Interventions to improve mental health and well-being in care-experienced children and young people aged less than 25: the CHIMES systematic review

Evans et al., (2024)

National Institute for Health and Care Research - https://doi.org/10.3310/MKYP6299

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Evidence Categories

• Care setting: Residential care setting (children)
• Population group: Young adults (18-25)
• Population group: Preschool age (under 5s)
• Population group: Primary school age (5-11)
• Population group: Secondary school/college age (11-18)
• Population group: At risk Children & Young People
• Intervention: Health promotion/education Or Curriculum-based in
• Intervention: Psychotherapy
• Intervention: Fostering Healthy Futures (FHF)
• Intervention: Didactic emotional development
• Outcome: Social, emotional and mental wellbeing outcomes

Type of Evidence

Systematic Review

Aims

The authors state:

"The CHIMES review is a complex-systems-informed mixed-method systematic review that aimed to synthesise the international evidence base for interventions addressing the mental health and well-being of care-experienced children and young people (age ≤ 25 years) and to assess the potential transportability of this evidence base to the United Kingdom context"

Findings

The authors state:

"We identified 64 interventions from 124 study reports. Interventions were primarily evaluated in the United States and targeted young people’s competencies or carers’ parenting practices. Meta-analysis reported limited evidence that interventions effectively improved mental health in the shorter term (0–6 months): total social, emotional and behavioural problems (d = −0.15, 95% confidence interval −0.28 to −0.02); internalising problem behaviours (d = −0.35, 95% confidence interval −0.61 to −0.08); externalising problem behaviours (d = −0.30, 95% confidence interval −0.53 to −0.08); depression and anxiety (d = −0.26, 95% confidence interval −0.40 to −0.13) and social–emotional functioning difficulties (d = −0.18, 95% confidence interval −0.31 to −0.05), but these impacts were not observed in the longer term (> 6 months).

 

Five key context factors potentially explain challenges to implementation and acceptability: lack of system resources; the time, cognitive and emotional burden of delivery or participation; interprofessional tensions; the devaluing of young people, meaning that they felt unable to express dissatisfaction with interventions; and the devaluating of carers’ expertise and needs. From the evidence, stakeholder consultation identified two priority interventions: (1) mentoring by individuals with knowledge and experience of care and (2) system and ethos change to create harmonisation between organisations and facilitate interprofessional relationships. Well-being and suicide-related behaviours are priority outcomes alongside mental health."

Conclusions

The authors state:

"The review identified some evidence for interventions impacting mental health in the short term. There is a lack of system-level interventions and approaches that target subjective well-being and suicide-related outcomes. Future intervention might prioritise mentoring and targeting system culture."