The psychiatric diagnosis of Borderline Personality Disorder (BPD) leads to service users experiencing stigmatising and disempowering attitudes from professional mental health staff. To date, a nursing theory has not been developed to understand mental health nurses’ personal and professional constructions towards service users with this diagnosis. The development of such theory may enable improved service user engagement, collaboration and recovery for this group of individuals. This study answered the questions of determining the nature of mental health nurses’ beliefs towards service users with a diagnosis of BPD and how these beliefs affect their therapeutic relationships with this service user group. An ethnographic approach was used in this study. Data was collected using a combination of observation of the patient assessment and allocation meeting within a community mental health team; and ethnographic interviews with named nurses for service users with a diagnosis of Borderline Personality Disorder. A reflective journal was also kept by the lead researcher. N-Vivo Version 7 was used to aid data analysis and this involved examining the scripts for repetitive patterns or sequences including descriptions, figures of speech, metaphors etc. in order to illuminate differences between different practices and contexts. Findings from the study elicited a model of how CPNs construct BPD categorisations and a potential pathway to alienation is described together with recommendations for the development of CMHTs and CPNs when working with BPD. Development of reflexive practice can be a vehicle for developing alternative constructions of BPD and recovery informed practice can reduce stigmatising practices experienced by service users with BPD.

The principal aims of the study were to investigate the determinants for alcohol use in adolescence and formulate a framework for intervention design, and to use this framework to design an interactive intervention to prevent alcohol misuse in adolescents. The first study was a focus group study with 27 11-14 year olds to gauge opinions related to alcohol use and the drinking environments. The results of the analysis supported a framework of the combination of the theory of planned behaviour (Ajzen, 1991), the prototype willingness model (Gibbons & Gerrard, 1995, 1997), the social norms approach (Perkins & Berkowitz, 1986). The second study was a pilot of a questionnaire based on the combined model constructs, personality characteristics associated with adolescent alcohol misuse and behavioural measures of frequency and quantity. The first pilot was with 19 adolescents aged 11-15, which indicated that three subscales needed amendment. The participants rated the scale as easy to complete. The second pilot with 31, 16-19 year olds indicated that the subscales were reliable. The third study was a quantitative longitudinal study to evaluate the threats to external validity. The cross sectional analysis (n=239) indicated that past behaviour, subjective norm, affective attitude, drinker image and typical peer frequency predicted intention to drink alcohol. The results of longitudinal study (n=60) indicated that there were no significant differences between variables at baseline. This supported the validity of the questionnaire for intervention evaluation. The most significant predictor of behaviour at follow-up was past behaviour and subjective norm at baseline. The fourth study was a focus group study with 15, 11-14 year old participants to gauge their opinions about computer games and using games for health interventions. The themes that were identified were used to formulate a conceptual framework for an interactive computer game. The fifth study was a quantitative evaluation of a preliminary interactive role-play study to examine interactive scenarios based on the environments identified in the alcohol focus group study and behaviour change techniques from the taxonomy for alcohol use (Michie, et al., 2012). The post-intervention results indicated a significant difference in perceptions of peer drinking norms. Overall, the research supported the use of a combined theory to predict and prevent alcohol use in adolescents and an interactive method for intervention.

In the current policy, commissioning and delivery environments for services aimed at improving the lives of children and their families, increasing priority is placed on the ability to measure and demonstrate the effectiveness of social welfare intervention. This is particularly acute for voluntary sector services that increasingly provide services on behalf of local authorities and operate in a highly competitive environment in which the ability to demonstrate effectiveness and value for money can ultimately determine survival. However, social welfare intervention is delivered in the context of complex social systems in which a multiplicity of factors interplay between those individuals who are managing, providing and using social services. This complexity presents significant methodological challenges in terms of understanding the effect of intervention on individuals’ lives. Often the pressures to produce highly aggregated data about outcomes mean that the experience and the voice of those using services is overlooked and the connection between data and lived experience is lost. This thesis describes the evaluation of an approach to measuring outcomes known as Goal Attainment Scaling (GAS). This places the service user at the heart of measuring outcomes whilst collecting data that can be used to evaluate effectiveness within a service, or comparatively between services, or between service user groups. The approach was implemented with practitioners and young people within the context of a leaving care support service provided by a voluntary sector service. The GAS implementation was evaluated using a realist research strategy in order to understand the ways in which a complex policy and operating environment interplayed with the challenging contexts of transition for young people and their heterogeneous pathways in leaving care. For a variety of reasons, explained within this thesis, participation levels in the trial were low and therefore quantitative data regarding outcomes was too limited to be conclusive. Nevertheless the study represents a useful pilot of this approach and highlights the importance of context in determining results when introducing new approaches to outcomes measurement into practice environments. The findings that emerge from the evaluation betray a concerning picture of the pressures and constraints on practice experienced by a large leaving care service in the current climate of cuts to local authority funding and statutory services. As opposed to being an independent or somewhat removed undertaking, this study was concerned to frame ‘evaluation’ and ‘outcomes measurement’ as participatory and reflexive activities that should be embedded within service delivery. By so doing, it aimed to facilitate reciprocal or ‘bi-directional’ learning between providers and the users of services to underpin interventions, particularly with vulnerable populations of service users. Given that the support provided by leaving care services may represent the last intervention before young people disappear from the system’s view, this is particularly significant in supporting them to develop agency and self-determination to take them through the often compressed and accelerated journeys that characterise adolescence for this group.

England and Wales have the same criminal justice system, but devolution in Wales has created some differences between the two countries. In Wales all child and young person related services, with the exception of youth justice, are devolved to the Welsh Government. It is claimed by some that devolution has resulted in youth justice policy in Wales diverging from that of England. This is because of the Welsh Government’s adoption of the United Nations Convention on the Rights of the Child, which has been incorporated into its domestic legislation. This is not mirrored in England, as the UK Government’s youth justice policies during the New Labour period have been characterised as punitive, risk-led and managerialist. Although attitudes and approaches changed during the Coalition Government’s administration, the fundamental features of the system have not. Youth justice in Wales has been described as taking a ‘children first, offenders second’ approach to children and young people in trouble with the law, which by inference suggests the opposite for youth justice in England. The purpose of this study is to examine whether there is a different youth justice in Wales. This was done by scrutinising a range of evidence that included the policies of the Youth Justice Board for England and Wales and the Welsh Government and the interface and relationship between them, to determine what youth justice in Wales looks like and how it compares to youth justice in England. This was supported by an analysis of YJB data about the operation of the system, which disaggregated information about Wales from national statistics, to establish if outcomes for young people in Wales differed from their counter-parts in England. Finally, the perspectives of practitioners in two youth offending teams in England and two in Wales were explored to establish what their practice cultures looked like and the extent to which practitioners had similar or different views about how the system should and does operate, whether a ‘children first’ philosophy is dominant in Wales and how this relates to the policy positions of the respective governments.

An extensive review of research and policy literature revealed that links are made between: going missing and forced marriage; going missing and child sexual exploitation; and forced marriage and child sexual exploitation. However, despite these overlaps, no links are made between all three issues. Given that some South Asian young women will run away from home in order to avoid being forced into marriage and that young people who run away or go missing from home are at risk of, or abused, through child sexual exploitation a research proposition was developed on the basis that a three way link was theoretically possible. A case study methodology was developed to test the research proposition. Eight cases were identified in which South Asian young people (under 18 years of age) had experienced some combination of all three issues. However, the pattern identified within the research proposition was not the ‘final explanation’. Analysis of the research findings revealed that variation existed within the pattern proposed. Moreover, a second pattern was identified in which forced marriage emerged as a parental response to young people who were already being sexually exploited and going missing in this context. The patterns identified were confirmed through analysis of interviews undertaken with twelve subject experts (key informants) and resonated with a specifically selected group of nine young people who were presented with a composite case study during focus group discussion. I argue that awareness of patterns linking all three issues will help practitioners to identify and respond appropriately to cases where the issues of going missing, forced marriage and child sexual exploitation overlap. That said the complexity of the cases highlighted risks associated with overlooking diversities: social divisions related to age, gender, ethnicity, class, sexuality and disability were explored to see how they shaped the young people’s experiences. This process revealed that they were located within complex axes of power which then intersected with social systems, including family, community and public institutions. As a consequence, young people lacked relational support and had limited access to safe accommodation and economic resources. This resulted in some young people making attempts to try and self-manage the competing harms that they were facing. The practitioners who supported the young people highlighted the challenges involved in working with them. Analysis of practitioners’ accounts further revealed how power dynamics within multi-agency working arrangements also impacted their efforts to respond to the needs of young people. Through testing the research proposition, I addressed a recognised need for more focused research into the issue of going missing as it relates to young people from different ethnic backgrounds (Berelowitz et al. 2012; Berelowitz et al., 2013; OCC, 2012; Patel, 1994; Safe on the Streets Research Team, 1999; Stein et al. 1994) as well as furthering knowledge about how child sexual exploitation is experienced by young people from black and minority ethnic (BME) communities (Chase & Statham, 2004; CEOP, 2011b; Jago et al., 2011; Berelowitz et al., 2013; Thiara & Gill, 2010; Kelly, 2013; Ward & Patel, 2006). The development of a typology of patterns linking going missing, forced marriage and child sexual exploitation provides a unique contribution to the scholarly literature.

An existing body of research indicates that peer-on-peer abuse, involving the physical, sexual and/or emotional abuse of young people by their peers, is an issue of serious concern within the UK. Whilst a range of studies have explored the individual and familial vulnerabilities associated with this phenomenon, there is an increasing recognition of the need to also consider the relationship between young people‟s peer groups, and other pertinent social fields, to their experiences of such abuse. This thesis offers an original contribution to the field by explicitly seeking to develop this contextual approach. It applies an age-specific and gendered interpretation of Bourdieu‟s constructivist structuralism (and specifically the concepts of field, habitus and symbolic violence) to the analysis of nine cases where young people raped or murdered their peers. In doing so, it offers a unique, in-depth, exploration of the interaction between individuals and the social fields that they navigate, in the context of nine abusive incidents. This methodological approach demonstrates how harmful norms underpinning these incidents are informed by a multi-way interplay between various social fields and young people‟s reflexive engagement with this process. It is through this interplay that motives and power hierarchies are established, and gender, age, consent, culpability, vulnerability and ultimately safety, are socially constructed and experienced.