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Adolescent Theme: Putting Research to Work Valerie Dunn October 10, 2013

Adolescent Theme: Putting Research to Work Valerie Dunn October 10, 2013. Adolescent Theme. TC-17 Study (Transfer of Care at 17): Mental health of potentially vulnerable young people in transition: care leavers (27) & CAMHS leavers (26)

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Adolescent Theme: Putting Research to Work Valerie Dunn October 10, 2013

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  1. Adolescent Theme: Putting Research to Work Valerie Dunn October 10, 2013

  2. Adolescent Theme TC-17 Study (Transfer of Care at 17): • Mental health of potentially vulnerable young people in transition: care leavers (27) & CAMHS leavers (26) • Clinical interviews plus service use, experiences, opinions at transition & 12 months later Why? Adolescence – high risk for emergence of MH problems • Approx half lifetime mental disorders onset in mid-teens; 75% <25 • transition from child-centred services is at 16-18 (regional variation & flexibility; CCC offers extended support) • MH need in both groups which may compromise transition

  3. What do we know ? • CAMHS leavers: ); around 1/3 eligible for adult services – don’t make it; transition most successful in the most severely ill (eg inpatients or those with psychosis • Care leavers: large unmet MH need, poor service uptake, placement instability, poor outcomes on most indicators (education, employment, social, criminality) Research suggests need for improved support at a difficult time

  4. TC17 care leavers (n=27) results in brief: * 74% lifetime MH diagnosis , often undetected/untreated * 52% MH diagnosis as YP face transition ; 44% 12 months later * 48% NEET (not in education, employment or training) at transition; 54% 12 months later * 62% had not taken up at referrals * Placement breakdown often associated with MH problems 18/27 (66%) – moved to independent living

  5. Foster care Accounts for around 75% of all care placements Our survey of Cambs foster carers (LA & agency): • Children’s behaviour & emotional ‘damage’ one of the biggest challenges • Around 40% ‘pushed to their limits’: aggression, violence, destruction & complex MH problems (ADHD, self-harm, overdoses). • Difficulties had last 3 weeks – 10 years • Often resulted in placement breakdown FC (ours & national surveys) want better training, support & better access to psychological services for those most in need

  6. Next step … By addressing MH problems early we could prevent escalation, encourage stable placements & improve chances of successful transition in young adulthood ‘Decisions at the outset of a care journey can set in motion a domino effect of positive or negative outcomes, with costs accumulating over a lifetime’1 Our response: Devise & evaluate CloseUp Training for foster carers 1 Hannon C, Wood C, Bazalgette L,In Loco Parentis, Demos. 2010

  7. Challenges: • To fully engage foster carers in the training • To understand: What is it really like to be taken away from one’s family and placed in local authority care? Essential to involve young people How can we actively & usefully involve young people in an innovative, engaging & creative way? Maverick approach required, surveys won’t do it ... but maybe a film could …

  8. My name is Joe • Partnership with Cambs Film Consortium – core team of animator, composer, volunteers, Children’s Participation team, workshop facilitator (YOS) • Consultation & workshops for YP • 4-day animation summer school, August 2012 • Premiere w Q&A, Cambridge Arts Picturehouse, Oct 2012 • YouTube with ‘Behind the Scenes’ http://youtu.be/ArBjWe3IWs0

  9. Patient Public Involvement (PPI)

  10. ‘Joe’ Impact • Foster carer training: fostering agencies, local authorities • National Agency – in discussions • NCAS website • YouTube – over 2,000 views • Social worker training • Youth Film Festival • Led to Finding My Way – launch October 15 – do come

  11. Feedback ‘Well, we were talking about it without talking about it weren’t we. Yep, it was good.’ Young person ‘This is a University isn’t it? I’m not clever enough to come here, but will you show us round?’ Young person ‘I wanted to say how brilliant it was ... nice to be involved in a project that was so well planned & supported, a great team I think!  I was really impressed with the young people, they were very courageous in sharing their ideas & taking on so many new challenges.’ Lizzy,animator ‘That film says it all’ Foster carer

  12. Aims of CloseUp Training: • to capitalise on the unique position of foster carers to build a bond with children & YP in their care • to equip FC with skills & knowledge to identify symptoms (sx) of common but severe emotional & behavioural problems in LAC • to devise a method of monitoring & recording mental state for mandatory review • to improve access to appropriate, timely treatment when necessary

  13. CloseUp Training: content • Common MH problems: attitudes & language, reassurances, evidence not folklore, definitions, prevalence, causation, bran development, services, impact, why it’s important • How to identify core symptoms (sx) across the spectrum • ‘Normal’ vs Common • Association w attachment problems • A-Z of Talking & Listening • How to complete the Wellbeing Profile (FC & child versions – design stage!)

  14. CloseUp: delivery • 2-day (or 3?) (4 hours per day) small groups • Handbook, slides, expert video clips, My Name is Joe • Mixture of direct instruction, discussion, case studies, small group/pair exercises & ‘homework’

  15. What words do YOU use? Exercise 2:What words do you use? Why? Impact?

  16. MI: what do we mean? We’re alldifferent ~What’s normal? A myth? ~More helpful - normal range of almost everything from emotions & behaviour to blood pressure, glucose levels, BMI ….. When does sadness/anxiety/behaviour become a clinical problem?

  17. Reassurances We’re NOT asking you to: • Make clinical diagnoses • Provide psychological treatment • Label children & young people as mentally ill • Deal with mountains of extra paperwork • Medicalize ordinary child/teenage behaviour

  18. Recording observations in the Well-P • Core signs/symptoms common to multiple disorders: mood irritability agitation/poor concentration eating sleep fear/’red alert’ • When: - daily for two weeks during first month in care in your care (can be repeated annually or if concerned) • Impairment It’s not the individual days that are important but the cumulative picture that emerges over the fortnight

  19. Feasibility stage: • Wisbech, December 2012, Cambridge March & Sept/Oct 2013 • 17 trained: 10 experienced carers (4 agency 6 LA) & 7 newly-approved (2 agency, 5 LA) • Experienced: largely unstructured – maximise FC input • Overwhelmingly positive response: *‘I wish I’d done this when I was a new carer’, *‘It makes so much sense.’ *‘All new carers should do this. It’s so relevant’ *‘The training was a really, really good idea, it was even helpful for me as a long time carer. The WELL-P is a great idea and very forward thinking”.

  20. The future: CLAHRC EoE – 2-year pilot, agencies and LAs: test the concept that FC can usefully identify & monitor MH symptoms Develop the child and teenage versions of the Well-P – stickers, online, apps … Data should help us understand the complex MH needs of children and YP when they enter the care system and, in turn, develop the appropriate services

  21. Many thanks to Cambridgeshire County Council Peterborough City Council Young people Film makers Foster carers CPFT

  22. Thank you for your time, interest & attention Valerie Dunn vjd20@cam.ac.uk, 01223 746053

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