The Power of Relationship: A study of key working as an intervention with traumatised young people

This paper explores the role of the key working relationship in helping traumatised and characteristically hard-to-reach young people. A grounded theory approach was used to analyse data from 18 semi-structured interviews carried out with both key workers and young users in a community-based, innovative project in Inner London, Kids Company. The following four codes emerged: titrating intimacy, the power of relationship, the therapeutic function of hope and ‘knowing your own ghosts’. As well as supporting the important therapeutic function of the key working relationship, this paper draws on the analysis of the data to outline a three-phase model of intervention (fostering place attachment–homeostatic attunement–disruptive attunement) when working with traumatised and often hard-to-reach young people.     

Using research questionnaires with young people in schools: the influence of the social context

Whilst there is an extensive literature on the use of self-completion questionnaires as a research tool, very little attention has been paid to the influence of the social context in determining the ways in which questionnaires are used in practice. This paper describes our experiences of working with 27 English, mixed sex, state schools to carry out a questionnaire survey with 4754 students aged 13–14 years. The survey was part of a randomized controlled trial of peer led sex education. Using data from the questionnaires and from researcher fieldnotes, we highlight ways in which aspects of the social context affected the administration of the questionnaire, students' participation in the survey and the quality of the data collected.     

Agency among young people in marginalised positions: towards a better understanding of mental health problems

ABSTRACT

Agency in marginalised youth has been studied from various perspectives, yet the challenges that mental health problems pose for their agency remain poorly understood. Drawing on data from a study on youth transitions fractured by mental health problems, this study sheds light on this important issue. The data consists of 49 life story interviews with young adults. Using Ruth Lister’s four-dimensional taxonomy of agency, the analysis shows how everyday struggles with mental distress are entangled with the practices of the social security system, medical care, education, labour markets, and work life. It also reveals how emerging attempts at strategic agency can fail or flourish depending on the response of the social and structural context. If strategic agency is restricted by institutional practices, it will soon return to day-to-day struggling or become everyday resistance and cynicism towards the system. However, if the strategic agency is supported by institutional practices, a genuine path out of distress emerges. The paper suggests that taking seriously the experiences of mental distress and situating them in a specific socio-political context is essential for understanding youth agency today.     

The social contract revisited: a re-examination of the influence individualistic and collectivistic value systems have on the psychological wellbeing of young people

ABSTRACT

The prevalence of psychological health problems experienced by young people living in Western societies is increasing. Evidence suggests the cultural dynamism of individualism may play a role in this, but this evidence is conflicting. Here, we focus on both the concepts of individualism and collectivism, distinguishing between their horizontal and vertical dimensions. We examine the influence of these dimensions on the psychological wellbeing of a sample of 507 Australian emerging adults (aged 18–25). We found that orientations towards vertical (but not horizontal) individualism predicted lower levels of psychological wellbeing, while orientations towards horizontal (but not vertical) collectivism predicted higher psychological wellbeing. These findings add clarity to the way in which key Western social values play an understated role in the increasing prevalence of psychological health problems experienced by young people today. They also provide an understanding of how various traits embedded within these concepts relate to psychological wellbeing.     

Multiple imputation for missing data in a longitudinal cohort study: a tutorial based on a detailed case study involving imputation of missing outcome data

Multiple imputation (MI), a two-stage process whereby missing data are imputed multiple times and the resulting estimates of the parameter(s) of interest are combined across the completed datasets, is becoming increasingly popular for handling missing data. However, MI can result in biased inference if not carried out appropriately or if the underlying assumptions are not justifiable. Despite this, there remains a scarcity of guidelines for carrying out MI. In this paper we provide a tutorial on the main issues involved in employing MI, as well as highlighting some common pitfalls and misconceptions, and areas requiring further development. When contemplating using MI we must first consider whether it is likely to offer gains (reduced bias or increased precision) over alternative methods of analysis. Once it has been decided to use MI, there are a number of decisions that must be made during the imputation process; we discuss the extent to which these decisions can be guided by the current literature. Finally we highlight the importance of checking the fit of the imputation model. This process is illustrated using a case study in which we impute missing outcome data in a five-wave longitudinal study that compared extremely preterm individuals with term-born controls.     

The impact of the COVID-19 pandemic on the mental health and well-being of children and young people

The COVID-19 pandemic has had an enormous impact across the world. In this discussion paper, we examine the effect that lockdown has had on the mental health and well-being of children and young people. We write from a UK perspective in the light of the international evidence. Many of the discussion points raised resonate globally. We discuss how these issues can be dealt with and set out potential solutions as we emerge from this global crisis.     

Mental health in vietnam and the move to incorporate social work: A mixed methods study of staff perceptions and expectations

In 2010, Vietnam established social work as a profession. As part of their strategic plan, the government aims to incorporate social work into existing hospitals and health care facilities in the country, including psychiatric hospitals and mental health care centers. This paper, based upon survey and focus group data from 194 people working in three major mental health facilities in Hanoi, explores direct care staffs’ perceptions of this historic incorporation of social work, with a particular eye to the benefits and challenges of the transition. Results show most staff members thought social workers would provide great support to the many unmet needs of their largely underserved and impoverished patients. They also viewed social workers as a potential resource to the treatment team by reducing work overload. Existing staff, however, were less attuned to the clinical functions of social workers in mental health settings, often equating social work with community development and social movements. Some were concerned about social workers taking on their tasks; others about new social workers being hindered by the professional hierarchy in which doctors were placed at the top. Successful integration of social workers will hinge on strong support from policy-makers and leaders of mental health systems.     

Understanding dissociation in relation to child trauma,mental health needs,and intensity of services in child welfare: A possible missing link

Abstract

While there is limited research on the role of dissociation among children and adolescents, emerging evidence links child trauma history, dissociation, risk behaviors, and other negative outcomes among youth. This study examined dissociation in relation to mental health needs and intensity of services among a large sample of youth in Illinois child welfare, upon entry into care and in residential treatment settings. The Child and Adolescent Needs and Strengths (CANS), a comprehensive, trauma-informed assessment strategy and information integration/planning tool was the primary measure. This study included two overall samples of child welfare-involved youth, ages 3–18: at entry into care (N?=?27,737) and in residential treatment (N?=?5,758). Findings indicated that rates of clinically significant dissociation were generally highest among younger youth (under age 14) and among youth with more cumulative and severe trauma. Dissociative youth were significantly more likely to exhibit several risk behaviors (e.g., fire setting and self-harm) and mental health symptoms (e.g., psychosis and somatization). Those youth with significant dissociation at entry into care were more likely to be psychiatrically hospitalized, placed into residential treatment, with greater likelihood of placement disruptions within the 2 years following entry into care. Implications of these findings are discussed in terms of the value of identifying and assessing dissociation and other trauma-related symptoms that may be less recognized but can be linked to high-risk behaviors and other negative outcomes within child welfare and across child-serving systems. Understanding dissociation may be an important component of training, service/treatment planning, and clinical care within child-serving systems.     

Living on a knife edge: the responses of people with physical health conditions to changes in disability benefits

Abstract

This article documents the experiences of people with a physical health condition or disability who have experienced a loss of or change in disability benefits under the welfare reform programme in the United Kingdom. A theoretical model was constructed using in-depth interviews and grounded theory methods. The findings show that participants experienced the benefits system as dehumanising, and felt that they lived in a judgemental and invalidating society, where they were perceived as ‘scroungers’ and faced discrimination from others. These experiences negatively affected their mental and physical health and well-being. They also negatively affected participants’ identity, leading to experiences of shame, hopelessness and social isolation. However, many participants attempted to resist these negative impacts (e.g. through seeking support or taking political action). The findings demonstrate the significant impact of benefit changes on well-being and identity, thus highlighting important implications for claimants, and staff in healthcare, the benefits system and government.     

Using modern methods for missing data analysis with the social relations model: A bridge to social network analysis

Social network analysis identifies social ties, and perceptual measures identify peer norms. The social relations model (SRM) can decompose interval-level perceptual measures among all dyads in a network into multiple person- and dyad-level components. This study demonstrates how to accommodate missing round-robin data using Bayesian data augmentation, including how to incorporate partially observed covariates as auxiliary correlates or as substantive predictors. We discuss how data augmentation opens the possibility to fit SRM to network ties (potentially without boundaries) rather than round-robin data. An illustrative application explores the relationship between sorority members’ self-reported body comparisons and perceptions of friends’ body talk.     

Young people,emotional suspicion and the emergence of paediatric selfhood in Palestine

This paper explores young people's relationships to emotions and mental health care in Ramallah, Palestine. Palestinian young people—via public anger, sadness, or even joy—are often marked as emotionally other in familial, institutional and other public spaces as part of NGO-driven constructions of emerging paediatric selfhood. In response, they reproduce and/or reframe notions of emotional suspicion that underwrite these marginalizing processes. Thinking along such axes as possibility and impossibility; mobility and immobility; and the local and international, they simultaneously integrate and resist representational subjection, which is an important part of understanding broader post-Oslo Palestinian identity and community formation.     

Multifamily therapy in the community mental health network: A pragmatic randomized and controlled study

Multifamily therapy (MFT) is a psychotherapeutic group intervention for patients with severe mental disorders (SMDs) and their families. The present study is a multicenter, randomized, and controlled trial that analyzes the benefit of MFT during outpatient treatment. The recruited patients were randomly assigned to the experimental group (n = 26), which received 24 MFT sessions in addition to their treatment as usual (TAU), or to the control group (n = 29), which received only TAU (individual and family sessions). Six months after the inclusion in the MFT, the experimental group showed a significant decrease in number of visits to the psychiatric emergency services, number of psychiatric admissions, and the days of admission. The need for hospital care 6 months after recruitment was also lower in the experimental group compared to the control group. These results suggest that the implementation of MFT during outpatient treatment facilitates community management of people diagnosed with mental health problems.     

A Leadership Role for Social Work in the Mental Health Transition to Local Care

Current philosophy, policy, and practice involving care of persons with serious mental illnesses are reviewed, with a focus on the movement that is usually called deinstitutionalization. Past efforts and future trends are discussed within the context of public mental health systems at the state level. The paper argues for a greater leadership role for social work in providing mental health care in local communities because of the social work tradition of client empowerment, family involvement, and systems intervention.     

Variability in measures of health and health behavior among emerging adults 1 year after high school according to college status

Objective: To examine changes in health behaviors among US emerging adults 1 year after high school. Participants: The national sample of participants (N = 1,927), including those attending 4-year college/university (n = 884), 2-year colleges/technical schools (n = 588), and no college (n = 455), participated in annual spring surveys 2013–2014. Methods: Health behaviors were assessed the last year of high school and first year of college; differences by college status controlling for previous-year values were estimated using regression analyses. Results: Relative to 4-year college attendees, those attending technical school/community college were less likely to binge drink (odds ratio [OR] = 0.57, confidence interval [CI] = 0.38–0.86) but more likely to speed (OR = 1.26, CI = 1.0–2.84), consume sodas (OR = 1.57, CI = 1.0–2.47), and report lower family satisfaction (p < .01), with marginally more physical and depressive symptoms. College nonattendees reported more DWI (driving while intoxicated; OR = 1.60, CI = 1.05–2.47), soda drinking (OR = 2.51, CI = 1.76–3.59), oversleeping (OR = 4.78, CI = 3.65–8.63), and less family satisfaction (p < .04). Conclusions: Health risk behaviors among emerging adults varied by college status.     

Managing the process of change in residential child care: A consultancy approach

This article explores the impact of a consultancy undertaken with groups of residential child care staff within a large local authority who were experiencing considerable changes in their working environment as a result of a review of residential care structures. The authors were invited to engage directly with staff on an individual and group basis to help them work through the barriers they perceived to changing their approach to practice. The theoretical underpinning for the work was Charles Handy's [1993, Understanding Organisations (Harmondsworth, Penguin)] belief that change is more likely to have a positive outcome when staff have an investment in and contribution to the change processes. The model of change utilised within the sessions with staff was Kurt Lewin's three stages of 'unfreezing', 'change' and 'refreezing'. The consultancy raised a number of issues about the process of change and how this can be achieved within the residential child care context. In particular, it highlighted the problems of assuming that change is a linear process which can be directly controlled and managed in the flux and uncertainty which characterises this sector.     

Case management for people with psychiatric disabilities in rural Sweden; experiences from the implementation of a national policy

The aim is to analyse the implementation of a case manager-model in rural Sweden. A sample of 15 case management teams was selected. Written materials were collected and interviews on location were carried out. Results: rural case managers design their work methods themselves, which entail several deviations from the national policy guidelines in this field. The case management boards have a low capacity to direct and manage the activities of the case managers. Consequently, case managers develop into ‘welfare entrepreneurs’. One salient risk is that teams become isolated from the surrounding welfare system. In conclusion, the Swedish version of case management in rural areas is a result of local processes of adaptation and negotiation that result in services that differ from those envisaged in national policy guidelines.     

Using social support for LGBTQ clients with mental illness to be out of the closet,in treatment,and in the community

ABSTRACT

Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) individuals are often faced with societal challenges that can lead to mental health or substance abuse issues. They may be misunderstood or mistreated when seeking services because of a lack of training in offering culturally sensitive treatment by service providers. A program, the Rainbow Heights Club, was developed to support LGBTQ individuals with a mental health diagnosis. All of the members are in treatment for their mental health and/or substance abuse problems, but prior to the development of the program did not have a place to feel accepted, supported, or have a sense of community. Members were surveyed determine if Rainbow Heights was helpful in maintaining themselves in the community. Results indicated that 75% of members are more consistent in following prescribed treatments, keeping them free from inpatient hospitalization, and 79% reported being clean and sober since coming to the Club.     

Uncertain identities and health-risking behaviour: the case of young people and smoking in late modernity

This paper argues that 'uncertain identities' are a distinct contributing factor to the residual and intractable level of smoking among young people. Further, it argues that the significance of this factor is increased by the specific social/historical context of late modernity. Findings from research with 15 to 16 year olds in the East Midlands of England are used to explore the role that smoking is perceived to play in constructing a self identity. A voluntaristic perspective is adopted on the use of tobacco, reflecting both the focus on young people's motivation to smoke and the tendency for many young people to perceive smoking as a matter of personal choice. Smoking was found to have a symbolic significance not only in terms of the presentation of self to others but also in terms of the reflexive construction of the self by those involved. The paper analyses the role of smoking in relation to self-image, self-empowerment and self-affirmation and it is concluded that for many young people smoking has certain benefits in terms of coping with uncertain identities.     

Adaptation to Parenthood During the Post-Adoption Period: A Review of the Literature

Substantial research has been conducted on new parents’ adjustment during the transition to biological parenthood. However, very little is known about adjustment experiences during the transition to adoptive parenthood. Such information could assist in creating support systems for adoptive parents similar to those that currently exist for biological parents. A systematic literature review was conducted to examine individual and relational adjustment outcomes during the transition to adoptive parenthood, limited to those studies that examined the immediate post-adoption period through 3 years post-placement. By searching six databases using a variety of keywords including post-adoption, adapt, and parent, 11 research studies were identified that reported on parental mental health, physical health, and intimate partner relationship satisfaction in the immediate post-adoption period. The studies reviewed appear to indicate that post-adoption depression is relatively common, although perhaps less so than depression among biological parents. It is difficult to draw conclusions about physical health and relationship satisfaction as only one study directly assessing each outcome was located. Findings suggest that additional research is warranted to provide a clearer characterization of physical and psychological adaptation to parenthood among adoptive parents.