Mary John

Children and young people (CYP) with type 1 diabetes (T1D) are twice as likely to develop disordered eating (T1DE) and clinical eating disorders than those without. This has significant implications for physical and mental health, with some eating disorders associated with repeated diabetic ketoacidosis and higher HbA1c levels, both of which are life threatening. There is currently limited psychological support for CYP and families with T1D but increasingly, policy and practice are suggesting disordered eating in T1D may be effectively prevented through psychological intervention. We describe the development and theoretical underpinnings of a preventative psychological intervention for parents of CYP aged 11-14, with T1D. The intervention was informed by psychological theory, notably the Information Motivation Behaviour Skills model and Behaviour Change Technique Taxonomy. The intervention was co-developed with an expert advisory group of clinicians, and families with T1D. The manualised intervention includes two online group workshops, and supplementary online materials. The intervention continues to evolve, and feasibility findings will inform how best to align the intervention with routine care in NHS diabetes teams. Early detection and intervention are crucial in preventing T1DE, and it is hoped that the current intervention can contribute to improving the psychological and physical wellbeing of young people and families managing T1D.

Paediatric intensive care has a significant impact on the children and families who experience it. This effect continues post-discharge as the family attempt to recover from their ordeal. This article begins with an exploration of what makes a Paediatric Intensive Care Unit (PICU) admission potentially so traumatising and then examines current models for recovery which exist in the literature. These remain sparse and do not provide a coherent model for recovery after PICU. This paper therefore presents research which aimed to develop a model to understand the recovery journey for families. Children who had been PICU patients and their parents were interviewed and the transcripts analysed using grounded theory. Participants highlighted the importance of physical, psychological and social recovery and these have been integrated into a biopsychosocial model of recovery. Finding and accepting a 'new normal' were the culmination of this biopsychosocial journey. This paper concludes that an integrated approach to recovery is necessary and makes some recommendations for further research and clinical practice. © 2011 Elsevier Ltd.

Background: Looked-after children (LAC) frequently experience greater mental health challenges than the general child population. There has been a call for greater focus on early preventative interventions and priority access to specialist mental health support for this population. Brief mental health screening tools often provide the gateway to services and yet there is a lack of suitable assessment tools available for LAC. The current study is the first to explore the perspectives of foster carers and CAMHS clinicians’ in relation to the use of two brief screening tools; the Strengths and Difficulties Questionnaire (SDQ) and the Brief Assessment Checklists (BAC’s). Method: Qualitative data was collected via semi-structured telephone interviews and face-to-face focus groups with female foster carers (N=13) and clinicians working in a CAMHS setting (N=9). Results: Thematic analyses generated six themes which were organised into three superordinate themes centred around: 1) relevance to LAC, 2) using measures to inform care planning and; 3) current problems when using psychometric measures within the LAC population. Foster carers and clinicians emphasised the need for a comprehensive understanding of LAC given the complexity of their difficulties. There was acknowledgement that psychometric measures could facilitate and contribute to this by highlighting difficulties, providing accurate feedback to carers and clinicians, and enabling access to support. However, both groups seldom felt that current measures were nuanced enough to adequately capture the needs of LAC. Conclusion: Screening tools play a crucial role in identifying the mental health needs of LAC and facilitating access to services. Further research is needed to establish the ability of such measures to increase the sensitivity of the complex needs’ assessment of LAC. A number of clinical recommendations are also discussed in relation to the assessment of mental health in the LAC population.

The presence of a dermatological condition may deter contact with the affected person because it falsely signals the threat of infection. The current study investigated interpersonal aversion towards individuals with the appearance of acne and psoriasis. Participants (N=196) either viewed a female face with the appearance of acne, psoriasis, or no visible dermatological condition. Participants rated the attractiveness of the person, and indicated their willingness for social and indirect contact with them. The person depicted with acne was rated significantly less attractive than the person with psoriasis or no dermatological condition. Participants reported significantly less willingness for indirect contact with the person depicted with acne or psoriasis compared to the person with no visible dermatological condition. In contrast, participants expressed more willingness for social contact with a person with acne than with the person with psoriasis or no dermatological condition. Group differences were significant when controlling for attractiveness ratings. Unwarranted fear of infection might underpin avoidance and discriminatory behaviour towards those with skin conditions. Further research is required to understand factors that influence avoidance of contact.

Objective Social and occupational functioning are important for psychological health. However, quantitative research has suggested that these areas can be adversely affected by multiple chemical sensitivity (MCS). This systematic review therefore sought to explore what qualitative research has suggested about how people with MCS perceive it to affect their social and occupational functioning. Method Journal articles were included if they were 1) peer reviewed 2) qualitative or mixed methods 3) published in English 4) reported qualitative findings relevant to the review. Studies were excluded if they were 1) descriptive only 2) primarily concerned with environmental intolerances other than chemicals or 3) focussed on specific populations such as veterans. Quality was assessed using the National Institute for Health and Care Excellence (NICE, 2018) qualitative quality criteria. However, quality was not used to determine eligibility for inclusion. Six databases (CINAHL, Medline, PsychArticles, PsychInfo, Scopus and Web of Science) were searched between the 24th of February 2019 and 2nd of March 2019. Results Having removed duplicates, database searches identified 388 potential articles. Thirteen of these articles were eligible for inclusion. Following review, no more articles were included from the reference lists of these studies. Meta-aggregation of the findings identified seven categories. These were synthesised into three themes; ‘limited access’, ‘loss & anxiety’ and ‘seeking engagement’. Conclusions The findings suggested that MCS limits some people's social and occupational functioning. The results warrant further research, and, the development of prevention and intervention strategies. Studies predominantly recruited United States and Canadian females and had several limitations.

Like other self-conscious emotions, shame takes on particular significance during late childhood and adolescence because of a developing capacity for self-reflection, self-other comparisons, and sensitivity to the views of others. Shame is a potentially important variable in adolescent well-being given its established associations with depression, reduced feelings of self-worth, and problematic anger. Three studies are reported that describe the development and validation of the Adolescent Shame-Proneness Scale (ASPS), a novel semi-idiographic measure of shame-proneness. The ASPS is a 19-item measure assessing 3 components of shame-proneness-negative self-evaluation, externalization, and emotional discomfort. Taken together, the studies support the reliability and validity of the ASPS as a semi-idiographic measure of shame-proneness in adolescents aged 11 to 18 years. ASPS scores correlate as expected with scores on existing measure of shame-proneness and with measures of anger, negative affect, and self-esteem. More important, the data suggest that ASPS scores are related to, but distinct from, guilt. Confirmatory factor analysis supported the validity of the ASPS factor structure (RMSEA = .08, SRMR = .05, CFI = .97, NNFI = .97). The ASPS represents a unique contribution to existing options for measuring shame-proneness in research and clinical contexts. Further work is required to assess the ASPS' temporal stability and its viability and psychometric properties in more culturally diverse samples. (PsycINFO Database Record

Social recovery has become a prominent aspect of mental health service design and delivery in the past decade. Much of the literature on social recovery is derived from first-person accounts or primary research with adult service users experiencing severe mental illness. There is a lack of both theoretical and empirical work that could inform consideration of how the concept of social recovery might apply to adolescents experiencing common (non-psychotic) mental health problems such as anxiety and depression. The current study was conducted to understand the process of experiencing anxiety and depression in young people. Semi-structured interviews were conducted with nine adolescents with anxiety and depression (seven girls and two boys aged 14-16 years) and 12 mothers who were recruited from a specialist Child and Adolescent Mental Health Service in the South of England. Thematic analysis indicated that young people do experience a process of 'recovery'; the processes participants described have some congruence with the earlier stages of adult recovery models involving biographical disruption and the development of new meanings, in this case of anxiety or depression, and changes in sense of identity. The accounts diverge with regard to later stages of adult models involving the development of hope and responsibility. The findings suggest that services should attend to social isolation and emphasise support for positive aspirations for future selves whilst also attending to young people's and parents' expectations about change. Methodological challenges face enquiry about 'recovery' given its connotations with cure in everyday language. Copyright © 2013 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE: Theoretical and empirical work on social recovery in young people and families is lacking. Using interviews, this study sought to understand the relevance of social recovery for adolescents with anxiety and depression and their mothers. Findings suggest some congruence with the earlier stages of adult recovery models involving meaning and identity. Findings diverge with regard to later stages of adult recovery models involving hope and responsibility. Social recovery in mental health services for young people needs significant empirical attention and critical debate.

Background Recovery has become a central concept in mental health service delivery, and several recovery-focused measures exist for adults. The concept's applicability to young people's mental health experience has been neglected, and no measures yet exist. Aim The aim of this work is to develop measures of recovery for use in specialist child and adolescent mental health services. Method On the basis of 21 semi-structured interviews, three recovery measures were devised, one for completion by the young person and two for completion by the parent/carer. Two parent/carer measures were devised in order to assess both their perspective on their child's recovery and their own recovery process. The questionnaires were administered to a UK sample of 47 young people (10–18 years old) with anxiety and depression and their parents, along with a measure used to routinely assess treatment progress and outcome and a measure of self-esteem. Results All three measures had high internal consistency (alpha ≥ 0.89). Young people's recovery scores were correlated negatively with scores on a measure used to routinely assess treatment progress and outcome (r = −0.75) and positively with self-esteem (r = 0.84). Parent and young persons' reports of the young person's recovery were positively correlated (r = 0.61). Parent report of the young person's recovery and of their own recovery process were positively correlated (r = 0.75). Conclusion The three measures have the potential to be used in mental health services to assess recovery processes in young people with mental health difficulties and correspondence with symptomatic improvement. The measures provide a novel way of capturing the parental/caregiver perspective on recovery and caregivers' own wellbeing. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Message •No tools exist to evaluate recovery-relevant processes in young people treated in specialist mental health services. •This study reports on the development and psychometric evaluation of three self-report recovery-relevant assessments for young people and their caregivers. •Findings indicate a high degree of correspondence between young person and caregiver reports of recovery in the former. •The recovery assessments correlate inversely with a standardized symptom-focused measure and positively with self-esteem.

Background: The assessment of children and young people with history of complex developmental trauma presents a significant challenge to services. Traditional diagnostic categories such as post-traumatic stress disorder (PTSD) are argued to be of limited value, and while the proposed ‘Developmental Trauma Disorder’ definition attempts to address this debate, associated assessment tools have yet to be developed. This review builds on a previous review of assessment measures, undertaken in 2005. Aim: To identify trauma assessment tools developed or evaluated since 2004 and determine which are developmentally appropriate for children or adolescents with histories of complex trauma. Method: A systematic search of electronic databases was conducted with explicit inclusion and exclusion criteria. Results: A total of 35 papers were identified evaluating 29 measures assessing general functioning and mental health (N = 10), PTSD (N = 7) and trauma symptomatology outside, or in addition to, PTSD (N = 11). Studies were evaluated on sample quality, trauma/adversity type, as well as demographic and psychometric data. Distinction was made between measures validated for children (0–12 years) and adolescents (12–18 years). Conclusion: Few instruments could be recommended for immediate use as many required further validation. The Assessment Checklist questionnaires, designed with a developmental and attachment focus, were the most promising tools.

The increasing emphasis on outcomes for children in care has prompted much research and drawn attention to the importance of harnessing users' views on the services they receive. However, this awareness is still limited in some areas, one of which is the loyalty conflict experienced by children in foster care who have to negotiate living with a new family while also retaining their birth family membership. This study assesses the extent to which they experience such conflict and how they cope with the challenges it presents. A qualitative methodology, involving semi-structured interviews with 15 children was employed and grounded theory used to inform the data analysis and construction of a theoretical model. The model comprises five core categories: new realities; considering position; making sense; relating emotionally; and working out loyalties. A sixth category, considering others' perspectives, emerged from respondent validation and an overarching perspective, self-determination, was found to permeate all other processes and contributed to highlighting complexity. New knowledge is gained through seeking the voices of the children and exploring the position they hold by being within and between two families. Implications for practice and future research are also discussed.

Objective Previous research suggests that female partners have a key role in encouraging men to seek help from a mental health professional. This study investigated the communication forms that female partners use to encourage their male partners to seek help for a mental health problem. Methods Fifteen women with experience of working with a partner to seek help, aged 28-71 years, participated in a semi-structured interview. The interviews were analysed using Thematic Analysis. Results The main themes indicated that the women initially undertook "Role Adaption/s" and changed their roles to reduce the stress on their male partners. They made "attempts to activate engagement" with their wellbeing through conversations about mental health and the benefits of help-seeking. Discussions began with "gentle" communications, such as hinting and sowing seeds, and escalated to more assertive communications which could be conceived of as "threats" and "emotional blackmail," if the women were concerned their partners were not seeking help or were at risk of suicide. Finally, the couples entered "Attempted Resolution" where they had conversations around help-seeking, and/or their male partner considered suicide. Conclusions Female partners perceived themselves as having a key role in supporting men to seek help from a professional and in maintaining their partner's safety and they adapted their communication strategies to implement this. Access to high-quality information and some amendments to general practitioner confidentiality would facilitate them in their role.

In the general population, confiding is typically associated with increased well-being, reduced distress and strengthened relationships. However, there is a lack of research exploring the role of confiding among young people who have been in the care system. The current study employed Interpretative Phenomenological Analysis (IPA) to guide the analysis of semi-structured interviews with eight young people with a range of care experiences, looking at the topic of confiding in others. Five themes emerged from the data analysis that indicated difficulties with confiding related to: holding unacceptable identities that are difficult to reveal to others; holding anticipations and expectations that confiding leads to harm; experiencing internal conflict between wanting to be open versus wanting to remain closed; and varying opportunities to develop trusted, confiding relationships across different environments within the care system. The findings suggest a need for safe, secure and stable care placements that can support the potential development of trusted confiding relationships wherein young people may be able to develop greater attachment security, and the capacity to build safe, supportive and trusted relationships through their lives. Implications for practice are discussed.

This article follows on from 'How children in foster care engage with loyalty conflict: presenting a model of processes informing loyalty' (Dansey, John and Shbero, 2018), published in the previous edition of this journal. This model highlighted the themes of stigma and secrecy for children in care, which it was felt warranted further consideration in their own right. The current article shares further quotations from the children in relation to these themes, which add to the evidence of what children are saying in relation to stigma and bullying. Most importantly, it presents this topic in a manner that stimulates thought around the implications of what children are saying for their broader mental health and resilience and what might therefore be most supportive. Children in foster care are subject to stigma in relation to being in care and not living with their birth parents. The impact of this is important to explore, especially for those who already experience higher levels of disadvantage than other children. Themes of stigma and secrecy emerged from a recent grounded theory study that was conducted with 15 children and young people in foster care (Dansey, John and Shbero, 2018). These quotations highlighted how stigma was being internalised by children, how they had experienced, or believed that their care status would lead to, bullying and how some of them described keeping their foster care status a secret as a result. This article seeks to share the voices of these children, look at the existing literature in this area and consider the possible impact that stigma and secrecy may have on them. Implications for practice are discussed and the need for more targeted research is highlighted.

Aims Increasing evidence suggests that children and young people with type 1 diabetes (T1D) are at greater risk of disordered eating compared to children without T1D. Disordered eating in T1D has been linked to impaired well-being, increased health service use, and early mortality. To address this problem, we will co-develop a psycho-education intervention for parents of children and young people with T1D, informed by the Information Motivation Behavioural Skills model. Methods The objective of this study is to assess the feasibility and acceptability of the intervention compared to a waitlist control group using a feasibility randomised controlled trial (RCT) design. We aim to recruit 70 parents of children and young people with T1D (11-14 years), 35 in each arm. Those assigned to the intervention will be invited to participate in two workshops of two hours each. Parents will be asked to complete outcome measures regarding eating habits, diabetes management, as well as a questionnaire based on the Information Motivation Behavioural Skills model which provides a theoretical foundation for the intervention. These will be completed at baseline, 1- month and 3-months post intervention. Children and young people will be asked to complete questionnaires on their eating behaviours at the same time intervals. Parents randomised to receive the intervention will be invited to take part in interviews to feedback on the intervention and research protocol acceptability. Conclusion It is anticipated that the psycho-education intervention aimed at parents will help prevent the development of disordered eating in children and young people with T1D and improve parental wellbeing. The results of this feasibility trial will determine whether this intervention approach is acceptable to families living with T1D, and whether a definitive RCT of intervention effectiveness is justified. Qualitative findings will be used to refine the intervention and study protocols.

Black males within Western society, who navigate recurrent racism and discrimination, have frequently been constructed as “high risk” for mental health difficulties. Research, particularly in the USA, has identified the barriers that Black males face in relation to seeking help, with research outlining the underutilisation of mental health services and overrepresentation of acute mental health diagnoses such as psychosis. Research within the UK has explored barriers to help-seeking amongst males in general, or adult Black males who are within the mental health or prison systems, yet to date little is known about the ways in which Black male adolescent youth outside of formal services understand mental health. Therefore, this paper offers a contribution to knowledge by examining the way in which young Black males in the UK make sense of mental health and associated systems of support. Data from ten interviews with males aged 16–18 from a South London school was collected and analysed using thematic analysis (TA). The young Black males’ understandings of mental health were embedded with notions of masculinity, being in control and strong, and they understood mental health as something that is experienced by other people. Formal support for mental health difficulties was constructed as an unfamiliar and unapproachable system, that is often unkind and discriminatory towards Black males. Speaking to family and friends about mental health difficulties felt more accessible for these young males, however their construct of mental health and constructs within the community provided further silencing on using this support. This study suggests important implications for understanding the experiences of mental health and seeking support amongst Black male adolescents in the UK.

Background Self-harm is a major public health concern with evidence suggesting that the rates are higher in the United Kingdom than anywhere else in Europe. Increasingly, policy highlights the role of school staff in supporting young people (YP) who are self-harming, yet research indicates that school staff often feel ill-equipped to provide support and address self-harm behaviors. Here, we assess the impact of a bespoke eLearning module for United Kingdom secondary school teachers on teacher’s actual and perceived knowledge of self-harm, and their self-reported confidence in supporting and talking to YP who self-harm. Methods Twenty-one secondary schools across the West Midlands and South East of England were invited to complete a 30-min web-based eLearning module on self-harm in schools. Participants completed pre-and post-intervention measures. Results One-hundred and seventy-three teachers completed the eLearning, and pre-and post-measures. The eLearning significantly enhanced participants’ perceived knowledge, actual knowledge, and confidence in talking to and supporting YP who self-harm. The majority of participants (90.7%) felt that eLearning was a good way to receive training. Conclusion The 30-min eLearning module was rated highly and may be an effective way to increase secondary school teachers’ knowledge of self-harm, and confidence in supporting and talking to YP who self-harm.

Much of the burden associated with poor mental health is associated with symptom experience in the general population. We conducted a systematic review and meta-analysis of studies conducted in non-clinical samples, evaluating Mindfulness-Based Programs (MBPs) for outcomes related to psychological health and well-being. We focussed on Mindfulness-Based Stress Reduction (MBSR) and Mindfulness-Based Cognitive Therapy (MBCT) because they have the strongest evidence base. We searched MEDLINE, PsycINFO, EMBASE and CINAHL (2006 – February, 2019) for published peer-reviewed journals articles of intervention studies evaluating MBCT or MBSR for psychological health and well-being in non-clinical samples. Data were pooled using a random-effects model and effect estimates were reported as Hedges’ g. We included 49 studies conducted in non-clinical samples (n=4733). When compared to a passive control, MBPs significantly reduced symptoms of rumination/worry (g=-1.13, [-2.17, -0.08]), stress/psychological distress (g=-0.52 [-0.68, -0.36]), depression [g=-0.45 [-0.64, -0.26]), and anxiety (g=-0.44 [-0.65, -0.23]); and significantly improved quality of life/well-being (g=0.32 [0.10, 0.54]). In general, MBCT generated larger effect sizes than MBSR for all outcomes. This study provides evidence that in non-clinical samples, MBPs are associated with benefits to health and well-being. These findings add to the growing evidence-base suggesting that MBSR and MBCT may be effective approaches for sub-clinical levels of mental ill-health and could form part of the public mental health agenda.