Background Young people show differing patterns of appointment intensity and attendance with Child and Adolescent Mental Health Services (CAMHS) than Adult Mental Health Services (AMHS) reflecting what are often complex and negative transition experiences. Little is known about mental health appointment patterns of young people concurrently involved with social services, who are at greater risk of mental ill-health, and must navigate multiple transitions approaching adulthood. Methods This retrospective population-based cohort study used Secure Anonymised Information Linkage (SAIL) data to examine CAMHS and AMHS appointment patterns of young people age 16-to-20 in Wales. Social care involvement was the primary exposure. Gender, ethnicity, deprivation, health board, and diagnosis codes in health records were the covariates. Negative binomial and generalised linear regressions compared numbers of seen appointments and percentages of missed appointments by social services involvement and other covariates. Results Appointment intensity and attendance differed markedly by social services involvement and between services. Among young people in care, defined here as those looked after by the local authority, males had significantly reduced incidence of seen appointments in AMHS compared to females. Also among young people in care, prior residence in the most deprived areas in Wales was associated with higher CAMHS intensity, but not higher AMHS intensity; among those accessing AMHS, deprivation was associated with substantially higher levels of missed appointments. Diagnosis codes were associated with increased appointment intensity across groups, but this pattern was most consistent among young people not involved with social services. Among young people receiving social services support but not in local authority care, alcohol or drug use diagnosis codes were associated with higher levels of missed appointments in both services, but not with increased appointment intensity. Neurodevelopmental condition diagnosis codes were associated with the highest increase in seen appointments across all groups. Conclusions Mental health service intensity and attendance during transition varied substantially by social services involvement, with gender, deprivation, and diagnostic profile appearing to effect risk of disengagement at transition differently. Targeted, social care‑informed transition planning is needed to support continuity of care for vulnerable young people.

Family Group Conferences (FGCs) in children’s services are convened meetings of family networks to make plans for a child who is in need or at risk. There remain gaps in evidence, including how variation in implementation context affects FGC experiences and outcomes. The Family Views and Context Study is part of a wider realist-informed evaluation (Family VOICE). It involved 380 individuals who had attended FGCs, from 155 families across the UK. Family members completed questionnaires at three time points, including standardised measures for self-efficacy, family functioning, adult well-being and child psychosocial health. FGC coordinators also completed questionnaires. This paper focuses on one key aspect of variation in implementation context, namely the stage of child welfare concern. Three categories are compared: (1) early help and child in need; (2) child protection and edge of care; and (3) children in state care. In addition to questionnaires, a sub-group of participants (n=25) took part in semi-structured interviews, purposively sampled for these three stages of concern. Quantitative comparisons found almost no significant differences between the three categories in family experiences or outcomes. Qualitative interviews suggested more similarities than differences in participant experiences, perceptions of FGC mechanisms, and intended outcomes, across the three categories.

Background Transitions from Child and Adolescent Mental Health Services (CAMHS) to adult services (AMHS) are often complex and negative experiences for young people and those supporting them. Young people involved with social services are at greater risk of mental ill-health but little is known about their mental health service transitions. Methods This retrospective population-based cohort study used Secure Anonymised Information Linkage (SAIL) data to examine whether young people in Wales with CAMHS contact transitioned to AMHS. Social care status was the primary exposure. Gender, ethnicity, deprivation, health board, and mental health related diagnosis codes in health records were included as covariates. Stratified logistic regression compared odds of CAMHS with odds of transition, and estimated differences in transition by social services involvement. Results Results showed young people receiving care and support (YPRCS) and young people looked after (YPLA) had higher prevalence of diagnosis codes in health records than those with no social services involvement. YPRCS and YPLA were more than twice and nearly four times as likely to access CAMHS (OR = 2.03, 95% CI [1.86, 2.21], p < .001; OR = 3.74, 95% CI [3.07, 4.56], p < .001). However, likelihood of transition was much smaller for YPRCS (OR = 1.18, 95% CI [1.03, 1.35], p = 0.020) and not statistically significantly different for YPLA (OR = 1.27, 95% CI [0.96, 1.98], p = 0.095) when compared with their peers with no social services involvement. Recorded diagnosis codes were more strongly associated with CAMHS access than transition to AMHS. Associations between diagnosis codes and CAMHS were weaker among those involved with social services. Neurodevelopmental condition diagnosis codes influenced transition differently according to social services involvement. Conclusions Despite higher levels of diagnosis codes in health records and greater CAMHS access, young people involved with social services were only marginally or no more likely to transition to AMHS. This suggests potential discontinuity in care. The findings highlight the importance of considering how social services involvement interacts with diagnostic profiles in shaping transition outcomes. Further research is needed to explore mechanisms underlying these differences and to inform targeted support strategies.

Family group conferences (FGCs) in child welfare brings wider family members together to engage in the best way to meet a child’s needs. Shared decision-making is hypothesised to result in more even power-sharing between families and professionals, and greater trust. Previous research suggested FCGs may reduce more intrusive state intervention.

Background Family group conferences (FGCs) in child welfare bring immediate and wider family members together to decide on the best way to meet a child's needs. Unlike professionally led meetings, the aim is for decisions to be made by or with family members. Qualitative and mixed-method research with FGC participants tends to show positive experiences: most participants feel their voices are heard; FGCs facilitate family-driven solutions and closer relationships-within families and with social workers. Although there is existing literature on FGCs, there is a paucity of robust comparative UK evaluations, i.e., randomised controlled trials or quasi-experimental studies. Comparative studies internationally have focused on a narrow range of outcomes, not recognised the importance of context, and paid little attention to the quality of delivery. Some qualitative studies have considered process and context but there is scant measurement of these. The aims of this study are, firstly, to establish how FGCs improve outcomes for families and what factors vary their quality, and, secondly, to assess longer-term outcomes in terms of service use and associated costs.Methods Given the importance of process and context, evaluation informed by realist and complex systems approaches is needed. This multi-method evaluation includes a survey of FGC services in all UK local authorities (n = 212) to map service provision; co-design of programme theory and evaluation measures with family members who have experienced an FGC (n = 16-24) and practitioners (n = 16-24) in two sites; a prospective single-arm study of FGC variability and outcomes after six months; and comparison of service use and costs in FGC participants (n >= 300 families) and a control group (n >= 1000) after two years using a quasi-experiment.Discussion This is a pragmatic evaluation of an existing intervention, to identify what mechanisms and contexts influence effective process and longer-term outcomes. The study is registered with Research Registry (ref. 7432).

Appropriate allegation investigations within social care are paramount to protect children. However, many allegations are unsubstantiated ( Biehal et al., 2014 ) and result in stress and anxiety for fostering families ( Adams, Hassett and Lumsden, 2018 ), financial uncertainty ( Boffey, Stanton and Thomas, 2019 ), unplanned endings and foster carers leaving their role ( Adams, Hassett and Lumsden, 2018 ). There is little research into the prevalence, nature and outcomes of allegations against foster carers. This UK-based study uses The Fostering Network’s State of the Nation’s Foster Care (SOTN) 2021 survey and analyses responses from 3,352 UK foster carers and 99 fostering service staff. Qualitative findings reflect six themes: (1) emotional impacts, (2) financial implications, (3) independent support, (4) social services involvement, (5) understanding allegations, and (6) children being removed or foster carers leaving their role. Quantitative findings show only 25% of those experiencing an allegation believed they were sufficiently communicated with, only 20% believed specified timescales were adhered to, 57% did not receive independent support, and 36% said no support was offered to children in their home. Poor information-sharing and lack of support were found to have exacerbated the stress experienced.

The transcription factor FOXL2 is required in ovarian somatic cells for female fertility. Differential timing of Foxl2 deletion, in embryonic versus adult mouse ovary, leads to distinctive outcomes, suggesting different roles across development. Here, we comprehensively investigated FOXL2's role through a multi-omics approach to characterize gene expression dynamics and chromatin accessibility changes, coupled with genome-wide identification of FOXL2 targets and on-chromatin interacting partners in somatic cells across ovarian development. We found that FOXL2 regulates more targets postnatally, through interaction with factors regulating primordial follicle formation and steroidogenesis. Deletion of one interactor, ubiquitin-specific protease 7 (Usp7), results in impairment of somatic cell differentiation, germ cell nest breakdown, and ovarian development, leading to sterility. Our datasets constitute a comprehensive resource for exploration of the molecular mechanisms of ovarian development and causes of female infertility.

Family group conferences (FGCs) in child welfare share decision-making with family members by bringing the immediate and wider family together to make a plan to meet a child's needs. This paper reports survey findings on FGC provision in the UK in 2022 and explores whether in England the presence of an FGC service and the rate of FGC provision is associated with the rate of children in care, entering care, in kinship foster care and leaving care. Seventy-nine per cent (n = 167) of local authorities in the UK provided FGCs to families, and 14 per cent (n = 29) did not. Services that were more established offered a more diverse range of FGCs. The introduction of FGCs in English local authorities was associated with a higher rate of children in care, but also higher rates of kinship foster care, a key goal of FGCs where it is not possible for children to stay with their parents. Higher rates of FGCs were associated with more children leaving care, possibly due to reunification with birth families. To understand in more detail, the circumstances of children in and leaving care in local authorities with FGCs, individual data linkage studies are needed. Family group conferences share decision-making with families to meet the needs of a child. A key aim of family group conferences is to prevent out-of-home care. If it is not possible for a child to stay with their parents, family group conferences try to keep the child within the extended family, where possible. This study explored the provision of family group conferences in the UK and how this is related to the rates of children in care, kinship foster care, children entering care and children leaving care. The study found higher rates of children in care and kinship foster care two years after the family group conference service was introduced compared to two years before, but further testing is needed to understand if this was due to the family group conference or other events. It also found that the more family group conferences a local authority holds each year, the more children leave care. This could be due to reunification with birth families.

PurposeSecure children's homes (SCHs) restrict the liberty of young people considered to be a danger to themselves or others. However, not all young people referred to SCHs find a placement, and little is known about the outcomes of the young person after an SCH or alternative placement. The purpose of this paper is to understand which characteristics most likely predict allocation to an SCH placement, and to explore the outcomes of the young people in the year after referral.Design/methodology/approachA retrospective electronic cohort study was conducted using linked social care data sets in England. The study population was all young people from England referred to SCHs for welfare reasons between 1st October 2016 to 31st March 2018 (n = 527). Logistic regression tested for differences in characteristics of SCH placement allocation and outcomes in the year after referral.FindingsIn total, 60% of young people referred to an SCH were allocated a place. Factors predicting successful or unsuccessful SCH allocation were previous placement in an SCH (OR = 2.12, p = 0.01); being female (OR = 2.26, p = 0.001); older age (OR = 0.75, p = 0.001); and a history of challenging behaviour (OR = 0.34, p = 0.01). In the year after referral, there were little differences in outcomes between young people placed in a SCH versus alternative accommodation.Originality/valueThe study raised concerns about the capacity of current services to recognise and meet the needs of this complex and vulnerable group of young people and highlights the necessity to explore and evaluate alternatives to SCHs.

ObjectivesThis presentation provides an overview of young peoples’ transitions from child to adult mental health services in Wales. Transitions are unstable times where need for support can be greatest, yet many young adults fail to qualify for ongoing specialist support. Young people with social care needs and/or living in poverty face an increased likelihood of mental ill health. These underlying factors of disadvantage are modifiable and can be considered ‘solution linked variables’ (O’Campo and Dunn, 2011) of particular relevance in public health policy development. ApproachThis study positions intersectionality theory within a quantitative, secondary data methodology. Descriptive statistics and logistic regression models were used to elicit how social care need, deprivation, mental health diagnoses, gender and ethnicity might interact to influence likelihood of transition from child to adult mental health services. Sequence analyses developed pathway typologies from varying patterns of mental health service access. ResultsNovel findings reflecting the interactional influences of differing social care need and area levels of deprivation on child to adult mental health service transitions will be presented alongside results controlling for gender, ethnicity and mental health diagnoses. The value of mapping typologies of mental health service use will be discussed in relation to the findings. ConclusionsInterim findings suggest greatly increased mental health service use and differing patterns of access for young people with social care needs and/or living in the most deprived areas as they transition to adulthood. The implications for service development and delivery in times of unprecedented demand are explored.

Objective This scoping review explores the role of a healthcare assistant on a stroke unit, potential barriers to role fulfilment and whether stroke-specific training could enhance rehabilitative practice. Data sources Searches were conducted on CINAHL, MEDLINE and APA PsycInfo in May 2021 and repeated in September 2022. Methods This scoping review was guided by Arksey and O’Malley's framework. Article selection and data extraction were conducted by one researcher using a structured proforma. A narrative approach to data synthesis was undertaken following the research questions. Results From a combined total of 533 articles, sixty-six full-text articles were assessed for eligibility. Sixteen full articles were included in this review. A healthcare assistants’ role was viewed as caring directly for patients – some individuals felt they contributed to rehabilitation during these tasks, and that they could be undervalued by multidisciplinary team members, patients and their families. The barriers identified to healthcare assistants’ role fulfilment were lack of time, training and staffing shortages. Training was perceived to improve healthcare assistants’ communication, confidence and knowledge but training needed to be flexible, ward based and accommodate staffing shortages. However, it is unclear whether training has any clinical benefit for patients. Conclusion Healthcare assistants are well placed to enhance rehabilitative practice with patients; however, there are clear perceived barriers to this occurring. Future research should aim to define the role of healthcare assistants and explore whether further stroke-specific training could cause clinical benefits for patients.

For young people the online world affords creative, entertainment and socialisation opportunities but also poses risks including cyberbullying, grooming and harmful content. Little is known about online experiences of care-experienced young people, a vulnerable group who may benefit from online experiences but may be at increased risk online. This cross-sectional study used data from 11- to 16-year-olds in Wales from the School Health Research Network (SHRN) Student Health and Wellbeing Survey 2017/18 ( n = 103,971). Cyberbullying, face-to-face bullying and other online experiences were analysed. The prevalence of these experiences and associated mean wellbeing scores were compared for young people in care ( n = 1,921) and not in care ( n = 83,551), controlling for socio-demographic variables gender, ethnicity and year group. Higher numbers of young people in care were involved in cyberbullying, bullying, sharing explicit images, problematic social media use and regular contact with online only friends. These online experiences were associated with lower mean wellbeing scores. Lower numbers of young people in care had access to smartphones and social networking sites from age 12, and lower numbers were regularly in online contact with close friends and a wider peer group. These online experiences were associated with higher mean wellbeing scores. Young people in care appear to be less involved with online experiences that positively impact wellbeing and more involved in online experiences that negatively impact wellbeing. Promoting positive online experiences and education around problematic social media use may be particularly valuable in helping young people living in care develop healthy, safe and positive online lives.

The rate of children in care in Wales is one of the highest in the world and has increased considerably in the past two decades. Whilst many factors may be driving these increases, there is considerable variation between local authorities. This article presents findings from a survey completed by children's social care workers in Wales (n = 792). It compares the views, values and responses to case study vignettes of workers in authorities with increasing to those with decreasing care rates over five years (2016-2020). Statistically significant differences were found relating to the values and the practices of workers, with workers in local authorities with reducing rates having stronger pro-family values, less risk averse responses to case vignettes, more confidence in the decisions made in their local authority and being more positive about support for practice. The findings indicate that variations in local authority values and practices may influence the rate of children in care and that some with significant social problems seem able to avoid the large numbers of children in care found in other authorities. The challenge faced in Wales and the UK is how local authorities can learn from one another to ensure consistency and quality in services. The rate of children in care in Wales is one of the highest in the world. Considerable variations in the rates of children in care exist between local authorities. This raises issues of fairness in the consistency and quality of services received by families. To try to understand why there is such variation in rates of children in care, a survey was completed by children's social care workers in Wales. This article presents the results of this survey. It found that values and practices of workers varied between local authorities with decreasing rates of care compared with those with increasing rates. Furthermore, workers in local authorities with decreasing rates of care felt supported to make the right decisions about whether a child should be taken into care and were more confident taking risks to keep families together when it was safe and possible. More work is needed to better understand the differences in local authority culture and how best to achieve changes in the values and practices in these organisations.

Secure Children's Homes (SCH) in the UK are locked establishments for children perceived to be at serious risk and referred through welfare or youth justice systems. The UK SCH population has recently decreased, but the percentage accommodated for welfare concerns has not. It is of concern that some of the children referred to SCHs through the welfare system cannot be placed and are therefore found an alternative accommodation. This article is concerned with children from England referred to SCHs for welfare reasons particularly the process of trying to find a SCH place, the characteristics of children placed in alternative accommodations and the residences used for alternative accommodation. Findings show that two-fifths of the children, typically older males with challenging, offending, or sexually harmful behaviors were not placed in a SCH. While the children's behaviors contributed to SCH refusals, the situations were more nuanced with other contributory factors including children not meeting secure accommodation criteria, non-implementation of secure orders and children entering different secure settings. The study returns attention to the difficulty of finding an SCH place for extremely vulnerable children and raises concerns about current SCH service capacity and the unknown nature of alternative accommodations.

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.

Wales has seen a rise in both the number and rate of children looked after. The rate is now higher than any time since the 1980s. In addition, Wales has consistently had more children looked after per 10,000 of the population than the rest of the UK. This trend is a cause for concern; particularly the impact on the outcomes of children who are taken into care in terms of educational attainment, health, unemployment, homelessness, and criminal justice. Moreover, the Covid-19 pandemic is expected to have worsened the situation. To understand better the factors influencing care rates, the Welsh Government commissioned the Wales Centre for Public Policy and the Centre for Children’s Social Care Research and Development (CASCADE) at Cardiff University to undertake a survey with the children’s social care (CSC) workforce.

Interventions that change family income include any policy or practice that directly or indirectly changes the amount of money a family have. Although theory regarding the relationship between poverty and child maltreatment is well established, theories of how family income change affects the likelihood of children being in out-of-home are not well developed. This realist rapid evidence assessment provides an overview of the process of how interventions that change family income affect the rate of children in out-of-home care. The study population is families at risk of their children entering care and families whose children are in care and are pursuing reunification. Ten studies were identified from an earlier scoping review. Intervention effect results are described and qualitative evidence about mechanisms and moderators is presented as an initial "programme theory". The review makes an initial suggestion of four pathways through which a change in family income can alter the risk of child abuse and neglect and thus affect the rate of children in out-of-home care. These are: 1) the impact of employment; 2) changes to the home environment; 3) risk/prevention of homelessness; 4) building trusting relationships with social workers. National or local policies which increase a family's income, for instance through tax and benefits regimes or the provision of free childcare, could potentially reduce the rate of children in out-of-home care. There is also a role for social workers in providing direct material help to families. More work is needed to develop intervention theories and better understanding of the process of using material resources to help families at risk of their children being in out-of-home care.