Child mental health: better services and outcomes for traumatised and vulnerable children
Submitting Institution
University of LeicesterUnit of Assessment
Psychology, Psychiatry and NeuroscienceSummary Impact Type
SocietalResearch Subject Area(s)
Medical and Health Sciences: Public Health and Health Services
Studies In Human Society: Policy and Administration
Summary of the impact
The Greenwood Institute of Child Health is a unique collaboration between
the University and
public service providers such as the NHS, which aims to improve
psychological outcomes for
children in high-risk settings. From 1993 to 2013, Greenwood's research
has highlighted the
increased risk of mental health, drug dependence and criminal activity
among children who suffer
trauma — through abuse, living in care, homelessness or war. Greenwood's
programme of
research has identified the complex and persistent needs of vulnerable
children and contributed to
changes in policy guidelines and service provision across social care in
the UK (foster care /
adoption, juvenile detention and homelessness) and abroad (war).
Collaboration between
researchers at the Greenwood Institute, service providers and
practitioners has been instrumental
in the establishment of clinically relevant and cost-effective care
pathways, while community
engagement has led to improved service provision and outcomes for
vulnerable children and their
families / carers in the UK and further afield.
Underpinning research
Common approach to a wide range of traumas
The Greenwood Institute, led by Professor Panos Vostanis, conducts
research across different and
increasingly diverse types of trauma: from long-standing studies
concerning `looked-after' children,
young offenders, homeless families and war-affected children; to more
recent research into
emerging groups such as young refugees, children with autistic spectrum
disorder (ASD) and
substance abusers. The Institute shares its experience in policy,
practice, training and research
with academics and practitioners in low-income countries, which have
limited specialist resources,
most notably the Occupied Palestinian Territories (OPT) but also Pakistan,
Iran, Serbia, Nigeria,
India and Turkey. The needs, policy provision, service requirements and
possible outcomes of
interventions for the above groups all vary greatly, but there is a common
approach to all research
undertaken by the Institute: to develop an evidence-base of needs; to
understand the reasons
behind poor service access and engagement, and to develop and evaluate
interventions and
service models designated to assist these groups.
Research projects in the UK
Looked-after children (in care, fostered and adopted) — The
institute undertook two National Child
Mental Health Surveys of deprived and non-deprived children living in
private households in
England, Wales and Scotland, and another for children in the care of local
authorities (2005-2008).
These were the first randomly sampled and nationally representative
studies of looked-after
children in the world (in collaboration with Kings College London and
Peninsula Medical School).
Leicester contributed expertise to the design and analyses of these
studies (Professor Howard
Meltzer) and the translation of the results for practice and service
implications (Vostanis).
The third survey compared 1,453 looked-after children with 10,428
children from the above general
population surveys. The finding, that 40% of looked-after children have a
psychiatric disorder,
compared to 10% of children in private households, highlighted the high
level of mental health
problems and disorders, the relationship of these to other social and
health needs, and their limited
access to support services (1).
The Institute has conducted a series of studies (2004-2013) with
Leicestershire CAMHS (Child and
Adolescent Mental Health Service) on predicting positive outcomes from
services for fostered and
adopted children, such as specialist input and group intervention for
foster carers, and adoptive
parents of children with attachment difficulties (2).
Young offenders — A systematic review (2005-2006) in conjunction
with Nottingham University,
examined the evidence on the prevalence and nature of mental health
problems among young
people in contact with judicial services (both custodial and in the
community). It considered the
effectiveness of interventions relevant to young offenders with mood or
anxiety disorders, or
problems with self-harm. The Institute's expertise and knowledge of best
practice were
fundamental to the review process, with staff contributing to the design,
analyses and interpretation
of the review's findings (3).
Homeless families — The inability of homeless families to access
health services was established
by a study (2005-2006) of Leicester's family shelters, together with
collaborators at Warwick
University (4). The study found that unless the whole spectrum of a
families' needs were
addressed, including benefits, housing assistance and child protection,
attendance was likely to
lapse, trapping families in a vicious cycle. Vostanis is now revisiting
the family shelters (2013-2014)
and developing a focused intervention for homeless children who have
experienced domestic
violence.
Research projects in developing countries
Pakistan — A study of school children (2012) reported rates of
child psychiatric disorders (17%)
which appear higher than in other countries (5). The findings
emphasised the need to train
teachers to recognise and manage common mental health problems in schools
in the absence of
specialist services. The Institute contributed research methods expertise
to this study.
Palestine — Studies in Gaza have established a high prevalence
(35%) of post-traumatic stress
disorder (PTSD; 6). Risk factors during exposure to trauma, the
assessment of which is important
for interventions and services, are measured by the Institute's widely
used Gaza Traumatic
Checklist, and subsequent behavioural and emotional problems by the
Behaviour Checklist (BCL)
and Strengths and Difficulties Questionnaire (SDQ). Other studies have
investigated the
prevalence of ADHD and mental health problems among high-risk children
living in orphanages
and working as labourers.
Integration of training with research and practice
The Institute offers part-time and distance learning degrees for those
working in child and
adolescent mental health, all over the world (Hassan and Thabet are former
PhD students), as well
as multiagency training in child and adolescent mental health. The
Institute's trainers are
experienced and practicing professionals and clinicians who work with
children with mental health
issues. This strengthens the training by making it clinically relevant,
and by relating theory to
practice. In 2012 the institute trained 953 people from services across
Leicester and surrounding
areas. The institute also offers a service to assist CAMHS staff with
their research.
Key staff:
Leicester: Panos Vostanis, Professor of Psychology (1998 -
present); Howard Meltzer, Professor
of Health and Disability (2006 - 2013), Dr Sajida Hassan, Hon Research
Fellow (2011 - 2013)
Other institutions: Dr M.Stuttaford and Professor G. Hundt
(Warwick University); Dr E.Townsend,
(Nottingham University); Professor R. Goodman (Kings College London); Dr
T. Ford (Peninsula
Medical School). Professor A.Thabet (Al-Quds University)
Clinicians: Dr Pradeep Rao, Dr Alvina Ali and Dr Jeanette
Bowlay-Williams (Leicester CAMHS)
References to the research
1 Ford, T., Vostanis, P., Meltzer, H. & Goodman, R. (2007)
Psychiatric disorder among British
children looked after by local authorities. British Journal of
Psychiatry. 190: 319-325.
2 Rao, P., Ali, A. & Vostanis, P (2010) Looked after and
adopted children: how should specialist
CAMHS be involved? Adoption and Fostering. 34: 58-72.
3 Townsend, E., Walker, D.M., Sargeant, S., Vostanis, P., Hawton,
K., Stocker, O. & Sithole, J.
(2010) Systematic review and meta-analysis of interventions relevant for
young offenders with
mood disorders, anxiety disorders, or self-harm. Journal of
Adolescence. 33: 9-20.
4 Stuttaford, M., Hundt, G. & Vostanis, P. (2009) Sites for
health rights: the experiences of
homeless families in England. Journal of Human Rights Practice.
53: 257-278.
5 Hussein, S.A., Bankart, J. and Vostanis, P. (2013) School based
survey of psychiatric disorders
amongst Pakistani children: A feasibility study. International Psychiatry.
10(1): 15-17.
6 Thabet, A A, Karim K and Vostanis, P. (2006) Trauma exposure in
pre-school children in a war
zone. British Journal of Psychiatry. 188: 154-158.
Funding: NHS Research Infrastructure: Evaluation of
attachment-focused groups for foster carers
and adoptive parents (2011-2012) £30,000.
National Forensic Mental Health Research & Development: Systematic
review of research relevant
to mental health of young offenders (2005-2006) £50,000.
Gatsby Foundation: National evaluation of mental health service provision
for young homeless
people (2003-2006) £120,000.
Details of the impact
Background
Attitudes to children and their mental health were moving from a
biological to a psychosocial
interpretation when the Institute was set up in 1993. Long before
child-centred care was placed at
the core of the NHS, academics at Leicester recognised that closer
engagement with service
providers and practitioners could lead to better care, resource allocation
and psychological
outcomes. The aim was to effectively translate academic theory and
research into policy practice.
Researchers, teachers and clinicians work alongside social workers,
nursery nurses, housing
officers, educators and youth/community workers. The findings of the
studies reported in the case
study have informed organisations working with or on behalf of vulnerable
children, ranging from
central government (e.g. DoH, DSS, DCSF) to local authorities
(Leicestershire Partnership NHS
Trust, Leicester City Educational Psychology Service) to the voluntary
sector (BAAF, ADHD
Solutions, Unicef).
Informing policy and practice
The philosophy of the Institute is to apply research and teaching to
policy requirements, services
and practice. John Simmonds of BAAF says: "The respect that has developed
for the quality of this
work because it links a valid and reliable description of the issues with
a clear pathway for what
can be done to improve the situation of those studied, cannot be
overestimated." (A).
Miranda Wolpert of the Anna Freud Centre says: "It [the Institute's
research] has made
practitioners more aware of the evidence-base that applies to marginalised
children and more able
to evaluate and adapt their work. Every day I hear people talk about more
interactive work and
closer liaising with schoolchildren with mental health needs." (B).
Outcomes of research projects
Looked-after children — The evidence from the Institute's studies
into looked-after and adopted
children (around 80,000 at any one time in the UK) has informed the
expansion of mental health
services through major policy initiatives such as the National Child and
Adolescent Mental Health
Services (CAMHS) Review in 2008 (C), where Vostanis was an Expert
Reviewer, and NICE
Guidelines for Looked After Children in 2010 (D).The research
provided the impetus to transform a
long-held concern about the mental health status of looked-after children
into a comprehensive
approach, with formal assessment of a child's mental health and subsequent
provision of
appropriate services. This has resulted in closer working between local
authorities and CAMHS,
with CAMHS professionals being routinely integrated into looked-after
children's teams. Research
informed guidelines were embedded in the Adoption and Children Act 2006
and subsequent
regulations in relation to adoption support.
Each year Dr Jeanette Bowlay-Williams, a clinical psychologist, uses the
Institute's research
findings to help around 30 adoptive parents and 60 foster carers to
understand their children's
behaviour through group training and to build a new level of acceptance.
She says: "There has
been a marked reduction in placement breakdown in recent years as a
result." (E).
Young people in the criminal justice system — The research led to
a Cochrane Review in 2003 that
has been widely disseminated to Youth Offending Services and the Youth
Justice Board (F),
informing policy and service development, which is still in place in 2013.
Young offenders, who
number around 3,500 in the UK at any given time and who often experience
mood and anxiety
disorders and problems with self-harm, are now seen by mental health teams
and receive
assessment and intervention within two weeks of offending.
Homeless children and young people — The Institute's research into
young homeless peoples'
needs and how non-statutory and statutory services should be integrated to
meet these, have been
presented at national events hosted by the Department for Communities and
Local Government. A
2010 report that acknowledges Vostanis' contribution has been disseminated
to local housing
departments and national organisations for homeless people (G).
A study establishing homeless families' perspectives on their health
needs and barriers to
accessing services has informed the 2012 consultation of the Leicester
Council and helped sustain
services (the family hostel at Border House, the Family Support Service
and Corner Club) for
homeless families in the current economic climate. The findings have
informed the Standards of
the National Faculty for Homeless and Inclusion Health (2013; H).
The institute's Family Support
Service, staffed by a dedicated team of five, extends support to families
on leaving hostels to be
rehoused, and is regarded as a model of excellence and innovation. In ten
years to 2013, more
than 2,500 children have been helped by this service. Dr Bowlay-Williams
says: "The Institute's
research into homeless victims of domestic abuse and PTSD helped
psychologists working with
this vulnerable group to understand and have the confidence to undertake
symptom management,
which led to a reduction in intrusive images and flashbacks, and better
sleep patterns, and
therefore increased access to education."
School children in Pakistan — Under the supervision of the
Institute, Dr Sajida Hassan has set up
the Husseini Foundation in Karachi, Pakistan, which has developed a
training programme
(handbook for teachers and mothers, trainers' manual and research
evaluation tools) for early
intervention in the identification and school-based management of less
complex emotional and
behavioural problems. Between April 2011 and June 2013, 400 teachers, 160
mothers and 3,500
children benefited (I). The programme has now been set up elsewhere
in the country, with different
levels of courses for teachers, psychologists and parents.
Child victims of war in Gaza — The Institute's studies and
measurement tools have been used by
local and international NGOs, such as MSF and Save the Children, for
recruitment and training of
staff and specialists; for fundraising and advocacy in their home
countries; and for proposing
services and evaluating their work. The Palestinian Ministry of Education
established counselling
units and trained teachers to recognise the symptoms of PTSD for referral.
Al-Quds' School of
Public Health's MSc in Community Mental Health has recently added Trauma
as a module. Many
leaders in the Ministries of Health and Education are graduates of this
programme (J).
Sources to corroborate the impact
A. Letter from Director of Policy Research and Development at the British
Association for
Adoption and Fostering (BAAF)
B. Statement from Director, CAMHS Evidence Based Practice Unit, Anna
Freud Centre.
C. Final Report of the National Child and Adolescent Mental Health
Services Review: Children
and Young People in Mind. Department for Children, Schools and Families,
2008.
D. National Institute for Clinical and Health Excellence (2010) Looked
After Children and Young
People: NICE /SCIE Guidance
E. Statement from Dr Jeanette Bowlay-Williams, Young Persons Team, CAMHS
Leicester.
F. Report: Screening for Mental Disorder in the Youth Justice System.
Youth Justice Board
(2003)
G. Mental Health Good Practice Guide: Meeting the Psychological and
Emotional Needs of
Homeless People. Department for Communities and Local Government, May
2010.
H. Faculty for Homeless and Inclusion Health (2013) Standards for
Commissioners and Service
Providers. London: College of Medicine.
I. Progress report from Dr Sajida Hassan, Husseini Foundation, Pakistan.
June 2013.
J. Statement from Associate Professor of Child & Adolescent
Psychiatry, School of Public
Health, Al-Quds University.