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Accommodating complexity: The need for evidence-informed mental health assessments for children in out-of-home care

Hiller, Rachel M., Lehmann, Stine, Lewis, Stephanie J., Minnis, Helen, Shelton, Katherine H. ORCID:, Tarren-Sweeney, Michael and Taussig, Heather N. 2023. Accommodating complexity: The need for evidence-informed mental health assessments for children in out-of-home care. Journal of the American Academy of Child and Adolescent Psychiatry 62 (1) , pp. 12-18. 10.1016/j.jaac.2022.06.021

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Children in out-of-home care have all experienced adversity and most have been exposed to maltreatment. Research across many decades has shown that these experiences are important risk factors for mental health problems. However, there is a lack of consensus about how best to formulate and manage the mental health needs of these children. Our own experience, supported by the empirical literature and clinical commentaries, 1 , 2 , 3 , 4 , 5 suggests that there can be considerable reluctance to use standard assessment protocols and diagnostic frameworks when formulating the needs of this group of young people. Whilst some children in the welfare system may experience significant emotional distress and functional impairment yet not meet current diagnostic thresholds, multiple reviews have shown that almost half of children in the welfare system do meet criteria for a diagnosable mental health disorder[6,7]. More still may be subsyndromal but still benefit from assessment and formulation based on current diagnostic frameworks. Thus, we contend that standard diagnostic frameworks should be central to the formulation and management of mental health difficulties for this group of children, as for any child. Of note, both our opinions here and the empirical literature are near exclusively derived from work in high-income Western countries. [6] ,[7] Further research across a range of cultures and particularly in lower- and middle-income countries is vital.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Psychology
Additional Information: License information from Publisher: LICENSE 1: Title: This article is under embargo with an end date yet to be finalised.
Publisher: Elsevier
ISSN: 0890-8567
Date of First Compliant Deposit: 23 August 2022
Date of Acceptance: 6 June 2022
Last Modified: 07 Nov 2023 05:25

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