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. . Do all mental health professionals need to know about the mental health needs of looked after children and, if so, why?. . An outline. Part 1. What do we know about the mental health needs of looked after children?Part 2. What happens after leaving care?Part 3. How can lessons from clinical experience and research influence best practice, further research and policy?.
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The mental health needs of looked after children Dr Antonella Ingrassia
Consultant Child and Adolescent Psychiatrist
Greenwich CAMHS
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An outline Part 1. What do we know about the mental health needs of looked after children?
Part 2. What happens after leaving care?
Part 3. How can lessons from clinical experience and research influence best practice, further research and policy?
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A preface- the history of alternative care The ‘kindness of strangers’
The first Poor Law (1531) – apprenticeship for children
Voluntary care – Children Act 1948
Looked after children - Children Act 1989
Leaving care act 2000
The Foundling Hospital (1857) – boarding out to families
7. 60,900 children were in care on 31 March 2005Care matters White paper 2006
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All lac in oxfordshire at a point in time
134 adolescents (response rate was 66%)
2 stage design- achenbach child behaviour checklist and youth self report questionnairesAll lac in oxfordshire at a point in time
134 adolescents (response rate was 66%)
2 stage design- achenbach child behaviour checklist and youth self report questionnaires
10. Uses the deveraux scale of mental disorders (based on DSM IV criteria)Uses the deveraux scale of mental disorders (based on DSM IV criteria)
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Are looked after children different? Entering care (Sinclair et al 2007)
Abuse and neglect
65% of those first in care under 11
Chronic adversities
Parental substance misuse and domestic violence in 41% of those first in care under 11
Interaction of biological and environmental factors
Chronic adversities related to poor health outcomes
17.7% considered ‘disabled’ by their social worker
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Are looked after children different? Abuse whilst in care Hobbs et al 1999 (133 children in foster/residential care involved in 158 incidents)
Children in care are more likely to be assessed by a paediatrician for suspected abuse (7-8 times FC, 6 times RC)
Confirmed cases- 42 physically abused, 76 sexually abused, 15 both
FC perpetrators of physical abuse (28) and sexual abuse (22) Retrospective study
All suspected cases of child abuse assessed and reported by a paediatrician over a period of 6 years (1990-1995)Retrospective study
All suspected cases of child abuse assessed and reported by a paediatrician over a period of 6 years (1990-1995)
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Are looked after children different? Abuse whilst in care Abuse perpetrated by individuals
Institutional abuse
Peer abuse
Targeting
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Are looked after children different? Moves and placement breakdown
Minty 1999 - breakdowns between 20 and 50%
Sinclair et al 2007 – 17% of the sample had had 6 or more placements Review by Minty on outcomes of long term foster careReview by Minty on outcomes of long term foster care
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Children “on the edge of care” In and out of care
More than one period of care
Children in need as a result of abuse or neglect (around 30% will enter care during their childhood)
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Psychiatric disorder among British children looked after by local authorities: comparison with children living in private households (Ford et al 2007) Comparison between looked after children and children living at home from deprived and non deprived background
Data combined from 3 surveys of looked after children (England, Scotland, Wales)
ONS sample of children living at home (Meltzer el al 2000) from the child benefit register
Age 5-17
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Measures (Same measure in the 4 surveys) Strengths and difficulties questionnaire
(Goodman 1997)
Teacher’s report
Social worker’s and carer’s report
Development and Well Being Assessment
(DAWBA- Goodman et al 2000)
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Questions (true or false) Research evidence suggests that:
10% of young people who have been in care go on to become young prisoners
Looked after children are 10 times more likely to be excluded from school than their peers
Of young women leaving care, 25-30% are parents
Young people leaving care have a 1 in 10 chance of becoming homeless
Studies of care leavers show that:
8% had a long term mental disorder
20% had self harmed since the age of 15
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Looking at care leavers-mental health (Buchanan 1999)
At age 16
less satisfied with their lives
25% had significant levels of maladjustment
At age 33
Higher rates of depression than other parental groups
National child development study
17000 children born in 1958 in england scotland and wales
National child development study
17000 children born in 1958 in england scotland and wales
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Looking at care leavers-mental health (Saunders and Broad 1997)
16.6% had a mental disorder
35% had engaged in self harm since the age of 15
60% had felt suicidal
31% had self referred to mental health services (of whom 77% did not find services useful) N= 48, mostly womenN= 48, mostly women
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Looking at care leavers-social exclusion 50% will be unemployed on leaving care and 20% will be homeless within 2 years of leaving care (Biehal et al 1995, Broad 1998)
26% of all prisoners and 40% of prisoners under 21 (The national prison survey 1991: main findings, 1992)
23 % of adult prisoners and 38 % of young prisoners are care leavers (Department of Health, 1999)
75% have no formal qualifications (Garrett 1992)
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Looking at care leavers-parenthood On leaving care 1 in 7 young people already have or are expecting a child (Wade et al 2006)
On follow up (10 months) this is risen to 26% (35% of females and 15% males) (Wade et al 2006)
The children of women who have spent time in care are themselves two and a half times more likely to go into care than their peers (Sergeant 2006) 1 in 7= 14%1 in 7= 14%
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Looking at care leavers-substance misuse (Wade et al 2006- 106 people and their care leaving workers)
Cannabis use- 73% have smoked it, 52% in the last month, 34% report daily smoking
One-tenth had used cocaine within the last month
15% have used ecstasy within the month
7 local authorities in england
106 people and their care leaving workers7 local authorities in england
106 people and their care leaving workers
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The state makes a rotten parent
(Sergeant 2006)
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The mental health needs of looked after children:everybody’s business