Exploring Clinicians’ Perspectives on Outcomes of Psychological Interventions for Looked After Children

Background and Aims: Looked After Children (LAC) have complex mental health needs, as a result of the trauma and inadequate care which they have typically experienced during their early years, and the instability that continues to permeate their lives in many cases. Outcomes of psychological interventions with this group may be particularly difficult to assess, yet little consideration has been given to this issue in the research literature to date. The current study aims to explore the perspectives of clinicians working in specialist Child and Adolescent Mental Health Services (CAMHS) for LAC, on the nature, process and outcomes of the psychological interventions they undertake with clients, and the implications of their observations for measuring outcomes. Method: Fourteen individual interviews with clinicians were undertaken, each exploring clinicians’ experiences and observations of a particular case with which they had undertaken an intervention. Preliminary themes from these interviews, regarding the nature, process and outcomes of clinicians’ interventions, were fed back to clinicians during two focus groups; clinicians were asked to reflect on the implications of these themes for measuring outcomes of psychological interventions with LAC. Results and Conclusions: Thematic analysis of interview and focus group data was conducted. The data was organised into five super ordinate themes, relating to the impact of the external context of the child’s life, the nature of presenting problems, the nature of interventions undertaken by clinicians, changes and outcomes observed by the clinician and implications for measuring outcomes. Relationship factors, particularly those in the relationship between the carer and child, were identified as the focus of CAMHS interventions and the changes that clinicians most commonly observed. Measuring these changes in the carer-child relationship, which existing outcome measures do not capture, is crucial. The need to contextualise treatment outcomes within the child’s overall life was also highlighted.