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The mental health and wellbeing of children and young people who have been in care, primarily foster care, kinship care or residential care, remains a public health priority. The Care-experienced cHildren and young people's Interventions to improve Mental health and wEll-being outcomes Systematic review (CHIMES) synthesized evidence for the effectiveness of interventions targeting: subjective wellbeing; mental, behavioral and neurodevelopmental disorders; and suicide-related outcomes. Searches were conducted in 16 bibliographic databases and 22 websites between 1990 and 2022. This was supplemented by citation tracking, screening of relevant systematic reviews, and expert recommendation. We identified 35 interventions, with 44 evaluations via randomized controlled trials. Through meta-analyses, we found that interventions have a small beneficial impact on a variety of mental health outcomes in the short term (0–6 months). Interventions improved total social, emotional, and behavioral problems (d = −0.15, 95% CI [−0.28, −0.02]), social-emotional functioning difficulties (d = −0.18, 95% CI [−0.31, −0.05]), externalizing problem behaviors (d = −0.30, 95% CI [−0.53, −0.08]), internalizing problem behaviors (d = −0.35, 95% CI [−0.61, −0.08]); and depression and anxiety (d = −0.26, 95% CI [−0.40, −0.13]). Interventions did not demonstrate any effectiveness for outcomes assessed in the longer term (>6 months). Certainty of effectiveness was limited by risk of bias and imprecision. There was limited available evidence for interventions targeting subjective wellbeing and suicide-related outcomes. Future intervention design and delivery must ensure that programs are sufficient to activate causal mechanisms and facilitate change. Evaluation research should use a robust methodology. PROSPERO Registration: CRD42020177478 [ABSTRACT FROM AUTHOR]

Introduction: Professional classical musicians operate within a highly demanding environment, which includes organizational, social, and emotional demands. When not effectively coped with, these demands may cause stress and negatively impact well-being. This qualitative study explored the perceived stress and well-being experiences of professional classical musicians through a transactional theory of stress. The study employed a double hermeneutic interpretation of the lived experiences of the perceived demands faced, stress appraisals made, resources used, and the influence on well-being. Methods: Six professional classical musicians were purposefully selected for participation. Semi-structured interviews were conducted and participants reflected on two events: one they perceived as a positive experience and one that was negative. Transcripts were analyzed using Interpretative Phenomenological Analysis and Group Experiential Themes emerged. Results: Three Group Experiential Themes were identified: (a) Performance Demands; (b) Organizational Demands; and, (c) Relationship Demands. Participants predominantly appraised demands as a threat. A small number of demands were appraised as a challenge or benefit, and the fewest demands were appraised as causing harm or loss. Participants' appraisals were informed by underlying properties of stress appraisal such as self and other comparison, and preparation. Participants often relied on personal resources as opposed to available workplace resources. They perceived well-being to relate to stress appraisals with participants experiencing acute and long-term outcomes. Discussion: This study offers insight into the lived experience of the occupational stress process within professional classical musicians. The findings demonstrate that organizational interventions targeted at continuing professional development and social support are appropriate to help musicians cope more effectively with demands. [ABSTRACT FROM AUTHOR]

Introduction: Provision of school‐ and community‐based counselling services differs in terms of funding, implementation and eligibility criteria across the UK. The existing evidence of the effectiveness of counselling services is mixed, with little consideration of service context, implementation or acceptability. This rapid review seeks to address the gaps in the extant evidence syntheses by exploring the effectiveness, implementation and acceptability of school‐ and community‐based counselling services in the UK. Methods: A systematic literature search was conducted in five electronic databases. Grey literature searches were conducted in 23 national government and third‐sector organisational websites. The searches focussed on studies examining counselling interventions aimed at children aged 7–18 years that examined either effectiveness, implementation, acceptability or context. Results: Fifty‐four studies were included in the review. The few RCT studies suggest that there is no clear evidence of effectiveness of the therapeutic approach, due to mixed findings. There is some tentative evidence for weaker study designs that counselling may have positive impacts across different settings. The service is highly valued by learners, teachers and parents and is believed to improve well‐being; however, it is often seen as a discrete service that is not well‐embedded within the education system. Conclusions: There is mixed evidence for the effectiveness of school‐ and community‐based counselling. However, this needs to be understood in the context of acceptability and implementation. Future work is needed to improve the implementation of services by considering the wider complexity of the systems in which these services are embedded. [ABSTRACT FROM AUTHOR]

Identifying which approaches can effectively reduce the need for out-of-home care for children is critically important. Despite the proliferation of different interventions and approaches globally, evidence summaries on this topic are limited. This study is a scoping review using a realist framework to explore what research evidence exists about reducing the number of children and young people in care. Searches of databases and websites were used to identify studies evaluating intervention effect on at least one of the following outcomes: reduction in initial entry to care; increase in family reunification post care. Data extracted from papers included type of study, outcome, type and level of intervention, effect, mechanism and moderator, implementation issues and economic (EMMIE) considerations. Data were coded by: primary outcome; level of intervention (community, policy, organisation, family or child); and type of evidence, using the realist EMMIE framework. This is the first example of a scoping review on any topic using this framework. Evaluated interventions were grouped and analysed according to system-level mechanism. We present the spread of evidence across system-level mechanisms and an overview of how each system-level mechanism might reduce the number of children in care. Implications and gaps are identified. [ABSTRACT FROM AUTHOR]

Meetings to enhance shared decision-making, such as family group conferences, potentially contribute to enhancing meaningful involvement of families. Such meetings are also claimed by some to reduce the need for children to be in care, either by increasing support from family for parents or by identifying care from within the family network. This rapid realist review aims to develop an understanding of how meetings that facilitate shared decision-making between professionals and families might work to safely reduce the need for children to be in care. It identifies mechanisms that are thought to make a difference and contextual factors that influence the impact of identified mechanisms.A comprehensive search of academic and gray literature identified 64 documents spanning seven types of shared decision-making meetings. Data from these papers were collected using an iterative process of juxtaposition, comparison, contrast, and combination with a developing program theory. Data from the literature was supplemented with consultation to ensure relevance to the UK setting. The review identified three key mechanisms that made shared decision-making meetings more likely to be effective in safely reducing children's entry to care: enabling participation and engagement; building trust and reducing shame; enabling participation in decision-making processes. It describes how these work before, during, and after meetings.The findings help us understand the complicated research findings about the relationship between meetings and care entry and provide a theory about what is needed to make such meetings work that is of practical use for practice and future research [ABSTRACT FROM AUTHOR]

Children and young people with care-experience (e.g. foster, kinship and residential care) report poorer mental health and wellbeing than the general population. Despite an emerging evidence-base for intervention, it is not clear if current approaches create, exacerbate or mitigate outcome inequities between different types of participants. We conducted a systematic review of international interventions targeting mental health, subjective wellbeing and suicide-related outcomes amongst care-experienced children and young people aged up to 25 years old. The review included a narrative synthesis of intervention inequities, exploring if they were more or less effective for different participant groups. Eight interventions, with 14 study reports, presented relevant data. Overall, there was no clear evidence that intervention participation could lead to inequitable impacts, being more or less effective for different groups. However, there was some tentative indication that individuals with lower exposure to maltreatment, fewer care placements, and increased baseline mental health problems, might be more responsive to intervention than other participants. There was limited evidence for wellbeing and no data availability for suicide. Future intervention evaluation should focus on assessing if there is potential to create, sustain or exacerbate inequities, and how approaches may be designed to mitigate this risk. [ABSTRACT FROM AUTHOR]