Many young people, particularly older adolescents, emphasised the importance of working out their problems, and learning to cope, autonomously and “alone”. Seeking or accepting interventions from adults, particularly those in positions of authority, was considered pathetic, and associated with a loss of personal control, autonomy and power. For example, one boy explained how he tried to avoid those in positions of authority from “interfering” in his personal life, because he didn’t want them “seeing” he “was weak” (Walsh et al., 2011). Another child claimed he was seeking to “keep” his mentalhealth problems to himself, “to stop others getting involved” (Walsh et al., 2011). Interestingly, the author of one study noted that the conceptualisation and image that many young people had of “mental illness” as being a “problem in your head”, reinforced their ideas that they ought to be able to “sort things out” and manage on their own (Walsh et al., 2011).
Her sentiments were echoed by a number of children, who felt that social workers made decisions about their lives without concern for their wellbeing. The feeling of having their needs ignored was also experienced by children in foster care, several of whom believed that their carers weren’t interested in their care, but were using them to earn money. For one young Nigerian girl in foster care, this was illustrated by her foster mother’s approach to feeding her: “She never used to ask me what I would like to eat. She would just buy cheap thing from Lidl’s and then give it to us to eat. She never bought anything once. Okay, the first Christmas I was there, she went shopping and we went to Sainsbury’s and she asked me to pick up an item that I liked and it was like one pound and she had done a whole trolley for her family shopping and she asked me to pick up one thing and that is the only thing she asked me to. You are not supposed to just buy for your own family and then buy cheap stuff for me on the side and just let me eat when you cook (Georgina, from Nigeria)” (Kohli, Connolly, & Warman, 2010).
‘My mum makes me come in [laughs]’. Female student in AP, aged 12 to 16 (Michael 2013) “I don't think you are born clever but if you study really hard… If your parents are more pushy then you are more clever.” Student at risk of exclusion, aged 11 to 16 (Sartory 2014) Other young people discussed some of the challenges that they had faced in their family lives. Some of the difficulties included: bereavement; witnessing and experiencing domestic violence and abuse; living with family members with mentalhealth issues; and family members’ involvement with the police. Children related some of these experiences to the behaviour that they displayed at school:
Khan et al. (2010) was an audit review study carried out by the Centre for MentalHealth, exploring mentalhealth services for young people in secure justice settings. The study was initially excluded as most of the data was collected from (70) members of staff, rather than from young people themselves. Nonetheless, a couple of points of analysis from this study were ultimately judged to be useful and relevant during the write up of the report, and therefore the study was re-included. In addition to interviews with 70 members of staff, researchers sat in on multidisciplinary meetings and observed interactions between mentalhealth teams and their colleagues and between staff and young people. A small (unspecified) number of young people and family members with experiences of mentalhealth difficulties and the youth justice system were consulted throughout the review and invited to discuss the findings and contribute to service user experiences and perspectives. User Voice, the Office of the Children’s Commissioner (2011), ‘Young People’s Views on
Child and family social workers hold an average of 17.8 cases (Figure 4). DfE’s methodology for calculating caseload has changed successively over the last two years making it difficult to compare figures over time – in 2016 the number of cases per case holder was 16.1. Social workers in London have a slightly lower than average caseload, managed by a heavy reliance on agency workers to fill vacancies compared with other regions (the FTE agency worker rate is 26.5 compared to 15.8 in England overall). London’s workforce is also characterised by a comparatively high turnover rate. Meanwhile in the Midlands and parts of the North, caseloads are higher than average, but vacancy rates are lower as is the proportion of agency workers.
In the Department for Education we want all children and young people to have the opportunity to achieve and develop the skills and character to make a successful transition to adult life. Good mentalhealth is a vital part of that. The challenges young people face are hugely varied – from stress and anxiety about exams to incredibly serious and debilitating long-term conditions. Everyone who works with children and young people has a role in helping them to get the help they need. That is why I am so pleased to be the first minister in the Department for Education with a specific responsibility for child and adolescent mentalhealth. And why I wanted the department to work closely with the Taskforce to look at how we can make a better offer to children and young people. I believe success in this area comes from Government departments working closely together. We want to make sure young people no longer feel that they have to suffer in silence, that they understand the support that’s available for them and that they see mentalhealth services as something that can make a real difference to their lives.
disruptive children cannot be left alone, but they are also likely to need services that help alleviate family-related contributors to their problems, and clinicians that treat their problems from a family-based perspective. When such interventions to serve the family or to keep children safe from maltreatment are unsuccessful, the results may be particularly damaging. Children may feel hopeless that their situation will change, and alone because adults that have been called in to assist have not been able to. This may help explain increased rates of depression among child welfare-involved children, the hallmarks of which are feelings of hopelessness, helplessness, and sometimes worry and anxiety (Kovacs, 1992; McCrae, 2006). A model of psychological intervention for maltreated children at school is needed that focuses on prevention, and on a range of emotional-behavioral problems that likely stem from children’s maltreatment and home experiences. Mentalhealth professionals need to be abreast of, and interested in helping to improve, children’s home situation, and child welfare professionals ought to work with clinicians to ensure that children’s family situation is prominent in the treatment process. As long as the picture remains one in which families are often not provided evidence-based services (Hurlburt et al., 2006), nor services that improve family problems such as domestic violence (Kohl, 2006) and harmful parenting (Casanueva, 2005), children may remain at risk for declining mentalhealth and behavior, regardless of receiving individual psychological attention.
The findings presented in this review are based on a comprehensive literature search of studies on the health of children on the move in Europe from 1 January 2007 to 8 August 2017. Searches were run in PubMed and EMBASE on 8 August 2017. Search terms included combinations of terms for children such as ‘child’, ‘youth’ and ‘adolescent’ with terms for migrant, such as ‘migrant’, ‘asylum seeker’, ‘refugee’ and ‘undocumented migrant’ and with terms for countries in the European Union as well as five coun- tries that are major origin and transit countries for children travelling to Europe, including Afghanistan, Jordan, Lebanon, Syria and Turkey. The database searches were limited to papers providing data on children (birth–18 years) in the English language. Papers were included if they addressed physical and mentalhealth of children on the move, health exam- inations of these children, the effect of caregiver mentalhealth, access to care or disparities in care between children on the move and the local popula- tion. Multiregional reviews that provided data on chil- dren in Europe were also included. Papers on adult populations (defined as a study population ≥18 years) that did not provide disaggregated data on children were excluded. However, papers including UASC with a stated age ≤19 years were included, as well as longi- tudinal cohort studies that followed migrant chil- dren into early adulthood (<24 years old). Additional exclusion criteria included special populations, small single-facility studies, lack of migrant and/or health focus, intervention studies that did not provide data on child health outcomes and papers from non-Euro- pean host countries. Commentaries and conference abstracts were excluded. For further information on specific child health and policy topics, hand searches were also undertaken to identify relevant peer-re- viewed papers and grey literature reports.
From a public health perspective, a strategy for preventing perinatal mentalhealth problems and treating them effectively therefore has the potential to prevent significant long-term burden of ill-health and problems in parents and children. A critical aspect of this is identifying efficient and acceptable measures of mentalhealth for use with men and women during the early years. Guidelines for screening vary in their recommendations (Milgrom & Gemmill, 2014) but most focus on specific disorders, such as depression. In the UK, national guidelines recommend asking the Whooley questions (Whooley, Avins, Miranda, & Browner, 1997) to identify depression and the General Anxiety Disorder-2 question screen (Spitzer, Kroenke, Williams, & Lowe, 2006) to identify anxiety (NICE, 2014). Other countries use the Edinburgh Postnatal Depression Scale to screen for postpartum depression (Milgrom & Gemmill, 2014). However, this method of focusing on a specific disorder (in this case depression or anxiety) is unlikely to identify women or men experiencing different affective disorders such as PTSD or OCD. This means only a proportion of parents are offered treatment to reduce the possible adverse impact of mentalhealth problems on them and their child.
knowledge of the health care and welfare systems of that nation (Crawley, 2010). They are likely to experience poverty, dependence and a lack of cohesive social support arriving in a new country as a refugee. Children and young people could be living with adults that are unfamiliar to them. They may have experienced the death of a close family member or friend, or be unaware of their current circumstances leading to an increased sense of vulnerability (Connelly et al. 2006). Such factors can undermine both physical and mentalhealth. Health is culture dependent (Burnett & Peel, 2001) and both what a young person is able to talk about in relation to their health, and the symptoms they present with may be influenced by their cultural background and current circumstances. For example, in some cultures having stomach aches or headaches or a low mood, may be their way of discussing anxiety or depression.
For children of an active duty service member with a chronic medical condition, a DD Form 2792 documenting medical diagnoses and therapeutic needs is required from their pediatrician and should be taken by the family to their respective EFMP service coordinator to complete the enrollment process. The educational form (DD Form 2792-1) should be completed by an early intervention program or school special education program provider if the child is receiving Individuals with Disabilities Education Act Part C or Part B services, respectively. An EFMP quick reference guide is available on the Military OneSource Web site (www. militaryonesource . mil) and may be used to guide families and providers when enrolling in the EFMP. Enrollment in the EFMP is mandatory for dependents of active duty members and ensures that medical and educational needs can be met when service members are considered for various duty stations.
Results: Sixty-five studies from 10,154 citations were included spanning parenting programs, other parent behavior change interventions, peer support, support for hospital admission and discharge and others. Interventions for parents of children with a wide range of conditions were included. These targeted a broad selection of parent outcomes, delivered by a wide variety of professionals and lay workers. Most studies reported positive outcomes. No serious adverse events were noted but issues identified included group and peer relationship dynamics, timing of interventions in relation to the child ’ s disease trajectory, the possibility of expectations not fulfilled, and parent ’ s support needs following intervention. Children with medical complexity were not identified explicitly in any studies. Conclusions: The range of interventions identified in this review confirms that parents have significant and diverse support needs, and are likely to benefit from a number of interventions targeting specific issues and outcomes across their child ’ s condition trajectory. There is much scope for these to be provided within existing multi- disciplinary teams during routine health care contacts. Careful tailoring is needed to ensure interventions are both feasible for delivery within routine care settings and relevant and accessible for parents of children across the complexity spectrum. Further review of the existing literature is needed to quantify the benefits for parents and assess the quality of the evidence. Further development of interventions to address issues that are relevant and meaningful to parents is needed to maximize intervention effectiveness in this context.
Currently there are a limited number of facilities available to provide competency restoration to youth deemed incompetent to proceed. As a consequence, youth with serious mental illness remain in detention centers for long periods of time. Additionally, most youth are sent far away from home to attend competency restoration programs that deprive them of close communication with their family.
The increasing prevalence of behavioral and/or mentalhealth (B/MH) problems among children, adolescents, and young adults is rapidly forcing the pediatric community to examine its professional responsibility in response to this epidemic. Stakeholders involved in pediatric workforce training were brought together in April 2018, invited by the American Board of Pediatrics and the National Academies of Sciences, Engineering, and Medicine, to consider facilitators and barriers for pediatrician training to enhance care for B/MH problems and to catalyze commitment to improvement efforts. During the interactive meeting, parents, young adult patients, and trainees, together with leaders of pediatric training programs and health care organizations, acknowledged the growing B/MH epidemic and discussed past and current efforts to improve training and care, including integrated delivery models. Attendees committed in writing to making a change within their department or organization to improve training. There also was agreement that
4.30 Mentalhealth problems were both obscured by and exacerbated by drug-taking. Clinical experience shows that many prisoners use substances as a form of self-medication to help them deal with the depths of depression or the overwhelming effects of anxiety associated with traumatic early life experiences, and they are anxious about these feelings returning once the drugs are stopped. In these circumstances, clinical detoxification alone does not stop a habit that meets psychological needs. It is precisely at this point that the underlying mentalhealth issues may be manifested. However, the psychological aspect of detoxification was rarely considered. In our reception sample, only 43% of those undergoing detoxification said they were given any emotional support, and from comments this was more often from the CARATs team than from healthcare staff, except for those who were on the MHIRT caseload, most of whom claimed their mental state was monitored at this time.
Although children are not at the highest risk for coronavirus disease 2019 (COVID-19) 1 severe illness, necessary pandemic public health measures will have unintended consequences for the health and well-being of the nation’s at-risk children. School closures, social distancing, reduction in health care services (eg, canceling nonurgent health care visits), and ubiquitous public health messaging are just some of the measures intended to slow the COVID-19 spread. Here, we (1) highlight the health risks of the pandemic response measures to vulnerable pediatric subpopulations and (2) propose risk mitigation strategies that can be enacted by policy makers, health care providers and systems, and communities (Table 1). The selected risks and proposed mitigation strategies are based on existing evidence and opinions of expert stakeholders, including clinicians, academicians, frontline service providers (eg, social workers), and public health leaders.
A positive and healthy development, potential behaviour, beliefs and attitude changes exist as a result of a developmental and an ecological approach (Bronfenbrenner, 2001; 2005) including the relationship between the individual’s development of biological and psychological factors, family, community, culture, physical environment and historical niche. The settings for an adaptive development emerge from this two-way interaction between the individual and his context, promoting the well being in both components (Lerner, Almerigi, Theokas & Lerner, 2005; Lerner et al., 2005). The promotion of subjectivewellbeing is consistent with the preventive efforts in psychology services in schools, indirectly related services, non-traditional assessments, application of scientific psychology, issues of cultural diversity, and collaboration with parents and teachers. The subjectivewellbeing clearly demonstrates the importance of ecological factors, which goes against programs that focus exclusively on individual changes rather than on the environment. Thus, not only should efforts be included to change individual behaviour, but also to modify the surrounding environment. The assessment of subjectivewellbeing may be useful in screening and identifying individuals who are at risk of developing behaviour problems, which is crucial for academic programs, health promotion and prevention programs (Bird & Markle, 2012).
It should be noted that a number of factors, such as the parent's and adolescent's gender, the adolescent's age, the socio-economic status of the family and the presence of a chronic illness on the adolescent, may facilitate or impede positive adjustment to parental poor health. From availa- ble literature, it appears that children facing a chronic ill- ness and those coming from low income families, older adolescents, and girls more than boys, are at higher risk for multiple problems when parents -especially mothers - fall ill [1,34,38]. Moreover, research examining the ways in which families are able to continue to meet their chil- dren's developmental needs, despite the presence of phys- ical illness, suggests the important role of social support networks, as a major benefit for adolescents' resilience (i.e. the assets and resources that enable some adolescents to overcome the negative effects of risk exposure . The aim of the present paper was to extend previous research by examining the relationship between parental subjective physical and mentalhealth and adolescents' reporting of their HRQoL in a general population. Paren- tal subjective physical and mentalhealth here is approached in terms of everyday functioning and wellbe- ing rather than of a specific diagnosed illness. This study also sought to determine whether relationships observed between parental subjective general health status and ado- lescents' HRQoL are similar across different domains of adolescents' wellbeing and functioning (e.g. physical, psy- chological, social aspects of HRQoL). Specifically, the present study investigated the relationship between parental subjective general health and adolescents' HRQoL on the basis of the following hypotheses: 1) Parental subjectivehealth variables, i.e. self-perceived physical and mentalhealth, will be positively associated
Being a rapid review of the literature, this paper is by def- inition limited by its short timeframe . However, it has included a large number of systematic reviews covering a broad range of veterans’ physical, mental and social care needs. The systematic reviews were of a moderate quality according to the AMSTAR ratings, with no high quality systematic reviews identified. This could relate to the quality of the studies themselves, or to the application of the AMSTAR assessment tool, designed for systematic re- views of randomised controlled trails, to reviews of both randomised and non-randomised studies. While the tool has been validated for application to these studies, show- ing good psychometric properties , the items on the tool most responsible for lower scores (no a priori design provided, failure to include potential sources of support for both the systematic review and for each of the in- cluded studies, and failure to include a list of excluded studies) are perhaps less commonly included in reviews of non-randomised studies.