A growing proportion of children entering state care are born to mothers involved in recurrent care proceedings; a group often characterised by trauma, social disadvantage, and low trust in services. Although a range of interventions have been developed to prevent care entry and support reunification, there remains limited understanding of how and why these approaches operate within complex child protection systems.This study reports a four-stage realist synthesis of 108 academic and grey literature sources to examine what works, for whom, and in what contexts to prevent care entry and enable reunification for mothers at risk of recurrent proceedings. Programme theory development was informed by three stakeholder advisory groups comprising mothers with experience of child removal, practitioners, and academic experts.Findings show that outcomes are shaped not only by individual interventions, but by how these interact with the relational and organisational dynamics of child protection systems. Trauma is conceptualised as both relational and systemic, emerging through interactions between individual experiences and the high-threat, low trust dynamics of child protection systems and influencing interactions between mothers, practitioners, and multi-agency teams. Two key mechanisms underpin improved outcomes: (1) a relational bridge, wherein a trusted practitioner supports communication and shared understanding between mothers and professionals; and (2) a neutral outsider, who promotes fairness, redistributes power, and aligns multi-agency working around shared goals. These mechanisms may be particularly important for women who experience structural disadvantage. Where these mechanisms are absent, interventions may either engage mothers without achieving credible risk reduction or manage risk in ways that undermine engagement.The findings highlight the importance of designing child protection services that build trust, clarify roles, and support coordinated decision-making across agencies. By providing a practice-relevant explanatory framework, this study contributes to understanding how services can better prevent unnecessary care entry and support safe, sustainable reunification, with implications for improving outcomes for children and families.

We explored disabled birthing parents' fear of, and involvement with, child protective services in the perinatal period, including how such experiences impacted their prenatal, birth, and postpartum care. Birthing parents with a physical, sensory, and/or intellectual or developmental disability were recruited in Ontario, Canada, and completed semi-structured interviews about their perinatal care experiences. Using an interpretive phenomenological analysis approach, the following themes were constructed among 11 participants. Participants described being labelled as an 'instant red flag', with assumptions from perinatal health care providers about their parenting impacting their perinatal care experiences. They remembered 'jumping through hoops' to prove themselves as parents, describing unrealistic expectations from child protective services and noting that such services often hindered their early parenting abilities. Finally, they identified that 'no one helps us', pointing out a lack of tailored support to facilitate parenting and newborn care and scepticism towards perinatal service involvement. Our findings show the need for systemic reform in the practices and policies of child protective services, enhanced disability training for perinatal health care providers and social service professionals, and tailored services and strengthened informal support networks for prospective and new parents with disabilities.

IntroductionLinkage of public law family court care proceedings (CP) data to all women giving birth in NHS hospitals in England allows calculation of the cumulative incidence of CP involvement for mothers with first children born. ObjectivesTo assess linkage accuracy and determine the 10-year cumulative incidence of CP after a first live birth (FLB) for population subgroups. MethodNHS England linked records for mothers in Cafcass (Children and Family Court Advisory and Support Service) involved in CP (2007-2021) to all mothers with a delivery in England using Hospital Episode Statistics (HES: 1997-21). We calculated match rates and assessed indirect evidence of potential false positive and missed links. We used survival analyses to estimate cumulative incidence of CP within 10 years overall and for five-year maternal age groups at first live birth. ResultsOf 120,937 mothers involved in CP, 6.6% (n = 8,010) were excluded due to missing postcode or date of birth, or age < 15 or > 50. Of the remaining 112,927 mothers, 92,891 (82.8%) were linked to a HES delivery record. Match rates were lowest for mothers with an ethnic minority background, older at first case, or residing in Greater London, but improved over time. Of 3,572,737 mothers with a FLB, 38,462 had CP involvement. The cumulative incidence of CP at 10 years from FLB was 1.31% (95% Confidence Interval [CI]; 1.29-1.32) overall and highest in mothers aged 15--19 years (6.79%, 95% CI: 6.69-6.89) and those living in the most deprived areas (2.47%, 95% CI: 2.43-2.51). ConclusionOne in 77 of all mothers and one in 15 aged less than 20 at first live birth were involved in CP within 10 years. Linkage error may underestimate the incidence of CP for mothers in London or with an ethnic minority background.

Background Women with complex health needs are more at risk of having children’s social care involvement with their newborns than other mothers. Around the time of pregnancy, there are opportunities for health services to support women with these needs and mitigate the risk of mother–baby separation. Yet little is known about healthcare professionals’ experiences of providing this support.Methods We administered an online survey to perinatal healthcare professionals across England (n=70 responders), including midwives, obstetricians, perinatal psychologists/psychiatrists and health visitors. We asked about their experiences of providing care for pregnant women with chronic physical conditions, mental health needs, intellectual/developmental disabilities and substance use disorders, who might be at risk of children’s social care involvement. We conducted a framework analysis.Results We constructed five themes from participant data. These include (1) inaccessible healthcare for women with complex needs, (2) the challenges and importance of restoring trust, (3) services focusing on individuals, not families, (4) the necessity and caution around multidisciplinary support and (5) underfunded services inhibiting good practice.Conclusions Women who are at risk of children’s social care involvement will likely experience perinatal healthcare inequities. Our findings suggest that current perinatal healthcare provision for this population is inadequate and national guidelines need updated to inform support.

IntroductionRemoving a child from their family is the option of last resort for social services. However, decisions to place children into care are occurring more frequently and earlier in children's lives, with newborn discharge to social services being a particular concern due to the effects of mother-newborn separations on child development. Women with disabilities face negative assumptions about their parenting capacity, but little is known about their rates of newborn discharge to social services. ObjectivesTo examine the risk of discharge to social services among newborns of women with and without disabilities. MethodsWe conducted a population-based cohort study of singleton livebirths in Ontario, Canada, 2008-2019. We used modified Poisson regression to estimate the relative risk (RR) of discharge to social services immediately after the birth hospital stay, comparing newborns of women with physical (n = 114,685), sensory (n = 38,268), intellectual/developmental (n = 2,094), and multiple disabilities (n = 8,075) to newborns of women without a disability (n = 1,221,765). Within each group, we also examined maternal sociodemographic, health, health care, and pregnancy-related characteristics associated with the outcome. ResultsCompared to newborns of women without disabilities (0.2%), newborns of women with physical (0.5%; aRR 1.53, 95% CI 1.39-1.69), sensory (0.4%; aRR 1.34, 95% CI 1.12-1.59), intellectual/developmental (5.6%; aRR 5.34, 95% CI 4.36-6.53), and multiple disabilities (1.7%; aRR 3.09, 95% CI 2.56-3.72) had increased risk of being discharged to social services after the birth hospital stay. Within each group, the strongest predictors of the outcome were young maternal age, low income quintile, social assistance, maternal mental illness and substance use disorders, inadequate prenatal care, and neonatal morbidity. ConclusionsNewborns of women with disabilities are at increased risk of being discharged to social services after the birth hospital stay. These findings can be used to inform the development of tailored supports for new mothers with disabilities and their infants.

In a post-Covid context, the term presence has become the subject of renewed academic focus, amplified by mass phenomena such as Zoom fatigue and online classroom teaching. The prism of new materialism allows for a new reading of relationships between technology and human sensing, physical and virtual presence and copresence, with possible design implications: Current research in public health and social-environment discourse is interested in the effect of presence on well-being. As a theoretical framework, new materialism provides a lens that foregrounds complex relations between affect and technology, enabling us, through interventions like the KIMA: Colour participatory artwork, to interrogate the broad discourse on mediated presence and social connectivity. This paper provides an overview of the AHRC-funded research project, 'p_ART_icipate!', which is a collaborative investigation led by the University of Greenwich, CNWL NHS Foundation Trust, and Brunel University. This paper describes one of the case studies within the project, 'KIMA Colour', a collaboration with the art collective Analema Group, the National Gallery and the Royal National Institute of the Blind (RNIB). The case study explores the effect of collective cultural experiences and participatory art on a sense of social connectivity and copresence. In collaboration with RNIB and a group of visually impaired individuals, the team asked how we can design meaningful and accessible online interfaces that actively contribute to a sense of 'participatory presence'. Findings suggest a possible link between the experience, presence and social connectedness. This research aims to contribute to our understanding of participatory art and to provide recommendations for accessibility and facilitation designc for participatory online interfaces.

A range of professionals and services are often involved in supporting parents with mental health needs where there are child protection concerns. However, they do not always meet the needs of this population who tend to experience inadequate support and mistrust of services. This review aimed to synthesize parent and practitioner experiences of support for parents with both mental health needs and children's social services involvement. We performed electronic searches of the following databases: PsycINFO, CINAHL, HMIC, MEDLINE, Embase, Social Policy and Practice, Social Services Abstracts, Social Science Citation Index, OpenGrey, Social Care Online, and ProQuest. Following searching and screening, 41 studies were identified including 359 parents and 1370 practitioners. We worked with a Lived Experience Advisory Group to develop the following themes: (1) a downward spiral of service intervention; (2) working with parents, not against them; (3) support wanted versus support provided; and (4) constrained by service rigidity. We found that families were often parenting amidst trauma and adversity. However, service involvement could trigger a "downward spiral" of stressful processes over which parents felt they lacked control. Instead of improving their situations, support sometimes added to families' difficulties, worsening parents' mental health and making them feel marginalised, criticised, and retraumatised. There were, however, also examples of positive practice, where practitioners and parents developed trusting, open, and mutually respectful relationships. Practitioners often felt that they were limited in their ability to offer collaborative, holistic care because services were fragmented, underfunded, crisis driven, and inflexible. Difficulties mentioned most often by parents, such as financial issues, tended not to be a focus of available interventions. We conclude that the key issues identified must be targeted to improve support.

BACKGROUND:Mothers who have children removed from their care often have complex needs. These women have poor health outcomes and are dying earlier than their peers from preventable and amenable causes. Yet there is little known about how health care services might mitigate these risks. This study aimed to listen to the voices of women who had children removed from their care to understand their experiences of health and healthcare.METHODS:We used a narrative approach to collect and analyse interview data with six mothers who had experienced child removal in England. Each participant was asked to reflect on their life and main health challenges.RESULTS:Three narrative subplots were developed to consolidate experiences of unmet health need: (i) 'on paper you're normal': narratives of complex need, (ii) 'in my family, everyone had issues': narratives of whole family need and (iii) 'I'm still mummy, no matter where they are': narratives of maternal identity and health.CONCLUSIONS:Findings highlight limitations within current systems of support, including a culture of distrust and women falling between the gaps of services. Women's narratives illustrate opportunities for health intervention, especially immediately following child removal.

Background In the United Kingdom, schools play an increasingly important role in supporting young peoples' mental health. While there is a growing evidence base to support the effectiveness of school-based interventions, less is known about how these provisions impact on local Child and Adolescent Mental Health Service (CAMHS) referral rates. There is a concern that an increase in school-based provision might lead to an increase in CAMHS referrals and overwhelm services. We aimed to examine the longitudinal association between Place2Be counselling provision in primary schools on CAMHS referral rates in South London. Method This was a retrospective cohort study using linked data from the National Pupil Database (NPD) and CAMHS referrals to the South London and Maudsley's NHS Foundation Trust (SLaM) identified through the Clinical Record Interactive Search (CRIS) tool. The cohort included a total of 285 state-maintained primary schools in four London boroughs for the academic years of 2007-2012. During the study period, 23 of these schools received school-based mental health provision from Place2Be. The primary outcome was the incident rate ratio (IRR) of school-level accepted CAMHS referrals in 2012/13 in schools with, or without, Place2Be provision. Results There was no significant association between elevated rates of CAMHS referral and Place2Be provision, even after comprehensive adjustment for school-level and pupil characteristics (IRR 0.91 (0.67-1.23)). School-level characteristics, including higher proportion of white-British pupils (IRR 1.009 (1.002-1.02)), medical staff ratio (IRR 6.49 (2.05-20.6)) and poorer Ofsted school inspection ratings (e.g. IRR 1.58 (1.06-2.34) for 'Requires Improvement' vs. 'Outstanding') were associated with increased CAMHS referral rates. Conclusions Place2Be provision did not result in increased specialist mental health referrals; however, other school-level characteristics did. Future research should investigate pupils' Place2Be clinical outcomes, as well the outcomes of individuals referred to CAMHS to better understand which needs are being met by which services.

Objective: The objective of this review was to understand the scope of evidence relating to the use of telehealth for gross motor assessment tools in children 0-12 years of age. Background: Telehealth has been widely used by physiotherapists since the start of the Covid-19 pandemic, however, little is known about the validity and reliability of using gross motor assessment tools via telehealth. Gross motor assessment tools are used by physiotherapists to understand motor function, support diagnoses of motor disorders, and plan and evaluate interventions. Qualitative research identifies a lack of confidence by physiotherapists in undertaking physical assessment via telehealth. Method: A comprehensive search was undertaken of MEDLINE, Scopus, CINAHL, Physiotherapy Evidence Database (PEDro) and OTseeker in August 2022. Grey searching was also implemented. Two independent reviewers identified articles for inclusion and critically appraised the articles. Data was analysed using a narrative review. Results: 34 studies met the inclusion criteria.

ObjectivesOne in 8 pregnancies are to women with disabilities. These mothers can face additional social, structural, and health-related challenges, and negative health care provider assumptions about their parenting capacity. We aimed to examine rates of newborn discharge to child protection comparing newborns of mothers with and without a disability. MethodWe are conducting a population-based cohort study in Ontario, Canada using linked administrative health data. The cohort includes all women in Ontario with a live birth between 2003 and 2020. Diagnostic algorithms were applied to health care encounters prior to pregnancy to identify maternal disability. We will use modified Poisson regression to estimate the relative risk of discharge to child protection immediately after the birth hospital stay, comparing newborns of women with physical, sensory, developmental, and multiple disabilities to those without disabilities. Models will be adjusted for socio-demographic factors, antenatal care receipt, and maternal mental illness and substance use disorders. ResultsThe study cohort includes of over 1.4 million newborns delivered to women with physical disabilities (n=120,014), sensory disabilities (n=39,892), developmental disabilities (n=2,182), multiple disabilities (n=8,428), and no known disability (n=1,269,633). Analyses are ongoing and results will be concluded by the conference date. ConclusionEarly infancy is a critical period for breastfeeding and maternal-infant bonding. Findings will inform the development of tailored services and resources for supporting women with disabilities in antenatal care and after birth by identifying those most at-risk of child protection intervention, thus potentially reducing maternal-newborn separations.

There was no funding for this study.

Purpose: The purposes of the study are to (1) determine what barriers and facilitators physiotherapists perceive to using telehealth, (2) to determine willingness to use and (3) to determine perspectives on training in the use of telehealth. Method: This is a qualitative semi structured interview and focus group design. Participants were recruited from the first stage of the larger research process using purposive sampling. A semi structured guide was used to facilitate discussion of shared experiences and to allow themes to emerge from the discussion. Results: Thematic analysis was used to synthesise frequent and important themes. Ten participants took part in either a focus group (n=7) or interview (n=3). Nine main themes identified were split into barriers and facilitators. Facilitators were the right family, right child, adequate technology and space, and collaboration. Barriers were technology, time management, lack of physical touch, lack of organisational support, and work environment. Conclusion: Results suggest that physiotherapists working with children with developmental delay consider telehealth to be unsuitable to replace face-to-face therapy entirely but are willing to use it to provide follow up services to the right family and the right child. Physiotherapists in the study were positive about telehealth’s potential to improve services to children in rural areas. Physiotherapists said that specific physiotherapy training in telehealth was currently lacking.

Background Research in England suggests a high burden of mental health problems and substance misuse among women whose children enter care. Family courts therefore need to consider timely support for parental mental health and likely time to recovery within public family law proceedings concerning placement of a child into care (‘care proceedings’). We report population-based evidence from linked, routinely collected, de-identified records on the type and severity of maternal mental health problems in relation to care proceedings. Methods We linked family court data and mental health service records for 2137 (66%) of women involved in care proceedings between 2007-2019 in the South London and Maudsley NHS Mental Health Trust (SLaM) catchment area. We compared their mental health service use and risk of dying with 17,096 female matched controls who accessed SLaM between 2007 and 2019, aged 16-55 years old. Results Most women (79%) were known to SLaM before care proceedings began. Compared to the matched controls, women had higher rates of schizophrenia spectrum disorders (19% vs 11% matched controls), personality disorders (21% vs 11%), and substance misuse (33% vs 12%). They were more likely to be admitted to a SLaM inpatient unit (27% vs 14%) or to be sectioned under the Mental Health Act (19% vs 8%). Finally, women had a 2.15 (95% CI: 1.68 to 2.74) times greater hazard of dying, compared with the matched controls, adjusted for age. Conclusions Given the high prevalence and severity of mental health problems among women involved in care proceedings, family law and social care policy is needed to ensure adequate and timely treatment for parent mental health problems. The increased risk of dying among those accessing mental health services highlights the critical need for post-proceeding services to ensure parents whose children enter care continue to receive support after care proceedings conclude.

Child Health Research Charitable Incorporated Organisation PhD Studentship (award number 563654) and in part by the NIHR Great Ormond Street Hospital Biomedical Research Centre.

Abstract Objective To identify the attitudes and perspectives of speech pathologists, occupational therapists and physiotherapists on using telehealth videoconferencing for service delivery to children with developmental delays. Design Systematic Literature Review. Method An electronic search of databases Scopus, CINAHL, MEDLINE, PEDro, Speechbite, OTseeker and ScienceDirect was undertaken in October 2020. Articles were compared with eligibility criteria by 2 authors. All articles were appraised for quality and level of evidence. Findings Fourteen studies were deemed to be eligible. Results were synthesised using a narrative analysis. The themes identified were technology, self‐efficacy, replacement of face‐to‐face services, time management, relationships, access and family‐centred care. Each of these themes was seen as both a potential barrier and a facilitator when trying to provide services via telehealth. Conclusions The results in this review cannot be generalised due to small sampling size, low response rates, lack of maximum variation sampling and under‐representation of occupational therapists and physiotherapists. Study design was either mixed‐methods survey or interview or only survey or interview. Risk of bias in studies was high. Further research is required including comparison studies and cost‐benefit analysis.

BACKGROUNDAround a third of people with schizophrenia or related serious mental illness will be a parent. Both the parents and the children in this population are at increased risk of adverse outcomes due to parental mental illness. Parenting interventions are known to improve parenting skills and decrease child disruptive behaviour. This systematic review aimed to synthesise the evidence base for parenting interventions designed specifically for parents who have schizophrenia or related serious mental illness.OBJECTIVESTo assess the effects of parenting interventions for people with schizophrenia or related serious mental illness.SEARCH METHODSOn 10 February 2021 we searched the Cochrane Schizophrenia Group's Study-Based Register of Trials, which is based on the following: Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), ClinicalTrials.Gov, Embase, International Standard Randomised Controlled Trial Number (ISRCTN), MEDLINE, PsycINFO, PubMed, and the World Health Organization International Clinical Trials Registry Platform.SELECTION CRITERIAEligible studies were randomised controlled trials (RCTs) that compared parenting interventions with a control condition for people with schizophrenia or related serious mental illness with a child between the ages of 0 and 18 years.DATA COLLECTION AND ANALYSISWe independently inspected citations, selected studies, extracted data and appraised study quality. We assessed risk of bias for included studies.MAIN RESULTSWe only included one trial (n = 50), and it was not possible to extract any data because the authors did not provide any means and standard deviations for our outcomes of interest; they only reported whether outcomes were significant or not at the 0.05 level. Three domains of the trial were rated as having a high risk of bias.AUTHORS' CONCLUSIONSThe only included trial provided inconclusive evidence. There is insufficient evidence to make recommendations to people with schizophrenia (or related serious mental illness) or clinicians, or for policy changes. Although there is no RCT evidence, parenting interventions for people with schizophrenia or related serious mental illness have been developed. Future research should test these in RCTs in order to improve the evidence base for this population.

Background : The use of new technologies and methodologies in young people’s mental health research is needed to allow more frequent and reliable sampling. Mobile applications and e-platforms create exciting potential for the collection of large-scale cohort data, however there are various feasibility and ethical issues to consider. Consultation with young people is needed to inform the research agenda, and ensure these technologies are engaging, useful and safe. This article describes the process of Public and Patient Involvement (PPI) with a sample of young people in London, with the aim of i) informing the development of a mood-monitoring e-platform, and ii) providing feedback and advice for researchers developing web-based technologies in the mental health field. Methods : A total of 26 young people were consulted across four advisory group sessions. All young people were students enrolled at one of the participating London based sixth form colleges, and voluntarily attended a workshop session. Audio recordings of the sessions were analysed using a theory driven thematic analysis framework. Results: Young people were generally receptive to e-health technologies and valued the opportunity to collaborate throughout the development process. The advisory groups identified key considerations for future web-development work to encourage engagement and prolonged use, including, the promotion of trust and transparency, consideration of accessibility, provision of support, production of engaging and functional design, and acknowledgment of specific contextual influences surrounding young people’s wellbeing. Conclusions : Involving young people in the development process of e-health technologies contributes to optimising the successful adoption and prolonged usage of new methodologies. The thematic map outlines can be used to inform researchers interested in developing web-based technologies in the mental health field and will be directly applicable to the development of a mood-monitoring e-platform.

Background : The use of new technologies and methodologies in young people’s mental health research is needed to allow more frequent and reliable sampling. Mobile applications and e-platforms create exciting potential for the collection of large-scale cohort data, however there are various feasibility and ethical issues to consider. Consultation with young people is needed to inform the research agenda, and ensure these technologies are engaging, useful and safe. This article describes the process of Public and Patient Involvement (PPI) with a sample of young people in London, with the aim of i) informing the development of a mood-monitoring e-platform, and ii) providing feedback and advice for researchers developing web-based technologies in the mental health field. Methods : A total of 26 young people were consulted across four advisory group co-design sessions. All young people were students enrolled at one of the participating London based sixth form colleges, and voluntarily attended a workshop session. Audio recordings of the sessions were analysed using a thematic analysis framework. Results: We found that young people were engaged in discussions around mobile health technologies and valued the opportunity to collaborate throughout the early stages of the development process The advisory groups identified key considerations for future web-development work to encourage engagement and prolonged use, including, the promotion of trust and transparency, consideration of accessibility, provision of support, production of engaging and functional design, and acknowledgment of specific contextual influences surrounding young people’s wellbeing. Conclusions : Involving young people in the development process of e-health technologies contributes to optimising the successful adoption and prolonged usage of new methodologies. The thematic map and informant examples can be used to guide researchers interested in developing web-based technologies in the mental health field and will be directly applicable to the development of a mood-monitoring e-platform.