familiarity, affection-seeking and attention-seeking behaviours, and absence of personal boundaries in social relationships compared to males. Aboriginal and/or Torres Strait Islander adolescents were more emotionally withdrawn and displayed greater avoidant and non-reciprocal social behaviours than non-Indigenous adolescents. Although not a representative sample of Queensland C/YP in care, the data identified the complexity of social and emotional wellbeing challenges faced by some of those in care. The study highlighted the importance of using assessment tools tailored to assess challenges that are often experienced by children and young people in care. Further, given the complexity, severity and breadth of symptom manifestation, the data highlighted a need for comprehensive individual, dyadic, and systematic therapeutic approaches.
Introduction : Youth with child welfare involvement face unique challenges associated with transition into adulthood and access to healthcare once they exit foster : care. Methods: Using longitudinal data between 2012 and 2022 from the Jim Casey Opportunity Passport Survey, this study explored if sociodemographic characteristics of foster youth alumni ( n = 2,420) were associated with differences in insurance coverage over time, and if foster youth alumni without insurance were more likely to forgo health care when needed. Results : Youth without insurance had lower odds of not seeking physical or health care even when they perceived a need. The overall likelihood of having health insurance coverage decreased over time for those assigned male at birth but not for those assigned female at birth. Results further indicate that Black, Indigenous and other People of Color (BIPOC) foster youth alumni were less likely to report having insurance relative to non-Hispanic White peers, and that LGBTQ + foster youth alumni assigned male at birth were more likely to be insured than their non-LGBTQ + male peers. Implications : Strategies for increasing health equity in relation to practice and policy are explored.
Research into the primary connections between child maltreatment and posttraumatic symptoms has centered on emotional dysregulation and especially trauma-related dissociation or psychological processes of compartmentalization and detachment. This study examined demographic, psychological, and clinical variables that may place maltreated youth at risk for experiencing various subtypes of traumatic dissociation. Participants included 102 gender and racially diverse youth aged 11–17 ( M = 14.10, SD = 2.12) years who were removed from home due to maltreatment. Higher- and lower-risk profiles were identified via classification and regression analyses for dissociative amnesia, absorption and imaginative involvement, passive influence, depersonalization and derealization, and total dissociative symptoms. Age, racial identity, and gender emerged as key demographic variables across models. Emotional reactivity, sense of relatedness, sense of mastery, and self-blaming thoughts emerged as key psychological variables across models. PTSD symptoms, separation anxiety, and combined anxiety scores emerged as key clinical variables across models. Results from the present study may have clinical implications for maltreated youth experiencing traumatic dissociation, particularly with respect to how certain variables clustered together in higher- and lower-risk profiles. Such nuances may support the need for more culturally sensitive and targeted assessment and treatment protocols for this population, particularly in venues that demand rapid clinical decision-making processes.
Background: Exposure to war in childhood and adolescence can have enduring effects on mental health, particularly posttraumatic stress disorder (PTSD). The long-term role of both wartime and postwar traumatic experiences, and the moderating influence of gender, remain insufficiently understood. Purpose: This study examined the contribution of potentially traumatic events (PTEs) during and after the Croatian Homeland War (1991–1995) to PTSD symptoms in adulthood, with attention to gender differences. Research Design: A cross-sectional, retrospective design was used to link childhood and adolescent trauma exposure to adult PTSD symptoms. Study Sample: Participants were 298 adults (197 women, 101 men) who were 3–18 years old during the war and currently living in three war-affected Croatian counties. Data Collection and/or Analysis: Self-report measures included sociodemographic characteristics, 26 PTEs experienced during or after the war, and PTSD symptoms (PCL-5). Analyses included correlations, multilevel linear mixed models, and multigroup structural equation modeling to test predictive effects and gender moderation. Results: Thirteen wartime and ten postwar PTEs were significantly associated with PTSD symptoms. Wartime exposure explained 11.7% of the variance, while combined wartime and postwar exposure explained 24.5%. Key predictors were sexual or nonsexual assault by a family member or known person and deprivation of food or water. Women reported more severe PTSD symptoms and showed greater vulnerability across contexts. Conclusions: Interpersonal violence and deprivation, rather than combat-related experiences, predicted adult PTSD. Gender-sensitive interventions that ensure safety, address deprivation, and strengthen caregiving are essential for supporting the long-term wellbeing of war-affected children.
Background: Child maltreatment is an international public health issue that requires interprofessional collaboration across all sectors providing services for children and families. Effective collaborative interprofessional responses are underpinned by professionals who are equipped with knowledge, skills and values to respond to children’s complex health, wellbeing and developmental needs. However, little is known about how health and welfare professionals are equipped during preservice education to prepare for interprofessional public health responses to child maltreatment. Purpose: Using a qualitative World Café approach, this study aimed to engage key professional stakeholders in discussions about what is needed in child protection interprofessional education for preservice health and welfare professionals in Australia. Research Design and Study Sample: Three online roundtables were held with a total of twenty-five participants, inclusive of nurses, midwives, and social workers, in education, research, and practice. Data Analysis: Inductive analysis identified how the interplay of broader political, sociocultural and regulatory factors results in failure to equip graduates for interprofessional public health responses to child maltreatment. Results: Key challenges included a perceived lack of leadership from governments, no shared interprofessional definitions, inadequate resourcing for early support, and local barriers to implementing interprofessional education. Coordinated national leadership by and across governments and professional regulatory bodies was identified as essential to underpin a shared vision and adequate resources for sustained change. Conclusions: As change gathers momentum, higher education institutions are optimally positioned to address challenges of interprofessional education for public health responses to child maltreatment for all professionals who will work with children. Ongoing commitment is needed across all sectors, including government, professional regulators and higher education, to establish a shared vision that underpins interprofessional understanding of roles and core knowledge, skills and values for graduates.
Background: Little is known about how alexithymia and loneliness might influence the connection between childhood emotional abuse (CEA) and nomophobia, and whether gender plays a role. Adolescence, a critical developmental stage in which emotional competencies, social relationships, and technology use patterns consolidate, can be considered a key period for understanding the pathways from early adversity to technology-related vulnerabilities. Purpose: Our study aims to investigate whether alexithymia and loneliness sequentially mediate the relationship between CEA and nomophobia in adolescence, and whether this mediation is invariant across genders. Research Design: A structural equation modeling (SEM) with latent variables was conducted to test the mediation model. Study Sample: A total of 1,032 adolescents (50% girls) aged 14–17 participated in the study. Data Collection and Analysis: Self-report questionnaires assessed CEA, alexithymia, loneliness, and nomophobia. Main analyses were controlled for background variables. Results : Findings showed significant links between all direct paths: CEA → alexithymia (β = .36), CEA → loneliness (β = .23), CEA → nomophobia (β = .11), alexithymia → loneliness (β = .23), alexithymia → nomophobia (β = .33), loneliness → nomophobia (β = .23). Furthermore, significant links were found between all indirect paths, and gender invariance of the model was also confirmed. Conclusions : These results suggest that emotionally abused adolescents with high levels of alexithymia and feelings of loneliness may be more likely to experience nomophobic behaviors. Consequently, developing interventions targeting alexithymia and loneliness could be beneficial in preventing and managing nomophobia in emotionally abused adolescents. Further implications are discussed.
Mental health is a key issue for forcibly displaced youth. The evidence base on the mental health of youth forcibly displaced since the start of the pandemic is undefined, as well as sources of stressors and coping approaches. This systematic review aims to identify literature on the mental health of forcibly displaced youth in low- and middle-income settings, with focus on displacement since the advent of the COVID-19 pandemic. Objectives are to examine (1) sources of stress, (2) prevalence and covariates of common mental disorders (CMDs) and (3) coping approaches. Six databases were searched in February 2023. Search terms focused on CMDs, stress and forcibly displaced populations. Articles based on data collected after the onset of the COVID-19 pandemic focused on forcibly displaced persons aged 10-29 were included. Quantitative observation and intervention studies reporting CMD prevalences and related concepts were included, as were qualitative studies about stressors and/or coping approaches. Prevalences of CMDs and covariates were tabulated. Inductive thematic coding was conducted on qualitative data on stressors and coping. Interpretation of coping data was guided by a taxonomy including problem solving, support seeking, distraction/avoidance and positive cognitive restructuring. Twenty-one articles were included. Economic issues were the most prominent source of stress and led to subsequent stressors. Depression and anxiety symptom prevalence ranged from 6.2% to 77.4% and 17.2%-32.8% respectively. Problem-solving and support seeking were the most common coping approaches. Supporting the mental health and coping approaches of this marginalised group is critical to recovery in the post-COVID era.
Background: Adolescents in foster care often have had risk factors and critical life events in their biographies. However, little is known about their coping with developmental tasks and psychosocial adjustment in adolescence. The current study examines the identity development and problem burden of adolescents in out-of-home care compared to a control group. Methods: The sample consists of 30 adolescents, living in foster families and their biological families. The control group was matched with regard to gender, age and school education. The youths were between 13 and 17 years old. We examined adolescents’ identity dimensions using the Utrecht-Management of Identity Commitments Scale (Crocetti et al., 2010). Psychosocial adjustment was assessed using the Strength and Difficulties Questionnaire (Goodman et al., 2003). Results: Our findings indicate a significantly lower commitment in foster adolescents compared to the control group. No differences were found in reconsideration of commitment and exploration. Various dimensions of identity development were associated with the problem burden. Discussion: Results indicate that adolescents in foster care were faced with challenges in coping with the central developmental task of identity formation. Identity development, especially in terms of commitment, seems to be more complex for youths living in foster homes. Hence, supporting services should pay attention to foster adolescents’ needs regarding their identity development, long-term perspectives and constructing a coherent autobiographical story.
Purpose: This systematic literature review examines the differences in mental health outcomes among children exposed to intimate partner violence, focusing on age and gender variations. Background: While much of the existing research has centered on adult victims of IPV, fewer studies have systematically analyzed its effects on children and how these impacts differ based on developmental stages and gender. Design and Sample: Following PRISMA guidelines, this systematic review evaluates 25 quantitative studies published from 2007 to 2024, with sample sizes ranging from small cohorts of 41 children to larger groups exceeding 5,000 participants. Results: The findings indicate that younger children exposed to IPV often face immediate behavioral issues and cognitive disruptions. In contrast, older children are more likely to experience complex emotional challenges, including depression, anxiety, and post-traumatic stress disorder (PTSD). Gender differences are also apparent: boys typically display externalizing behaviors such as aggression, while girls are more prone to internalizing their distress, leading to higher rates of anxiety and depression. Conclusions: These patterns suggest that socialization and coping mechanisms vary significantly by gender. This review emphasizes the need for age- and gender-responsive interventions tailored to the specific mental health needs of children. It advocates for resilience-building, emotional regulation, and supportive coping strategies.
While many studies have shown that adoptees develop more positively than peers placed in other types of care, less is known about whether these outcomes are influenced by initial differences in family circumstances. This study investigates whether family circumstances before childbirth predict infant domestic adoption compared to out-of-home care. Using Firth logistic regressions (penalized Maximum Likelihood logistic regressions) on Danish administrative data from the 1998-2004 birth cohorts, we examine how family circumstances are associated with adoption versus out-of-home care placement before age one (n = 1,348). Our results show that initial differences in family circumstances such as parents’ age at childbirth, parents’ cohabitation status, parents’ education, parents’ crime history, mother’s employment, and mother’s mental health are associated with the probability of adoption before age one compared to out-of-home care placement before age one. These findings suggest potential selection bias in previous studies on adoption that have not taken pre-adoption differences into account, indicating a need for further investigation of this topic.
As a response to the substantial health problems and unmet needs among children in out-of-home care, a comprehensive health assessment was piloted in a Norwegian region, as the first of its kind in Norway. The current study is a follow-up of service use among children who received the assessment, designed to investigate the relationship between service recommendations and service contact with six services within the following year. Participants included children (ages 1–17 years) living in out-of-home care, who had received the health assessment ( N = 103, M age = 7.5 years). Baseline data on service recommendations were extracted from assessment reports, while data on service contact was collected through a survey to carers 12 months after the assessment. Bivariate analyses and logistic regression models tested associations between service recommendations and service contact. Results show that for low-threshold services within municipal primary health care, recommendations were associated with service contact (OR 5.0, [1.65–15.19] p = .001). For specialized mental and somatic health care and educational services, no associations between service recommendation and service contact were found. Around 40% of the children had been in contact with recommended specialized mental or physical healthcare services, and educational services at follow-up. The findings illustrate the failure of the existing service systems in meeting the severe health challenges of this high-risk child population. This has implications for assessment practices, child welfare services referral routines and interagency collaboration, and may indicate a need for specialized organizational solutions to provide necessary services to children in out-of-home care.
Background: Leaving the care system heightens the vulnerability of care experienced young people (CEYP), and all-too-often signals a cliff-edge in support. There is a lack of evidence-based psychological interventions for CEYP and they face numerous challenges in accessing what is available. Objectives: This study explored the feasibility, accessibility, acceptability, and outcomes of a novel intervention – DISCOVER “Getting the Life You Want” (GtLYW) – that has been developed for and with CEYP aged 16–19. GtLYW is rooted in psychological theory and coaches CEYP in skills to boost their emotional wellbeing. Method: GtLYW was evaluated using a mixed methods design. YP completed emotional wellbeing measures pre- and post-intervention, as well as giving feedback about taking part. Social care professionals completed a semi-structured interview and their responses were examined using interpretive phenomenological analysis. Results: Twenty-one CEYP were referred to GtLYW, ten signed up to take part and seven completed the programme. GtLYW was not associated with change in depression or wellbeing, but there were significant improvements in anxiety (t(6) = 3.34, p = .016) and mindfulness (t(6) = −4.84, p = .003) over time. Five social care professionals reflected on their experiences of GtLYW, including access barriers that CEYP face, valued intervention characteristics and ways to enable more meaningful engagement. Conclusions: Promising outcome data and feedback from CEYP and social care staff indicate that GtLYW warrants larger-scale investigation. Future ways to improve GtLYW uptake and delivery are discussed that also have value for any emotional wellbeing support offered to this at-risk group.
