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10 JULY 2009
NO 1459
Mental health needs of looked-after children
Compared with a normative sample of British children aged 5-15 years, the Craigavon and Banbridge Looked After sample were assessed by their carers, teachers and themselves as having higher levels of emotional symptoms, conduct problems and inattention-hyperactivity. They also had higher levels of problems in their relationships with peers and were assessed as demonstrating fewer prosocial behaviours.
Within the younger group more than 30% may have diagnosable emotional disorders. Forty-five per cent and 50% may have attention deficit hyperactivity disorder and conduct disorders, respectively. The distribution of these percentages clearly indicates that a significant number of children are appearing in more than one diagnostic category, indicating the complexity of their presentation and probable co-morbid diagnoses. Within this group almost 40% were indicated as likely to receive psychiatric diagnoses in two or more categories.
A similar pattern is evident within the older group, the main differences being less overlap between the disorders and a lower level of reporting of emotional disorders. Nonetheless, around 30% present as likely to receive diagnoses in two or more categories.
It has been suggested in recent literature that as well as investigating overall difficulties or probable "caseness" among groups of children in substitute care, the impact of emotional and behavioural difficulties on their everyday lives should be studied more precisely (McCarthy, Janeway, & Geddes, 2003). Within the current data there were notable differences in the levels and patterns of difficulty reported by carers, teachers and the young people themselves. This may have important implications, for example, in terms the reliability of single-informant screening procedures. Further analysis of the current data set is ongoing with regard these issues and will be reported subsequently.
Although the current research project has
clearly identified need, it does not clarify to what extent that need is
unmet. Social workers in a study carried out by Phillips (1997) believed
that 80% of Looked After Children on their caseloads required referral
to CAMH services, yet only 27% were referred. More recently, Nicholas
and colleagues have identified a changing pattern of services to
children in residential care in Leeds. An increase in consultation and
training available to staff was noted while ongoing questions of unmet
therapeutic needs were also raised (Nicholas, Roberts, & Wurr, 2003). A
follow-up to the current research project has been instigated in
Craigavon and Banbridge to investigate what services are being offered
to and used by young people looked after by the Trust.
While further clarity will be helpful, it is beyond doubt that children
in substitute care have significant need for mental health supports in
view of the levels of difficulty identified. The delivery of services to
this population is complex and can meet with impediments such as the
impacts of high staff turnover rates in residential care (Richardson &
Lelliot, 2003) or multiple foster placements and unclear planning (Payne
& Butler, 1998).
Outlining models of effective mental health provision for Looked After Children is beyond the ambition of the current report. What is apparent, however, is that a population that experiences such complex social circumstances and psychological realities requires the availability of a sophisticated array of supports and treatments. The need for individual therapeutic intervention for young people has been detailed.
Tom Teggart and Joanne Menary
Teggart, T. and Menary, J. (2005) An investigation ofthe mental health needs of children looked after by Craigavon and Banbridge Health and Social Services Trust. Child Care in Practice, Vol.11 No.1, January 2005, pp 39-49
References
McCarthy, G., Janeway, J. and Geddes, A. (2003). The impact of emotional and behavioural problems on the lives of children growing up in the care system. Adoption an Fosteing, 27(3), 14-19
Nicholas, B., Roberts, S. and Wurr, C. (2003). Looked after children in residential homes. Child and Adolescent Mental Health, 8(2), 78-83
Payne, H. and Butler, I (1998). Improving the health care process and determining outcomes for children looked after by the local authority. Ambulatory Child Health, 4, 165-172
Phillips, J. (1997). Meeting the psychiatric needs of children in care. Psychiatric Bulletin, 21, 609-611
