Allied health professional support for children and young adults living in and leaving care: A systematic scoping review.

BACKGROUND: Children and young people living in and leaving care are known to have experienced significant childhood adversity and trauma resulting in potentially deleterious impact on their health and well-being across the life course. Studies point to the complex needs of this population who may benefit from allied health professional (AHP)-related support with limited studies located. This review sought to address this gap by systematically scoping empirical literature focused on the provision of AHP support to this cohort of children and young adults to assist an understanding of the service needs for this vulnerable population. METHODS: This scoping review followed Arskey and O'Malley's five steps framework (2005) to identify and review relevant literature. A focus on identifying the evidence, challenges and gaps in research relating to AHP support for children and young people living in and leaving care was initially agreed, followed by a systematic search using a combination of three key concepts to identify relevant studies in five AHP disciplinary areas to identify best evidence in the past decade (2011-2021). Study inclusion criteria were based on empirical studies of children and young people living in care (0-17 years) and leaving care (18-25 years). A data extraction table was formulated as a means of charting the data, aligned with the scope and objectives of this review. Finally, data were subsequently collated, synthesised and reported based on key thematic areas emerging from included studies regarding AHP support to children and young people living in and leaving care. RESULTS: A total of 13 studies met the review inclusion criteria. Included studies reported specifically on speech and language therapist (SLT; n = 5), occupational therapist (OT; n = 3) and arts-based therapies (n = 5). No studies were identified with regard to the use of physiotherapy and dietetics with this population. Results indicated that children and young people living in and leaving care have high rates of speech, language, communication and sensory needs. More rigorous screening, assessment and early intervention were identified as essential for this vulnerable group. Increased multidisciplinary collaboration and OT support for young adults in preparation for transition to independent living was identified as an urgent requirement. Included studies indicate promising results in relation to access to arts-based therapies with particular reference to identity formation for children and young people living in and leaving care. CONCLUSIONS: Although evidence of effectiveness remains limited, AHP service provision (specifically speech and language therapy, occupational therapy and arts-based therapies) has the potential to contribute positively to addressing the complex and interacting needs of this vulnerable population. As a result, it is recommended that AHP service provision is integrated into the collaborative, multidisciplinary care available to children living in and leaving care. More extensive, higher quality research related to the benefits of AHP provision for this population of children and young people is essential to provide a more robust evidence base across the various professional disciplines that constitute allied health provision.

La evaluación de habilidades para la vida independiente de jóvenes en el sistema de protección: un enfoque multiinformante / Assessing Independent Life Skills of Youth in Child Protection: A MultiInformant Approach

Resultados:Los resultados confirman la estructura interna esperada para los instrumentos (tres factores de primer orden y un factor de segundo orden para PLANEA-S, modelo unidimensional para PLANEA-9-S y modelo bifactorial correlacionado para PLANEA-T-S). Los instrumentos mostraron niveles excelentes de fiabilidad (ω = .80-.97) y capacidad discriminativa. El personal informó de menor nivel de habilidades para la vida independiente que el grupo de jóvenes, pero no de autonomía en la vida diaria, lo cual estuvo mediado por el rol del informante adulto con respecto al joven.Conclusiones: Se concluye que la versión para educadores de los instrumentos PLANEA de evaluación de habilidades para la vida independiente amplía el campo de evaluación de este constructo en jóvenes en acogimiento desde una perspectiva multiinformante, lo que es clave para que los servicios de protección infantil puedan identificar y atender las necesidades individuales de estos jóvenes, seleccionando los apoyos necesarios en cada caso para la promoción de una transición exitosa desde el sistema de protección a la vida adulta.

Background:This study aimed to adapt and validate a staff version of the PLANEA Independent Life Skills Assessment tools, which were then used to explore the convergence between self-reported and staff views of independent living skills of young people in residential child care in Spain. Method: A sample of 422 care-experienced young people was evaluated by their residential or care workers (n = 219) using the staff version of PLANEA instruments. Psychometric analyses were carried out to study dimensionality and measuring properties of the instruments, while t-tests, Pearson correlations and Fisher’s z were used to study convergence between informants. Results: The results show that the internal structure of the instruments was confirmed for the staff versions (three first-order factors and one second-order factor model for PLANEA-S, unidimensional model for PLANEA-9-S, and two-factor correlated model for PLANEA-T-S). The instruments showed excellent reliability (ω = .80-.97) and discriminative capacity. Staff showed less optimistic views than young people about their independent living skills but not their autonomy to perform everyday life tasks. This was mediated by the role of the adult respondent towards the young person evaluated. Conclusions: As conclusions we can say that the validated staff version of the PLANEA Independent Life Skills Assessment tools expands the scope for assessing this construct in young people in care from a multi-informant perspective. This is key for child protection services to address young people’s individual needs and inform decision-making regarding the provision of support services that will promote a successful transition from care to adulthood for them.

Transitioning to adulthood from residential childcare during COVID-19: Experiences of young people with intellectual disabilities and/or autism spectrum disorder in South Africa.

For young people with intellectual disabilities and/or autism, the transition from children's residential care into adulthood during COVID-19 has been difficult.Opportunities for greater independence were blocked because of the lockdown.Some of these young people experienced an increase in depression or other mental health difficulties.But more time at home due to public health restrictions also helped to deepen the relationship with caregivers.Service continuity is crucial, both in person and online, to support care leavers with intellectual disability and/or autism, as well as training and support to caregivers to continue with independent and interdependent living programmes at home. BACKGROUND: This study focuses on young people with intellectual disabilities and/or autism who, due to child welfare concerns, have grown up in children's residential care and are now transitioning out of care at the age of 18 years towards young adulthood. This transition is termed "care leaving" and the young people in transition "care leavers". The care leaving transition can be particularly difficult for young people with intellectual disabilities and/or autism. These challenges can be magnified in a time of a global crisis like COVID-19, which has resulted in countries being on lockdown and care leavers' transitions being curtailed. Many mental health problems have emerged due to the COVID-19 outbreak and resultant lockdown that may negatively impact on the care leaving transition of young people with intellectual disabilities. METHODS: Semi-structured interviews were conducted with six care leavers with intellectual disabilities and their three caregivers in June 2020 in the Cape Peninsula region of South Africa to explore the impact of COVID-19 on their transitional journeys. FINDINGS: Three core themes emerged from the analysis: young people evidenced regression of independence, rather than the expected growth in young adult independence, due to disruptions to routines and opportunities to move out into the world; some young people experienced an exacerbation or emergence of mental health problems, which impacted on their transition to young adulthood; and young people and their caregivers experienced a deepening of caregiver relationships, which enhanced the transition of the care leaver. CONCLUSIONS: Services must continue to facilitate progress towards independence and promote personal and caregiver well-being. Support service for care leavers with intellectual disabilities should be essential services, offered in person or online while adhering to COVID-19 regulations. Caregivers should be trained in continuing independent and interdependent living programmes for care leavers in their care, supported through in person or online training, mentoring and supervision. Service continuity is recommended to avoid the contraction of young people's social world at a time when it should be opening up.

Protocol for a systematic review of policies, programs or interventions designed to improve health and wellbeing of young people leaving the out-of-home care system.

BACKGROUND: Relative to their counterparts in the general population, young people who leave, or transition out of, out-of-home (OOHC) arrangements commonly experience poorer outcomes across a range of indicators, including higher rates of homelessness, unemployment, reliance on public assistance, physical and mental health problems and contact with the criminal justice system. The age at which young people transition from OOHC varies between and within some countries, but for most, formal support ceases between the ages of 18 and 21. Programs designed to support transitions are generally available to young people toward the end of their OOHC placement, although some can extend beyond. They often encourage the development of skills required for continued engagement in education, obtaining employment, maintaining housing and general life skills. Little is known about the effectiveness of these programs or of extended care policies that raise the age at which support remains available to young people after leaving OOHC. This systematic review will seek to identify programs and/or interventions that improve outcomes for youth transitioning from the OOHC system into adult living arrangements. METHODS: This review will identify programs, interventions and policies that seek to improve health and wellbeing of this population that have been tested using robust controlled methods. Primary outcomes of interest are homelessness, health, education, employment, exposure to violence and risky behaviour. Secondary outcomes are relationships and life skills. We will search, from January 1990 onwards, MEDLINE, EMBASE, PsycINFO, ERIC, CINAHL, Cochrane CENTRAL, SocINDEX, Sociological Abstracts, Social Services Abstracts, NHS Economic Evaluation Database and Health Technology Assessment. Grey literature will be identified through searching websites and databases, e.g. clearing houses, government agencies and organisations known to be undertaking or consolidating research on this topic area. Two reviewers will independently screen all title and abstracts and full text articles with conflicts to be resolved by a third reviewer. Data extraction will be undertaken by pairs of review authors, with one reviewer checking the results of the other. If more than one study with suitable data can be identified, we plan to undertake both fixed-effects and random-effects meta-analyses and intend to present the random-effects result if there is no indication of funnel plot asymmetry. Risk of bias will be assessed using tools appropriate to the study methodology. Quality of evidence across studies will be assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. DISCUSSION: Previous reviews were unable to identify any programs or interventions, backed by methodologically rigorous research, that improve outcomes for this population. This review seeks to update this previous work, taking into account changes in the provision of extended care, which is now available in some jurisdictions. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020146999.

Crossing Countries and Crossing Ages: The Difficult Transition to Adulthood of Unaccompanied Migrant Care Leavers.

The social changes experienced in many countries have prolonged the transition to adult life for young people. That being said, those who leave child care cannot afford this privilege, in that they do not benefit from the same support and resources, having to confront an accelerated transition which exposes them to increased risk of negative outcomes and social exclusion. Moreover, this transition might be even riskier for unaccompanied migrant care leavers, who are four times as vulnerable, given their status as young people in care, as adolescents, as migrants and being unaccompanied. This paper seeks to explore the profiles, needs, and experiences of unaccompanied young migrants in comparison with other care leavers. Data were collected by means of a semi-structured interview to explore their pre-care, in-care, and aftercare experiences. A highly specific profile of unaccompanied young migrants has been revealed that differs from the other care leavers in terms of worse educational, occupational, and economic outcomes, limited support networks, and more obstacles to accessing aftercare supports. Conversely, they also exhibited some strengths, such as having less pre-care, in care, and aftercare traumatic experiences, less psychological distress and fewer risky behaviors compared with other care leavers.

Corporate parenting in a pandemic: Considering the delivery and receipt of support to care leavers in Wales during Covid-19.

This paper considers the support available to care leavers during the Covid-19 pandemic from their corporate parents. The paper contributes to a developing evidence base concerned with social work efforts to adapt and maintain support provision during the unprecedented circumstances, and provides insight into how such support was perceived and experienced. Funded by Voices from Care Cymru and Cardiff University, a qualitative, mixed method study was conducted which included a survey of Welsh Local Authority professionals (n = 22) and interviews with Welsh care-experienced young people aged 17-24 (n = 17). The findings of this paper show the propensity of corporate parents to provide protection against the adversities of the pandemic, or to compound difficulties. While some young people reported being both practically and emotionally supported, for others corporate parenting support was perceived as unavailable, unhelpful and / or uncaring. The Covid-19 pandemic provides a unique lens to consider the strengths, flaws and future opportunities for corporate parenting. The findings emphasise the need for parity of support for young people leaving care and consideration of national, local and individual responses is included. Yet consistent with findings pre-dating the pandemic, the findings reaffirm the enduring importance of both relationships and resources in ensuring good support for care leavers.

The impact of transitional programmes on post-transition outcomes for youth leaving out-of-home care: a meta-analysis.

Youth residing in out-of-home care settings have often been exposed to childhood trauma, and commonly report experiencing adverse outcomes after transitioning from care. This meta-analysis appraised internationally published literature investigating the impact of transitional programme participation (among youth with a baseline age of 15-24 years) on post-transition outcomes of housing, education, employment, mental health and substance use. A comprehensive search of sociology (e.g. ProQuest Sociology), psychology (e.g. PsycInfo) and health (e.g. ProQuest Family Health) electronic abstraction databases was conducted for the period 1990-2014. Search terms included 'out-of-home care', 'transition', 'housing', 'education', 'employment', 'mental health' and 'substance use'. Nineteen studies, all from the United States, met the inclusion criteria and were included in the meta-analysis. Living independently and homelessness were the most commonly described housing outcomes. Rates of post-transition employment varied, while rates of post-secondary education were low. Depression and alcohol use were commonly reported among transitioning youth. Findings of the meta-analysis showed that attention should be given to the potential benefit of transitional programme participation on outcomes such as housing, employment and education. Moderator analyses showed that these benefits may differ based on study design, sample size and sampling unit, but not for mean age or gender. Detailed and rigorous research is needed internationally to examine the characteristics of transitional programmes resulting in more successful outcomes for youth, and whether these outcomes are sustained longitudinally.

Falling off the ladder: Using focal theory to understand and improve the educational experiences of young people in transition from public care.

Coleman's focal theory, developed in relation to adolescents in the general population, appears to offer some explanation for the poor educational achievement and social exclusion of care leavers, but has been little tested empirically. This paper revisits data from two studies of care-experienced young people aged 18-25, drawing on qualitative interviews in the UK and four other European countries, to see if focal theory would have helped to predict their educational progression or otherwise. The lives of research participants were found to be characterised by disruptions and uncertainty, with multiple challenges confronting them in quick succession, making it hard for them to pace their transitions as, according to focal theory, other young people do. Findings suggest that the theory could be used to inform policy designed to improve educational outcomes and should be incorporated into training for those responsible for supporting care leavers through their transition to adulthood.

Jóvenes que estuvieron en el sistema de protección social a la infancia: Reflexiones a partir de una investigación realizada en Girona, España / Young people who were in the child protection system: reflections from a study done in Girona, Spain

Los estudios sobre la atención residencial en España son aún escasos a pesar de la importancia de este recurso. Se presenta una investigación realizada con metodología cualitativa, que analiza la situación vivida por jóvenes que pasaron por centros residenciales de la provincia de Girona (1994-2002), a partir de sus opiniones y percepciones expresadas en una entrevista semiestructurada. Los resultados obtenidos, agrupados en subcategorías, muestran su desconocimiento del motivo del ingreso en el centro y cambios posteriores, a la vez que reconocen que fue mejor entrar en el centro que permanecer en casa, y apuntan insuficientes apoyos para la transición a la vida adulta. Supone implicaciones a nivel de políticas de infancia y juventud y para la práctica profesional e investigadora.(AU)

Research on residential care is still scarce despite its high implementation in Spain. This article presents the results of a research using qualitative methods. The study analyses the situation experienced by young people who lived in foster care in the province of Girona (1994 - 2002) based on their opinions and perceptions expressed in a semi-structured interview. The results, clustered into subcategories, show lack of knowledge about the reasons why they needed foster care, if it was better being there than staying with their parents, and the lack of support for transition to adulthood. The study shows implications for children and youth policies, professional practice and research.(AU)

Jóvenes que estuvieron en el sistema de protección social a la infancia. Reflexiones a partir de una investigación realizada en Girona, España / Young people who were in the child protection system: reflections from a study done in Girona, Spain

Los estudios sobre la atención residencial en España son aún escasos a pesar de la importancia de este recurso. Se presenta una investigación realizada con metodología cualitativa, que analiza la situación vivida por jóvenes que pasaron por centros residenciales de la provincia de Girona (1994-2002), a partir de sus opiniones y percepciones expresadas en una entrevista semiestructurada. Los resultados obtenidos, agrupados en subcategorías, muestran su desconocimiento del motivo del ingreso en el centro y cambios posteriores, a la vez que reconocen que fue mejor entrar en el centro que permanecer en casa, y apuntan insuficientes apoyos para la transición a la vida adulta. Supone implicaciones a nivel de políticas de infancia y juventud y para la práctica profesional e investigadora.

Research on residential care is still scarce despite its high implementation in Spain. This article presents the results of a research using qualitative methods. The study analyses the situation experienced by young people who lived in foster care in the province of Girona (1994 - 2002) based on their opinions and perceptions expressed in a semi-structured interview. The results, clustered into subcategories, show lack of knowledge about the reasons why they needed foster care, if it was better being there than staying with their parents, and the lack of support for transition to adulthood. The study shows implications for children and youth policies, professional practice and research.