Adolescent Theme:

Putting Research to Work

Valerie Dunn

October 10, 2013

Adolescent Theme

TC-17 Study (Transfer of Care at 17): • Mental health of potentially vulnerable young people in

transition: care leavers (27) & CAMHS leavers (26)• Clinical interviews plus service use, experiences, opinions at

transition & 12 months later

Why? Adolescence – high risk for emergence of MH problems

• Approx half lifetime mental disorders onset in mid-teens; 75% <25

• transition from child-centred services is at 16-18 (regional variation & flexibility; CCC offers extended support)

• MH need in both groups which may compromise transition

What do we know ?

• CAMHS leavers: ); around 1/3 eligible for adult services – don’t make it; transition most successful in the most severely ill (eg inpatients or those with psychosis

• Care leavers: large unmet MH need, poor service uptake, placement instability, poor outcomes on most indicators (education, employment, social, criminality)

Research suggests need for improved support at a difficult time

TC17 care leavers (n=27) results in brief:

* 74% lifetime MH diagnosis , often undetected/untreated * 52% MH diagnosis as YP face transition ; 44% 12 months later * 48% NEET (not in education, employment or training) at transition; 54% 12 months

later

* 62% had not taken up at referrals

* Placement breakdown often associated with MH problems18/27 (66%) – moved to independent living

Foster care

Accounts for around 75% of all care placementsOur survey of Cambs foster carers (LA & agency): • Children’s behaviour & emotional ‘damage’ one of

the biggest challenges• Around 40% ‘pushed to their limits’: aggression,

violence, destruction & complex MH problems (ADHD, self-harm, overdoses). – Difficulties had last 3 weeks – 10 years– Often resulted in placement breakdown

FC (ours & national surveys) want better training, support & better access to psychological services for those most in need

Next step …

By addressing MH problems early we could prevent escalation, encourage stable placements & improve chances of successful transition in young adulthood

‘Decisions at the outset of a care journey can set in motion a domino effect of positive or negative outcomes, with costs accumulating

over a lifetime’1

Our response: Devise & evaluate CloseUp Training for foster carers

1 Hannon C, Wood C, Bazalgette L, In Loco Parentis, Demos. 2010

• To fully engage foster carers in the training• To understand: What is it really like to be taken away

from one’s family and placed in local authority care?

Essential to involve young people

How can we actively & usefully involve young people in an innovative, engaging & creative way?

Maverick approach required, surveys won’t do it ... but maybe a film could …

Challenges:

My name is Joe

- Partnership with Cambs Film Consortium – core team of animator, composer, volunteers, Children’s Participation team, workshop facilitator (YOS)

- Consultation & workshops for YP- 4-day animation summer school, August 2012- Premiere w Q&A, Cambridge Arts Picturehouse, Oct 2012- YouTube with ‘Behind the Scenes’

http://youtu.be/ArBjWe3IWs0

Principles of PPI

Active involvement

YP perspective

‘Feeling part of stuff’ (Action for Children)

Bottom-up approach

Everybody learns something

Gains for YP: views matter, new skills, confidence, CV

Form bond for future work

Patient Public Involvement (PPI)

‘Joe’ Impact

• Foster carer training: fostering agencies, local authorities

• National Agency – in discussions • NCAS website• YouTube – over 2,000 views• Social worker training• Youth Film Festival• Led to Finding My Way – launch October 15 –

do come

Feedback‘Well, we were talking about it without talking about it weren’t we. Yep, it was good.’ Young person

‘This is a University isn’t it? I’m not clever enough to come here, but will you show us round?’ Young person

‘I wanted to say how brilliant it was ... nice to be involved in a project that was so well planned & supported, a great team I think!  I was really impressed with the young people, they were very courageous in sharing their ideas & taking on so many new challenges.’ Lizzy,animator

‘That film says it all’ Foster carer

Aims of CloseUp Training:

- to capitalise on the unique position of foster carers to build a bond with children & YP in their care

- to equip FC with skills & knowledge to identify symptoms (sx) of common but severe emotional & behavioural problems in LAC

- to devise a method of monitoring & recording mental

state for mandatory review

- to improve access to appropriate, timely treatment when necessary

CloseUp Training: content

• Common MH problems: attitudes & language, reassurances, evidence not folklore, definitions, prevalence, causation, bran development, services, impact, why it’s important

• How to identify core symptoms (sx) across the spectrum

• ‘Normal’ vs Common• Association w attachment problems• A-Z of Talking & Listening• How to complete the Wellbeing Profile (FC & child

versions – design stage!)

CloseUp: delivery

- 2-day (or 3?) (4 hours per day) small groups

- Handbook, slides, expert video clips, My Name is Joe

- Mixture of direct instruction, discussion, case studies, small group/pair exercises & ‘homework’

What words do YOU use?

Exercise 2: What words do you use? Why? Impact?

MI: what do we mean?

~What’s normal? A myth? ~More helpful - normal range of almost everything from emotions & behaviour to blood pressure, glucose levels, BMI …..When does sadness/anxiety/behaviour become a clinical problem?

We’re all different

Reassurances

We’re NOT asking you to:

- Make clinical diagnoses- Provide psychological treatment- Label children & young people as

mentally ill- Deal with mountains of extra paperwork- Medicalize ordinary child/teenage

behaviour

Recording observations in the Well-P

• Core signs/symptoms common to multiple disorders: mood irritability agitation/poor concentration

eating sleep fear/’red alert’

• When: - daily for two weeks during first month in care in your care (can be repeated annually or if concerned)

• Impairment

It’s not the individual days that are important but the cumulative picture that emerges over the

fortnight

Feasibility stage:

• Wisbech, December 2012, Cambridge March & Sept/Oct 2013

• 17 trained: 10 experienced carers (4 agency 6 LA) & 7 newly-approved (2 agency, 5 LA)

• Experienced: largely unstructured – maximise FC input• Overwhelmingly positive response: *‘I wish I’d done this when I was a new carer’,

*‘It makes so much sense.’ *‘All new carers should do this. It’s so relevant’

*‘The training was a really, really good idea, it was even helpful for me as a long time carer. The WELL-P is a great idea and very forward thinking”.

The future:

CLAHRC EoE – 2-year pilot, agencies and LAs: test the concept that FC can usefully identify & monitor MH symptoms

Develop the child and teenage versions of the Well-P – stickers, online, apps …

Data should help us understand the complex MH needs of children and YP when they enter the care system and, in turn, develop the appropriate services

Many thanks toCambridgeshire County Council

Peterborough City CouncilYoung people Film makersFoster carers

CPFT

Thank you for your time, interest & attention

Valerie Dunn vjd20@cam.ac.uk, 01223 746053