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Addressing the Mental Health Needs of Looked after Children Who Move
Placement Frequently
Alison Beck
Adoption & Fostering 2006 30: 60
DOI: 10.1177/030857590603000308
The online version of this article can be found at:
http://aaf.sagepub.com/content/30/3/60
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What is This?
Alison Beck is
Consultant Clinical
Psychologist, South
West London and St
Georges NHS Trust,
London
Key words: mental
health, looked after
children, frequent
placement moves
60
Introduction
This study compares the mental health
needs of looked after children who move
placement frequently with those in more
stable placements. A number of UK
studies have found high rates of mental
health need among looked after children
(McCann et al, 1996; Dimigen et al,
1999; Minnis and Devine, 2001). These
findings are supported by the results of
the Office for National Statistics (ONS)
survey of the mental health needs of
looked after children.
Methods
All 786 young people looked after by
Lambeth local authority who were aged
over three years were included. Social
workers withdrew consent to approach 37
young people and 45 carers/birth parents,
the most common reason being that there
were ongoing care proceedings. Twenty
birth parents withheld consent for their
children to participate in the project.
All looked after children and young
people over the age of 11, for whom
consent was not withdrawn, were invited
to take part (N = 529). In addition, the
main carers of all young people (aged
over three years) in the care of the local
authority were invited to participate (N =
661). All individuals were sent a letter
describing the project and emphasising
that they were under no obligation to take
part, although they were offered a financial incentive of 5 for returning the
questionnaires.
Participants were sent two questionnaires: the Strengths and Difficulties
Questionnaire (SDQ, Goodman, 1997)
and either a Carer or a Young Person
questionnaire. The latter was a nonstandardised tool developed for the study
to obtain demographic details and qualitative information about a variety of aspects
of young peoples lives relevant to their
mental health and access to mental health
services.
The Carer and Young Person questionnaires were developed to provide young
people and their carers with an opportunity to share more descriptive information about factors affecting their mental
health. Questions were therefore largely
open-ended, allowing for the expression
of a broad range of views about placements, about young peoples relationships
with social workers and foster carers, and
about their views of mental health services. Information was also collected
about young people and their carers
perceptions of risk and protective factors for mental ill-health, about their
perceptions of the young peoples emotional and behavioural difficulties, and
X2 = 7.5, p = 0.006
X2 = 11.3, p = 0.001
3 2
X = 21.6, p<0.001
2
61
Table 1
Prediction of psychiatric diagnoses using SDQ
Unlikely
Possible
Probable
Conduct
409 (58%)
120 (17%)
177 (25%)
Emotional
586 (83%)
78 (11%)
42 (6%)
Hyperactivity
459 (65%)
233 (33%)
14 (2%)
Any diagnosis
353 (50%)
141 (20%)
212 (30%)
Protective factors
Six factors were repeatedly mentioned by
carers as protecting the young people in
general from mental health problems.
Furthermore, when those young people
perceived by their carers as having one of
the protective factors were grouped and
compared with those who did not display
these factors, they were less likely to have
a probable psychiatric diagnosis. The
factors were a consistent hobby or
interest,14 somebody they are close to,15 a
sociable and independent nature,16 a
warm and affectionate disposition,17 selfconfidence18 and a sense of responsibility.19 These results must be cautiously
interpreted and causal links cannot be
made. Further studies with longitudinal
11
12
X2 = 4.0, p = 0.05
X2 = 0.4, p = 0.5
6
For example, white vs non-white X2 = 0.08,
p = 0.8
7
X2 = 3.8, p = 0.053
8
For example, full care order compared to
section 20: X2 = 1.8, p = 0.2
9
X2 = 2.5, p = 0.1
10
t (782) = 1.6, p = 0.1
62
Discussion
This study confirms previous findings of
high rates of mental health problems in
looked after children and raised levels
among those who move around placements. Young people who had moved
placement three or more times in the last
year seemed to be at particular risk of
developing a psychiatric disorder,
especially conduct disorder. They were
found to be three times more likely to
have a conduct disorder than looked after
children who had moved placement less
often. Young people in the first category
had a number of other distinguishing
characteristics. They were more likely
than children in more stable placements
to live out of borough, to be aged between
11 and 15 years and to be placed in residential units. Further studies are needed
to explore these associations further to
clarify questions of causality.
The high rates of deliberate self-harm
found in this study are extremely concerning and worthy of targeted intervention. Twenty-seven per cent of the young
people reported having deliberately
harmed themselves in the last six months.
As a percentage of the looked after
children in the care of Lambeth, this
translates into 191 young people. Furthermore, children with probable conduct
disorders were 24 times more likely than
those without to report self-harming, and
young people who had moved placement
frequently were significantly more likely
to report self-harm than those in more
stable placements.
It is significant that these results
confirm those of a smaller but similar
study published in Adoption & Fostering
(McCarthy, 2004). McCarthy found that
children who move around placements
display multiple problems before entry to
care, experience a mixture of living
situations in and out of their home area
and get caught up in a negative cycle of
instability that reinforces their
20
X2 = 4.6, p = 0.03
X2 = 4.7, p = 0.03
22
X2 = 11.4, p = 0.001
23
X2 = 5.2, p = 0.02
24
X2 = 5.6, p = 0.02
25
X2 = 5.2, p = 0.02
21
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65