Jane Callaghan

Evaluation of a New Mental Health Service for Looked after Children

A mental health team for looked after children, and the evaluation of its first phase are presented. The team combines primary mental health worker, psychology and psychiatry skills. It offers telephone and face-to-face consultation to local authority staff, assessment, treatment and training. Forty-five children and their carers, who consecutively attended the service, were independently assessed by a researcher at the time of referral and at five-month follow-up. Outcome measures included the Strengths and Difficulties Questionnaire (SDQ), the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) and a service satisfaction questionnaire. At 5 months, children had significantly improved on a number of HoNOSCA scales, and on the emotional SDQ scales. Carers perceived the interventions as targeting different aspects of the child’s functioning, but wished they were more involved in decision-making. Carers and children were generally positive about their clinical contact. The findings are discussed in the context of developing mental health services for vulnerable children and young people, and interagency partnership.

Group Identification and Outgroup Attitudes in Four South African Ethnic Groups: A Multidimensional Approach

Although Sumner’s ethnocentrism hypothesis, which expects stronger group identification to be associated with more negative outgroup attitudes, has been widely accepted, empirical findings have been inconsistent. This research investigates the relationship of four dimensions of ethnocultural group identification previously proposed by Phinney, that is, salience, evaluation, attachment, and involvement, with attitudes to ethnic outgroups in four South African ethnocultural groups (Africans, Afrikaans Whites, English Whites, Indians). The findings supported the factorial independence of the four identification dimensions and indicated that only one, ethnocultural evaluation (ingroup attitudes), was systematically related to outgroup attitudes, but the association could be positive, negative, or zero. Both functionalist and similarity-dissimilarity approaches to intergroup relations seemed to provide plausible explanations for the pattern of relationships obtained between ingroup and outgroup attitudes.

Primary Mental Health Workers within Youth Offending Teams: A New Service Model.

Primary Mental Health Workers (PMHWs) have been deployed to address the mental health needs of young offenders referred to Youth Offending Teams (YOTs) in two UK areas. The mental health characteristics of 60 young people consecutively referred to these PMHWs, the assessment outcome and interventions offered, are described. In addition to the anticipated concerns about oppositional/aggressive behaviour, young people were referred for a range of mental health problems. There were high levels of emotional problems, self-harm, peer and family relationships difficulties, and school non-attendance. PMHWs offered a range of direct interventions, as well as consultation to YOT staff. The service findings indicate the usefulness of such an inter-agency model in strengthening the links between specialist CAMHS and YOTs, and providing an accessible, responsive and effective service to a needy group of young people.

Developing New Mental Health Services for Looked after Children: A Focus Group Study

Looked after children have extensive mental health needs that are not often met by current mental health service provision. Jane Callaghan, Bridget Young, Maxine Richards and Panos Vostanis describe the use of focus groups with various stakeholders — social services staff, foster carers and residential social workers — to inform the development of a specialist mental health team for looked after children. Thirteen focus groups were conducted, comprising 58 participants in total, and all sessions were audio-taped and transcribed. Data were analysed using the constant comparative method and this revealed several emergent themes: difficulties accessing mental health services, the importance of developing a working partnership between child and adolescent mental health services, social services and foster carers, the need for consultation, and the importance of developing a service that is appropriate to the specific needs of looked after children. The newly developed model of mental health provision for looked after children is described, and the ways in which its form was influenced by the issues identified in focus groups are highlighted.

‘Please don’t put the whole dang thing out there!’: A discursive analysis of internet discussions around infant feeding

The promotion of breastfeeding is an important focus of intervention for professionals working to improve infant health outcomes. Literature in this area focuses largely on ‘choices’ and ‘barriers to breastfeeding’. It is our argument, however, that womens cultural context plays a key role in infant feeding ‘choices’. In this article, we explore contested representations of infant feeding and infant feeding choices in public debates conducted on a large British parenting website. To sample dominant representations of infant feeding circulating in UK culture, two threads were chosen from the debating board of a busy online parenting community (105 and 99 individual posts, respectively). Participants on the threads were largely women. A feminist informed Foucauldian discourse analysis was used to deconstruct the intersecting constructions of gender, childhood and motherhood implicit in public discussions about infant feeding choices. We identify dominant constructions of women who breastfeed or bottle feed, social representations of both forms of infant feeding, and explore the relationship between constructions of infant feeding choices and constructions of ‘good’ or ‘bad’ motherhood. This analysis functions to trouble the individualist assumptions underpinning the notion of infant feeding ‘choices’, considering the cultural context within which British mothers ‘choose’ how to feed their babies.

Beyond "Witnessing": Children’s Experiences of Coercive Control in Domestic Violence and Abuse

Children’s experiences and voices are underrepresented in academic literature and professional practice around domestic violence and abuse. The project “Understanding Agency and Resistance Strategies” (UNARS) addresses this absence, through direct engagement with children. We present an analysis from interviews with 21 children in the United Kingdom (12 girls and 9 boys, aged 8-18 years), about their experiences of domestic violence and abuse, and their responses to this violence. These interviews were analyzed using interpretive interactionism. Three themes from this analysis are presented: (a) “Children’s experiences of abusive control,” which explores children’s awareness of controlling behavior by the adult perpetrator, their experience of that control, and its impact on them; (b) “Constraint,” which explores how children experience the constraint associated with coercive control in situations of domestic violence; and (c) “Children as agents,” which explores children’s strategies for managing controlling behavior in their home and in family relationships. The article argues that, in situations where violence and abuse occur between adult intimate partners, children are significantly affected, and can be reasonably described as victims of abusive control. Recognizing children as direct victims of domestic violence and abuse would produce significant changes in the way professionals respond to them, by (a) recognizing children’s experience of the impact of domestic violence and abuse; (b) recognizing children’s agency, undermining the perception of them as passive “witnesses” or “collateral damage” in adult abusive encounters; and (c) strengthening professional responses to them as direct victims, not as passive witnesses to violence.

Hearing the Silences: Adult Nigerian Women's Accounts of 'Early Marriages'

‘Early marriage’ is a relatively common but under-researched global phenomenon, associated with poor physical and mental health and educational and occupational outcomes, particularly for young girls. In this article, we draw on qualitative interviews with six Nigerian women from Sokoto state, who were married between the ages of 8 and 15. The interviews explored young women’s experiences of the transition to marriage, being married, pregnancy and their understanding of the marital and parental role. Using interpretive phenomenological analysis, we explore women’s constrained articulations of their experiences of early marriage, as they are constituted within a social context where the identity of ‘woman’ is bound up in values and practices around marriage and motherhood. We explore the complexity of ‘hearing’ women’s experiences when their identities are bound up in culturally overdetermined ideas of femininity that function explicitly to silence and constrain the spaces in which women can speak.

Children's experiences of domestic violence and abuse: siblings' accounts of relational coping

This article explores how children see their relationships, particularly their sibling relationships, in families affected by domestic violence (DV) and how relationality emerges in their accounts as a resource to build an agentic sense of self. The ‘voice’ of children is largely absent from the DV literature, which typically portrays them as passive, damaged and relationally incompetent. Children’s own understandings of their relational worlds are often overlooked, and consequently, existing models of children’s social interactions give inadequate accounts of their meaning-making-in-context. Drawn from a larger study of children’s experiences of DV and abuse, this article uses two case studies of sibling relationships to explore young people’s use of relational resources, for coping with violence in the home. The article explores how relationality and coping intertwine in young people’s accounts and disrupts the taken-for-granted assumption that children’s ‘premature caring’ or ‘parentification’ is (only) pathological in children’s responses to DV. This has implications for understanding young people’s experiences in the present and supporting their capacity for relationship building in the future.

The Management of Disclosure in Children’s Accounts of Domestic Violence: Practices of Telling and Not Telling

Children and young people who experience domestic violence are often represented as passive witnesses, too vulnerable to tell the stories of their own lives. This article reports on findings from a 2 year European research project (Understanding Agency and Resistance Strategies, UNARS) with children and young people in Greece, Italy, Spain and the UK, who had experienced domestic violence. It explores children and young people’s understandings of their own capacity to reflect on and disclose their experiences Extracts from individual interviews with 107 children and young people (age 8–18) were analysed. Three themes are presented, that illustrate children and young people’s strategies for managing disclosure: (1) “Being silenced or choosing silence?”, explores children and young people’s practices of self-silencing; (2) “Managing disclosures: Finding ways to tell” outlines how children and young people value self-expression, and the strategies they use to disclose safely; and in (3) “Speaking with many voices” considers how children and young people’s accounts of their experiences are constituted relationally, and are often polyvocal. The article concludes that children and young people can be articulate, strategic and reflexive communicators, and that good support for families struggling with domestic violence must enable space for children and young people’s voice to be heard. This is possible only in an integrated framework able to encompass multiple layers and perspectives, rather than privileging the adult point of view. Practitioners who work with families affected by domestic violence need to recognize that children and young people are able to reflect on and speak about their experiences. This requires that attention is paid to the complexity of children and young people’s communication practices, and the relational context of those communications.

A critical analysis of Child and Adolescent Mental Health Services policy in England

Policy on Child and Adolescent Mental Health Services (CAMHS) in England has undergone radical changes in the last 15 years, with far reaching implications for funding models, access to services and service delivery. Using corpus analysis and critical discourse analysis, we explore how childhood, mental health and CAMHS are constituted in 15 policy documents, 9 pre-2010 and 6 post-2010. We trace how these constructions have changed over time and consider the practice implications of these changes. We identify how children’s distress is individualised, through medicalising discourses and shifting understandings of the relationship between socio-economic context and mental health. This is evidenced in a shift from seeing children’s mental health challenges as produced by social and economic inequities to a view that children’s mental health must be addressed early to prevent future socio-economic burden. We consider the implications of CAMHS policies for the relationship between children, families, mental health services and the state. The article concludes by exploring how concepts of ‘parity of esteem’ and ‘stigma reduction’ may inadvertently exacerbate the individualisation of children’s mental health.