Claire McCartan

‘If I am brutally honest, research has never appealed to me …’ The problems and successes of a peer research project

This paper describes the use of a peer research methodology to explore disaffected young people’s views on alternative education. This model was adopted in order to try to ensure an equilibrium of power between interviewer and interviewee, allow marginalised young people’s voices to be heard and help generate social action. The approach is examined from the perspective of both the peer research and adult research teams. An experiential and honest account is given including the problems and successes, as well as the lessons learned. The paper concludes by considering the value of the model, whether it helps to reach those alienated from education and any evidence that it provides an opportunity for them to have a stake in their future.

The effectiveness, acceptability and cost-effectiveness of psychosocial interventions for maltreated children and adolescents: an evidence synthesis

BACKGROUND Child maltreatment is a substantial social problem that affects large numbers of children and young people in the UK, resulting in a range of significant short- and long-term psychosocial problems. OBJECTIVES To synthesise evidence of the effectiveness, cost-effectiveness and acceptability of interventions addressing the adverse consequences of child maltreatment. STUDY DESIGN For effectiveness, we included any controlled study. Other study designs were considered for economic decision modelling. For acceptability, we included any study that asked participants for their views. PARTICIPANTS Children and young people up to 24 years 11 months, who had experienced maltreatment before the age of 17 years 11 months. INTERVENTIONS Any psychosocial intervention provided in any setting aiming to address the consequences of maltreatment. MAIN OUTCOME MEASURES Psychological distress [particularly post-traumatic stress disorder (PTSD), depression and anxiety, and self-harm], behaviour, social functioning, quality of life and acceptability. METHODS Young Persons and Professional Advisory Groups guided the project, which was conducted in accordance with Cochrane Collaboration and NHS Centre for Reviews and Dissemination guidance. Departures from the published protocol were recorded and explained. Meta-analyses and cost-effectiveness analyses of available data were undertaken where possible. RESULTS We identified 198 effectiveness studies (including 62 randomised trials); six economic evaluations (five using trial data and one decision-analytic model); and 73 studies investigating treatment acceptability. Pooled data on cognitive-behavioural therapy (CBT) for sexual abuse suggested post-treatment reductions in PTSD [standardised mean difference (SMD) -0.44 (95% CI -4.43 to -1.53)], depression [mean difference -2.83 (95% CI -4.53 to -1.13)] and anxiety [SMD -0.23 (95% CI -0.03 to -0.42)]. No differences were observed for post-treatment sexualised behaviour, externalising behaviour, behaviour management skills of parents, or parental support to the child. Findings from attachment-focused interventions suggested improvements in secure attachment [odds ratio 0.14 (95% CI 0.03 to 0.70)] and reductions in disorganised behaviour [SMD 0.23 (95% CI 0.13 to 0.42)], but no differences in avoidant attachment or externalising behaviour. Few studies addressed the role of caregivers, or the impact of the therapist-child relationship. Economic evaluations suffered methodological limitations and provided conflicting results. As a result, decision-analytic modelling was not possible, but cost-effectiveness analysis using effectiveness data from meta-analyses was undertaken for the most promising intervention: CBT for sexual abuse. Analyses of the cost-effectiveness of CBT were limited by the lack of cost data beyond the cost of CBT itself. CONCLUSIONS It is not possible to draw firm conclusions about which interventions are effective for children with different maltreatment profiles, which are of no benefit or are harmful, and which factors encourage people to seek therapy, accept the offer of therapy and actively engage with therapy. Little is known about the cost-effectiveness of alternative interventions. LIMITATIONS Studies were largely conducted outside the UK. The heterogeneity of outcomes and measures seriously impacted on the ability to conduct meta-analyses. FUTURE WORK Studies are needed that assess the effectiveness of interventions within a UK context, which address the wider effects of maltreatment, as well as specific clinical outcomes. STUDY REGISTRATION This study is registered as PROSPERO CRD42013003889. FUNDING The National Institute for Health Research Health Technology Assessment programme.

Assessing elements of a family approach to reduce adolescent drinking frequency: parent-adolescent relationship, knowledge management, and keeping secrets.

Abstract Aims To estimate (1) the associations between parent–adolescent relationship, parental knowledge and subsequent adolescent drinking frequency and (2) the influence of alcohol use on parental knowledge. Design Path analysis of school based cohort study with annual surveys. Setting Post‐primary schools from urban and intermediate/rural areas in Northern Ireland. Participants A total of 4937 post‐primary school students aged approximately 11 years in 2000 followed until approximately age 16 years in 2005. Measurements Pupil‐reported measures of: frequency of alcohol use; parent–child relationship quality; subdimensions of parental monitoring: parental control, parental solicitation, child disclosure and child secrecy. Findings Higher levels of parental control [ordinal logistic odds ratio (OR) = 0.86, 95% confidence interval (CI) = 0.78, 0.95] and lower levels of child secrecy (OR = 0.83, 95% CI = 0.75, 0.92) were associated subsequently with less frequent alcohol use. Parental solicitation and parent–child relationship quality were not associated with drinking frequency. Weekly alcohol drinking was associated with higher subsequent secrecy (beta −0.42, 95% CI = –0.53, −0.32) and lower parental control (beta −0.15, 95% CI = –0.26, −0.04). Secrecy was more strongly predictive of alcohol use at younger compared with older ages (P = 0.02), and alcohol use was associated less strongly with parental control among families with poorer relationships (P = 0.04). Conclusions Adolescent alcohol use appears to increase as parental control decreases and child secrecy increases. Greater parental control is associated with less frequent adolescent drinking subsequently, while parent–child attachment and parental solicitation have little influence on alcohol use.

Adolescent ecstasy use and depression: cause and effect, or two outcomes of home environment?

BACKGROUND This study assessed the association between adolescent ecstasy use and depressive symptoms in adolescence. METHODS The Belfast Youth Development Study surveyed a cohort annually from age 11 to 16 years. Gender, Strengths and Difficulties Questionnaire emotional subscale, living arrangements, parental affluence, parent and peer attachment, tobacco, alcohol, cannabis and ecstasy use were investigated as predictors of Short Mood and Feelings Questionnaire (SMFQ) outcome. RESULTS Of 5371 respondents, 301 (5.6%) had an SMFQ > 15, and 1620 (30.2) had missing data for SMFQ. Around 8% of the cohort had used ecstasy by the end of follow-up. Of the non-drug users, ∼2% showed symptoms of depression, compared with 6% of those who had used alcohol, 6% of cannabis users, 6% of ecstasy users and 7% of frequent ecstasy users. Without adjustment, ecstasy users showed around a 4-fold increased odds of depressive symptoms compared with non-drug users [odds ratio (OR) = 0.26; 95% confidence interval (CI) = 0.10, 0.68]. Further adjustment for living arrangements, peer and parental attachment attenuated the association to under a 3-fold increase (OR = 0.37; 95% CI = 0.15, 0.94). There were no differences by frequency of use. CONCLUSIONS Ecstasy use during adolescence may be associated with poorer mental health; however, this association can be explained by the confounding social influence of family dynamics. These findings could be used to aid effective evidence-based drug policies, which concentrate criminal justice and public health resources on reducing harm.

Child welfare inequalities in the four nations of the UK

Comparative international data on patterns of inequality in child welfare interventions, for example, the proportion of children about whom there are substantiated child protection concerns or who are in out-of-home care, are far less developed than data about inequalities in health. Few countries collect reliable, comprehensive information and definitions, methods of data collection and analysis are rarely consistent. The four UK countries (England, Northern Ireland, Scotland and Wales) provide a potential ‘natural experiment’ for comparing intervention patterns. This study reports on a large quantitative, descriptive study focusing on children in contact with children’s services on a single date in 2015. It found that children’s chances of receiving a child protection intervention were related to family socio-economic circumstances, measured by neighbourhood deprivation, within all four countries. There was a strong social gradient which was significantly steeper in some countries than others. Ethnicity was another important factor underlying inequalities. While inequalities in patterns of intervention between the four countries were considerable, they did not mirror relative levels of deprivation in the child population. Inequalities in intervention rates result from a combination of demand and supply factors. The level and extent of inequity raise profound ethical, economic and practical challenges to those involved in child protection, the wider society and the state.

Centre-based early education interventions for improving school readiness

This is the protocol for a review and there is no abstract. The objectives are as follows: To evaluate the effectiveness of centre-based interventions for improving school readiness in preschool children.

A Four-Nation comparison of kinship care in the UK: The relationship between formal kinship care and deprivation

The practice of extended family and friends helping to care for children when their parents are unable to is an enduring tradition in many cultures. Kinship care provides the largest proportion of out of home care in Western society but many of these carers experience poverty and deprivation, and do not receive comparable levels of support, financial or professional, to other placement types. This study provides UK evidence for the relationship between kinship care and deprivation and examines how the welfare state frames kinship care in policy and practice.

The Belfast Youth Development Study (BYDS): A prospective cohort study of the initiation, persistence and desistance of substance use from adolescence to adulthood in Northern Ireland.

Background Substance misuse persists as a major public health issue worldwide with significant costs for society. The development of interventions requires methodologically sound studies to explore substance misuse causes and consequences. This Cohort description paper outlines the design of the Belfast Youth Development (BYDS), one of the largest cohort studies of its kind in the UK. The study was established to address the need for a long-term prospective cohort study to investigate the initiation, persistence and desistance of substance use, alongside life course processes in adolescence and adulthood. The paper provides an overview of BYDS as a longitudinal data source for investigating substance misuse and outlines the study measures, sample retention and characteristics. We also outline how the BYDS data have been used to date and highlight areas ripe for future work by interested researchers. Methods The study began in 2000/1 when participants (n = 3,834) were pupils in their first year of post-primary education (age 10/11 years, school year 8) from over 40 schools in Northern Ireland. Children were followed during the school years: Year 9 (in 2002; aged 12; n = 4,343), Year 10 (in 2003; aged 13; n = 4,522), Year 11 (in 2004; aged 14; n = 3,965) and Year 12 (in 2005; aged 15; n = 3,830) and on two more occasions: 2006/07 (aged 16/17; n = 2,335) and 2010/11 (aged 20/21; n = 2,087). Data were collected on substance use, family, schools, neighbourhoods, offending behaviour and mental health. The most novel aspect of the study was the collection of detailed social network data via friendship nominations allowing the investigation of the spread of substance use via friendship networks. In 2004 (school year 11; respondents aged 14), a sub-sample of participants’ parents (n = 1,097) and siblings (n = 211) also completed measures on substance use and family dynamics. Results The most recent wave (in 2010/2011; respondents aged 20/21 years) indicated lifetime use of alcohol, tobacco and cannabis among the cohort was 94, 70 and 45 per cent, respectively. The paper charts the development of drug use behaviour and some of the key results to date are presented. We have also identified a number of key areas ripe for analysis by interested researchers including sexual health and education. Conclusions We have established a cohort with detailed data from adolescence to young adulthood, supplemented with parent and sibling reports and peer network data. The dataset, allowing for investigation of trajectories of adolescent substance use, associated factors and subsequent long-term outcomes, constitutes an important resource for longitudinal substance misuse research. A planned further wave as the cohort enter their late twenties and potential to link to administrative data sources, will further enrich the datasets.

PP42 The Influence of Parental Monitoring and School Environment on Adolescent Alcohol Use

Background The importance of social determinants of adolescent health behaviour such as alcohol use has stimulated interest in family and school environments that may act as risk or protective factors. This study looked at characteristics of schools and parents, and how they influence young people’s alcohol use. Methods The Belfast Youth Development Study began in 2000. It surveyed secondary school children annually for five years of compulsory schooling, and two further years (age 16/17 & 21/22). This study is based on data from the first five data sweeps. We used the Stattin & Kerr parental monitoring measures, and alcohol use coded as: rarely/never, infrequently, monthly or less, weekly or more. Phase 1: Cross-lagged structural equation models assessed bi-directional associations between parental monitoring and subsequent alcohol use. Phase 2: Multilevel regression models assessed between-school variation in alcohol use frequency and the effect of parental monitoring. Phase 3: Structural equation models assessed the effect of parental attachment and parental monitoring, and how these two factors interacted to influence alcohol use. Results Analysis was based on 4,775 respondents attending 38 schools, the proportions drinking weekly or more frequently in each of the five years of the study were 4%, 11%, 21%, 27% and 34%. Phase 1: Parental monitoring was protective against frequent alcohol use (OR = 0.76, p < 0.01). More frequent alcohol use was also associated with lower parental monitoring to a lesser extent (b = -0.04 p < 0.05). Phase 2: Around 6% of the variation in alcohol use was attributable to differences between schools. The effect of parental monitoring on alcohol use varied widely between schools (OR 0.70 [95% coverage interval 0.52, 0.93]). Phase 3: Higher parental monitoring, and better parental attachment were protective against alcohol use. Better parental attachment was also associated with lower levels of parental monitoring; this meant better parental attachment was indirectly associated with higher frequency of drinking due to its effect to reduce monitoring. The combination of these two opposing influences led to parental attachment having zero overall influence on alcohol use. Conclusion School and home environment play an important role in shaping young people’s health risk behaviours. What these findings show is that the school environment may influence the extent to which parental behaviours can successfully reduce risk behaviour. While parent-child attachment may provide an important role for overall social functioning, improving monitoring behaviour may have a greater influence on alcohol use than improving attachment.

023 Prevalence of self-harm and help-seeking behaviours among young people in Northern Ireland

Background Compared to other parts of the British Isles, until recently there has been little information on rates of self-harm in Northern Ireland. Objectives To investigate the rates of self-harming among adolescents, help seeking behaviour among self-harmers, and risk factors associated with these behaviours in Northern Ireland. Design Two large scale surveys based on the Northern Ireland adolescent population were undertaken that contained questions on self-harm: the 2006/07 Belfast Youth Development Study (BYDS), a school based longitudinal study of adolescents, and the 2008 Young Life and Times survey, a postal survey of 16-year olds using the Child Benefit Register to identify the target population. Both surveys included questions asked in the CASE (Child and Adolescent Self-harm in Europe) study. Logistic regression models were used to analyse the association of personal characteristics with the odds of reporting having self-harmed. We also assessed the association between these characteristics and help seeking behaviour for those participants who had self-harmed. Setting/participants In total there were 3178 respondents. The 2249 (71%) BYDS respondents were 17 or 18 years of age at the time of the study. The 929 (29%) YLT respondents 16 years old when surveyed. Around 59% were female, 99% had used alcohol, 37% had used drugs, and 22% had mental health problems. Results 333 (10.4%) respondents reported self-harm, with similar proportions in both surveys. Females were 84% more likely to self-harm than males (OR 2.31 95% CI 1.93 to 2.78), but were also 70% more likely to seek help before self-harming (OR 1.70 95% CI 1.12 to 2.57). Smoking, using illegal drugs, and poorer mental health were more likely to be associated with those reporting self-harm. People who reported having smoked (OR 3.41 95% CI 2.66 to 4.37) or having used illegal drugs (OR 2.40 95% CI 1.97 to 2.94) were more likely to self-harm than those who did not. Poor mental health was associated with a greater likelihood of seeking help before self-harming (OR 1.81 95% CI 1.11 to 2.93). Conclusion The relative association of gender with self-harm was low compared to other countries. Males reported much higher relative rates of self-harm compared to other regions of the UK, suggesting there may be risk factors for poor adolescent mental health specific to Northern Ireland. Reasons for these differences should be further investigated.