Improving mental health and well-being: How can we best support children and young people in care?

Dr Sarah MacDonald and Dr Rhiannon Evans provide an overview of new DECIPHer-led research, the CHIMES study (Care-experienced cHildren and young people’s Interventions to improve Mental health and wEllbeing outcomes: Systematic review). The study is funded by the National Institute for Health Research (NIHR) and commenced in April 2020.

The mental health of children and young people who have been in care, or ‘looked-after’, is a major priority. Research has shown that they are more likely to have poorer mental health than young people who are not in care, and are at a higher risk of attempting suicide. Recent events, including the advance of COVID-19, have introduced particular risks and stresses for this group, amidst concerns about local authorities reducing some statutory provisions and maintaining safety and standards.  Meanwhile, Welsh Parliament has issued guidance to support the mental health and well-being for vulnerable children and young people during the COVID-19 pandemic, while The Fostering Network continues to offer support for carers. 

Within the context of these events, important questions remain about the best ways to support the mental health and well-being of children and young people in care, in addition to preventing self-harm and suicide. Cardiff University, in collaboration with the University of Exeter and the University of Bangor have been funded by the UK National Institute for Health Research’s Public Health Research (NIHR-PHR) panel to address these questions. 

The types of interventions that might be considered include the development of children’s social and emotional skills, training for foster carers, or development of a trauma-informed approach among social work teams.’

The CHIMES study commenced in April 2020 and will run for two years. It will conduct a systematic review, drawing together existing international evidence of the effectiveness of interventions to improve the overall mental health and well-being of children and young people who have been in care. The types of interventions that might be considered include the development of children’s social and emotional skills, training for foster carers, or development of a trauma-informed approach among social work teams. As social care systems and health care systems vary between different countries, the study is particularly interested in how different interventions work for different individuals in different contexts, and if they might achieve the same outcomes in the UK.  

The specific research questions to be addressed by the review are:  

1) What types of interventions have been developed and evaluated?  

2) What are barriers and facilitators to implementing these interventions?  

3) Do these interventions improve the mental health and well-being of children and young people who are in care?  

4) Are these interventions acceptable to the people who take part in them?  

The study will use the existing research to assess what is the most promising type of intervention for improving mental health and well-being. It will also consult with young people and carers and to identify what interventions they think will work best in their communities. From here, the research team will hopefully be able to identify a potential intervention that can be developed and evaluate within the UK. 

The study is being conducted in collaboration with The Fostering Network. It will be particularly involved in ensuring the voices of carers are listened to when deciding which intervention should be taken forward for further development and evaluation. The Network will also lead on disseminating the results of the review to policy and practice. 

Maria Boffey, of the Fostering Network, said: “The Fostering Network has long called for a greater focus and investment in the mental health and well-being of children and young people in care. The quality of, and access to, the appropriate mental health support is something that our foster carer members frequently tell us is inconsistent or unavailable.

We therefore very much welcome this research looking at the best mental health and well-being interventions, and especially the focus on ensuring that the views and experiences of care experienced young people and foster carers will be at the centre of the research.”

CHIMES will also engage with CASCADE Voices, a collaboration between Voices from Care Cymru and CASCADE, Cardiff University. This is a group of care-experienced young people who provide advice on research studies. We will work with the group to refine and confirm the scope of the review and to identify interventions that might be most feasible and acceptable within the UK context.  

Further support resources 

Carers, young people and children can access advice and support about mental health from the following: 

Samaritans 

Childline 

YoungMinds 

The Fostering Network 

Voices from Care Cymru 

Grandparents Plus 

Government advice on supporting children’s mental health during covid-19 

This research was funded by the National Institute for Health Research (NIHR) (NIHR129113) using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK Department of Health and Social Care.

Dr Sarah MacDonald is a Research Associate in DECIPHer where she undertakes qualitative health research, with a focus on children and young people. Follow her on Twitter: @Sarahmaccardiff 

Dr Rhiannon Evans is a Senior Lecturer in Social Science and Health based at DECIPHer. She leads the work programme on Healthy Relationships. Her research focuses on the improvement of the mental health and wellbeing of children and young people, in addition to the prevention of self-harm and suicide. Follow her on Twitter: @1RhiannonEvans 

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