Search Results (24)

Background/Objectives: Children and adolescents who care for family members with illness, disability, or mental health conditions face challenges across educational, health, and psychosocial domains. Although research and practice have developed conceptual models and assessment tools to better understand and address young carers’ situations, a persistent gap remains between their needs and available support, reflecting structural fragmentation across health, education, and social care systems. To address this gap, this article presents the development of a family-centred framework spanning these sectors. Methods: The framework was developed through an iterative, empirically grounded process based on two studies within a larger research project on young carers in Switzerland. Key themes, structural challenges, and support-related factors were identified by systematically synthesising the findings of the two studies and integrated into an overarching framework linking young carers’ family contexts with cross-sectoral service structures. Results: The Caring in Context Framework synthesises empirical findings into a coherent framework for understanding and addressing young carers’ situations. By systematically extending the whole family approach to include a cross-sectoral dimension, it bridges relational family dynamics and structural service contexts. Sustainable support is conceptualised as dependent on the structural visibility and institutional recognition of young carers across all system levels, positioning identification and recognition as prerequisites for coordinated responses in research, policy, and practice. Conclusion: The framework advances conceptual clarity by integrating family-centred and cross-sectoral perspectives. Rather than creating new services, it emphasises adapting and coordinating existing structures while ensuring systematic recognition of young carers to support coherent, sustainable, and inclusive strategies. Full article

Background: Self-harm is a growing public health concern and the strongest predictor of suicide in young people (YP). The “Supporting Adolescents with Self-Harm” (SASH) intervention was developed with YP with lived experience and expert clinicians. It involves rapid follow-up after ED attendance and up to six intervention sessions. The intervention has three components: Therapeutic Assessment (TA) of self-harm; an enhanced safety plan (SP); and Solution-Focused Brief Therapy (SFBT). Depending on the YP’s preference, carers can join sessions. Carers can also receive two individual sessions. The clinical and cost-effectiveness of SASH is being evaluated in a randomised controlled trial across nine emergency departments in three NHS Trusts in London, England. A total of 154 YP were recruited between May 2023 and March 2025 and randomised on a 1:1 ratio to SASH alongside Treatment As Usual (TAU) or TAU. A logic model describes the SASH inputs, activities, mechanisms, outcomes and longer-term impacts. The aim of this paper is to (1) illustrate how TA, SP, and SFBT were implemented in practice by presenting intervention materials and session recordings for four YP cases and one carer case and (2) explore how the case study materials/recordings reflect the intervention mechanisms in the SASH logic model. Methods: Each case focused on a different component of the intervention. Intervention materials (TA self-harm diagram and completed SP) and recorded SFBT sessions with four YP and one carer were analysed using a descriptive case study approach. The TA diagram and SP were extracted from medical records. Audio/video recordings of intervention sessions were identified. Recordings of intervention sessions and qualitative interviews were transcribed. Quotes from qualitative interviews with the same participants were included where relevant. Results: Across the four YP cases, some core themes emerged. The role of friendships for young people, particularly at school, was important in both negative and positive ways. Experiencing difficulties with friends at school led to feelings of sadness and stress, which could become overwhelming, leading to thoughts of self-harm (“I just need to hurt myself”), triggering self-harm behaviour. YP described mood changes and signs that they were becoming stressed, which improved their self-awareness and understanding of the link between their feelings and self-harm behaviour. They reflected on what kept them feeling calm and overcoming their fear of burdening others by sharing how they were feeling, as this helped them not to self-harm. They also described difficult feelings stemming from a need to please everyone or needing validation from others. Overcoming these feelings led to less social anxiety and more confidence. This made it easier to go to school and to be more social with friends/student peers, which in turn improved their mood. Conclusions: These case studies demonstrate how YP improved their self-awareness and understanding of the link between feelings and self-harm behaviour and identified personal strategies for managing difficult feelings and situations. The carer case study demonstrates how sessions with carers can facilitate carers better supporting their YP’s mental health. Supporting YP and carers in this way has the potential to reduce the risk of future self-harm. Full article

From a critical feminist perspective, it is hypothesised that the gender digital divide may be related to new forms of virtual gender-based violence that particularly affect girls and young women. If this is the case, these forms of violence would fall within the dimension of exploitation or quality of use of technologies that characterises the digital divide. To test this hypothesis, a documentary analysis of the phenomenon was carried out by reviewing different cases reported in various media outlets, which show that the well-being of girls and adolescents is at risk when technology is involved. Four categories emerge that reflect situations in which technology becomes a tool for promoting self-harm and suicide among minors through exposure to harmful content, grooming, sexting and/or sextortion; the digital sexual exploitation of underage girls through deepfakes or intimate images generated with artificial intelligence; the consumption of violent and hateful content in mass chats; and the incitement of gender-based violence through video games. The results show the reproduction and perpetuation of gender-based violence in the digital world. To guarantee safe, inclusive and equitable digital environments, various measures are essential, including European policies or plans aimed at guaranteeing digital security and rights, and those related to critical digital literacy with a gender perspective in formal education (school and university) and informal education (parents, carers and guardians). Finally, we urge that the focus be placed on personal digital resilience, since thinking of a completely secure digital world is a naive and unattainable utopia. Full article

Background/Objectives: The child and adolescent mental health service (CAMHS) hand-over to adult mental health service (AMHS) remains an ongoing shortfall in eating disorder (ED) treatment, typically in tandem with diagnostic drift, heightened suicide risk, and carer burn-out. We created one 14-to-25 Transition—ED track within our own unit, where a single multidisciplinary team continuously follows each patient and family across the CAMHS–AMHS boundary (via weekly joint paediatric and adult clinician meeting) without changing the individual psychotherapist, family therapist, or dietitian at the age 18 transition. We investigated the manner in which patients and parents perceive this model. Methods: A survey of two naturalistic parent cohorts—CAMHS (n = 16) and Transition—Adult arm (n = 15)—also joined, alongside the original group of young adults who had entered the programme during its set-up phase (n = 9). Here, the 14–25 pathway denotes one unified route of care across adolescence and young adulthood; the Transition—Adult arm is its ≥ 18-years component. All index patients had a primary DSM-5-TR diagnosis of restricting-type anorexia nervosa. Participants completed the Client Satisfaction Questionnaire-8 (CSQ-8; range 8–32) and four bespoke Continuity-of-Care items (1–4 Likert). Results: Overall, the caregivers in both cohorts were pleased (median CSQ-8 = 28.5 [CAMHS] vs. 27.0 [Transition]; p = 0.75). Continuity items were universally well rated across cohorts. Cohort parents reported a median of two unchanged core clinicians (i.e., the individual psychotherapist, the family therapist, or the dietitian), which was nonsignificantly positively correlated with CSQ-8 scores (ρ = 0.22). Early-group patients mirrored caregiver impressions (mean CSQ-8 = 27.0 ± 3.9). Conclusions: It is feasible and highly acceptable to both caregivers and anorexia nervosa young adults to have the same key staff and family-centred sessions over the 14-to-25 age span. Constrained by single-site study and small sample size, these preliminary data provide a rationale for wider implementation and controlled follow-up studies. Full article

Around 2–8% of children and adolescents in developed societies are young carers, who provide care for ill, disabled, or addicted family members. This paper investigates the vulnerability and multidimensional injustices faced by young carers, drawing on empirical studies—both qualitative and quantitative—and social theory to reveal how young carers navigate their roles within the broader context of social inequality, highlighting the social structures and mechanisms that contribute to their marginalization and the detrimental consequences for their social inclusion, well-being, and personal development. The methodology of this article is a narrative analysis of relevant empirical research on young carers, combined with an analysis of this literature through a normative framework of social justice, which examines four dimensions of justice in order to highlight the vulnerability of young carers. (1) Firstly, young carers are often pushed into their situation because of economic and social constraints, which do not allow the family to find a different solution. Economic inequalities lead to and enforce caring obligations and have a cumulative negative effect on the young carer. Limited resources can be problematic for social inclusion, and when combined with caring obligations, they are corrosive. (2) Secondly, young carers are often victims of moral blackmail, which is that they are trapped in a situation where it would be morally wrong for them to act otherwise. Such moral blackmail can be carried out by those who are cared for, by the family and relatives or even by society, which could, but does not provide alternatives to young carers. (3) Thirdly, young carers are often manipulated to accept their caring obligations through distorted social norms and practices. Other than in the case of moral blackmail, such young carers do not care because they want to do the morally right thing and do have no alternatives available, but because they internalized that it would be normal for them to do so. Two concepts are useful to capture this aspect: adaptive preferences and indoctrination. (4) Fourthly, young people caring is often a form of exploitation, in that it takes unfair advantage of the young carer by receiving something from them, without giving an equivalent in return (and harming them in the process). Full article

Background/Objectives: This cross-national study focuses on adolescents who provide care and support to family members or significant others. Current evidence regarding their mental health and solutions to strengthen it is limited and mostly available in a few countries. The aim of this study is to evaluate the results of a primary prevention intervention for improving the mental health and well-being of adolescent young carers (AYCs) aged 15–17 years in six European countries. The intervention was based on a psychoeducational program and tools adapted from the Discoverer, Noticer, Advisor, and Values (DNA-V) model. Methods: We designed a randomized controlled trial with 217 AYCs participating in the study, either in the intervention or control group. Quantitative and qualitative data were collected via questionnaires at baseline, post-intervention, and a 3-month follow up. Results: The results were mixed, as positive improvements in primary (i.e., psychological well-being and skills) and secondary (school/training/work functioning) outcomes were shown by the experimental group but, in most cases, they were not statistically significant. The qualitative data supported positive claims about the intervention and its appropriateness for AYCs. Conclusions: The study implementation during the peak of the COVID-19 pandemic forced the consortium to adapt the design and may have influenced the results. More long-term studies are needed to assess similar mental health programs with this hard-to-reach target group. Full article

Young carers face a variety of challenges at school. While schools can be vital places of support, the assistance they receive at school often seems selective and fails to consider the unique life situations of individual students. This paper examines the perspective of multiple actors in the student’s school environment and explores how schools can develop comprehensive, sustainable support systems for young carers—systems that consider and involve as many actors as possible in the student’s school environment. In a secondary analysis of two interview studies, we analyzed how young carers as well as their parents, teachers, and school counsellors perceived the school support the carers received. We then developed an integrated model that incorporates these differing perspectives. The model offers an approach for implementing low-threshold support for young carers within existing school structures in relation to their family situation and outlines conditions that can support both recognized and “invisible” young carers, as well as other students. Full article

A child’s disability, long-term illness, or mental ill-health is known to affect siblings’ health, social life, school engagement, and quality of life. This article addresses a research gap by its focus on young sibling carers and the impact of providing care to a sibling. A cross-national survey study was conducted in 2018–2019 (Italy, the Netherlands, Slovenia, Sweden, Switzerland, the UK) to examine the incidence of adolescent sibling carers, the extent of care they provide, and their self-reported health, well-being, and school situation. The survey was completed by 7146 adolescents, aged 15–17, and 1444 of them provided care to family members with health-related conditions. Out of these, 286 were identified as Sibling Carers and 668 as Parent Carers, while 181 had both sibling(s) and parent(s) with health-related conditions, and thus were identified as Sibling–Parent Carers. Sibling Carers and Sibling–Parent Carers carried out higher levels of caring activities compared to Parent Carers. They reported both positive aspects of caring, such as increased maturity, and negative aspects, such as mental ill-health, impact on schooling and a lack of support. To reduce the negative aspects of a sibling carer role, it is important to recognise them and to implement early preventive measures and formal support. Full article

Young dementia carers (YDCs) rarely receive appropriate training and support. Their visibility and identification remain dangerously low, and, consequently, support initiatives being developed are failing to reach them. This study explored the success (or failure) of YDC identification pathways as well as the barriers and enablers to their implementation. An explorative qualitative approach was followed, drawing on the experiences of parents of YDCs, dementia researchers, professionals in the field of dementia/young carers, and young adult carers. Data collection involved semi-structured interviews (n = 17) and a participatory 2-h workshop to discuss and critique preliminary themes as well as explore strategies to increase the visibility and identification of YDCs. Five themes were identified: a “whole-family approach” (as a pathway to identification), “not a carer” (self/family identification), a postcode lottery (high variability of support services), tailored support that is “fit for purpose”, and the “power” of peer support. Recommendations on potential initiatives and actions that can help raise awareness and increase the identification success of YDCs are proposed. Our findings support the need for a broad and holistic approach to the identification of YDCs that runs alongside the development of support initiatives that are accessible and relatable. The support itself will play a role in improving subsequent identification or hindering it if not “fit for purpose”. Full article

Caring for an ill or disabled relative can present significant challenges that may exceed the personal resources of the caregiver. Young carers (YCs) often take on this role, providing support to family members or friends, which can have far-reaching effects on various aspects of their lives. This study involved 235 adolescents, 106 YCs, and 129 non-carers (NCs), who completed questionnaires assessing life satisfaction, satisfaction with social support, family functioning, academic functioning, and caregiving activities. Tests of group differences (MANOVA and MANCOVA controlling for age) showed YCs had more caregiving activities than NCs (as expected) and, critically, significantly lower life satisfaction. Hierarchical regressions with the YCS subsample showed academic functioning, social support, and the negative impact of caregiving were associated with life satisfaction, and that the negative influence of caregiving was linked to family functioning and the quantity of caregiving activities. For NCs, academic functioning, satisfaction with social support, and family functioning were associated with life satisfaction. In conclusion, caregiving in adolescents appears to be linked to lower life satisfaction, but this effect is determined by their social support, academic functioning, and negative impact of caring, which in turn depends on their family functioning and amount of caring activities. Full article

Prior studies emphasize the value of friends’ support for children/adolescents who have a disability or suffer from mental ill-health or a long-term illness. However, few studies have explored how a caring role affects those young friend carers themselves. This paper addresses a gap in the research by focusing on this hitherto neglected group of young carers to explore the impact of providing care to friends. An online survey was employed for a cross-national study conducted in 2018–2019 in Sweden, Italy, Slovenia, the Netherlands, Switzerland, and the United Kingdom to examine the incidence of adolescent young friend carers, the extent of care they provide, and their self-reported health, well-being, and school situation. The survey was completed by 7146 adolescents, aged 15–17, and 1121 of them provided care to a friend with a health-related condition, most frequently mental ill-health. They carried out high levels of caring activities, and a quarter of them also provided care to a family member. They experienced both positive and negative aspects of caring. Nevertheless, in comparison with adolescents who provided care to family members, they reported more health problems, with a dominance of mental ill-health, and they received lower levels of support. Since adolescent friends play a valuable role for young people with health-related conditions, especially mental ill-health, it is important to find ways of optimizing their caring experiences in order that those adolescents who choose to care for a friend can do so without it having a negative impact on their own mental health, well-being, and life situation. Full article

Anorexia nervosa is an illness affecting primarily adolescent girls and young women. Clinical guidelines recommend early intervention, with inpatient treatment for more severe cases. We present an evaluation of a multi-modal cognitive–behavioral inpatient treatment (CBT-E) involving carers in specialized units for adolescents. Routine data of 962 adolescent inpatients (26 boys) (mean age 15.48 [1.26]; range 12–17 years) were analyzed. Predictors of good body weight outcome (achieving a discharge BMI of at least 18.5 kg/m²) were identified by logistic regression analysis. Mean inpatient treatment lasted 96.69 (45.96) days. The BMI increased significantly from 14.93 (1.38) kg/m² at admission to 17.53 (1.58) kg/m² at discharge (z = 26.41; p < 0.001; d = 1.708). Drive for thinness decreased from 29.08 (9.87) to 22.63 (9.77; z = 18.41; p < 0.001; d = 0.787). All other subscores of the Eating Disorder Inventory also decreased significantly, with small to medium effect sizes. General psychopathology also showed significant decreases. The Beck Depression Inventory-II score decreased from 26.06 (11.74) to 16.35 (12.51; z = 18.41; p < 0.001; d = 0.883). A good body weight outcome was predicted by a higher BMI at admission (OR = 1.828), age at onset at 15 years or higher (OR = 1.722), and higher Somatization (OR = 1.436), Anxiety (OR = 1.320), and Bulimia (OR = 1.029) scores. CBT-E involving carers is an efficient intervention for adolescents with anorexia nervosa. Full article

Background: There is an established evidence-base for dialectical behaviour therapy for adolescents (DBT-A) in the treatment of young people with severe emotion dysregulation and related problems, including repeated self-harm and suicidal behaviours. However, few studies have reported on parental involvement in such treatments. This study aims to explore the outcomes and experiences of participants of a dedicated skills group for parents and carers embedded within an adapted DBT-A programme in the United Kingdom. Method: This study was conducted within a specialist outpatient Child and Adolescent Mental Health Services (CAMHS) DBT programme in the National Health Service (NHS) in London. Participants were parents and carers of adolescents engaged in the DBT-A programme. Participants attended a 6-month parent and carer skills group intervention and completed self-report measures relating to carer distress, communication and family functioning, at pre-intervention and post-intervention. Following the intervention, semi-structured interviews were also completed with a subgroup of participants to explore their experiences of the skills group and how they perceived its effectiveness. Quantitative and qualitative methods were used to analyse the data collected from participants. Results: Forty-one parents and carers completed the intervention. Participants reported a number of statistically significant changes from pre- to post-intervention: general levels of distress and problems in family communication decreased, while perceived openness of family communication and strengths and adaptability in family functioning increased. A thematic analysis of post-intervention interviews examining participant experiences identified six themes: (1) experiences prior to DBT; (2) safety in DBT; (3) experiences with other parents and carers; (4) new understandings; (5) changes in behaviours; and (6) future suggestions. Discussion: Parents and carers who attended a dedicated DBT skills groups, adapted for local needs, reported improvements in their wellbeing, as well as interactions with their adolescents and more general family functioning, by the end of the intervention. Further studies are needed which report on caregiver involvement in DBT. Full article

Young carers provide a substantial amount of care to family members and support to friends, yet their situation has not been actively addressed in research and policy in many European countries or indeed globally. Awareness of their situation by professionals and among children and young carers themselves remains low overall. Thus, young carers remain a largely hidden group within society. This study reports and analyses the recruitment process in a multi-centre intervention study offering psychosocial support to adolescent young carers (AYCs) aged 15–17 years. A cluster-randomised controlled trial was designed, with recruitment taking place in Italy, the Netherlands, Slovenia, Sweden, Switzerland and the United Kingdom exploiting various channels, including partnerships with schools, health and social services and carers organisations. In total, 478 AYCs were recruited and, after screening failures, withdrawals and initial dropouts, 217 were enrolled and started the intervention. Challenges encountered in reaching, recruiting and retaining AYCs included low levels of awareness among AYCs, a low willingness to participate in study activities, uncertainty about the prevalence of AYCs, a limited school capacity to support the recruitment; COVID-19 spreading in 2020–2021 and related restrictions. Based on this experience, recommendations are put forward for how to better engage AYCs in research. Full article

This paper examines the health-related quality of life (HRQL) and mental health of adolescent young carers (AYCs) aged 15–17 in Switzerland, based on data collected within the Horizon 2020 project ‘Psychosocial support for promoting mental health and well-being among AYCs in Europe’ (ME-WE). It addresses the following questions: (1) Which characteristics of AYCs are associated with lower HRQL and with higher level of mental health problems? (2) Do AYCs who are less visible and less supported report a lower HRQL and more mental health issues than other AYCs? A total of 2343 young people in Switzerland, amongst them 240 AYCs, completed an online survey. The results show that female AYCs and AYCs with Swiss nationality more often reported having mental health issues than their male and non-Swiss counterparts. Furthermore, the findings show a significant association between receiving support for themselves and visibility from their school or employer and the HRQL. Moreover, AYCs who reported that their school or employer knew about the situation also reported fewer mental health issues. These findings can inform recommendations for policy and practice to develop measures aimed at raising the visibility of AYCs, which is the first step for planning AYC tailored support. Full article