Outcome-Network.org

An International Database and eJournal for Outcome-Evaluation and Research

Paper

Emotional and behavioural problems and outcomes for adolescents on the edge of care

abstract

 

Background

Around 40% of new entrants to the English care system are older children and adolescents, yet there is surprisingly little evidence on the needs of young people referred for preventive services. The principal focus of research on family support/preservation services has been on much younger children. The research that does exist on prevention and early intervention with adolescents has focused fairly narrowly on adolescents in the youth justice system rather than on a wider group of troubled and troublesome adolescents in the community.

 

Aims and methods

This paper draws on a recent evaluation of preventive interventions for adolescents to examine the mental health needs of adolescents at imminent risk of entering care. Some of our sample of young people on the edge of care did indeed enter the care system, so this paper also provides evidence on the mental health needs of young people who enter the care system (not necessarily for the first time) during adolescence.

 

This quasi-experimental study compared outcomes for young people considered to be at imminent risk of placement who were referred to specialist family support teams, with those for similar young people receiving the mainstream 'service as usual' from area-based social workers. Data were collected on 209 young people aged eleven to sixteen years. Interviews with young people, parents and professionals were conducted at referral and at six-month follow-up.

 

The study used both quantitative and qualitative methods and included in-depth interviews with 50 young people, their parents and the professionals working with them. A number of change measures were used, including the Strengths and Difficulties Questionnaire (SDQ), a measure of children and young people's emotional and behavioural difficulties completed by both young people and parents; the Family Assessment Device (FAD), a measure of family functioning also completed by both young people and parents and the General Health Questionnaire (GHQ-12), a measure of mental health completed by parents.

 

Key findings

This paper presents evidence on the nature and severity of mental health difficulties among a sample of 209 young people considered at imminent risk of care, of whom one quarter entered care during the follow-up period. Most admissions were brief, but 8% were thought likely to remain in care long-term. The paper describes the number, nature and severity of the young people's emotional and behavioural problems at referral. In many cases, these difficulties had emerged in a context of abuse, neglect and domestic violence had sometimes persisted for many years.

 

The nature and severity of the young people's emotional and behavioural difficulties, as measured by the SDQ, were found to be more severe than those for national samples of young people in the community and in the care system. There was some evidence that family risk factors, including problems in family functioning, parental mental health problems and domestic violence, may have contributed to the young people's emotional and behavioural difficulties.

 

By follow-up, there was some improvement both in SDQ scores and in the number and severity of specific emotional and behavioural difficulties. This paper examines the factors that mediated and moderated the process of change. These included an ecological approach to service provision, advice on concrete parenting strategies to parents and on behaviour management skills to the young people, the motivation and optimism of young people and parents and the development of a therapeutic alliance between workers and young people and families.

 

Implications for policy and practice

Young people referred for family support interventions often have multiple emotional and behavioural difficulties. This population may include a higher proportion with clinically significant mental health difficulties (as measured on the SDQ ) than has been found among older children in the care population. However thresholds for receiving a family support service are extremely high and few families receive help before they reach crisis point.

 

An ecological approach which intervened in different areas of the child's life was found to be helpful, as positive changes in the child, the family and at school were mutually reinforcing. The cognitive -behavioural approaches that were typically used with these young people and parents, combining parent-training with self-management techniques, were often helpful. Their effectiveness appeared to be mediated by the therapeutic alliance that developed between professionals and families, in which the development of the helping relationship provided a platform for more structured work on parenting and child behaviour. However the most wary young people, often those with chronic and severe difficulties, often needed more time to develop such relationships, so short-term services are not appropriate for all. A continuum of services is needed, offering earlier intervention to this group of young people at high risk of experiencing mental health and other difficulties.

 

Key references

Biehal, N. (2008) 'Preventive services for adolescents: exploring the process of change.' British Journal of Social Work 38, 3, 444-461.

 

Biehal, N. (2005) Working with Adolescents. Supporting Families, Preventing Breakdown. London: BAAF.

 

Biehal, N. (2005) 'Working with adolescents at risk of out-of-home care: the effectiveness of specialist teams.' Children and Youth Services Review 27, 9, 1045-1059.

 

 

Contact details

Professor Nina Biehal, Social Policy Research Unit, University of York, B Block, Alcuin College, University of York, Heslington, York, YO10 5DD, UK.

Email: nb6@york.ac.uk

 

© copyright 2024 Outcome-Network.org all rights reserved, in partnership with FondazioneZancan | iaOBERfcs | read the legal notice.