No description available.

Conduct Disorder is the most common reason for referral to child and adolescent mental health services (Audit Commission, 1999) and without treatment the long term prognosis for the child is poor (Kim-Cohen et al., 2003). The National Institute for Clinical Excellence Guidelines (NICE, 2006) recommend parenting interventions for the treatment of conduct disorder; however parental engagement in these interventions is low, particularly for families with multiple psycho-social stressors (Kazdin, Muzurick & Bass, 1993). Research has explored the variables which predict parental engagement in treatment and a positive therapeutic alliance has consistently been found to be associated with increased engagement in parenting interventions (Kazdin, Holland & Crowley, 1997). However little is known about the nature of the parent-therapist alliance and how it impacts on engagement. This is of particular interest given that parents are engaging in an intervention for their child's problem but the intervention is focussed on parenting practices. The aim of the study was to explore parent's experience of engaging in a parenting intervention and their experience of the therapeutic alliance with their clinician. Eight in-depth qualitative interviews were undertaken with parents of children with conduct disorder who were involved with an individual home based parenting intervention. The data was analysed in line with Interpretative Phenomenological Analysis (Smith, Flowers & Larkin, 2009). Five master themes emerged from the data; Experience of help-seeking as threatening. Making sense of the problem. A different relationship to help. 3 ---.. •................................ --- --- --- - -- ---------- The meaning of the parent-clinician relationship. A new approach to parenting. The results are discussed in relation to the existing literature and clinical implications for promoting engagement and the therapeutic alliance with this population are considered. The impact of parents' previous experiences of help seeking, their attributions of the problem and the impact of a diagnosis are also discussed. Clinically the findings can be used to understand the facilitators and barriers to the delivery of parenting interventions for child conduct disorder. 4

Evidence indicates disparities in the help-seeking experiences of Black African families engaging with Child and Adolescent Mental Health Services (CAMHS). UK health policy aims to reduce these inequalities and ensure that services are appropriate in meeting the needs of a multicultural society. Literature exploring the reasons for service use disparities has identified numerous correlates of service engagement, however the experience and operation of these correlates is less well understood. As such, clinicians lack a depth of knowledge that could facilitate their work. Help-seeking research has highlighted that service engagement is a dynamic and social process shaped by cultural context. As such, qualitative research methods have been advocated to explore the individual's understanding of this experience. This study sought to develop a qualitative and in-depth understanding of the experience of Black African mothers attending a CAMHS and explore how cultural values and perceptions contribute to this experience. Six Black African mothers were interviewed regarding their experiences of attending CAMHS. Semi-structured interviews explored how participants understood their experience and how their cultural background may relate to their experience. Interviews were analysed using Interpretative Phenomenological Analysis (IPA). Three superordinate themes were identified concerning the experiences of 'parenting in a new context', 'the problem' and 'power and acceptability'. Participants' experiences 3 of CAMHS occurred in the context of raising a child in a new cultural context associated with various changes. This context contributed to the experience of defining a problem and understanding the responses taken. The experience challenged participants' existing understanding and introduced alternatives that were acceptable to different degrees across the sample. The findings indicate that culturally shaped beliefs regarding parenting, childhood behaviour and help-seeking are important in understanding the engagement of Black African families. Recommendations are made that aim to consider the world view of the client and service in order to deliver acceptable and appropriate services.

The principles of Recovery have become prominent in shaping UK health care policy across the lifespan. However there has been little research conducted to determine Recovery's applicability to young people or their families. This study therefore aimed to explore whether a Recovery concept was relevant to the family's experience of childhood mental illness. Method A qualitative methodology was applied to the study. 11 participants took part in semi-structured interviews. A social constructionist position was adopted and Abbreviated Grounded Theory was used to analyse the transcripts. Results Four related categories were constructed from the data, including "Experiencing Distress". "Family Reactivity, "Gaining Control as Individuals" and "Adjusting the Status Quo". Individuals' search for containment and connection resonated as core processes across categories. Conclusions The constructed model was compared against the current literature on Recovery. Whilst the data did not support the notion of a collective Family Recovery, similarities with the Recovery literature supported an argument for the presence of a Family Member Recovery process. However, a direct transfer from the adult literature could not be supported in the data, with clear differences identified between the current conceptualisation and the themes within the adult Family Recovery literature. A critique of the study was considered and implications of the results for policy, practise and research development were discussed.

Childhood adversities can impact negatively on the stress response, which is associated with psychological disorders and suicidal behaviour. Parenting practices such as over­control, over-protection and over-indulgence can also be detrimental. Additionally, harmful childhood experiences may result in reduced social networks, poor emotion regulation and coping strategies, factors which can be protective. Mild to moderate levels of adversity may also be protective. However, there is a paucity of research in this area. This thesis aimed to uncover links between childhood experiences and psychopathology and suicidality, identifying risk and protective factors. Secondary data analyses were conducted utilising data from the Northern Ireland Study of Health and Stress (n= 1,986), an epidemiological study conducted as part of the WHO World Mental Health (WMH) Survey Initiative. Primary data was also collected for the Ulster University Student Wellbeing Study (n=739), part of the WMH International College Student Project. Both surveys use the well validated WHO-CIDI to examine psychopathology and associated risk factors (Kessler & Ustun, 2008). The studies revealed that elevated levels of childhood adversities, parental over-control and over-indulgence were significant risk factors for mental health problems and suicidality. Such experiences also had an indirect impact as they were related to lower levels of social networks, poor emotion regulation strategies and maladaptive coping. These factors when available were protective. Moderate levels of adversity were also protective in some instances. The findings highlight areas for early intervention and prevention programmes to reduce the likelihood of childhood adversities or negative parenting practices and to minimise the impact of such experiences. Programmes and initiatives which aim to build resilience, social networks, good emotion regulation and coping strategies in offspring, would be particularly beneficial. The findings also provide backing for campaigns and promotions to encourage help seeking and the establishment of support programmes within schools, universities and the wider community.

The British Child and Adolescent Mental Health Surveys (B-CAMHS) of 1999 and 2004 found a substantially lower prevalence of any child mental disorder in Indians compared to the general population (3.4% vs. 9.4%, p<0.001). This PhD sought to understand this apparent Indian mental health advantage through secondary analyses comparing the 16 449 White and 419 Indian children aged 5-16 in B-CAMHS. There was strong evidence (p<0.002) of an Indian advantage for externalising problems/disorders and little or no difference for internalising problems. This was consistently observed for clinical diagnosis and for the Strengths and Difficulties Questionnaire (SDQ) administered separately to parents, teachers and children. Detailed psychometric analyses provided no evidence that measurement bias could account for this observed Indian advantage. There was likewise no evidence that the advantage could be explained by participation bias. In multivariable analyses the unexplained difference between Indians and Whites for externalising problems decreased somewhat after adjusting for the fact that Indian children were more likely to live in two-parent families (92.2% vs. 65.4%) and less likely to have academic difficulties (e.g. 2.9% vs. 8.6% for parent-reported learning difficulties). In models adjusting for a larger number of child, family, school and area variables the difference reduced only by about a quarter (e.g. from 1.08 to 0.75 SDQ points on the parent SDQ) and remained highly significant (p<0.001). In both unadjusted and adjusted models, the unexplained Indian advantage for externalising problems was consistently larger in families of low SEP. There was little or no evidence of an ethnic difference for internalising problems/disorders in unadjusted or adjusted models. In conclusion, the Indian mental health advantage is genuine and is specific to externalising problems/disorders. Family type and academic abilities mediate part of this advantage, but most of the advantage is not explained by major child mental health risk factors.

This research study evaluated the effectiveness of the R time intervention and the Circle Time intervention to promote year 2/3 children‘s emotional literacy and mental well-being. Theoretical perspectives of emotional literacy and the related broader concept of mental well-being provided a framework to evaluate the development of a wide range of social and emotional skills and behaviours (Goleman‘s, 1996, 1998; Mayer & Salovey, 1997). The emphasis on developing child well-being in UK government agendas (e.g. DfEE, 2001) and intervention research (e.g. Weare & Gray, 2002; Adi, Killoran, Janmohamed, & Stewart-Brown, 2007), made the study of whole class interventions such as R time and Circle Time a relevant area of study. In three schools, the class teacher delivered the R time intervention (n=25), the Circle Time intervention (n=14) and normal practice (n=16) over 8 weeks to year 2/3 children. The Emotional Literacy Assessment Instrument (ELAI) and the Strengths and Difficulties Questionnaire (SDQ) measured pre- to post-test change in teacher, parent and pupil informant scores. A Multivariate Analysis of Variance (MANOVA) showed Circle Time self-awareness scores and R time and Circle Time pro-social behaviour scores significantly increased following the intervention. The results suggest Circle Time had significant positive effects on children‘s self-awareness compared to R time. The discussion considered the session length and duration of the interventions as possible threats to internal validity of the study. Future studies might investigate the effectiveness of the interventions implemented over a longer period and if positive gains remain at a follow up. This study suggests EPs have a role in supporting schools to implement, design and evaluate interventions in this area. In conclusion, the results of the study suggest R time effectively promoted an aspect of children‘s mental well-being (pro-social behaviour) and Circle Time effectively promoted an aspect of children‘s emotional literacy skills (self-awareness) and mental well-being (pro-social behaviour).

Over the past 10 years there has been increasing awareness and concern that a significant number of young people either in, or deemed to be at risk of being in, the criminal justice system have identified or unidentified special educational needs. Youth offending teams were set up to address young people’s offending behaviour but knowledge among professionals working in the teams of teaching and learning and, more specifically, about special educational needs is not a necessary prerequisite for gaining employment. There is therefore a potential role for educational psychologists to support youth offending workers so that they can take account of and respond to the special educational needs of the young people for whom they are responsible.This research was divided into two phases and used an action research methodology in order to explore the development of the role of an Educational Psychology Service within a Youth Offending Team (YOT). Phase 1 explored the views of the YOTs using three focus groups on issues relating to special educational needs and their views on if, and how, educational psychologists (EPs) could support them in their delivery of services to young people. Although views differed across different teams there was a general perception that overall the knowledge base in relation to SEN within the service was limited. Other key themes related to relationships with schools and other professionals as well as issues around confidence and working with conflicting time scales.Potential areas of work were identified by the three focus groups and, in particular, the usefulness of being able to have direct access to an EP. Consultation was chosen as model of service delivery as, not only is this a growing model of service delivery for EPs, it also met the YOT’s request for direct access in that there was no threshold that needed to be met before they could access the service. Phase 2 of the study therefore consisted of the implementation and evaluation of a pilot consultation service.In phase 2 seven consultations with YOT staff took place which focused on how they could develop their work with individual children for whom they were responsible. Findings indicated that the presenting difficulties experienced by the young people varied as did the ‘type’ and ‘degree’ of their special educational needs. In relation to the content of the consultations, the emphasis was often on ‘increasing engagement’ by the young person in the work they had to do. Interestingly the range of difficulties experienced by the young people was no different from those raised by schools in their regular work with EPs. Although the sample was small, all of the consultees perceived positive outcomes to the consultations. However, potential barriers were also identified in relation to the continuation of the service.

This research comprises three linked projects stemming from the first project which aimed to define “long-term” pupil absence from school and discover the principal reasons for such absence. The second project focussed on the area of Child and Adolescent Mental Health Services (CAMHS), an issue emerging from the first project. The CAMHS 4-Tier Strategic Framework (or “CAMHS Concept”), including links between CAMHS providers were examined and referral pathways investigated and measured against published criteria. The third project explored the new CAMHS Strategic Framework and considered whether implementation problems were to blame for its lack of transformational impact.

The upward trend in the prevalence of childhood mental disorders observed in the UK over the previous two decades, together with UK’s poor performance in recent international comparisons of child well-being, has brought childhood social and emotional well-being (SEW) to the forefront of policy. Key to tackling this issue is to understand what causes SEW in childhood, what interventions are successful in improving it, and what are its late-life consequences. This thesis furthers the literature in each of these areas. Firstly, we examine whether foetal (or in-utero) exposure to influenza hampers the development of childhood SEW. To do so, we examine the use of an instrumental variables approach, whereby the severity of the 1957 Asian Flu epidemic in the local authority of birth is used as an instrument for whether mothers self-report contracting influenza during pregnancy. We establish that exposure has little effect on childhood SEW, but that it results in a 60% increase in the risk of being stillborn, suggesting an increasing focus on influenza vaccination during pregnancy is needed. Secondly, we investigate the long-term effectiveness of school-based interventions to improve SEW. In order to overcome the absence of long follow-up in trial datasets, we develop a new modelling approach which involves the matching of trial participants to individuals in birth cohort datasets. An application of this method found that a Promoting Alternative Thinking Strategies (PATHS) intervention implemented in Greater Manchester schools led to a statistically significant improvement in childhood SEW, and had a positive, although statistically insignificant, effect on health across the life-course. Finally, we address the paucity of studies examining the effects of childhood SEW on late-life health and labour market outcomes. To do so, we develop a method for generating predictions of the effects of childhood characteristics beyond the currently available follow-up periods in birth cohort datasets, adapting an existing mediation analysis framework. Applying this method, we establish that a one-standard deviation improvement in childhood SEW leads to an increase of up to 0.18 accumulated quality-adjusted-life-years in late-life, and an increase in pre-tax labour income in late-life of up to £23,850. Both of these effects are primarily driven by large positive effects of childhood SEW on educational attainment, employment, income and health in mid-life. Childhood SEW is a predictor of important outcomes throughout the lifecourse. More research is needed to identify its causes and interventions to successfully improve it.