Care-experienced children and young people (CYP), for example, those who have been under state care through foster, kinship, or residential placements, or adopted from care, experience disproportionately high levels of mental health difficulties. Yet little is known about the forms of social support that may protect or promote their mental health and well-being (MHW). This scoping review mapped the international evidence on the types, sources, and quality of MHW-related social support for this population. Seven bibliographic databases were systematically searched for English-language, peer-reviewed studies published from 2008 onward in high-income countries. Eligible studies included quantitative, qualitative, mixed-methods, and intervention designs that examined social support for care-experienced CYP aged ≤25. Study selection followed scoping-review methodology and PRISMA-ScR guidelines. Data were summarised using descriptive numerical mapping and qualitative thematic synthesis. Young people with lived experience contributed to interpretation and identification of priorities. A total of 246 study reports met the inclusion criteria, representing research from 13 countries, most commonly the United States (60%) and United Kingdom (13%). Emotional support was the most frequently examined type, followed by tangible, esteem, and informational support. Foster carers, birth families, peers, and professionals were the most common sources. High-quality support characterised by trust, empathy, and stability was consistently associated with better MHW, though many relationships were shaped by complexity. Evidence was limited regarding special guardianship and romantic partners. Findings highlight the need for holistic, relationship-centred approaches to promote the MHW of care-experienced young people.

Conservatoire music students experience a range of demands including performance, academic, and interpersonal demands. If not effectively managed, demands may lead to stress and negative well-being outcomes. This qualitative study explored conservatoire music students' experiences of occupational stress and well-being, informed by a transactional stress theory. Six conservatoire music students were purposively selected to participate in semi-structured interviews. Participants discussed two stressful events: one perceived positively and a second perceived negatively. Interpretative Phenomenological Analysis was adopted and five themes developed: (a) Performance Demands; (b) Organisational Demands; (c) Relationship Demands; (d) Academic Demands; and (e) Multiple Demands. Participants commonly appraised demands as a threat. A smaller number of challenge or benefit appraisals were reported, with few harm or loss appraisals. Key underlying properties of stress appraisal were self and other comparison, preparation, and novelty. Participants highlighted the personal resources, psychological skills and problem-solving, and the organisational resource of social support to manage stressful experiences. Well-being outcomes related to stress appraisals. This study provides insight into the intra-individual processes related to occupational stress and well-being of conservatoire music students. Findings suggest interventions targeting the conservatoire culture and curriculum need exploring to create a positive learning culture and support students to cope with demands.

BACKGROUND:Volunteering is a recognised component of palliative and end-of-life care. The impact of volunteering on palliative care volunteers and their role in specific settings has been reviewed. The impact of volunteers is becoming increasingly relevant in light of the growing demand for palliative care internationally. AIM:Explore the roles and impact of volunteers in palliative care on the wellbeing, mental health, physical health, satisfaction with care, and service use of patients and unpaid carers. DESIGN:Mixed studies systematic review. Protocol registration PROSPERO: CRD42024560700. DATA SOURCES:The following databases were searched from 2013 to 2025: AMED, CINAHL, Embase, PsycINFO, HMIC, Web of Science, ProQuest Dissertations and Theses, International Biography of Social Sciences, Cochrane Library. Eligible studies included adults with a terminal illness, their family members or unpaid carers participating in volunteering interventions. Critical appraisal was conducted using Joanna Briggs Institute tools. RESULTS:Twenty-nine reports relating to 24 studies were included. Volunteering roles included peer support, befriending, information provision, arts-based interventions, and practical support. Volunteering interventions positively impacted patients' hedonic wellbeing, quality of life, and mental health. For eudaimonic wellbeing, quantitative data demonstrated mixed results, while qualitative studies suggested improved social connection. For unpaid carers, there was limited quantitative evidence of impact on wellbeing. Qualitative data indicated interventions were beneficial in supporting advocacy and were well received. CONCLUSIONS:Qualitative data indicated volunteering interventions were well received by patients and unpaid carers. Quantitative studies were limited by small sample sizes but demonstrated positive trends. Little evidence that volunteering was associated with harm.

Introduction:Adult social care in the UK faces increasing demand and persistent inequalities in terms of access and care quality, yet national-level understanding remains limited. The CARE Lab study aims to address these gaps using newly available individual-level routine administrative data for the whole of Wales from the Adults Receiving Care and Support (ARCS) census. This study will explore patterns of care provision, transitions from children's to adult services, and socio-demographic disparities, using linked data to inform service planning and policy. Methods:and analysis This quantitatively-led mixed-methods study comprises five research questions. Quantitative analysis will use ARCS census data, both standalone and linked to health, education, and social care datasets within the Secure Anonymised Information Linkage (SAIL) Databank. Qualitative interviews with people receiving care and support, carers, and professionals will contextualise findings. Key research questions address care patterns, demographic comparisons, regional variation, transitions from child to adult care, and the feasibility of evaluating care models using linked data. Statistical analyses will include descriptive and inferential statistics, propensity score matching, and there will be thematic analysis of qualitative data. Ethics:Ethical approval has been obtained from Cardiff University. Data access approvals will be sought from Welsh Government, SAIL, and the Office for National Statistics. Dissemination will occur through peer-reviewed publications, policy briefings, accessible multimedia outputs, and stakeholder engagement via an action group. The study will also produce a research-ready data asset and recommendations for future data infrastructure development across the UK.

Summary Meetings to enhance shared decision-making, such as family group conferences, potentially contribute to enhancing meaningful involvement of families. Such meetings are also claimed by some to reduce the need for children to be in care, either by increasing support from family for parents or by identifying care from within the family network. This rapid realist review aims to develop an understanding of how meetings that facilitate shared decision-making between professionals and families might work to safely reduce the need for children to be in care. It identifies mechanisms that are thought to make a difference and contextual factors that influence the impact of identified mechanisms. Findings A comprehensive search of academic and gray literature identified 64 documents spanning seven types of shared decision-making meetings. Data from these papers were collected using an iterative process of juxtaposition, comparison, contrast, and combination with a developing program theory. Data from the literature was supplemented with consultation to ensure relevance to the UK setting. The review identified three key mechanisms that made shared decision-making meetings more likely to be effective in safely reducing children's entry to care: enabling participation and engagement; building trust and reducing shame; enabling participation in decision-making processes. It describes how these work before, during, and after meetings. Applications The findings help us understand the complicated research findings about the relationship between meetings and care entry and provide a theory about what is needed to make such meetings work that is of practical use for practice and future research

This article presents a review and map of program theories used in mental health and well-being interventions tested with care-experienced children and young people (foster care, kinship care, residential care). Program theories are important in knowing how interventions should bring about change, how they might be implemented, and how they will be influenced by contextual factors. Currently, we do not fully understand if and how interventions are using program theories. We synthesized the international evidence base for interventions targeting subjective well-being, mental health, and suicide-related outcomes among care-experienced individuals aged ≤ 25 years. We identified interventions’ theories of change, implementation theories, and context theories. Study reports were retrieved through 16 electronic databases and 22 websites, expert recommendations, citation tracking, and screening of systematic reviews. We charted interventions and their associated theories, constructing narrative, and visual summaries. We further conducted stakeholder consultations to identify which theories should be prioritized in the UK. The review identified 13 interventions, with 24 study reports. Most interventions primarily drew on interpersonal theories of change ( n = 12), notably Attachment, Positive Youth Development, and Social Learning Theory. These targeted mental health, behavioral, or neurodevelopmental disorders, with minimal focus on well-being or suicide-related outcomes. Reports were limited by a lack of theoretical clarity and coherency, scare implementation and context theories, and minimal stakeholder involvement in theory development. Future interventions need to explicitly articulate their program theory. Stakeholders suggested drawing on theories that will help interventions strengthen relationships and bring about structural change.

Background: The mental health and well-being of care-experienced children and young people remains a concern. Despite a range of interventions, the existing evidence base is limited in scope, with a reliance on standalone outcome evaluations which limits understanding of how contextual factors influence implementation and acceptability. The Care-experienced cHildren and young people's Interventions to improve Mental health and wEll-being outcomes Systematic review (CHIMES) aimed to synthesise evidence of intervention theory, outcome, process and economic effectiveness. This paper reports the process evaluation synthesis, exploring how system factors facilitate and inhibit implementation and acceptability of mental health and wellbeing interventions for care-experienced children and young people. Methods: Sixteen databases and 22 websites were searched between 2020 and 2022 for studies published from 1990 and May 2022. This was supplemented with contacting experts in the field, citation tracking, screening of relevant systematic reviews and stakeholder consultations. We drew on framework synthesis of qualitative data and incorporated a systems lens, taking account of contextual influences across socio-ecological domains. Quality appraisal assessed reliability and usefulness. Confidence in synthesised findings was assessed with the GRADECERQual tool. We report the review in accordance with relevant elements of both the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA), and the Enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) checklist. Results: Searches retrieved 15,068 unique study reports, and 23 of these were eligible for process evaluation synthesis, reporting on sixteen interventions. Studies were published between 2003 and 2021. Nine interventions were from the UK and Ireland, six interventions were from the USA, and one was from Australia. They were largely classified as interpersonal, where the aim was to modify carer-child relationships. Five key context factors were identified that supported and prohibited intervention delivery: (1) lack of system resources; (2) intervention burden, which encompasses the time, cognitive, and emotional burden associated with implementation and participation; (3) interprofessional relationships between health and social care professionals; (4) careexperienced young people's identity; and (5) carer identity. Conclusion: We identified several supportive and restrictive factors across social and health care systems that may impact intervention implementation and acceptability. Key implications include: the importance of involving diverse stakeholders in intervention development and delivery; the need to better resource and support those involved in interventions, particularly training and support for carers; and ensuring future evaluations integrate process evaluations in order to optimise interventions.

IntroductionProfessional classical musicians operate within a highly demanding environment, which includes organizational, social, and emotional demands. When not effectively coped with, these demands may cause stress and negatively impact well-being. This qualitative study explored the perceived stress and well-being experiences of professional classical musicians through a transactional theory of stress. The study employed a double hermeneutic interpretation of the lived experiences of the perceived demands faced, stress appraisals made, resources used, and the influence on well-being.MethodsSix professional classical musicians were purposefully selected for participation. Semi-structured interviews were conducted and participants reflected on two events: one they perceived as a positive experience and one that was negative. Transcripts were analyzed using Interpretative Phenomenological Analysis and Group Experiential Themes emerged.ResultsThree Group Experiential Themes were identified: (a) Performance Demands; (b) Organizational Demands; and, (c) Relationship Demands. Participants predominantly appraised demands as a threat. A small number of demands were appraised as a challenge or benefit, and the fewest demands were appraised as causing harm or loss. Participants’ appraisals were informed by underlying properties of stress appraisal such as self and other comparison, and preparation. Participants often relied on personal resources as opposed to available workplace resources. They perceived well-being to relate to stress appraisals with participants experiencing acute and long-term outcomes.DiscussionThis study offers insight into the lived experience of the occupational stress process within professional classical musicians. The findings demonstrate that organizational interventions targeted at continuing professional development and social support are appropriate to help musicians cope more effectively with demands.

IntroductionProvision of school- and community-based counselling services differs in terms of funding, implementation and eligibility criteria across the UK. The existing evidence of the effectiveness of counselling services is mixed, with little consideration of service context, implementation or acceptability. This rapid review seeks to address the gaps in the extant evidence syntheses by exploring the effectiveness, implementation and acceptability of school- and community-based counselling services in the UK. MethodsA systematic literature search was conducted in five electronic databases. Grey literature searches were conducted in 23 national government and third-sector organisational websites. The searches focussed on studies examining counselling interventions aimed at children aged 7-18 years that examined either effectiveness, implementation, acceptability or context. ResultsFifty-four studies were included in the review. The few RCT studies suggest that there is no clear evidence of effectiveness of the therapeutic approach, due to mixed findings. There is some tentative evidence for weaker study designs that counselling may have positive impacts across different settings. The service is highly valued by learners, teachers and parents and is believed to improve well-being; however, it is often seen as a discrete service that is not well-embedded within the education system. ConclusionsThere is mixed evidence for the effectiveness of school- and community-based counselling. However, this needs to be understood in the context of acceptability and implementation. Future work is needed to improve the implementation of services by considering the wider complexity of the systems in which these services are embedded.

Background:Children and young people with experience of being in care (e.g. foster care, kinship care, residential care or at home with a supervision requirement order) are at higher risk of adverse mental health and well-being outcomes compared to the general population. Despite a range of policy recommendations and interventions, it is not clear what approaches are effective in the United Kingdom, or how context factors give rise to facilitators and inhibitors of implementation and acceptability. Objectives:The CHIMES review is a complex-systems-informed mixed-method systematic review that aimed to synthesise the international evidence base for interventions addressing the mental health and well-being of care-experienced children and young people (age ≤ 25 years) and to assess the potential transportability of this evidence base to the United Kingdom context. Data sources:We searched 16 electronic bibliographic databases and 22 websites from 1990 to May 2022. We conducted citation tracking, screened relevant systematic reviews and contacted international experts. Method:We used a convergent synthesis design. We first constructed an evidence map to confirm review scope before undertaking method-level syntheses for outcome evaluations, process evaluations and economic evaluations. These elements were integrated into a review-level synthesis to identify potential evidence-based interventions that may progress to further development, adaptation and evaluation in the United Kingdom. We conducted stakeholder consultations to prioritise intervention theories, types and outcomes. Results:We identified 64 interventions from 124 study reports. Interventions were primarily evaluated in the United States and targeted young people's competencies or carers' parenting practices. Meta-analysis reported limited evidence that interventions effectively improved mental health in the shorter term (0-6 months): total social, emotional and behavioural problems (d = -0.15, 95% confidence interval -0.28 to -0.02); internalising problem behaviours (d = -0.35, 95% confidence interval -0.61 to -0.08); externalising problem behaviours (d = -0.30, 95% confidence interval -0.53 to -0.08); depression and anxiety (d = -0.26, 95% confidence interval -0.40 to -0.13) and social-emotional functioning difficulties (d = -0.18, 95% confidence interval -0.31 to -0.05), but these impacts were not observed in the longer term (> 6 months). Five key context factors potentially explain challenges to implementation and acceptability: lack of system resources; the time, cognitive and emotional burden of delivery or participation; interprofessional tensions; the devaluing of young people, meaning that they felt unable to express dissatisfaction with interventions; and the devaluating of carers' expertise and needs. From the evidence, stakeholder consultation identified two priority interventions: (1) mentoring by individuals with knowledge and experience of care and (2) system and ethos change to create harmonisation between organisations and facilitate interprofessional relationships. Well-being and suicide-related behaviours are priority outcomes alongside mental health. Limitations:The review was limited by a paucity of theory and economic evaluations, so it is unclear how interventions might function or their potential cost-effectiveness. Interventions were insufficiently described, making it challenging to map the evidence base. Outcome evaluations were poorly reported. Due to ongoing restrictions with COVID-19, stakeholder consultations were conducted later than intended with a smaller number of attendees. Conclusions:The review identified some evidence for interventions impacting mental health in the short term. There is a lack of system-level interventions and approaches that target subjective well-being and suicide-related outcomes. Future intervention might prioritise mentoring and targeting system culture. Study registration:This study is registered as PROSPERO CRD42020177478. Funding:This award was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (NIHR award ref: NIHR129113) and is published in full in Public Health Research; Vol. 12, No. 14. See the NIHR Funding and Awards website for further award information.

The mental health and wellbeing of children and young people who have been in care, primarily foster care, kinship care or residential care, remains a public health priority. The Care-experienced cHildren and young people’s Interventions to improve Mental health and wEll-being outcomes Systematic review (CHIMES) synthesized evidence for the effectiveness of interventions targeting: subjective wellbeing; mental, behavioral and neurodevelopmental disorders; and suicide-related outcomes. Searches were conducted in 16 bibliographic databases and 22 websites between 1990 and 2022. This was supplemented by citation tracking, screening of relevant systematic reviews, and expert recommendation. We identified 35 interventions, with 44 evaluations via randomized controlled trials. Through meta-analyses, we found that interventions have a small beneficial impact on a variety of mental health outcomes in the short term (0–6 months). Interventions improved total social, emotional, and behavioral problems ( d = −0.15, 95% CI [−0.28, −0.02]), social-emotional functioning difficulties ( d = −0.18, 95% CI [−0.31, −0.05]), externalizing problem behaviors ( d = −0.30, 95% CI [−0.53, −0.08]), internalizing problem behaviors ( d = −0.35, 95% CI [−0.61, −0.08]); and depression and anxiety ( d = −0.26, 95% CI [−0.40, −0.13]). Interventions did not demonstrate any effectiveness for outcomes assessed in the longer term (>6 months). Certainty of effectiveness was limited by risk of bias and imprecision. There was limited available evidence for interventions targeting subjective wellbeing and suicide-related outcomes. Future intervention design and delivery must ensure that programs are sufficient to activate causal mechanisms and facilitate change. Evaluation research should use a robust methodology. PROSPERO Registration: CRD42020177478

Children and young people with care-experience (e.g. foster, kinship and residential care) report poorer mental health and wellbeing than the general population. Despite an emerging evidence-base for intervention, it is not clear if current approaches create, exacerbate or mitigate outcome inequities between different types of participants. We conducted a systematic review of international interventions targeting mental health, subjective wellbeing and suicide-related outcomes amongst care-experienced children and young people aged up to 25 years old. The review included a narrative synthesis of intervention inequities, exploring if they were more or less effective for different participant groups. Eight interventions, with 14 study reports, presented relevant data. Overall, there was no clear evidence that intervention participation could lead to inequitable impacts, being more or less effective for different groups. However, there was some tentative indication that individuals with lower exposure to maltreatment, fewer care placements, and increased baseline mental health problems, might be more responsive to intervention than other participants. There was limited evidence for wellbeing and no data availability for suicide. Future intervention evaluation should focus on assessing if there is potential to create, sustain or exacerbate inequities, and how approaches may be designed to mitigate this risk.

The mental health and wellbeing of care-experienced children and young people (i.e. foster care, kinship care, residential care) is poorer than non-care-experienced populations. The Care-experienced cHildren and young people’s Interventions to improve Mental health and wEll-being outcomes Systematic review (CHIMES) aimed to synthesise the international evidence base for interventions targeting subjective wellbeing, mental health and suicide amongst care-experienced young people aged ≤ 25 years. For the first phase of the review, we constructed an evidence map identifying key clusters and gaps in interventions and evaluations. Studies were identified through 16 electronic databases and 22 health and social care websites, in addition to expert recommendations, citation tracking and screening of relevant systematic reviews. We charted interventions and evaluations with a summary narrative, tables and infographics. In total, 64 interventions with 124 associated study reports were eligible. The majority of study reports were from the USA (n = 77). Interventions primarily targeted children and young people’s skills and competencies (n = 9 interventions), the parental functioning and practices of carers (n = 26), or a combination of the two (n = 15). While theoretically under-specified, interventions were largely informed by theories of Attachment, Positive Youth Development, and Social Learning Theory. Current evaluations prioritised outcomes (n = 86) and processes (n = 50), with a paucity of study reports including theoretical descriptions (n = 24) or economic evaluations (n = 1). Interventions most frequently targeted outcomes related to mental, behavioural or neurodevelopmental disorders, notably total social, emotional and behavioural problems (n = 48 interventions) and externalising problem behaviours (n = 26). There were a limited number of interventions targeting subjective wellbeing or suicide-related outcomes. Future intervention development might focus on structural-level intervention theories and components, and target outcomes related to subjective wellbeing and suicide. In accordance with current methodological guidance for intervention development and evaluation, research needs to integrate theoretical, outcome, process and economic evaluation in order to strengthen the evidence base. PROSPERO CRD42020177478.

AbstractThis is the protocol for a Campbell review. The objectives are as follows: To carry out a mixed methods review to summarise current evidence relating to the components of case‐management interventions for people experiencing homelessness.

Identifying which approaches can effectively reduce the need for out-of-home care for children is critically important. Despite the proliferation of different interventions and approaches globally, evidence summaries on this topic are limited. This study is a scoping review using a realist framework to explore what research evidence exists about reducing the number of children and young people in care. Searches of databases and websites were used to identify studies evaluating intervention effect on at least one of the following outcomes: reduction in initial entry to care; increase in family reunification post care. Data extracted from papers included type of study, outcome, type and level of intervention, effect, mechanism and moderator, implementation issues and economic (EMMIE) considerations. Data were coded by: primary outcome; level of intervention (community, policy, organisation, family or child); and type of evidence, using the realist EMMIE framework. This is the first example of a scoping review on any topic using this framework. Evaluated interventions were grouped and analysed according to system-level mechanism. We present the spread of evidence across system-level mechanisms and an overview of how each system-level mechanism might reduce the number of children in care. Implications and gaps are identified.

Introduction The mental health and well-being of children and young people who have been in care (ie, care-experienced) are a priority. There are a range of interventions aimed at addressing these outcomes, but the international evidence-base remains ambiguous. There is a paucity of methodologically robust systematic reviews of intervention effectiveness, with few considering the contextual conditions under which evaluations were conducted. This is important in understanding the potential transferability of the evidence-base across contexts. The present systematic review will adopt a complex systems perspective to synthesise evidence reporting evaluations of mental health and well-being interventions for care-experienced children and young people. It will address impact, equity, cost-effectiveness, context, implementation and acceptability. Stakeholder consultation will prioritise a programme theory, and associated intervention, that may progress to further development and evaluation in the UK. Methods and analysis We will search 16 bibliographic databases from 1990 to June 2020. Supplementary searching will include citation tracking, author recommendation, and identification of evidence clusters relevant to included evaluations. The eligible population is children and young people (aged ≤25 years) with experience of being in care. Outcomes are (1) mental, behavioural or neurodevelopmental disorders; (2) subjective well-being; (3) self-harm; suicidal ideation; suicide. Study quality will be appraised with methodologically appropriate tools. We will construct a taxonomy of programme theories and intervention types. Thematic synthesis will be used for qualitative data reporting context, implementation and acceptability. If appropriate, meta-analysis will be conducted with outcome and economic data. Convergent synthesis will be used to integrate syntheses of qualitative and quantitative data. Ethics and dissemination We have a comprehensive strategy for engagement with care-experienced children and young people, carers and social care professionals. Dissemination will include academic and non-academic publications and conference presentations. Ethical approval from Cardiff University’s School of Social Sciences REC will be obtained if necessary. PROSPERO registration number CRD42020177478.

Purpose: What Works for Children’s Social Care has developed an ‘Evidence Store’ to improve awareness of evidence from systematic reviews in children’s social care. During review selection, some reviews were excluded due to methodological flaws, which this paper considers. Methods: Reviews were identified using a systematic search and screening process. Where reviews were identified as systematic reviews or meta-analyses, exclusion reasons were recorded and analysed. Results: The main methodological issue related to quality assessment, which was not conducted in the majority of cases. Several different types of quality assessment tools were used: scales, checklists, and domain-based approaches. Conclusions: This is the first study to examine the use of systematic review terminology in combination with the use of quality assessment tools in reviews in children’s social care. Consideration of appropriate systematic review methods will enable researchers to generate high quality evidence and support delivery of evidence-based care.

Background: Performing artists are exposed to a range of occupational demands from organisational, interpersonal and intrapersonal sources, which may impact their well-being. The aim of this systematic review was to evaluate and synthesise the literature where researchers have considered the relationship between occupational demands and well-being in performing artists. Methods: A mixed-methods systematic review was conducted including professional and student performing artists. Quantitative, qualitative and mixed-methods study designs were eligible for inclusion in the review. A total of 14 databases were searched from their inception through to October 2017, including MEDLINE, EMBASE, and Scopus. Critical appraisal was conducted using the Mixed-Methods Appraisal Tool and results presented as a narrative synthesis. Results: A total of 20 studies were included in the review, comprising of quantitative (n = 7), qualitative (n = 9) and mixed-methods (n = 4) study designs. Several frameworks of occupational stress and well-being were explored in relation to the results. Organisational, social and emotional demands were associated with lower well-being. Conversely, music-making, performance activities and social support were reported to be resources and were related to higher well-being. Conclusion: This systematic review highlights the need for researchers in this field to adopt methodologically robust study designs, which are informed by appropriate theoretical frameworks. The paucity of high quality and theoretically informed research in this area is a hindrance to the development of evidence-based interventions for this population.