Suchergebnisse

Ambiguities in the term 'evidence‐based practice' (EBP) are often used to hide some of the tensions within the idea itself. This article seeks to clarify what EBP means and how evidence and knowledge can contribute to the development of children's services. It acknowledges the 'implementation gap' between evidence‐based practice and evidence‐based practitioners, and discusses two contrasting perspectives on the problem and its solution. For 'disseminators' the primary issue is better translation of findings into practice, illustrated here by the work of the National Institute of Health and Clinical Excellence (NICE). 'Revisionists' look beyond obstacles and drivers to implementation and instead advocate looking again at the relationship between research and practice and propose a number of radical proposals for how this relationship can be re‐envisioned.

"What is 'mentalization'? How can this concept be applied to clinical work with children, young people and families? What will help therapists working with children and families to 'keep the mind in mind'? Why does it matter if a parent can 'see themselves from the outside, and their child from the inside'? Minding the Child considers the implications of the concept of mentalization for a range of therapeutic interventions with children and families. Mentalization, and the empirical research which has supported it, now plays a significant role in a range of psychotherapies for adults. In this book we see how these rich ideas about the development of the self and interpersonal relatedness can help to foster the emotional well-being of children and young people in clinical practice and a range of other settings. With contributions from a range of international experts, the three main sections of the book explore: - The concept of mentalization from a theoretical and research perspective - The value of mentalization-based interventions within child mental health services - The application of mentalizing ideas to work in community settings Minding the Child will be of particular interest to clinicians and those working therapeutically with children and families, but it will also be of interest to academics and students interested in child and adolescent mental health, developmental psychology and the study of social cognition"--

Children placed for adoption often face unique challenges and are at higher risk of mental health problems compared to the general population. Yet despite some important clinical developments, there is still a lack of evidence related to effective therapeutic interventions for this population. This study reports on the preliminary evaluation of a mentalization-based family therapy service, Adopting Minds, offered as part of a post-adoption support service. Thirty-six families who had adopted 42 children were referred to the service between September 2015 and December 2016. Demographic information was collected and assessments undertaken on the families at baseline and at the end of therapy, using a range of validated measures. Five families who had completed therapy were also interviewed about their experience of the approach. For those families on which data were available, positive outcomes in mental health and parental self-efficacy were identified, and adoptive parents reported high levels of satisfaction with the mentalization-based family therapy service. Analysis of the interviews revealed that the families found it a containing space that was supportive and non-judgemental. They felt able to express their fears and worries to a therapist who was friendly and knowledgeable and reported that the service helped them to deal with and link struggles they were facing to their own as well as their child's past experiences. However, some adoptive families felt that this short-term, six-session service alone was not enough to address all the difficulties that had brought the family to seek help, and would have preferred a longer-term intervention or therapy in combination with other types of support.

Although an understanding of the lived experience of foster care relationships can provide valuable information to guide social work practice and policy, few such studies have been carried out. This article presents findings from a qualitative investigation exploring experiences of relationships between foster carers and the young people in their care. Eight care-experienced young people and nine foster carers participated in interviews and focus groups. Interpretative Phenomenological Analysis (IPA) was used to explore their experiences. The insider's perspective was further amplified through engaging peer researchers with experience of fostering relationships – one a young person who had been in care, the other a long-term carer. Two overarching themes were identified. Firstly, participants made sense of fostering relationships through comparisons with birth family ones, particularly in relation to the impact of care systems, continuing biological family relationships and foster care language. Secondly, previous experiences created barriers to forming positive fostering relationships, but when these were overcome the experience could be life changing. The implications of these findings for social care policy regarding foster carer support, training and matching guidelines are discussed.

The needs of foster carers are complex as children in their care often present with complex emotional and behavioural difficulties. Previous studies have examined foster carers' perceptions of the unmet needs of the children in their care but there is a lack of knowledge regarding carers' own goals when seeking professional help. The present study seeks to fill this gap by examining the goals that carers who are looking after children with emotional and/or behavioural difficulties set at the start of an intervention, the Reflective Fostering Programme, designed to support them. Twenty-six foster carers were asked to complete a Goal-Based Outcome Measure (GBOM) before starting the programme. Qualitative content analysis revealed five main categories of goals. Three were child focused (child's relationships, challenging behaviours and emotions) and two were foster carer focused (personal goals and goals related to participating in the programme). By understanding the types of goals meaningful to foster carers, interventions can be developed to better target their specific needs and allow outcome measures to be more closely aligned to their goals. Results are discussed in terms of implications for the development and evaluation of interventions to support foster carers and the children they look after.

Background:In England and Wales, the single-informant Strengths and Difficulties Questionnaire (SDQ) is used to assess and monitor looked-after children's (LAC) mental health; and some targeted Child and Adolescent Mental Health Services (CAMHS) include a minimum SDQ score in their acceptance criteria. However, its ability to identify LAC who need mental health treatment is insufficiently understood.Methods:One hundred and forty four LAC referrals to a Targeted CAMHS Team were screened as part of a larger study. To establish how well the SDQ identified children who required treatment, Total Difficulties Scores from single-informant SDQs submitted at referral were compared to treatment recommendations following routine CAMHS assessment in a real-world setting. To explain the results, clinicians ( n = 9) from the team were interviewed and key themes identified using thematic analysis.Results:AUROC analysis found that the single-informant SDQ discriminated between children who were assessed as needing a mental health intervention and those who did not with low accuracy when SDQs were completed by carers or young people themselves, and moderate accuracy for teacher-completed SDQs. Optimal cutoff scores are calculated and are lower than advised in scoring guidance. Key themes from clinician interviews identified possible gaps and limitations: Developmental trauma and attachment difficulties, A different kind of patient?, Seeing the "bad" but neglecting the sad, and The importance of clinical judgment.Conclusions:Contrary to current UK Government policy, this study suggests that the single-report SDQ should not be relied upon as a sole means of identifying mental health difficulties in this vulnerable, high-risk population.

Purpose
The purpose of this study is to describe the development of the 14-item reflective fostering fidelity rating (RFFR), an observational rating system to evaluate model fidelity of group facilitators in the Reflective Fostering Programme (RFP), a mentalisation-based psychoeducation programme to support foster carers. The authors assess usability, dimensionality, inter-rater reliability and discriminative ability of the RFFR.


Design/methodology/approach
Eighty video clip extracts documenting 20 RFP sessions were independently rated by four raters using the RFFR. The dimensionality of the RFFR was assessed using principal components analysis. Inter-rater agreement was assessed using the intra-class correlation coefficient.


Findings
The proportion of missing ratings was low at 2.8%. A single principal component summarised over 90% of the variation in ratings for each rater. The inter-rater reliability of individual item ratings was poor-to-moderate, but a summary score had acceptable inter-rater reliability. The authors present evidence that the RFFR can distinguish RFP sessions that differ in treatment fidelity.


Originality/value
To the best of the authors' knowledge, this is the first investigation and report of the RFFR's validity in assessing the programme fidelity of the RFP. The paper concludes that the RFFR is an appropriate rating measure for treatment fidelity of the RFP and useful for the purposes of both quality control and supervision.

Purpose
There is little evidence regarding how to best support the emotional well-being of children in foster care. This paper aims to present the evaluation of an adaptation of the reflective fostering programme, a group-based programme to support foster carers. This study aimed to explore whether a version of the programme, co-delivered by a social work professional and an experienced foster carer, was acceptable and relevant to foster carers and to gather data on programme effectiveness.


Design/methodology/approach
In total, 38 foster carers attended the programme and took part in this study. Data was collected regarding carer- and child-focused outcomes at pre-intervention, post-intervention and four-month follow-up. Focus interviews were also conducted to further assess acceptability and relevance for foster carers.


Findings
Analysis of quantitative outcome showed statistically significant improvements in all outcomes considered including foster carers stress and carer-defined problems, as well as carer-reported measures of child difficulties. Focus group interviews with foster carers suggested that the programme as co-delivered by a foster carer and a social worker was felt to be relevant and helpful to foster carers.


Originality/value
These results provide a unique contribution to limited understandings of what works for supporting foster carers and the children in their care. Promising evidence is provided for the acceptability and relevance of the revised version of this novel support programme and its effectiveness in terms of carer- and child-related outcome measures. This work paves the way for further necessary impact evaluation.

This study presents the feasibility and pilot evaluation of the Reflective Fostering Programme (RFP), a recently developed, group-based program to support foster carers, based on the concept of "reflective parenting." This innovative development follows calls by the National Institute for Health and Clinical Excellence and other organizations to help improve outcomes for children in care by providing better support to their carers. This study aimed to establish whether it is possible to implement the RFP and to gather preliminary data on the acceptability and effectiveness of the program. Twenty-eight foster carers took part in the study. Results indicate that training and delivery of the RFP were feasible; the program was felt to be relevant and meaningful to both foster carers and social care professionals delivering it. Preliminary pre-post evaluation showed a statistically significant improvement in foster carers' stress, their achievement of self-defined goals and child's emotion lability and overall strengths and difficulties. There were no statistically significant changes in carers' reflective functioning, although some foster carers reported on changes in reflective capacity during focus groups. Preliminary findings about the feasibility of training and delivery of the RFP, as well as the acceptability and effectiveness of the program, are encouraging, but further impact evaluation is needed.

Looked after children represent a vulnerable group in society, many of whom are exposed to maltreatment, particularly in the form of relational trauma, prior to placement with a foster family. Challenging behaviours can place foster placements at risk and looked after children often confront the possibility of placement breakdown. A carer's capacity to retain a robust understanding of the children in their care as autonomous individuals with needs, feelings and thoughts can be important in enabling them to respond more effectively to the worrying or disruptive behaviour they may encounter. The Reflective Fostering Programme (RFP) is a new group-based programme aiming to support foster carers of children aged 4–11. This innovative development follows calls by the National Institute for Health and Care Excellence (NICE) and other organisations to help improve outcomes for children in care by improving resources for their carers. The RFP is rooted in evidence drawn from the field of contemporary attachment and mentalizing research, which indicates that children who have a carer high in reflective functioning tend to have more favourable outcomes in terms of social-emotional well-being. It also draws on the evidence that looking after a child who has impaired capacity to mentalize as a result of early relational trauma affects the carer's capacity to mentalize and respond sensitively to the child (Ensink, et al., 2015). This article sets out the rationale for the RFP, outlines its key elements and concludes by indicating future service implementation and a planned feasibility study examining this approach.

Background: The needs of children in care are a government priority, yet the evidence base for effective interventions to support the emotional wellbeing of children in care is lacking. Research suggests that supporting the carer-child relationship, by promoting the carer's reflective parenting, may be an effective approach to improving the wellbeing of these children. Methods: The study comprises a definitive, superiority, two-armed, parallel, pragmatic, randomised controlled trial, with embedded process evaluation and economic evaluation, and an internal pilot, to evaluate the effectiveness, and cost-effectiveness, of the Reflective Fostering Programme. Randomisation is at the individual level using a 1:1 allocation ratio. The study is being conducted in local authority sites across England, and is targeted at foster carers (including kinship carers) looking after children aged 4 to 13. Consenting participants are randomly allocated to the Reflective Fostering Programme (intervention arm) in addition to usual support or usual support alone (control arm). The primary outcome is behavioural and emotional wellbeing of the child 12 months post-baseline, and secondary outcomes include the following: foster carer's level of stress, quality of life, reflective capacity, compassion fatigue and burnout, placement stability, the quality of the child-carer relationship, child's capacity for emotional regulation, and achievement of personalised goals set by the carer. Discussion: A feasibility study has indicated effectiveness of the Programme in improving the child-carer relationship and emotional and behavioural wellbeing of children in care. This study will test the effectiveness and cost-effectiveness of implementing the Reflective Fostering Programme as an additional aid to the support already available to local authority foster carers. Trial registration: ISRCTN 70832140.