Happiness and Well-Being of Young Carers: Extent, Nature and Correlates of Caring Among 10 and 11 Year Old School Children

Young carers often take on practical and/or emotional caring responsibilities that would normally be expected of an adult. For many of these children and young people, caring has been shown to have a detrimental effect on their lives. For example, caring at a young age appears to be associated with poor health and well-being, bullying and poorer educational outcomes. However, previous research has tended to be retrospective, carried out using small surveys of secondary school-aged children or to use qualitative methods with young people associated with caring projects. In contrast, little is known about the extent and nature of caring undertaken by younger children. This paper reports findings from a random sample survey of 10 and 11 year old children in the final year of their primary school education. 4,192 children completed the Kids’ Life and Times (KLT) online survey in 2011. Twelve percent of respondents to KLT said they helped look after someone in their household who was sick, elderly or disabled. Supporting previous qualitative research, this survey showed that children who were carers had poorer health and well-being, reported less happiness with their lives, were more likely to be bullied at school and had poorer educational aspirations and outcomes than their peers who were not carers. These findings suggest that teachers need to discuss the issue of caring with children in the classroom in a general and supportive way so that young carers feel able to confide in them and seek support if they need it.

At Home in Care: Children living with birth parents on a Care Order

This study explored the processes, background information, and perceived reasons why children and young people returned home while remaining in care, in the five HSC Trusts in Northern Ireland. The research also focused on understanding the functions the Care Order had for social services, the birth parents, and young people involved.
It was found that on 31st March 2009, there were 193 children/young people living with their birth parents on a Care Order in Northern Ireland. This is eight per cent of the total population of Looked After children, and is lower than had been anticipated from governmental statistics. In total, the case files of 47 of these young people (24% of them) were reviewed, and interviews were conducted with ten of them and their birth parent/s.
The analysis revealed that the majority of them had in common a parental background history of alcohol abuse and domestic violence, and most return breakdowns in the study were related to continuing parental alcohol and/or drugs misuse. While some children had a planned return home after parents had engaged in supports and completed assessments, many young people had returns that were not planned, as they initiated the move themselves, or previous foster placements had broken down and there were no alternative placements identified for them. Many of these young people essentially ‘voted with their feet’, and social services were required to ensure that they remained safe in often less than optimal circumstances.
After returning home, for many, Care Orders remained for initially unintended lengthy periods because of the risks posed by parents’ intermittent alcohol abuse and their lifestyle, contact issues, and parents’ desire to ensure that their children were able to access the supports that they needed. Thus, Care Orders at home tended to serve two main functions: to either monitor and/or support the placement.

Improving allied health professionals' research implementation behaviours for children with cerebral palsy: protocol for a before-after study

BACKGROUND: Cerebral palsy is a permanent disorder of posture and movement caused by disturbances in the developing brain. It affects approximately 1 in every 500 children in developed countries and is the most common form of childhood physical disability. People with cerebral palsy may also have problems with speech, vision and hearing, intellectual difficulties and epilepsy. Health and therapy services are frequently required throughout life, and this care should be effective and evidence informed; however, accessing and adopting new research findings into day-to-day clinical practice is often delayed.

METHODS/DESIGN: This 3-year study employs a before and after design to evaluate if a multi-strategy intervention can improve research implementation among allied health professionals (AHPs) who work with children and young people with cerebral palsy and to establish if children's health outcomes can be improved by routine clinical assessment. The intervention comprises (1) knowledge brokering with AHPs, (2) access to an online research evidence library, (3) provision of negotiated evidence-based training and education, and (4) routine use of evidence-based measures with children and young people aged 3-18 years with cerebral palsy. The study is being implemented in four organisations, with a fifth organisation acting as a comparison site, across four Australian states. Effectiveness will be assessed using questionnaires completed by AHPs at baseline, 6, 12 and 24 months, and by monitoring the extent of use of evidence-based measures. Children's health outcomes will be evaluated by longitudinal analyses.

DISCUSSION: Government, policy makers and service providers all seek evidence-based information to support decision-making about how to distribute scarce resources, and families are seeking information to support intervention choices. This study will provide knowledge about what constitutes an efficient, evidence-informed service and which allied health interventions are implemented for children with cerebral palsy.

TRIAL REGISTRATION: Trial is not a controlled healthcare intervention and is not registered.

Teleconsultation in sexual and reproductive health for young adults through mobile devices: Experience in Colombia

Background: Sexual risk behaviors associated with poor information on sexuality have contributed to major public health problems in the area of sexual and reproductive health in teenagers and young adults in Colombia. Objective: To measure the perception of changes in sexual and reproductive risk behavior after the use of a teleconsultation service via mobile devices in a sample of young adults. Methods: A before and after observational study was designed, where a mobile application to inquire about sexual and reproductive health was developed. The perception of changes in sexual and reproductive health risk behaviors in a sample of young adults after the use of the application was measured using the validated survey “Family Health International (FHI) – Behavioral Surveillance Survey (BSS) – Survey for Adults between 15 to 40 Years”. Non-probabilistic convenience recruitment was undertaken through the study´s web page. Participants answered the survey online before and after the use of the mobile application for a six month period (intervention). For the inferential analysis, data was divided into three groups (dichotomous data, discrete quantitative data, and ordinal data), to compare the results of the questions between the first and the second survey. For all tests, a confidence interval of 95% was established. For dichotomous data, the Chi-squared test was used. For quantitative data, we used the Student’s t-test, and for ordinal data, the Mann-Whitney-Wilcoxon test. Results: A total of 257 subjects were registered in the study and met the selection criteria. The pre-intervention survey was answered by 232 subjects, and 127 completely answered the post-intervention survey, of which 54.3% did not use the application, leaving an effective population of 58 subjects for analysis. 53% (n=31) were female, and 47% (n=27) were male. The mean age was 21 years, ranging between 18 and 40 years. The differences between the answers on the first and the second survey were not statistically significant. The main risk behaviors identified in the population were homosexual relations, non-use of condoms, sexual relations with non-regular and commercial partners, the use of psychoactive substances, and ignorance about the symptoms of sexually transmitted diseases and HIV transmission. Conclusions: Although there were no differences between the pre- and post-intervention results, the study revealed different risk behaviors among the participating subjects. These findings highlight the importance of promoting educational strategies on this matter and the importance of providing patients with easily accessible tools with reliable health information.

To do or not to do (exercise) : physical activity in the lives of people with cerebral palsy

We examined the lives of adults with cerebral palsy who had minimal involvement in physical activity (Judy, aged 60; Alana, aged 29), who were involved in physical activity (Amy, aged 25; Ben, aged, 30), or who had minimal involvement in physical activity and who then participated in physical activity (David, aged 27; Tim, aged, 24). After receiving ethical approval, a life-history research approach (Denzin, 1989: Interpretive biography. Newbury Park, CA: Sage) was used, with the participants’ stories being interpreted using primarily psychodynamic theory (Freud, Erikson, Adler, Basch) to gain insight into their meaning and experiences of physical activity.

Judy and Alana had similar childhood experiences, which included: performing difficult, and sometimes painful, physiotherapy; wearing callipers to assist their walking; lacking competence at physical activity; and being socially isolated from their classmates. These aspects of their life histories seemed to contribute to their subsequent avoidance of physical activity and early onset of functional decline.

Amy and Ben had negative experiences with physical activity as children (similar to Judy and Alana), but were involved in, and valued, physical activity as adults. Physical activity was a means of displaying competence, delaying further functional loss, and becoming socially connected.

David and Tim lost the ability to walk in early adolescence. The minimal physical activity in which they engaged during their adult lives was directed towards trying to walk again. Walking seemed to be intimately connected with psychosocial growth. David’s weight-training programme seemed to provide him with another avenue for self-improvement towards his goal of attracting a life partner. Tim’s warm-water aerobic programme provided him with an opportunity to develop competence at swimming and at walking, and to enhance his self-esteem for these activities.

Involvement in physical activity may be important for people with cerebral palsy in their endeavours to successfully face the various psychosocial challenges throughout life. Implications of this research include: parents and teachers of children with cerebral palsy should provide support for their involvement in physical activity; physiotherapists should try to reduce the pain and increase the perceived relevancy of the treatments they deliver to young people with cerebral palsy; and psychologists should be aware of some of the difficulties people with cerebral palsy face and how they may manifest in adults with the condition.

Association of adolescent symptoms of depression and anxiety with alcohol use disorders in young adulthood : findings from the Victorian Adolescent Health Cohort Study

Objective: To examine the association of adolescent depression and anxiety symptoms with alcohol abuse or dependence in young adulthood.

Design, setting and participants: Cohort study of the health and wellbeing of adolescents and young adults in Victoria, assessed at 8 waves (periods) of data collection, from age 14 to 24 years, between 1992 and 2003. Young people who participated in the cohort study at least once during the six adolescent assessment points (conducted 6 months apart, from age 14 to 17 years), at least once during young adulthood and who were alive at Wave 8 (n = 1758).

Main outcome measure: Alcohol abuse or dependence assessed using the alcohol and substance abuse modules of the Composite International Diagnostic Interview at age 24 years.

Results: Adolescents with moderate to high levels of depression and anxiety symptoms (measured by the revised Clinical Interview Schedule) had an increased risk of alcohol abuse or dependence in young adulthood, compared with young adults with low levels of adolescent depression and anxiety symptoms, after adjusting for potential confounding factors. Risk was higher for those with symptoms at more than two adolescent assessment points (odds ratio [OR] 1.9; 95% CI, 1.7–2.0) and for those with symptoms at one or two assessment points (OR 1.3; 95% CI, 1.2–1.4), compared with those with no above-threshold symptoms in adolescence.

Conclusions: Adolescents with depression and anxiety symptoms are at increased risk for alcohol use disorders into young adulthood. They warrant vigilance from primary care providers in relation to alcohol use well into adulthood.

Information needs of young adults with type 2 diabetes : a literature review

Background Type 2 diabetes (T2DM) is increasingly prevalent in young adults but there is very little information about what information they need to undertake diabetes self-management.

Aim To undertake a structured literature review to identify what information people with type 2 diabetes aged 25 to 45 years need to manage their diabetes and how they would like to receive it.

Methods A structured literature search was conducted. The MEDLINE, CINAHL, AMI, APAIS-Health databases were searched for articles published between 1980 and 2011. The reference list of journals and relevant websites were searched. Inclusion criteria were: literature about T2DM in young adults and literature about education and information needs of young adults with T2DM.

Results Only one article specifically focussed on the information needs of young people with T2DM and two reports included some information about T2DM and young adults. The limited data available suggested young adults with T2DM have specific information needs that are not sufficiently addressed in current resources, and have some needs different from young people with type 1 diabetes. Young people with T2DM want clear, consistent information from credible sources, delivered in a range of formats. They also want psychological support and counselling, age-specific education groups, after hours access to health professionals and education provided to family members and the community about T2DM in young people and about how to support people with T2DM.

Conclusion With the prevalence of T2DM in young adults continuing to increase, the need to address the specific information needs and learning styles of people with T2DM aged 25 to 45 is increasingly important.

Psychosocial moderators of associations between life events and changes in physical activity after leaving high school

To examine 1) associations between life events and changes in leisure-time physical activity (LTPA) in school leavers and 2) whether these associations are moderated by psychosocial factors.

High blood pressure and sedentary behavior in adolescents are associated even after controlling for confounding factors

The aim of this study was to determine whether high blood pressure (HBP) is associated with sedentary behavior in young people even after controlling for potential confounders (gender, age, socioeconomic level, tobacco, alcohol, obesity and physical activity). In this epidemiological study, 1231 adolescents were evaluated. Blood pressure was measured with an oscillometric device and waist circumference with an inextensible tape. Sedentary behavior (watching television, computer use and playing video games) and physical activity were assessed by a questionnaire. We used mean and standard deviation to describe the statistical analysis, and the association between HBP and sedentary behavior was assessed by the chi-squared test. Binary logistic regression was used to observe the magnitude of association and cluster analyses (sedentary behavior and abdominal obesity; sedentary behavior and physical inactivity). HBP was associated with sedentary behaviors [odds ratio (OR) = 2.21, 95% confidence interval (CI) = 1.41-3.96], even after controlling for various confounders (OR = 1.68, CI = 1.03-2.75). In cluster analysis the combination of sedentary behavior and elevated abdominal obesity contributed significantly to an increased likelihood of having HBP (OR = 13.51, CI 7.21-23.97). Sedentary behavior was associated with HBP, and excess fat in the abdominal region contributed to the modulation of this association.

Evaluation of quality of life related to i-131 therapy in patients with well-differentiated thyroid cancer and emphasis in salivary morbidity: a follow up study after treatment

To evaluate the impact of iodine-131 therapy received during childhood and adolescence and correlate it with the quality of life in these patients. Methods: We studied 19 patients diagnosed with cancer in childhood or adolescence who underwent thyroidectomy and supplemental therapy with I-131. We also recruited a control group of healthy subjects with the same demographic parameters. All patients were subjected to a scintigraphy examination of the salivary glands, and were also asked to complete a questionnaire in order to assess their overall quality of life. In addition, a more specific questionnaire for patients with head and neck cancer was also given to all study participants. Results: The quantitative and qualitative analyses of the salivary glands showed functional deficits with greater involvement of the parotid gland for volume, concentration and excretion. The right submandibular gland showed significant changes for volume in the patient group. The questionnaires made it possible to observe significant differences between the patient and control groups for symptoms such as thick saliva, dry mouth and speech problems. Conclusion: In spite of being very effective and widely used, iodine radionuclide therapy is correlated with a lower quality of life in young people.

Marginalized Youth, the ‘Modern’ Professional and the ‘Modern’ Workplace: A note on the Need for a Critical Approach to ‘Modernizing’ Strategies

This paper briefly examines plans to ‘transform’ social work services for socially marginalized children and young people in England. More specifically, it will focus on moves to privatize social work services for children and young people who are in public care, or ‘looked after’. In what follows, the focus will be on how the promotion of ‘social work practices’ (SWPs) – the name of these envisaged new structures – is discursively embedded in the idea the idea that ‘liberation’ and worker fulfillment can only be delivered within a privatized sphere. In this context, it will be maintained, the work of Boltanski and Chiapello may help to illuminate how the government and other primary definers are seeking to ‘win hearts and minds’ for further neoliberal ‘transformations’ within Children’s Services in England.

One year after the Youth Guarantee: Policy fatigue or signs of action? EPC Policy Brief, 27 May 2015

In April 2013, the EU Council called on EU member states to establish Youth Guarantee (YG) schemes, ensuring that “all young people under the age of 25 years receive a good-quality offer of employment, continued education, apprenticeship or traineeship within a period of four months of becoming unemployed or leaving formal education”. Implementation was meant to start more than a year ago, but political interest seems to have waned a bit. Is a ‘policy fatigue’ contaminating youth employment policies across the EU? Have some timid signs of economic recovery led to youth unemployment being less urgent or are we witnessing the usual policy developments whereby grand EU statements are worn down by political realities and resistance on the ground? In this Policy Brief, Claire Dhéret and Martina Morosi assess the implementation of the Youth Guarantee and provide suggestions on how to renew a sense of enthusiasm for such an ambitious tool across Europe.

Changes in the initiation of heroin use after a reduction in heroin supply

Increasing heroin use in Australia over the past 30 years has been associated with a decline in the age of initiation to heroin use. The 2001 Australian heroin shortage was used to assess the effects of a reduction in heroin supply on age of initiation into heroin injecting. Data collected from regular injecting drug users (IDU) over the period 1996-2004 as part of the Australian Illicit Drug Reporting System were examined for changes in self- reported age of first heroin use after the onset of the heroin shortage. Estimates were also made of the number of young people who may not have commenced injecting heroin during the heroin shortage. The proportion of IDU interviewed in the IDRS who were aged

The Reliability and Validity of a Child and Adolescent Participation in Decision Making Questionnaire

Background
There is a growing impetus across the research, policy and practice communities for children and young people to participate in decisions that affect their lives. Furthermore, there is a dearth of general instruments that measure children and young people’s views on their participation in decision making. This paper presents the reliability and validity of the Child and Adolescent Participation in Decision Making Questionnaire (CAP-DMQ) and specifically looks at a population of looked-after children where a lack of participation in decision making is an acute issue.
Methods
The participants were 151 looked after children and adolescents between 10-23 years of age who completed the 10 item CAP-DMQ. Of the participants 113 were in receipt of an advocacy service that had an aim of increasing participation in decision-making with the remaining participants not having received this service.
Results
The results showed that the CAP-DMQ had good reliability (Cronbach’s alpha = .94) and showed promising uni-dimensional construct validity through an exploratory factor analysis. The items in the CAP-DMQ also demonstrated good content validity by overlapping with prominent models of child and adolescent participation (Lundy 2007) and decision making (Halpern 2014). A regression analysis showed that age and gender were not significant predictors of CAP-DMQ scores but receipt of advocacy was a significant predictor of scores (effect size d=.88), thus showing appropriate discriminant criterion validity.
Conclusion
Overall, the CAP-DMQ showed good reliability and validity. Therefore, the measure has excellent promise for theoretical investigation in the area of child and adolescent participation in decision making and equally shows empirical promise for use as a measure in evaluating services which have increasing the participation of children and adolescents in decision making as an intended outcome.

Home on a care order: who the children are and what the care order is for

Compared to children in other placements, there is much less known about the characteristics and needs of children in the UK who are returned to their birth parents with a care order still in place. That is in spite of evidence to suggest they face more difficulties than young people in other placements. Based on a 2009 census of looked after children in Northern Ireland, just under 10% (n = 193) were found to be living at home under a care order. Case file reviews were conducted for a quarter of these young people (n = 47) to generate descriptive statistics showing a very diverse population. That was followed by semi-structured interviews with members of eight families (ten children and eight birth parent/s), providing transcripts for thematic analysis. Nearly half of the young people whose case files were reviewed had experienced at least one home placement breakdown, but nearly two thirds had a stable last home placement. Care orders appeared to serve two functions: to give legal authority to social services for the monitoring of placements, and to facilitate family access to family support services. Replacing some care orders with supervision orders might better align legal status and actual function.