Providing specialist clinical support for adoptive parents and adoption professionals
Intended for healthcare professionals
Evidence and practice    

Providing specialist clinical support for adoptive parents and adoption professionals

Philip John Archard Mental health practitioner, child and adolescent mental health service (CAMHS), Leicestershire Partnership NHS Trust, Leicester, England
Jack Blackwell Honorary assistant psychologist, CAMHS, Leicestershire Partnership NHS Trust, Leicester, England
Isobel Moore Clinical psychologist, Derbyshire Healthcare NHS Foundation Trust, Derby, England
Louisa Briggs Deardon Assistant psychologist, CAMHS, Leicestershire Partnership NHS Trust, Leicester, England
Tina Adkins Assistant professor, The University of Texas at Austin, Austin, US
Michelle O’Reilly Associate professor of communication in mental health, University of Leicester, Leicester, England

Why you should read this article:
  • To read about the core aspects of the role of a specialist practitioner lead for adoption in a CAMHS team

  • To be aware of various methods of delivering advice, training, education and support to adoptive parents and adoption professionals

  • To appreciate the value of social science research expertise in developing clinical support for adoptive parents and adoption professionals

Children who are adopted are at greater risk of experiencing mental health issues than their nonadopted peers. This has influenced the development of dedicated care pathways, teams and clinical posts for adopted children in child and adolescent mental health services.

This article describes the role of a specialist practitioner lead for adoption, detailing the core duties, which include providing consultation clinics for professionals and parents, providing mental health awareness training for prospective adopters and the introduction of a group-based psychoeducation intervention. The article provides practice-based reflection and service evaluation findings on these core duties. Changes in practice during the coronavirus disease 2019 pandemic and the shift to remote care delivery, as well as the support role provided by nursing students and assistant and trainee psychologists during the consultation clinics, are also discussed.

Mental Health Practice. doi: 10.7748/mhp.2022.e1632

Peer review

This article has been subject to external double-blind peer review and checked for plagiarism using automated software

Correspondence

philip.archard@nhs.net

Conflict of interest

None declared

Archard PJ, Blackwell J, Moore I et al (2022) Providing specialist clinical support for adoptive parents and adoption professionals. Mental Health Practice. doi: 10.7748/mhp.2022.e1632

Published online: 20 September 2022

Introduction

Children who are adopted, much like those who are looked-after and live in out-of-home residential and foster care, are at increased risk of experiencing mental health issues. Rates differ by location and among surveys, but between one third and half of children in these groups are recognised as having clinical-level mental health needs, with up to an additional 25% displaying mental health issues that register on the threshold of clinical significance (Tarren-Sweeney 2019). Various factors contribute to this level of mental health need in these children, but the effects of trauma, adversity and compromised caregiving relationships early in life are particularly important (Fisher 2015).

The increased likelihood of mental health issues in adopted and looked-after children has influenced decisions to provide dedicated care pathways, specialist teams and specialist posts for these children in child and adolescent mental health services (CAMHS) (Rao et al 2010). However, the reach and scope of this provision can vary and researchers have emphasised the lack of services for very young children (Moriarty et al 2016). Evidence on the care of children with adoptive and foster parents in CAMHS is limited which risks practitioners becoming entrenched in outmoded approaches and deploying scarce resources ineffectively (Kerr and Cossar 2014, Harris-Waller et al 2018). There is an ongoing need for quality improvement work in services for adopted children in CAMHS, involving stakeholder feedback and reflection on practice to address gaps in knowledge and identify areas for research.

This article describes a designated adoption lead role based in a specialist CAMHS team serving adopted children who are considered particularly vulnerable to experiencing mental health issues. Usually but not exclusively held by a community psychiatric nurse, the post was until recently held by a psychodynamically-oriented clinician with additional experience in child welfare and mental health services research (the lead author). The article covers their time in post and explores core duties and development of the role, including:

  • Facilitating consultation clinics that provided support for adoption professionals, notably social workers, and adoptive parents.

  • Developing a mental health awareness training package for prospective adopters.

  • Introducing a group-based psychoeducation intervention – Family Minds – for adoptive parents and other parents and/or carers whose children are under the care of the CAMHS team.

The article is a reflective account of the adoption lead’s role in each of these areas, supplemented by relevant service evaluation findings based on analysis of data gathered via questionnaires. The article also explores the shift to online care delivery necessitated by the coronavirus disease 2019 (COVID-19) pandemic and the role of nursing students and assistant and trainee psychologists in supporting provision of the consultation clinics. The value of applied social science research expertise in developing this area of practice is also considered briefly.

Ethical considerations

Protocols for the service evaluation activity were reviewed by the research and development department of the Leicestershire Partnership NHS Trust in which the specialist CAMHS team is based. These protocols were approved as a form of quality improvement activity. They were also approved by the CAMHS team clinical lead. Anonymity of respondents’ comments were maintained throughout.

Facilitating consultation clinics

Key points

  • Adopted children have an increased likelihood of developing mental health issues

  • A designated CAMHS adoption lead role held by a clinician with specialist expertise can support adoptive parents and adoption professionals through consultations, training and group-based interventions

  • Consultations facilitated by a specialist clinician can offer adoptive parents and adoption professionals a space for dialogue, clarification, reassurance and meaningful advice

  • Short-term psychoeducation interventions may support adoptive parents to feel less isolated and encourage them to engage with longer-term interventions

As in other CAMHS teams, consultations with adoptive parents and external professionals such as social workers can have various functions. Consultations may serve as an indirect intervention via the clinical formulation of difficulties and professional advice, and as a pathway to direct assessment and intervention in CAMHS; for example, to consider a specific neurodevelopmental condition or access individual psychological therapy.

These consultation clinics were attended by individuals or groups of parents and professionals who were booked in by county council social work support staff in adoption and post-adoption support teams as part of an established care pathway.

Throughout the COVID-19 pandemic, demand was high and additional ad-hoc consultations were provided outside of the prearranged monthly clinics. Owing to social-distancing precautions, consultations were also conducted online via videoconferencing. As with pre-pandemic face-to-face consultations, each consultation began by clarifying expectations about information sharing and obtaining consent from attendees. Then a period of about 40 minutes was set aside for free discussion, with each attendee encouraged to share their perspective, followed by ten minutes for summative comments before a workable plan of action to ascertain suitable next steps was agreed with attendees. A record of the consultation in the form of a letter was sent to attendees.

Approach

Aligned with the adoption lead’s psychodynamic orientation, principles from a psychosocial consultee-centred model were used in the consultations (Caplan 1970), as well as aspects of integrative mentalisation-based and traditional psychiatric casework approaches (Joseph 1948, Mahlberg 2015) ‘exploration, assessment of the whole problem, quasi-therapy, quasi-advice’ (Joseph 1948).

Sensitivity is required as facilitator of consultations for adoptive parents. Adoptive parents can feel profoundly unprepared for parenting a child who has experienced early neglect. These parents often experience barriers in accessing CAMHS and may view any specialist input as overdue and unhelpful (Sturgess and Selwyn 2007, Monck and Rushton 2009, Harlow 2019). Offers of assistance from CAMHS and post-adoption support teams can also be experienced by parents as a vote of no confidence in their parenting abilities (Boswell and Cudmore 2014, Harlow 2019).

Reflection on facilitating consultations

Since COVID-19, facilitating consultations online has involved more direction to attendees than when these took place in-person – for example, requesting that they leave their video cameras on. In addition, without the usual ability to ‘read’ nonverbal communication, as with in-person consultations, comments were more often made by the adoption lead about feelings a parent may be experiencing about a child or children. At times, making such comments was not straightforward, with delays in connection interpreted as silences or leading to unintended interruptions. However, over time increased familiarity with the online medium led to a smoother experience for the attendees and adoption lead.

Attendees bring a diverse range of concerns to the consultations which did not change during the pandemic beyond an increased demand for assistance and guidance. Where some professionals access consultations simply to ascertain whether CAMHS-based care is indicated for a specific child or not, others view consultations as a means of reflecting on their decision-making, such as managing a child’s initial move to an adoptive placement or the meaning of recurrent soiling issues among a sibling group.

Parents can also request consultations for advice about childrearing challenges, including guidance on discussing a child’s birth parents with them, or because they are perplexed by a child’s behaviour. Routinely collected clinical data have established that adopted children were supported into assessment following consultations with the adoption lead more often than in other population groups served by the wider CAMHS team (Archard et al 2022).

Support

In most consultations, the adoption lead was supported by an assistant psychologist, trainee clinical psychologist or nursing student. One benefit of this arrangement was more comprehensive note taking, enabling the adoption lead to focus their attention on what was being said during the consultation. Another benefit was the opportunity to discuss observations and feelings evoked during the consultation with a colleague afterwards.

Various levels of guidance were required depending on the experience and abilities of these trainee professionals. For example, some trainees could produce a detailed report of a consultation while others only partially recorded pertinent information or misunderstood remarks due to their lack of familiarity with the professional context. However, these challenges represented a learning point when developing the consultation report letter that was sent to attendees as a clinical document. This correspondence required careful crafting since it aimed to provide attendees with an easily understandable record of their situation and the agreed actions, and to function as a document to which colleagues could refer during subsequent assessments. With support from the trainees and assistant psychologists, the use of various screening measures for mental health and neurodevelopmental conditions was revisited, as were simple differences in letter formatting – for example, using a bold font for suggestions and action points for attendees to consider.

Parent and professional feedback

Feedback on consultations indicated a high level of satisfaction. Questionnaires distributed to attendees after each consultation recorded a score on a single 1-5 Likert scale for satisfaction. A score of 1 represented a low level of satisfaction and a score of 5 represented a high level of satisfaction. There was also space on the questionnaire for free text comments on why a specific score was given. At the time of writing, 17 completed questionnaires had been received representing 12 professional and five parent attendances. The overall mean satisfaction score was 4.76, representing mean scores of 4.67 for professionals and 5 for parents.

Using the principles of a codebook style of thematic analysis (Braun and Clarke 2019), the free text responses were organised into four main themes concerning the attendees’ experiences of accessing consultations.

Clarification and reassurance

Consultations were described by respondents as helpful in providing reassurance and clarification in their understanding of the child or children concerned and in providing guidance to ensure that ‘key areas of need’ were identified and not overlooked (Respondent 8, social worker). This was referred to in ten responses, including that the consultations were:

‘Invaluable in providing a holistic support service to our adopted children and providing a streamlined opportunity to access services and meet the health needs of our adopted children.’ (Respondent 1, social worker)

Meaningful advice and identifying next steps

In ten of the responses, it was evident that guidance provided in the consultations offered clarity and reassurance on what respondents’ next steps should include. One respondent commented:

‘The consultation was… able to give me a clear insight into why my young person struggles in certain situations and what we can do to support him moving forward.’ (Respondent 11, social worker)

Linked to these comments, respondents noted their increased confidence in managing challenges and how consultations could assist in clarifying when longer-term support was indicated. The fact that parents or professional attendees could return for a follow-up consultation if required seemed to provide a sense of reassurance – during and after the consultation. As one respondent commented:

‘It felt that we would be able to come back… if we needed to, which is reassuring.’ (Respondent 16, social worker)

Space for dialogue

Respondents noted how the consultations provided a space for dialogue. This was linked to the adoption lead’s skills in putting attendees at ease so that they could discuss issues of personal significance and feel listened to and understood. Some of the parent respondents commented:

‘We felt listened to and validated.’ (Respondent 9, parent)

‘The facilitator listened to us, we felt heard and understood and he was able to make us feel comfortable and establish rapport very swiftly.’ (Respondent 14, parent)

In the 12 responses that referenced the space for dialogue afforded by the consultations, emphasis was placed on efforts made by the adoption lead to understand parents’ experiences. One respondent commented:

‘The consultation was very thorough, and the questions asked enabled me to give a true reflection of the difficulties my son faces on a daily basis.’ (Respondent 17, parent)

Mental health expertise

Access to mental health expertise was commented on by 12 respondents. It was noted that the atmosphere of the consultations fostered a more open dialogue, with different perspectives enabling development of robust plans of action. One respondent commented:

‘The consultations enable professionals to discuss difficult and complex cases in a unified manner drawing on expertise within each professional domain.’ (Respondent 1, social worker)

In addition, the respondents’ notion of expertise was not only linked to the adoption lead’s background knowledge but also focused on how they were able to draw out what was significant in attendees’ observations. One respondent commented:

‘The facilitator was immediately able to… quickly pick up the salient points from the child’s background and history and link to current presentation.’ (Respondent 4, social worker)

Mental health awareness training package

Scope and content

The mental health awareness training formed part of an introductory training package for prospective adopters provided via the county council in collaboration with the specialist CAMHS team and adoption lead. The training had been provided by the team for several years as part of a longstanding commissioning arrangement and covered:

  • Definitions of mental health and mental ill-health.

  • The greater likelihood of adopted children experiencing mental health and emotional challenges.

  • Introductory material on reflective and therapeutic parenting principles.

  • The role of specialist CAMHS in supporting adopted children.

Revisions to training content

The attachment-informed framework used in other aspects of the adoption lead’s role extended to the mental health awareness training, with emphasis placed on the consequences of early life relational adversity (Honig 2014, Hartinger-Saunders et al 2019). The training was facilitated online during COVID-19 and involved between ten and 16 prospective adopters attending a half-day workshop, which included practical exercises, guided discussion and direct teaching.

Revisions to this training package by the adoption lead involved overhauling the content, incorporating new illustrative material and ensuring that research findings were presented in a concise, factually accurate way with relevant epidemiological data referenced.

Insights from research into early adversity experienced by children can be misapprehended by professionals and policymakers, overlooking differences in individual children’s early development and leading to fixed views about their potential issues (Woolgar and Pinto 2016). To provide insight into how early adversity can affect children’s social and emotional development, the adoption lead incorporated clips from the influential films of James and Joyce Robertson into the training. This series of documentary films from the 1950s and 1960s showed young children experiencing separation from parents for hospital treatment and after being placed in foster care.

The films were influential in changing professional attitudes and hospital visiting policies. They relayed the tenets of John Bowlby’s influential work on attachment theory (see for example Bowlby 1958, 1960) to a public audience, detailing the emotional hardship experienced by young children when separated from attachment figures. Although the films adhere to a conventional documentary film format, the engagement of the viewer in the lived experience of the children can be ‘a formidable teaching tool’ (Guédeney and Guédeney 2010, Wierzchowska 2020).

Training feedback from attendees

Following the mental health awareness training, questionnaires were sent to the attendees. These included three 1-5 Likert scales for overall satisfaction, delivery and content. Only six attendees returned the questionnaires. Evidently, there is a need for larger-scale quality-improvement projects to explore the value of mental health awareness training via CAMHS providers. However, the responses to these questionnaires provided useful information.

The responses produced high mean and modal scores of 5. There was also space for free text comments that indicated respondents’ increased understanding of mental health, which appeared to be linked to the quality of the training. The interactive nature of the training was cited in four responses as a positive factor, particularly about engendering further discussion. The approachability of the adoption lead in their role as trainer also supported the interactive aspect of the training. One respondent commented:

‘It was a very interactive session – which isn’t easy on Zoom! – with [adoption lead] asking us questions and helping us unpack our answers.’ (Respondent 3, prospective adoptive mother)

There was also a comment on accessibility and how the delivery methods and combination of video content and group discussion were well balanced:

‘I think that the training was very clear, the content was good, and the videos and slides were really interesting.’ (Respondent 1, prospective adoptive father)

Additionally, there was a brief comment on the virtual nature of the training which was described as feeling less imposing than a formal classroom learning environment. Moreover, the relevance of the content was emphasised, with references made to the combination of theory, the findings of various studies and practical application. One respondent commented:

‘Mental health in adopted children was a heavy subject but we came out of it with a different mindset towards how this can be dealt with thanks to the explanations and details provided.’ (Respondent 5, prospective adoptive father)

Group-based psychoeducation intervention

Service rationale

A short-term group psychoeducation intervention for parents was introduced; this was not exclusively designed for adoptive parents involved with the specialist CAMHS team in which the adoption lead was based but was intended to enhance the overall offer to all parents whose children were under the care of the team.

Before the pandemic, the idea of introducing a brief group-based intervention for parents had been debated by clinical staff in the team for some time. Following referral, children and young people usually attended the CAMHS team with their parents or carers for an initial assessment, after which an initial care plan was formulated with the assessing clinician. They then waited for further assessment and/or intervention from the CAHMS team or were discharged back to the care of their GP, leaving a gap in which parents had anticipated there would be clinical input. The short-term group psychoeducation intervention filled this gap while parents waited for specialist assessment or other interventions such as psychological therapy to begin.

Family Minds model

The Family Minds model is a group-based manualised psychoeducation intervention for parents and carers and has a developing evidence base (Bammens et al 2015, Adkins et al 2018, 2021). Family Minds is not tailored specifically to the needs of parents of children experiencing mental health issues, as it was originally designed for foster and adoptive parents; however, it dovetails with the attachment-based therapeutic interventions used in the CAMHS team.

The adoption lead led the introduction of Family Minds in the team and facilitated most, but not all, of the groups. Other clinicians were involved. The Family Minds group-based psychoeducation intervention involved three hour-long online sessions delivered over a six-week period. The aim was to develop parents’ knowledge incrementally in the following topics:

  • Early caregiving relationships and their significance in children’s development.

  • Principles of reflective parenting.

  • Adverse childhood experiences, attachment trauma and mentalisation (the ability of an individual to understand their mental state and that of others and which underlies their behaviour).

  • The internal working model, which is a key construct of attachment theory, and links between a secure adult attachment style and parental reflective functioning (a parent’s capacity to recognise their child as a ‘psychological agent’).

  • Children’s behaviour that challenges and feelings of shame.

Opportunities were offered throughout the Family Minds intervention for parents to reflect on their children’s experiences via the use of video clips, experiential exercises and case studies. The focus was on increasing parents’ capacity for mentalisation, particularly in relation to challenging and ‘triggering’ behaviours, including supporting parents to reflect on attachment styles and their own experiences of being parented and how these may have influenced their own parenting. As the intervention progressed, at-home and play-based exercises were introduced for parents to try with their children away from the group. Parents were also signposted to avenues of support they could access if needed.

Reflection on Family Minds

Introducing Family Minds during the pandemic and delivering it online had its challenges. Some adaptations were necessary with the support of its developer (one of the authors, TA), who provided training and supervision to the adoption lead and other clinician facilitators during the early stages of implementation.

Six months after its implementation by the adoption lead, Family Minds had primarily been accessed by adoptive and foster parents whose children had attended CAMHS for initial assessments. Pre- and post-intervention questionnaires on child behaviour challenges, parenting stress and reflective functioning are used to evaluate Family Minds, alongside qualitative interviews exploring parent and clinician experiences. Returns of the pre- and post-intervention questionnaires were limited at the time of writing and were often obtained only after additional efforts from support staff.

Owing to technological challenges and the complexity of the situations some parents were contending with, the value of smaller groups has also been apparent, with five to ten parents participating rather than ten to 15; smaller groups allow more time for the attending parents to speak and share their experiences.

During the Family Minds groups many parents commented on a reduced sense of isolation after meeting others in similar situations and were enthusiastic about being able to access a longer-term support group. This appeared to represent a change in attitude, since initially most parents were only amenable to joining the Family Minds groups because they were required to commit to attending just three sessions.

The clinicians facilitating the Family Minds groups discussed the need to include additional material – beyond the primary focus on overt trauma in the form of parental violence, substance misuse and neglect. This additional material covered other life events and influences on subsequent difficulties in affective dysregulation, such as the role of prenatal stress and early separations. Overall, the Family Minds groups were viewed by the clinicians as a meaningful way of enhancing parents’ knowledge and supplying a common vocabulary for clinicians and parents to use in future work. The extent to which the intervention afforded clinicians greater insight into the reality of families’ lives was also apparent. However, it was also evident that a lot of work was involved in managing the group psychodynamics of the sessions to ensure shared understanding, that frames of reference were maintained and that participants understood the material.

Developing care through social science research expertise

The adoption lead role was held by a clinician with experience in applied social science and with research expertise. This increased the ‘absorptive capacity’ of the CAMHS team, not only fostering innovation in care provision through research but also in developing the capability to assimilate externally available information (Cohen and Levinthal 1989, Boaz et al 2015). The chief nursing officer for England’s strategic plan for research emphasised that, while a research-enabled nursing workforce is essential to ensure care quality and practice innovation, there must be opportunities to pursue research-based activities alongside the provision of clinical care (May 2021). Relationships with other clinician-researchers can support the introduction of new interventions. There are also advantages to a social science background in terms of understanding the psychosocial context of the issues with which people present to CAMHS, and understanding received ideas related to the psychology of adoptees and adoptive families in various care contexts (Hart and Luckock 2004).

Barriers to optimising research knowledge in developing care include competing demands on clinicians’ time and a service emphasis on throughput, which compromises the scope for evaluating the effectiveness of services.

Practice implications

The reflections and service evaluation findings relate to a single practitioner in an adoption lead role in one specialist CAMHS team. Caveats should therefore be applied when seeking to transfer their experiences to other comparable contexts. For example, feedback provided by adoptive parents, prospective adopters and professionals only represents the views of some of those who accessed the training and consultations and is therefore not reliably representative of all attendees, some of whom may have held negative views. This reflects the general challenge of including seldom-heard voices in efforts to enhance service quality (Sturgess and Selwyn 2007).

While acknowledging these limitations, the authors have three specific practice implications derived from the work described:

  • Adoptive parents and adoption professionals may benefit most from initial clinical consultations which involve space for dialogue, clarification, reassurance and meaningful advice, and which are facilitated by a clinician with specialist expertise.

  • The provision of group-based, short-term psychoeducation interventions, initially to adoptive parents, may mean that they are more inclined to engage with longer-term interventions and may feel less isolated with the challenges they are experiencing.

  • Expertise in applied social science and research can be valuable in this area of practice in terms of assimilating externally available information and using evaluation to develop care.

Alongside these points, it is important to mention nursing education. Mental health nurses working with adoptive families may wish to work alongside nursing educators to consider opportunities for specific training and placement opportunities for nursing students. By accessing such opportunities, nursing students can gain experience of the specialist skills involved in this area of practice at an earlier stage in their career.

Conclusion

Providing clinical support to adoptive parents and adoption professionals in a specialist CAMHS context requires specific skills in running consultations with parents and professionals, facilitating training and providing group-based interventions. A dedicated adoption lead role can ensure that relevant research expertise is used to develop care and support reflective practice, particularly in challenging times such as the COVID-19 pandemic.

References

  1. Adkins T, Luyten P, Fonagy P (2018) Development and preliminary evaluation of family minds: a mentalization-based psychoeducation program for foster parents. Journal of Child and Family Studies. 27, 2519-2532. doi: 10.1007/s10826-018-1080-x
  2. Adkins T, Reisz S, Hasdemir D et al (2021) Family minds: a randomized controlled trial of a group intervention to improve foster parents’ reflective functioning. Development and Psychopathology. 34, 1177-11911. doi: 10.1017/S095457942000214X
  3. Archard PJ, Fitzpatrick S, Morris N et al (2022) Consultation in a specialist mental health team for vulnerable children before and during the early stages of the COVID-19 pandemic: audit findings and practice-based reflections. Practice. Social Work in Action. 34, 2, 101-115. doi: 10.1080/09503153.2021.1998411
  4. Bammens AS, Adkins T, Badger J (2015) Psycho-educational intervention increases reflective functioning in foster and adoptive parents. Adoption and Fostering. 39, 1, 38-50. doi: 10.1177/0308575914565069
  5. Boaz A, Hanney S, Jones T et al (2015) Does the engagement of clinicians and organisations in research improve healthcare performance: a three-stage review. BMJ Open. 5, 12, e009415. doi: 10.1136/bmjopen-2015-009415
  6. Boswell S, Cudmore L (2014) ‘The children were fine’: acknowledging complex feelings in the move from foster care into adoption. Adoption and Fostering. 38, 1, 5-21. doi: 10.1177/0308575914522558
  7. Bowlby J (1958) The nature of the child’s tie to his mother. International Journal of Psychoanalysis. 39, 350-373.
  8. Bowlby J (1960) Grief and mourning in infancy and early child. The Psychoanalytic Study of the Child. 15, 1, 9-52. doi: 10.1080/00797308.1960.11822566
  9. Braun V, Clarke V (2019) Reflecting on reflexive thematic analysis. Qualitative Research in Sport, Exercise and Health. 11, 4, 589-597. doi: 10.1080/2159676X.2019.1628806
  10. Caplan G (1970) The Theory and Practice of Mental Health Consultation. Basic Books, New York NY.
  11. Cohen WM, Levinthal DA (1989) Innovation and learning: the two faces of R&D. The Economic Journal. 99, 397, 569-596. doi: 10.2307/2233763
  12. Fisher PA (2015) Review: adoption, fostering, and the needs of looked-after and adopted children. Child and Adolescent Mental Health. 20, 1, 5-12. doi: 10.1111/camh.12084
  13. Guédeney N, Guédeney A (2010) The Era of Using Video for Observation and Intervention in Infant Mental Health. http://perspectives.waimh.org/2010/06/15/era-using-video-observation-intervention-infant-mental-health (Last accessed: 1 September 2022).
  14. Harlow E (2019) Defining the problem and sourcing the solution: a reflection on some of the organisational, professional and emotional complexities of accessing post-adoption support. Journal of Social Work Practice. 33, 3, 269-280. doi: 10.1080/02650533.2018.1460588
  15. Harris-Waller J, Granger C, Hussain M (2018) Psychological interventions for adoptive parents: a systematic review. Adoption and Fostering. 42, 1, 6-21. doi: 10.1177/0308575918754481
  16. Hart A, Luckock B (2004) Developing Adoption Support and Therapy: New Approaches for Practice. Jessica Kingsley Publishers, London.
  17. Hartinger-Saunders RM, Semanchin Jones A, Rittner B (2019) Improving access to trauma-informed adoption services: applying a developmental trauma framework. Journal of Child and Adolescent Trauma. 12, 119-130. doi: 10.1007/s40653-016-0104-1
  18. Honig SB (2014) Adopted children: the risk of interactive misattunement between the infant and adoptive mother in the child relinquished at birth. Adoption Quarterly. 17, 3, 185-204. doi: 10.1080/10926755.2014.891547
  19. Joseph B (1948) A psychiatric social worker in a maternity and child welfare centre. British Journal of Psychiatric Social Work. 1, 2, 30-40.
  20. Kerr L, Cossar J (2014) Attachment interventions with foster and adoptive parents: a systematic review. Child Abuse Review. 23, 6 , 426-439. doi: 10.1002/car.2313
  21. Mahlberg NT (2015) Activating mentalisation in parents: an integrative framework. Journal of Infant, Child and Adolescent Psychotherapy. 14, 3 , 232-245. doi: 10.1080/15289168.2015.1068002
  22. May R (2021) Making Research Matter: Chief Nursing Officer for England’s Strategic Plan for Research. http://www.england.nhs.uk/publication/making-research-matter-chief-nursing-officer-for-englands-strategic-plan-for-research/ (Last accessed: 1 September 2022).
  23. Monck E, Rushton A (2009) Access to post-adoption services when the child has substantial problems. Journal of Children’s Services. 4, 3, 21-33. doi: 10.1108/17466660200900015
  24. Moriarty J, Baginsky W, Gorin S et al (2016) Mapping Mental Health Services for Looked After Children in London Aged 0-5 Years. http://www.scie-socialcareonline.org.uk/mapping-mental-health-services-for-looked-after-children-in-london-aged-0-5-years/r/a11G000000G65beIAB (Last accessed: 1 September 2022.)
  25. Rao P, Ali A, Vostanis P (2010) Looked after and adopted children: how should specialist CAMHS be involved? Adoption and Fostering. 34, 2, 58-72. doi: 10.1177/030857591003400208
  26. Sturgess W, Selwyn J (2007) Supporting the placements of children adopted out of care. Clinical Child Psychology and Psychiatry. 12, 1, 13-28. doi: 10.1177/1359104507071051
  27. Tarren-Sweeney M (2019) Mental Health Screening and Monitoring for Children in Care: A Short Guide for Children’s Agencies and Post-adoption Services. Routledge, London.
  28. Wierzchowska J (2020) ‘Nurse! I want my mummy!’. Empathy as Methodology in the Documentary Film ‘A Two-Year-Old Goes to Hospital’ (1952). http://www.pismowidok.org/en/archive/empathetic-images/nurse-i-want-my-mummy (Last accessed: 1 September 2022.)
  29. Woolgar M, Pinto C (2016) Neuroscience and CAMHS practice. In Campbell S, Morley D, Catchpole R (Eds) Critical Issues in Child and Adolescent Mental Health. Palgrave, London, 30-50.

Share this page

Related articles

Developing an e-learning package to provide chemotherapy updates
Cytotoxic chemotherapy is potentially carcinogenic,...

Improving nurses’ skills through e-learning
This article examines the development of an interactive...

Giving staff confidence to discuss sexual concerns with patients
This article describes a countywide event to raise awareness...

Services for women with metastatic breast cancer in the US
This article describes the experience of a nurse on an...

Award-winning project raises care standards and patient satisfaction
A project involving the introduction of a new discharge...