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The Inbetweeners Identifying and Quantifying the Unmet Mental Health Needs of Children and Adolescents in Tallaght

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The Inbetweeners Identifying and Quantifying the Unmet Mental Health Needs of Children and Adolescents in Tallaght inbetweeners The InBetweeners Identifying and quantifying the unmet mental health needs of children and adolescents in Tallaght Dr Elizabeth McCarthy Quinn and Professor Catherine Comiskey December 2019 “Like we have a year-long waiting list. Sure it is useless! Young people need something the day they need it. We need 24/7 services. We need services at weekends”. (Healthcare Professional) The InBetweeners: Identifying and quantifying the unmet mental health needs of children and adolescents in Tallaght Disclaimer and Copyright While every care is taken to ensure that this publication is as up to date and accurate as possible, no responsibility can be taken by the Childhood Development Initiative for any errors or omissions contained herein. Furthermore, responsibility for any loss, damage or distress resulting from adherence to any advice, suggestions or recommendations made available through this publication, however caused, is equally disclaimed by the Childhood Development Initiative. All text, images, graphics, and other materials in this publication are subject to the copyright and other intellectual property rights of the Childhood Development Initiative, unless otherwise stated. Copyright © Childhood Development Initiative (2019). You are free to share, copy, distribute and transmit the content of this work under the following conditions: • Attribution: you must attribute the work by citing the author and publisher, but not in a manner that suggests that they endorse you or your use of the work; • Non-commercial: you may not use this work for commercial purposes; and • No derivative works: you may not alter, transform or build upon this work. Any of the above conditions can be waived if you get permission from the copyright holder. Any citation of this report should use the following reference: McCarthy, E. and Comiskey, C. (2019) Identifying and quantifying the unmet mental health needs of children and adolescents in Tallaght. Dublin: Childhood Development Initiative (CDI). Childhood Development Initiative Ltd. St Mark’s Youth and Family Centre Cookstown Lane Fettercairn Tallaght Dublin 24 Tel: +353 (0)1 4940030 Fax: +353 (0)1 4627329 E-mail: [email protected] Web: www.cdi.ie Published by Childhood Development Initiative, Dublin ISBN: 978-1-9164499-2-3 This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. https://creativecommons.org/ licenses/by-nc/4.0 ii Contents List of Tables Vii List of Figures Vii List of Appendices viii Glossary iX The Authors X Foreword Xi Acknowledgements Xii Executive Summary 1 Recommendations 2 1. Resources 3 Service planning 3 Waiting lists 3 2. Communication 3 Clear and consistent referral pathways 3 One-stop shop 3 3. Models of intervention 3 Universal support 3 Counselling 3 Youth-focused and ‘whole family holistic model’ 3 Identification of effective model 3 Clarify the age of informed consent 3 4. Research 4 Ethics approval processes 4 Future research on effective models of intervention 4 CHAPTER 1 5 1.1 Introduction 7 1.1 1 Health promotion/early intervention 9 1.1.2 Primary and community care services and specialist services 9 1.2 Aims/objectives 10 1.3 Service providers referred to in this study 12 Child and Adolescent Mental Health Service (CAMHS) 12 iii The InBetweeners: Identifying and quantifying the unmet mental health needs of children and adolescents in Tallaght CAMHS – Linn Dara 12 Child Psychology Service 12 Counselling in Primary Care 13 Department of Children and Youth Affairs (DCYA) 13 Foróige 13 General practitioners (GPs) 13 Human Givens approach 14 Jigsaw 14 National Educational Psychological Service (NEPS) 14 Pieta House 15 Primary Care Teams (PCTs) 15 Village Counselling Tallaght 15 Youth Drug and Alcohol Service (YoDA) 15 Tusla 15 Child Protection and Welfare 16 Education Welfare Service (EWS) 16 Family Support 16 Home School Community Liaison (HSCL) 16 Meitheal 17 School Completion Programme (SCP) 17 CHAPTER 2 – Methodology 19 2.1 Research Design 21 2.1.1 Semi-structured interviews 21 2.1.2 Inclusion criteria 21 2.1.3 Exclusion criteria 21 2.1.4 Recruitment 21 2.1.5 Informed consent 22 2.1.6 Confidentiality 22 2.1.7 Child protection 22 2.1.8 Debriefing 23 2.2 Data Collection 23 2.2.1 Qualitative data 23 2.2.2 Quantitative data 24 2.3 Qualitative Data Analysis 25 2.3.1 Thematic analysis 25 2.3.2 Theoretical framework – Cultural Historical Activity Theory 25 2.4 Quality in multiple methods design 25 2.4.1 Rigor – qualitative aspect 26 iv 2.4.2 Credibility 26 2.4.3 Transferability 26 2.4.4 Dependability 26 2.4.5 Confirmability and authenticity 27 2.4.6 Reliability 27 2.4.7 Ethical considerations 27 2.4.8 Confidentiality 27 CHAPTER 3 – DATA ANALYSIS 29 3.1 Findings – service providers 32 3.1.1 Diagnosis not being a gateway to services 32 3.1.2 An uncertain first port of call 35 3.1.3 New issues emerging 37 3.1.4 Family, culture, and community 39 3.1.5 School as a gateway 42 3.1.6 Service quality and availability 43 3.2 Findings – parents 46 3.2.1 Diagnosis not being a gateway to services 47 3.2.2 An uncertain first port of call 49 3.2.3 New issues emerging 50 3.2.4 Family, culture, and community 51 3.2.5 School as a gateway 53 3.2.6 Service quality and availability 54 3.3 Quantitative data analysis 56 3.3.1 Prevalence 56 CHAPTER 4 – DISCUSSION AND RECOMMENDATIONS 65 4.1 Discussion 67 4.1.1 Diagnosis not a gateway to services 67 4.1.2 An uncertain first port of call 68 4.1.3 New issues emerging 69 4.1.4 Family, culture, and community 72 4.1.5 School as a gateway 74 4.1.6 Service quality and availability 75 4.2 Limitations of this research 77 4.3 Recommendations 77 4.3.1 Resources 77 4.3.2 Communication 78 4.3.3 Models of intervention 78 4.3.4 Research 79 v The InBetweeners: Identifying and quantifying the unmet mental health needs of children and adolescents in Tallaght Appendices 81 References 112 vi List of Tables Table 1: Details of service providers and parents who participated 24 Table 2: Six themes and sub-themes identified 32 Table 3: Semi-structured interviews with Parents (N = 11) – family details 47 Table 4: Population of Tallaght area (CSO, 2017): Aged 12 to 18 57 Table 5: Estimates of proportions experiencing mental health challenges as reported in the My World adolescent school surveys of 12- to 19-year-olds 60 Table 6: Indirect estimates of the number of 12- to 18-year-olds in the wider Tallaght region at risk of experiencing mental health symptom 62 Table 7: CHAT informing study design and survey questions (adapted from Mwanza, 2001) 106 Table 8: Five central principles of CHAT (Engeström et al., 1999) 107 List of Figures Figure 1: Model of child and adolescent mental health services (RCSI, 2015) 10 Figure 2: Agencies recommended for referral for the predominant difficulty presenting (RCSI, 2015, Figure 13.3, p. 6) 11 Figure 3: Population of young people by gender in each age group (CSO, 2017): Aged 12–18 58 Figure 4: Population of young people per region (CSO, 2017): Aged 12–18 58 Figure 5: Diagnosis not being a gateway to services? 67 Figure 6: An uncertain first port of call 68 Figure 7: New issues emerging 69 Figure 8: Interacting Activity System: parent and health professional (GP) 71 Figure 9: Family, culture, and community 72 Figure 10: School as a gateway 74 Figure 11: Service quality and availability 75 Figure 12: Source: Secondary inner contradictions example from Lim and Hang, 2003 108 Figure 13: Interacting activity system – parent and health professional (adapted from Engeström (2001); Engeström 2001, p. 136) 109 vii The InBetweeners: Identifying and quantifying the unmet mental health needs of children and adolescents in Tallaght List of Appendices Appendix A – Letter to Gatekeepers Appendix B – Parent/Guardian Information Leaflet Appendix C – Service Provider Information Leaflet Appendix D – Flyer for Parents Appendix E – Parent/Guardian Consent Form Appendix F – Parent/Guardian Consent Form – Tusla Appendix G – Service Provider Consent Form Appendix H – Interview Questions for Parents Appendix I – Interview Questions – Service Providers Appendix J – Parent/Guardian Debriefing Sheet Appendix K – Service Provider Debriefing Sheet Appendix L – Letter to Psychologist Appendix M – Ethical Approval Appendix N – Cultural Historical Activity Theory (CHAT) in the context of this study Appendix O – Role of the Researcher viii Glossary ADD Attention Deficit Disorder ADHD Attention Deficit Hyperactivity Disorder AON Assessment of Need AS Asperger’s syndrome ASD Autism Spectrum Disorder CAMHS Child and Adolescent Mental Health Service CDI Childhood Development Initiative CHAT Cultural Historical Activity Theory CHO Community Health Office DCYA Department of Children and Youth Affairs DEIS Delivering Equality of Opportunity in Schools: national programme to address the educational needs of children and young people in disadvantaged communities EWS/EWO Education Welfare Service/Education Welfare Officer GDPR General Data Protection Regulation GP General Practitioner HP Health Professional HSCL Home School Community Liaison IA Internet Addiction NEPS National Educational Psychological Service NOSP National Office for Suicide Prevention NVR Non Violent Resistance OCD Obsessive Compulsive Disorder PCT Primary Care Team PIU Problematic Internet Use PLE Psychotic-Like Experiences SCP/SPO School Completion Programme/School Completion Officer SPHE Social, Personal and Health Education TA Thematic Analysis YoDA Youth Drug and Alcohol Service ix The InBetweeners: Identifying and quantifying the unmet mental health needs of children and adolescents in Tallaght The Authors Elizabeth McCarthy Quinn is a post-doctoral Research Fellow at the School of Nursing and Midwifery, Trinity College Dublin, the University of Dublin.
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