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In a recent contribution to this journal, Cummings (2023) reports findings from a preliminary qualitative study of practitioner viewpoints regarding digitally delivered mental health support to care-experienced young people. Cummings' study highlights the need to engage with professional experiences of using digital methods with this group, both during and outside of the COVID-19 pandemic. A response to - and commentary on – Cummings' contribution is provided, to advance discussion of issues identified by the research. We reflect on our experience as practitioners and researchers working in and alongside specialist child and adolescent mental health service teams serving care-experienced children and young people. We focus on workspaces in remote working, therapeutic technique in online and telephone-based care, and virtues and challenges of remote care delivery. [ABSTRACT FROM AUTHOR]

Instability in the lives of young people in care is a public health concern. Placement moves and loss of relationships can have serious implications for young people's overall functioning, as well as their future life outcomes. Despite this, research often lacks the perspective and voice of young people in care. In this qualitative research, Interpretative Phenomenological Analysis was used to provide a deeper insight into young people's perceptions and beliefs about their care experiences to explore the impact of these on their ability to achieve a sense of stability and permanency across time. Semi-structured interviews were conducted with six males from UK foster, residential and semi-independent care homes. The main themes highlighted young people's perceptions of their care environment, relationships with others, sense of self and future under the overarching issue of permanence. Policy and practice implications propose strategies to target instability at the micro-level and how that may facilitate positive outcomes. The study revealed insights that may be helpful for frontline professionals and highlight to policy makers the importance of ensuring environmental and relational stability. An awareness of attachment theory to implement effective caregiving, should be a priority for training parents, caregivers, professionals and policy makers. [ABSTRACT FROM AUTHOR]

Background: Self‐harm amongst young people is an increasing problem, with looked‐after young people at higher risk. Despite this, little research exists on what young people who self‐harm find helpful. Method: One hundred and twenty‐six 11–21 year olds (53 who had experience of the care system and 73 who did not) were recruited from the community and NHS. All participants had self‐harmed in the past 6 months. Participants completed an Audio Computer‐Assisted Self‐interview (ACASI) regarding their views about the support they had received, how helpful it was, and what further help they felt they needed. Results: Looked‐after young people reported the three most helpful sources of support were Child and Adolescent Mental Health Services (CAMHS), friends and pets and the least helpful were CAMHS, Accident and Emergency (A&E) and Social services. For non‐looked‐after young people, CAMHS, counselling and Harmless (user‐led support service for self‐harm) were most helpful and CAMHS, cognitive behavioural therapy (CBT) and general practitioner (GP) were the least. Compared with the other group, more looked‐after young people had received help from A&E and CAMHS, whereas more non‐looked‐after young people had accessed GPs, parents, psychological therapies, self‐help books and websites. More looked‐after young people found support groups helpful, and more non‐looked‐after young people reported that distraction techniques, medication and their siblings were helpful. Conclusion: Young people who self‐harm have mixed views about CAMHS. Differences in the pattern of access and preferences for support between looked‐after and non‐looked‐after young people should be reflected in service availability and commissioning. Key Practitioner Message: Little is known about what young people who self‐harm find helpful, particularly for looked‐after young people.CAMHS was named amongst the most helpful and the least helpful services by both looked‐after and non‐looked‐after young people.Social services and A&E were frequently cited amongst the least helpful sources of support.Young people report finding informal support helpful, including family and friends.There appears to be a need for explorations of the reasons behind the apparent negative perception of statutory services in young people, and what is required to shift that. [ABSTRACT FROM AUTHOR]

Objectives Young people in the public care system ('looked-after' young people) have high levels of self-harm. Design This paper reports the first detailed study of factors leading to self-harm over time in looked-after young people in England, using sequence analyses of the Card Sort Task for Self-harm (Ca TS). Methods Young people in care (looked-after group: n = 24; 14-21 years) and young people who had never been in care (contrast group: n = 21; 13-21 years) completed the Ca TS, describing sequences of factors leading to their first and most recent episodes of self-harm. Lag sequential analysis determined patterns of significant transitions between factors (thoughts, feelings, behaviours, events) leading to self-harm across 6 months. Results Young people in care reported feeling better immediately following their first episode of self-harm. However, fearlessness of death, impulsivity, and access to means were reported most proximal to recent self-harm. Although difficult negative emotions were salient to self-harm sequences in both groups, young people with no experience of being in care reported a greater range of negative emotions and transitions between them. For the contrast group, feelings of depression and sadness were a significant starting point of the self-harm sequence 6 months prior to most recent self-harm. Conclusions Sequences of factors leading to self-harm can change and evolve over time, so regular monitoring and assessment of each self-harm episode are needed. Support around easing and dealing with emotional distress is required. Restricting access to means to carry out potentially fatal self-harm attempts, particularly for the young persons with experience of being in care, is recommended. Practitioner points Self-harm (and factors associated with self-harm) can change and evolve over time; assessments need to reflect this., Looked-after young people reported feeling better after first self-harm; fearlessness of death, access to means, and impulsivity were reported as key in recent self-harm., Underlying emotional distress, particularly depression and self-hatred were important in both first and most recent self-harm., Looked-after young people should undergo regular monitoring and assessment of each self-harm episode and access to potentially fatal means should be restricted., The CaTS would have clinical utility as an assessment tool, Recruiting participants can be a significant challenge in studies with looked-after children and young people., Future research with larger clinical samples would be valuable. [ABSTRACT FROM AUTHOR]

Rationale Self-harm in young people is of significant clinical concern. Multiple psychological, social and clinical factors contribute to self-harm, but it remains a poorly understood phenomenon with limited effective treatment options. Objective To explore young women's experience of self-harm in the context of interpersonal stressors and supports. Method Fourteen adolescent females (13–18 years) who had self-harmed in the last six months completed semi-structured interviews about self-harm and supports. Interpretative phenomenological analysis was undertaken. Results Themes identified were: 1) Arguments and worries about family breakdown; 2) Unhelpful parental response when self-harm discovered and impact on seeking support; 3) Ongoing parental support; 4) Long-term peer victimization/bullying as a backdrop to self-harm; 5) Mutual support and reactive support from friends (and instances of a lack of support); 6) Emotions shaped by others (shame, regret and feeling ‘stupid to self-harm’); and 7) ‘Empty promises’ - feeling personally let down by clinical services. These themes were organised under two broad meta-themes (psychosocial stressors, psychosocial supports). Two additional interconnected meta-themes were identified: Difficulties talking about self-harm and distress; and Impact on help-seeking. Conclusion Parents and peers play a key role in both precipitating self-harm and in supporting young people who self-harm. The identified themes, and the apparent inter-relationships between them, illustrate the complexity of self-harm experienced in the context of interpersonal difficulties, supports, and emotions. These results have implications for improving support from both informal and clinical sources. [ABSTRACT FROM AUTHOR]