blog.burnsforce.com/la-esencia-del-cristianismo.php Give serious consideration to a foster carer's desire to adopt a child and ensure that an adoption assessment fully considers the capacity of foster carers to provide long-term stability and secure attachment. Ensure alternative placements are available 'twin tracking' if assessments of birth parents or carers who are family or friends are unsatisfactory. This might include approving carers who wish to adopt as both foster carers and prospective adopters.
Evidence indicates that accurate and up-to-date personal health information has significant implications for the immediate and future wellbeing of children and young people during their time in care and afterwards. Understanding their own 'health history' is an essential part of growing up securely.
Inconsistent record keeping can lead to wrong decisions by professionals and adversely affect the child or young person. Ensure that all looked-after children and young people have their physical, emotional and mental health needs assessed by appropriately trained professionals according to 'Statutory guidance on promoting the health and well-being of looked after children Statutory guidance on promoting the health and well-being of looked after children Department for Children, Schools and Families.
Local authorities should make notifications about looked-after children and young people who are placed out of the authority's area or across NHS commissioning boundaries in good time and in accordance with the statutory guidance The Children Act guidance and regulations volume 2: care planning, placement and case review Department for Children Schools and Families. Consider introducing a protocol into information-sharing processes that addresses legal and confidentiality issues, to assist information flows between health and social care.
Ensure that healthcare professionals share health information with social workers and other professionals. Ensure that there is a process for social workers to obtain consent for statutory health assessments, routine screenings and immunisations. Ensure social workers obtain permission to access the child or young person's neonatal and early health information. Ensure social workers obtain permission to access information on parental health, including obstetric health.
Ensure that parental or delegated consent is given to healthcare professionals when they are scheduled to carry out a medical or surgical procedure on any looked-after child or young person. Ensure that a system is in place to monitor, and address failure to obtain, permission or consent for health matters. Ensure that any health information is collected and shared in a sensitive and professional manner.
Ensure health information is incorporated into relevant assessments and shared with healthcare professionals, as appropriate. Ensure that physical and emotional health information, and consent for medical procedures, including mental health interventions, follows the child or young person.
This may include deciding with partner agencies how hand-held paper records can stay with the child or young person. Ensure that early health information is available to enhance life-story work with the child or young person when they are ready see also recommendations 24, 25 and 48 or to help them make informed decisions when they are ready to start their own family. Ask social workers to ensure that the personal health record red book follows the child or young person up to the age of Ensure that if the original personal health record is lost or unavailable a new one is provided, and when it is reissued it should include as much information as possible; the issuer will need to look back and incorporate historic information.
Share all information obtained from parents and other sources to help complete the reissued record, and if birth parents are unwilling to give up the original personal health record, ensure social workers work with them to relinquish it temporarily to enable information to be copied.
Ensure that early health information is obtained, including obstetric and neonatal health information, on all children or young people entering care. Ensure there is a clear process to reissue the personal health record to all new carers for children or young people in their care. Ensure that a contact person is identified to manage the administration of the personal health record. Ensure that when assessments are commissioned for court processes, permission from the court is obtained to share this information with health professionals who carry out statutory assessments or advise on health needs.
Evidence indicates that developing a positive personal identity and a sense of personal history is associated with high self-esteem and emotional wellbeing. Life-story work, as an ongoing activity, can help children and young people understand their family history and life outside of care. Children and young people also have needs and preferences for contact with valued people and participation in the wider community as ways to build their self-esteem and assertiveness. Promote continued contact with former carers, siblings or family members personally valued by the child or young person where this is felt to be in their best interests.
Where this is not possible, acknowledge the significance of losing former attachment figures and relationships. Promote ongoing contact with valued friends, professionals or advocates where this enhances and promotes emotional wellbeing and self-esteem. Ensure access to creative arts, physical activities, and other hobbies and interests to support and encourage overall wellbeing and self-esteem.
Offer assertiveness training appropriate to age to all children and young people to promote self-esteem and safety, combat bullying and enhance wellbeing see also recommendations 26— Ensure looked-after children and young people participate in policy decisions that affect their life see also recommendations 1 and 2. Allow contact with close family members to diminish when it is clearly not in the best interests of the child or young person and contrary to their wishes see also recommendation Ensure that policies and activities are in place to allow each child or young person to explore their personal identity, including their life story.
For information gathering when a child or young person first becomes looked after, consider using forms such as those provided by the British Association of Fostering and Adoption, which collect data on early infant health and parents' general health. Ensure life-story activities are planned and supported using a sensitive approach that focuses on the needs of a child or young person and that information is delivered by a trusted individual known to them in a respectful, sensitive and supportive manner.
To carry out life-story activities:. Ensure that in life-story work looked-after children and young people have access to as much personal information including family history as possible by promoting ongoing conversations between children, young people and their carers and social workers that include discussion about their:. Extend existing good practice and policy on life-story work with children and young people during and after the adoption process to all children and young people who are looked after, including those leaving care.
Looked-after children and young people from black and minority ethnic backgrounds have particular needs. Other groups of looked-after children and young people also have particular needs, such as those seeking asylum and those who are gay or lesbian. Ensuring their needs are adequately met requires special attention and expertise to champion their rights. Strategic plans need to identify how appropriate services will be commissioned to ensure these looked-after children and young people are not marginalised. Recommendation 33 is about unaccompanied asylum seekers with looked-after status, and recommendation 34 is about black and minority ethnic children and young people.
Provide all professionals and managers with specialist training, resources and access to expertise to:. Consider setting up a multi-agency panel tailored to local needs to discuss particular requirements and placement choices for the looked-after children and young people identified at the beginning of this section.
This could be a priority in areas with low numbers of these looked-after children and young people as there may be a need to increase local knowledge. Ensure that children and young people with particular needs are consulted about their experiences of services see also recommendations 24 and Network and share good practice with other local authorities with a similar profile of looked-after children and young people.
Consider secondments of key staff to local authorities where good practice is recognised, and ensure that there are mentoring and co-working opportunities. Ensure children-in-care councils include discussion of looked-after children with particular needs as a standing item on their agenda. Appoint a local diversity champion with strategic and leadership responsibilities to increase awareness of the needs of looked-after children and young people identified at the beginning of this section and act as an advocate on their behalf.
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Ensure that the diversity champion reports to and is accountable to the director of children's services. Ensure the diversity champion also reports to and engages with the children-in-care council to help define the particular needs of these children and young people. Produce a local diversity profile covering the looked-after children and young people identified at the beginning of this section.
Use the diversity profile when commissioning services to ensure services are relevant and meet specific needs see also recommendation 5. Use the diversity profile to develop and train the workforce to meet existing and anticipated needs see also recommendations 35—38, 40 and 50— Ensure the placement strategy in the area includes a sufficiently diverse range of placements see also recommendations 5, 15, 46 and 47 and 'Sufficiency: statutory guidance on securing sufficient accommodation for looked after children'.
If the diversity profile see recommendation 26 indicates a more diverse range of placements is required now or in the future increase the number of foster carers accordingly. Ensure that core assessments contain an accurate and comprehensive picture of the child or young person's needs relating to their cultural, religious and ethnic identity, and pay particular attention to race, sexual orientation, language, faith and diet see also recommendations 8—11, 16, 20, 23, 24—25, 33, Ensure that the review of the care plan reflects the developing nature of the child or young person's cultural, religious and ethnic identity and sexual orientation and how these might change as a child or young person grows and matures.
Ensure that the particular needs of looked-after children and young people are clearly identified in local plans for health and wellbeing and that a delivery plan is in place to meet these needs that includes clear targets and outcomes. Provide support and training to foster parents and residential staff to ensure they have a good understanding of the particular issues affecting unaccompanied asylum-seeking children and young people who are looked after.
Ensure that unaccompanied asylum-seeking children and young people who are looked after have access to:. Ensure all professionals in services that work with unaccompanied asylum-seeking children and young people who are looked after have a good understanding of cultural differences in attitudes to and beliefs about physical and mental health or wellbeing see also recommendations 8—11, 46—49, 50— Provide all practitioners and managers with specialist training, resources, and access to expertise to:.
Evidence indicates that foster and residential care are complex activities that require rehabilitative and therapeutic approaches and skills. Carers who feel supported by their social worker and have ready access to support services are better able to use these skills to encourage healthy relationships and provide a more secure base, and so reduce the risk of placement breakdown. These skills should also be reflected in the recruitment of foster carers and residential staff, and in the training and support they receive. Ensure all fostering services and residential care homes meet and maintain statutory standards Fostering services: national minimum standards and Children's homes: national minimum standards Department for Education as set out in Revising the national minimum standards NMS for adoption, children's homes and fostering Department for Children, Families and Schools and mechanisms are in place to identify and remove those foster or residential carers who repeatedly underperform or are unwilling to undertake additional training to meet these standards.
Private and independent fostering agencies. Ensure foster and residential carers receive high-quality, core training from trainers with specialist knowledge and expertise that:. Ensure foster carers and their families including carers who are family or friends receive high quality ongoing support packages that are based on the approach set out in the core training recommendation see recommendation 50 and Family and friends care: statutory guidance for local authorities Department for Education.
A support package should include:. Ensure all social workers and managers who undertake direct supervision of carers receive training that enables them to provide support to carers and recognise the emotional impact of the role. Such training should include:. Ensure that social workers and managers provide support for cross-cultural placements see recommendations 26— Ensure that social workers and managers support sibling placements and contact between siblings and family members see recommendation Evidence suggests the high value of care provided by family and friends may lead to good long-term outcomes for many children and young people.
However, care by family and friends can be placed under strain without adequate financial support, clear signposting to services and timely access to mental health services for children and young people Family and friends care: statutory guidance for local authorities Department for Education. Since this guideline was originally produced October the Department for Education has issued statutory guidance for local authorities on the implementation of the duties in the Children Act with respect to children and young people who are brought up by members of their extended family, friends or other people who are connected with them 'Family and friends care: statutory guidance for local authorities'.
Support placements with family and friends as a choice of equal status to adoption, foster care and residential care for looked-after children and young people, by ensuring that:.
This support should include:. Education that encourages high aspirations, individual achievement and minimum disruption is central to improving immediate and long-term outcomes for looked-after children and young people. Evidence indicates that looked-after children do not generally do as well at school as their peers, which reduces their opportunity to move to further education, and affects their employment or training opportunities. It is important that education professionals are equipped with the necessary skills, knowledge and understanding to help looked-after children and young people get the most out of their time in education and to successfully negotiate their educational careers.
Ensure all teacher training programmes have a core training module that looks at the needs of looked-after children and young people see recommendations 50—52 and includes an understanding of:. Ensure designated teachers :. See The role and responsibilities of the designated teacher for looked after children: statutory guidance for school governing bodies Department of Children Schools and Families. Ensure that educational provision for looked-after children and young people including those placed out of area is appropriate and of high quality, in line with statutory regulations Promoting the education of looked after children: statutory guidance for local authorities Department for Children, Schools and Families.
Appoint a virtual school head 'Promoting the education of looked after children: statutory guidance for local authorities'; Children and Families Act and ensure that he or she:. Looked-after young people and care leavers who are continuing their education after school-leaving age. Identify and provide personal support before and during the application process, and continue to support students throughout their time at university or college. Ensure that looked-after young people and care leavers have access to bursaries and other forms of financial and practical support. Publicise the bursaries currently available for looked-after young people who continue in full time education 16—19 Bursary and for those who go to university and ensure all eligible care leavers receive this legal entitlement 'Promoting the education of looked after children: statutory guidance for local authorities'; Bursary Fund: examples of good practice Education Funding Agency.
Ensure that good quality accommodation, including return to carers, is guaranteed for the duration of the course, including holidays, for students who have been in care. Continue to support care leavers after they have left higher education. This should include support with housing and other forms of practical and emotional support, such as careers advice and coping with living alone, until they gain employment and are ready to be independent.
Ensure admissions procedures are transparent and accessible and that care leavers are given appropriate and easily accessible support and advice on accommodation, services, scholarships and any other support available to care leavers. Endeavour to provide good quality accommodation to students who have been looked after for the duration of the course, regardless of where they live.
Work to attain the Frank Buttle Trust quality mark, which recognises higher education institutions that provide additional and targeted support to students who have been looked after For additional information, see the website of Action on Access. The transition to adulthood for young people in care can be difficult.
Evidence indicates that services designed with young people in mind and delivered by friendly, approachable professionals can help young people find the right support and advice at the right time, to help them become independent see Children to stay with foster families until 21 Department for Education. Refer to and implement the statutory guidance, Planning transitions to adulthood for care leavers Department for Education and the cross departmental strategy for young people leaving care Care leaver strategy: a cross departmental strategy for young people leaving care Department for Education and others.
Ensure that preparation for adulthood is part of care planning for children and young people of all ages and abilities who are looked after, in a way that is appropriate to age and supports them to move at their own pace and feel integrated and secure within their local communities Care leavers' charter Department for Education. Establish protocols with housing, health and adult social care partners that help identify young people moving to independent living as a priority group for accessing adult services.
Ensure that supported housing commissioned for care leavers enables them to remain until they are ready to take the next step towards independence and a secure tenancy, or other suitable arrangement. Supported housing should not be unduly constrained by set periods of time or a predetermined age at which the young person must move on; it should be provided on the best interests and needs of the individual.
Give young people the option to remain in a stable foster home or residential home up to the age of 21, as outlined in government guidance on arrangements for care leavers to stay on with former foster carers 'Staying put': arrangements for care leavers aged 18 and above to stay on with their former foster carers HM Government and the Children and Families Act , and allow those who experience difficulty moving to independent living to return to the care of the local authority for support, including to the previous placement if available.
See '"'Staying put": arrangements for care leavers aged 18 and above to stay on with their former foster carers' and Children to stay with foster families until 21 Department for Education. Provide the same level of support to young people moving to independent living from the care of family or friends as given to those moving on from any other kind of placement. This should include:. Ensure young people moving to independent living are encouraged and helped to maintain contact with past foster or residential carers they value. Ensure that all young people have opportunities to develop the full range of life skills needed to make the transition to independent living and adulthood.
In particular, planning for transition should take account of the opportunities for learning skills such as cooking and shopping that may not be readily available to young people living in residential care or custodial settings. Ensure pathway planning pays full attention to the emotional needs and developmental capacity of young people preparing to move into independent accommodation. Ensure transition planning takes account of young people with complex needs including mental health problems , so they can proceed at a pace they can cope with.
It is important not to push young people into independence too fast and too far, as some may have crises and breakdowns. Ensure there is an effective and responsive leaving-care service that meets the needs of young people in transition between the ages of 16 and Ensure that services available to care leavers are clearly outlined in local plans for children and young people's health and wellbeing and these are readily available to children and young people in suitable formats. Consider a 'one-stop shop' approach to the provision of services to enable care leavers to more easily access a range of services in a familiar environment.
Consider making use of current one-stop shops to provide a specialist service for looked-after children and young people.
Ensure all young people know their entitlements to services and how to access them, including independent advocacy if needed. Designated health professionals. Ensure that when young people are offered their final statutory health assessment all available details of their medical history can be discussed.
Ensure young people are supported and encouraged to attend their final statutory health assessment. Ensure that if a young person declines to attend their final statutory health assessment they are offered the choice of having a written copy of their basic medical history such as immunisations and childhood illnesses and that a health professional, in partnership with the young person's social worker, ensures that the young person knows how to obtain their social care and detailed health history.
Ensure that leaving-care services that support young people when they move on to independent living have a process to contact health professionals when necessary to help the young person understand the information in their health history. Ensure that case management and treatment of young people receiving mental health services including CAMHS, see Children and young people in mind: the final report of the national CAMHS review Child Adolescent Mental Health Services continues until a handover with an assessment and completed care plan has been developed with the relevant adult service see also recommendations 8—11 and 12—14, Transition: getting it right for young people: Improving the transition of young people with long term conditions Department of Health and The Care Act Ensure the pathway plan identifies support that should be in place when care leavers do not meet thresholds for adult mental health services or social care despite having ongoing mental health needs that have been clearly identified see also recommendation 8—11 and 12— Also see NICE's guideline on service user experience in adult mental health.
Evidence suggests that the experiences and needs of looked-after children and young people are not well understood by all the professionals who come into contact with them. Developing national training curriculums, with levels appropriate for a wide range of professionals, will increase understanding of this diverse group of children and young people and can do much to support high-quality care, promote educational stability and achievement, and encourage timely access to services to help maintain or improve emotional health and wellbeing.
Agree a core training module at national level to inform professionals and carers about the needs of looked-after children and young people. This module should include developing understanding and awareness of:. Pay particular attention to developing reflective practice as an integral part of professional training for those working with looked-after children and young people. Work with education providers to include a module on looked-after children and young people in the educational setting in initial social worker training. Ensure all independent reviewing officers undertake a core training module which includes all issues identified in recommendation 50 core training and which also covers:.
Monitor the quality of training content and its delivery, and evaluate its impact on the quality of education and care of looked-after children and young people. Feed the outcomes into future planning and delivery of courses. Guidance Tools and resources Evidence History Overview. Next 1 Recommendations Influences on the quality of life of looked-after children and young people Strategic leadership, planning and commissioning Audit and inspection Care planning, placements and case review Professional collaboration Dedicated services to promote the mental health and emotional wellbeing of children and young people in care Placements for children and young people — residential care, foster care and care by family and friends Sibling placements and contact Supporting babies and young children Health assessments, records and information Personal quality of life Diversity Supporting foster and residential care Care provided by family and friends Improving education for looked-after children and young people Preparing for independence Training for professionals.
Influences on the quality of life of looked-after children and young people. Strategic leadership, planning and commissioning Evidence indicates that high-performing local authorities are those with strong leaders who have an aspirational vision of effective corporate parenting for all looked-after children and young people.
Recommendation 1 Prioritise the needs of looked-after children and young people Who should take action? Directors of children's services. Directors of public health. Senior staff with responsibility for commissioning and providing health services. What action should they take? Create strong leadership and strategic partnerships to develop a vision and a corporate parenting strategy that: focuses on effective partnership and multi-agency working addresses health and educational inequalities for looked-after children and young people.
Recommendation 2 Commission services for looked-after children and young people Who should take action? Commissioners of health services and local authority children's services. Ensure that service commissioning for looked-after children and young people is informed by: the views of children and young people see recommendation 24 national evidence, guidance and performance data the local corporate parenting strategy local knowledge and experts for example, the director of public health local audits the joint strategic needs assessment local plans and strategies for children and young people's health and wellbeing.
Audit and inspection Evidence suggests that a robust audit and inspection framework ensures that looked-after children and young people continue to be strategic priorities for local authorities, the NHS and their key partners. Recommendation 3 Regulate services Who should take action? Regulators and inspectors including the Care Quality Commission and Ofsted. Use the processes for auditing, monitoring and inspecting local authorities, providers of health services and key partners to ensure that local strategic partnerships including children's services and their partners provide services for looked-after children and young people including those placed out of area that: take account of their views see recommendation 24 meet the full range of their needs including needs relating to physical, social, educational and emotional health and wellbeing promote and support healthy lifestyles deliver quality care, and placement and educational stability comply with relevant standards and statutory guidance.
Recommendation 4 Inspect services for care leavers Whose health and wellbeing will benefit? Looked-after young people preparing to leave or leaving care.
Who should take action? Care Quality Commission. Care planning, placements and case review Evidence indicates that effective care planning, led by social workers, promotes permanence and reduces the need for emergency placements and placement changes. Recommendation 5 Implement care planning, placement and case review regulations and guidance Who should take action? Ensure the social worker's role is supported by: regular high-quality supervision with a particular focus on the management of the care plan and corrective action to ensure that interventions are acted on as agreed — preventing ' drift' in the care system continuing professional development for social workers to better understand and manage the role of a local corporate parent.
Professional collaboration Evidence suggests that for the ' team around the child' to provide effective care, professionals need to collaborate closely and share relevant and sensitive information. Recommendation 6 Support professional collaboration on complex casework Who should take action? The approach taken by this service should be based on the concept of reflective practice see also recommendations 33, 34, 36, 38 and 50—52 , and how to manage: conflicting views in the team about the best interests and needs of a looked-after child or young person risks to or disruptions of long-term placements patterns of repeated placement breakdown or exclusion from education uncertainty or delays in care planning communication with colleagues, decision making, information sharing and lead responsibilities, ensuring that the needs of the child continue to be prioritised.
Recommendation 7 Ensure everyone involved understands their role Who should take action? What action should they take Ensure that social workers undertake the key worker and coordinating role and fulfil their responsibility for managing the multidisciplinary care plan, including managing the transition between child and adult health services see recommendation Dedicated services to promote the mental health and emotional wellbeing of children and young people in care Evidence suggests that early intervention to promote mental health and wellbeing can prevent the escalation of challenging behaviours and reduce the risk of placement breakdown.
Recommendation 8 Commission mental health services Who should take action? Commissioners of mental health services. Ensure that the services include: training, support and access to specialist advisers for frontline practitioners, carers and other professionals in the multidisciplinary 'team around the child' see recommendation 6 specific training to prevent placement breakdown, covering early identification of those at risk of mental health problems see 16—19, 35—38, 50—52 therapeutic services for children and young people, including those in unstable, short-term and transitional placements continuing with and completing a therapeutic intervention after the young person reaches the age of 18, when this is necessary.
Recommendation 9 Ensure access to mental health services for black and minority ethnic children and young people Whose health and wellbeing will benefit? Black and minority ethnic looked-after children and young people. Commissioners and providers of mental health services. Recommendation 10 Ensure access to mental health services for unaccompanied asylum-seeking children who are looked after Whose health and wellbeing will benefit? Unaccompanied asylum-seeking children and young people who are looked after.
Ensure that unaccompanied asylum-seeking children and young people have access to specialist psychological services including CAMHS with the necessary capacity, skills and expertise to address their particular and exceptional health and wellbeing needs, including: post-traumatic stress dislocation from country, family, culture, language and religion risk of sexual exploitation lack of parental support and advocacy in a foreign country stress related to the immigration process physical and emotional trauma from war and disruption at home such as torture, beatings, rape and death of family members increased risk for suicide and mental illness.
Recommendation 11 Ensure access to specialist assessment services for young people entering secure accommodation or custody Who should take action? Commissioners and providers of health services. Social work managers. Placements for children and young people — residential care, foster care and care by family and friends To meet the diverse needs of all looked-after children and young people, it is necessary to have an adequate range of suitable placements, including secure and custodial care and ensure that children are involved in decisions about placement changes.
Recommendation 12 Plan and commission placements Who should take action? Senior staff with responsibility for commissioning health services.
Such a strategy should: Clearly set out how to meet the 'sufficiency' duty under the Children and Young Persons Act Sufficiency: statutory guidance on securing sufficient accommodation for looked after children Department for Education to provide suitable placements to meet the needs of looked-after children and young people with a statement of the role of various forms of care, to include: foster care, residential care and care provided by family and friends see recommendations 24, 25, 26—34, 35—38, 40 use of secure accommodation see also recommendations 11 and 20 how placements will be made if unavailable within the local authority area see also recommendation 20 consideration of sibling co-placement and contact including those placed out of area see recommendations 15, 20 and Recommendation 13 Use current information to make decisions about placement changes Who should take action?
Social workers and social work managers. Placement teams. Independent reviewing officers. When making decisions about moving children or young people from existing placements: fully take into account the wishes and feelings of a child or young person record the reasons for decisions taken that are not in accord with the wishes and feelings of the child or young person explain to the child or young person why these decisions were made ensure children and young people are made fully aware of their right to access advocacy services when a review decision is likely to overrule their wishes and feelings ensure sibling co-placement and contact are considered including those placed out of area see also recommendations 15, 20 and Recommendation 14 Ensure looked-after children and young people in secure and custodial settings have their care plan or pathway plan reviewed Who should take action?
Leaving care teams. Sibling placements and contact Evidence suggests that membership of a sibling group is a unique part of the identity of a child or young person and can promote a sense of belonging and promote positive self-esteem and emotional wellbeing. Recommendation 15 Support sibling placements Who should take action?
Ensure a placement strategy is in place that addresses any shortage of foster carers or suitable residential placements to meet the needs of sibling groups, for example through: recruiting foster families specifically for sibling groups commissioning homes for small family groups meeting the additional financial and housing needs of foster carers to enable siblings to be placed together.
Update to 'The Children Act guidance and regulations volume 2: care planning, placement and case review' Department for Education ensure social workers coordinate any ongoing contact desired by the child or young person, arranging appropriate supervision where necessary and supporting foster or residential carers review a separation decision if the circumstances of a sibling change.
Supporting babies and young children Evidence suggests that frequent moves and parents' physical and mental health problems can adversely affect the ability of babies and very young children to form healthy attachments that lead to healthy emotional and physical development. Recommendation 16 Assess the needs of babies and young children and ensure access to services Who should take action?
Ensure assessments: are conducted by appropriately trained health professionals and frontline practitioners who work with looked-after children, such as health visitors, community and specialist paediatricians, psychologists and nurses for looked-after children and young people include the views of carers, social workers and early years practitioners who have day-to-day contact with the baby or young child. In addition, many individuals continuously acquire new things and experience distress if they are not able to do so.
The inability to discard possessions can make living spaces nearly unusable. Relatedly, the cluttered living space can interfere with the performance of daily tasks, such as personal hygiene, cooking, and sleeping e. Other: The symptoms are not triggered by another medical e. Characterized by a preoccupation with the belief that one's body or appearance are unattractive, ugly, abnormal or deformed. This preoccupation can be directed towards one or many physical attributes e. Muscle dysmorphia is a subtype of this disorder that is characterized by belief that one's body is too small or insufficiently muscular.
Other: The symptoms are not better explained by concerns with body fat or weight in individuals diagnosed with an eating disorder. Characterized by repeatedly pulling out one's own hair , most commonly from the scalp, eyebrows, or eyelashes. Other: The symptoms are not triggered by another medical condition or mental health issue. Many individuals with trichotillomania also display other body-focused repetitive behaviors, such as skin-picking or nail-biting.
These are disorders that are related to the experience of a trauma e. Characterized by the development of certain trauma-related symptoms following exposure to a traumatic event see "Diagnostic criteria" below. Symptoms are separated into four main groups: re-experiencing, avoidance, negative cognitions and mood, and hyperarousal. The specific symptoms experienced can vary substantially by individuals; for instance, some individuals with PTSD are irritable and have angry outbursts, while others are not. In addition to the symptoms listed below, some individuals with PTSD feel detached from their own mind and body, or from their surroundings i.
Diagnostic criteria: A PTSD diagnosis entails that the individual's symptoms are related to a traumatic event that meets two criteria:. The individual was exposed to serious injury, sexual violence, or actual or threatened death. This exposure happened either by directly experiencing the event s , witnessing the event s in person, learning that the event s happened to a close friend or loved one note: for cases of death or near death, it must have been violent or accidental , or being repeatedly exposed to the aversive details from traumatic events e.
Dissociative Subtype: Presence of depersonalization i. Other: These symptoms are not attributable to the physiological effects of a substance e. Learn more about Post-Traumatic Stress Disorder. Characterized by a suite of symptoms that persist for at least three days and up to one month after a traumatic experience same diagnostic criteria for "trauma" as listed above. The specific symptoms of the disorder vary across individuals, but a common feature is intense anxiety in response to re-experiencing symptoms e. Other: Symptoms cannot be better accounted for by another mental disorders and do not represent normal bereavement.
Duration: Acute represents symptoms present for less than six months; chronic represents symptoms present for six months or longer. It's important to note that everyone feels anxiety to some degree regularly throughout their life - fear and anxiety are adaptive and helpful emotions that can function to help us notice danger or threat, keep us safe, and help us adapt to the environment. Anxiety disorders represent states when fear or anxiety becomes severe or extreme, to the extent that it causes an individual significant distress, or impairs their ability to function in important facets of life such as work, school, or relationships.
It is also important that risk factors don't at all imply that anxiety is anyone's fault; anxiety disorders are a very common difficulty that people experience. In this section, we will review risk factors for anxiety disorders. There are many potential risk factors for anxiety disorders, and most people likely experience multiple different combinations of risk factors, such as neurobiological factors , genetic markers, environmental factors, and life experiences.
However, we do not yet fully understand what causes some people to have anxiety disorders. Comorbidity is more common than not with anxiety disorders, meaning that most individuals who experience significant anxiety experience multiple different types of anxiety. Given this co-morbidity, it is not surprising that many risk factors are shared across anxiety disorders, or have the same underlying causes. There is a lot of research identifying risk factors for anxiety disorders, and this research suggests that both nature and nurture are very relevant.
It is important to note that no single risk factor is definitive - many people may have a risk factor for a disorder, and not ever develop that disorder. However, it is helpful for research to identify risk factors and for people to be aware of them, as being aware of who might be at risk can potentially help people get support or assistance in order to prevent the development of a disorder.
Genetic risk factors have been documented for all anxiety disorders. Many studies, past and present, have focused on identifying specific genetic factors that increase one's risk for an anxiety disorder. To date, an array of single nucleotide polymorphisms SNPs or small variations in genetic code, that confer heightened risk for anxiety have been discovered.
For the most part, the variants that have been associated with risk for anxiety are located within genes that are critical for the expression and regulation of neurotransmitter systems or stress hormones. It is important to note that genetic factors can also bestow resilience to anxiety disorders, and the field continues to pursue large-scale genomics studies to identify novel genetic factors that are associated with anxiety disorders in hopes of better understanding biological pathways that: 1 contribute to the development and maintenance of anxiety; and 2 may lead to better treatment for these disorders.
Most people are not aware of what specific genetic markers they may have that confer risk for anxiety disorders, so a straightforward way to approximate genetic risk is if an individual has a history of anxiety disorders in their family. While both nature and nurture can be at play with family history, if several people have anxiety disorders it is likely that a genetic vulnerability to anxiety exists in that family.
With regard to environmental factors within the family, parenting behavior can also impact risk for anxiety disorders. Parents who demonstrate high levels of control versus granting the child autonomy while interacting with their children has been associated with development of anxiety disorders. Parental modeling of anxious behaviors and parental rejection of the child has also been shown to potentially relate to greater risk for anxiety.
Experiencing stressful life events or chronic stress is also related to the development of anxiety disorders. Stressful life events in childhood, including experiencing adversity, sexual, physical, or emotional abuse, or parental loss or separation may increase risk for experiencing an anxiety disorder later in life. Having recently experienced a traumatic event or very stressful event can be a risk factor for the development of anxiety across different age groups.
Consistent with the notion of chronic life stress resulting in increased anxiety risk, having lower access to socioeconomic resources or being a member of a minority group has also been suggested to relate to greater risk. Experiencing a chronic medical condition or severe or frequent illness can also increase risk for anxiety disorders, as well as dealing with significant illness of a family member or loved one.
Given that several medical conditions have been linked to significant anxiety, in some cases a physician may perform medical tests to rule out an underlying medical condition.
For instance, thyroid disease is often characterized by experiencing significant symptoms of anxiety. Menopause, heart disease, and diabetes have also been linked to anxiety symptoms. Additionally, drug abuse or withdrawal for many substances is characterized by acute anxiety, and chronic substance abuse can increase risk for developing an anxiety disorder.
Anxiety can also be a side effect of certain medications. Experiencing significant sleep disturbances, such as difficulty falling asleep or staying asleep, may also be a risk factor for developing an anxiety disorder. Behavioral choices can also significantly impact risk, as excessive tobacco or caffeine use can increase anxiety, whereas regular exercise can decrease anxiety.
Specific temperament and personality traits also may confer risk of having an anxiety disorder. With regards to temperament, shyness and behavioral inhibition in childhood can increase risk of developing an anxiety disorder later in life. With regard to personality traits, the Five Factor Model of Personality consists of five broad trait domains including Neuroticism, Extraversion, Openness to Experience, Agreeableness, and Conscientiousness.
An individual higher on trait Neuroticism or low on Conscientiousness is at a higher risk for all anxiety disorders, and an individual low on trait Extraversion is at a higher risk of developing social phobia and agoraphobia. Some more narrow personality traits have also been found to relate to risk for anxiety, including anxiety sensitivity, a negative or hostile attributional style, and self-criticism.
Personality disorders have also been shown to relate to increased risk for anxiety disorders. Demographic factors also impact risk for anxiety disorders. While there is not a strong consensus, research suggests that risk for anxiety disorders decreases over the lifespan with lower risk being demonstrated later in life. Women are significantly more likely to experience anxiety disorders. Another robust biological and sociodemographic risk factor for anxiety disorders is gender, as women are twice as likely as men to suffer from anxiety.
Overall symptom severity has also been shown to be more severe in women compared to men, and women with anxiety disorders typically report a lower quality of life than men. This sex difference in the prevalence and severity of anxiety disorders that puts women at a disadvantage over men is not specific to anxiety disorders, but is also found in depression and other stress-related adverse health outcomes i.
Basic science and clinical studies suggest that ovarian hormones, such as estrogen and progesterone, and their fluctuations may play an important role in this sex difference in anxiety disorder prevalence and severity. While changes in estrogen and progesterone, over the month as well as over the lifetime, are linked to change in anxiety symptom severity and have been shown to impact systems implicated in the etiology of anxiety disorders i. Anxiety disorders increase one's chances for suffering from other medical illness, such as cardiovascular disorders, including obesity, heart disease and diabetes.
More specifically, increased body weight and abdominal fat, high blood pressure, and greater levels of cholesterol, triglycerides, and glucose have all been linked to anxiety. While it is still unclear what causes the high co-morbidity between anxiety and bad physical health outcomes, research suggests that changes in underlying biology that is characteristic of anxiety may also facilitate the emergence for these other physical health outcomes over time. For example, changes in stress hormones, autonomic responses, as well as heightened systemic inflammation are all associated with anxiety disorders and negative health outcomes.
These shared physiological states suggest a shared underlying biology and that anxiety maybe a whole-body condition. Anxiety disorders are associated with chronic life stress. Unpredictable, unrelenting, unresolvable stressors chronically stimulate the stress hormone system and cardiovascular system, and lead to states of constant increased activity.
Biologically, the body has evolved to deal with imminent and concrete danger in the environment, rather than continuous stressors. Under normal conditions where chronic stress is low, exposure to a sudden threat activates the autonomic nervous system, i. These reactions in turn trigger activation of stress hormones, such as cortisol. One of the effects of these stress hormones is to increase glucose levels in the bloodstream in order to respond to the imminent threat, so that muscles can be activated for the flight or fight response.
Another effect of stress hormones is to supress the immune system, since processes such as healing and repair can wait until after the threat subsides. However, in someone with an anxiety disorder, where there is constant activation of these responses to everyday stressors, the stress hormone system loses its ability to control immune function, thus contributing to heightened systemic inflammation that increases risk for cardiovascular and even autoimmune disorders.
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Neuroscience and clinical research continues to investigate how anxiety disorders increase individual risk for developing physical health co-morbidities in hopes of identifying new treatments that may alleviate suffering from and prevent the development of these whole-body disorders. There are many highly effective treatment options available for anxiety and anxiety-related disorders. These treatments can be broadly categorized as: 1 Psychotherapy; 2 Medications; and 3 Complementary and Alternative Therapies.
Patients diagnosed with anxiety can benefit from one or a combination of these various therapies. Discussions of emerging therapies and types of care providers are also included. Counseling is a form of talk therapy in which a mental healthcare provider helps patients develop strategies and coping skills to address specific issues like stress management or interpersonal problems.
Counseling is generally designed to be a short-term therapy. There are many types of psychotherapies used to treat anxiety. Unlike counseling, psychotherapy is more long-term and targets a broader range of issues such as patterns of behavior. The patient's particular anxiety diagnosis and personal preference guides what therapies would be best suited to treat them. The ultimate goal with any type of psychotherapy, is to help the patient regulate their emotions, manage stress, understand patterns in behavior that affect their interpersonal relationships. CBT is a short-term treatment designed to help patients identify inaccurate and negative thinking in situations that cause anxiety like panic attacks.
CBT can be used in one-on-one therapy or in a group therapy session with people facing similar problems. CBT primarily focuses on the ongoing problems in a patient's life and helps them develop new ways of processing their feelings, thoughts and behaviors to develop more effective ways of coping with their life.
In patients who suffer from PTSD, CBT can take on a trauma-focused approach, where the goal is to process and reframe the traumatic experience that lead to the symptoms. On average, the length of treatment is around weekly one-hour sessions depending on the type and severity of symptoms.
The goal of this therapy is to help patients overcome the overwhelming disstress they experience when reminded of past traumas or in confronting their fears. With the guidance of a licensed therapist, the patient is carefully reintroduced to the trauma memories or reminders. The goal of this therapy is to help patients realize that trauma-related memories or phobias are no longer dangerous and do not need to be avoided.
This type of treatment usually lasts weekly sessions. EMDR is a psychotherapy that alleviates the distress and emotional disturbances that are elicited from the memories of traumatic events. It is primarily administered to treat PTSD, and is very similar to exposure therapy. This therapy helps patients to process the trauma so that they can heal. During the therapy, patients pay attention to a back and forth movement or sound while recounting their traumatic memories.
Patients continue these sessions until the memory becomes less distressing. EMDR sessions typically last minutes and are administered weekly for months, although many patients report experiencing a reduction of symptoms after a few sessions of EMDR. DBT uses a skills-based approach to help patients regulate their emotions. This treatment teaches patients how to develop skills for how to regulate their emotions, stress-management, mindfulness, and interpersonal effectiveness. It was developed to be employed in either one-on-one therapy sessions or group sessions.
This type of therapy is typically long-term and patients are usually in treatment for a year or more. ACT is a type of CBT that encourages patients to again in positive behaviors even in the presence of negative thoughts and behaviors. The goal is to improve daily functioning despire having the disorder. It is particularly useful for treatment-resistant Generalized Anxiety Disorder and Depression. The length of treatment varies depending on the severity of symptoms. Family Therapy is a type of group therapy that includes the patient's family to help them improve communication and develop better skills for solving conflicts.
This therapy is useful if the family is contributing to the patient's anxiety. During this short-term therapy, the patient's family learns how not to make the anxiety symptoms worse and to better understand the patient. Medications are sometimes used in conjunction with psychotherapy. The most commonly prescribed medications are generally safe, although some do have side effects to consider.
The specific type of medication administered to patients will be determined by their providers based on the patient's specific symptoms and other factors like general health.
Antidepressants are medications used to treat symptoms of depression but can also used to treat anxiety symptoms as well. In particular, selective serotonin reuptake inhibitors SSRIs and selective norepinephrine reuptake inhibitors SNRIs are the primary class of antidepressant used to treat anxiety. Buspirone is a drug indicated for the treatment of anxiety. This drug has high efficacy for Generalized Anxiety Disorder and is particularly effective at reducing the cognitive and interpersonal problems associated with anxiety. Unlike benzodiazepines, buspirone does not have a sedative effect or interact with alcohol.
Most importantly there is a very low risk of developing a dependence on buspirone. Its side effects are minimal but can include dizziness, nervousness, and headaches. BuSpar and Vanspar are brand names associated with buspirone. Benzodiazepines are sedatives indicated for anxiety, epilepsy, alcohol withdrawal and muscle spasms. Benzodiazepines demonstrate short-term effectiveness in the treatment of Generalized Anxiety Disorder and can help with sleep disturbances.
A doctor may prescribe these drugs for a limited period of time to relieve acute symptoms of anxiety. However, long-term use of these medications is discouraged because they have a strong sedative effect and can be habit forming. In addition, taking benzodiazepines while also engaging in psychotherapy such as PE can reduce the effectiveness of the exposuere therapy,. Some well-known brand names are Librium, Xanax, Valium, and Ativan. Beta Blockers, also known as beta-adrenergic blocking agents, work by blocking the neurotransmitter epinephrine adrenaline.
Blocking adrenaline slows down and reduces the force of heart muscle contraction resulting in decreased blood pressure. Beta blockers also increase the diameter of blood vessels resulting in increased blood flow. Historically, beta blockers have been prescribed to treat the somatic symptoms of anxiety heart rate and tremors but they are not very effective at treating the generalized anxiety, panic attacks or phobias.
Lopressor and Inderal are some of the brand names with which you might be familiar. Complementary and Alternative Therapies can be used in conjunction with conventional therapies to reduce the symptoms of anxiety. There is a growing interest in these types of alternative therapies, since they are non-invasive and can be useful to patients. They are typically not intended to replace conventional therapies but rather can be an adjunct therapy that can improve the overall quality of life of patients. A collection of activities focused in which an individual consciously produces the relaxation response in their body.
This response consists of slower breathing, resulting in lower blood pressure and overall feeling of well-being. These activities include: progressive relaxation, guided imagery, biofeedback, and self-hypnosis and deep-breathing exercises. A mind and body practice in which individuals are instructed to be mindful of thoughts, feelings and sensations in non-judgmental way.
It has been shown to be useful in reducing the symptoms of psychological stress in patients with anxiety. A mindfulness practice that combines meditation, physical postures, breathing exercises and a distinct philosophy. It has been shown to be useful in reducing some symptoms of anxiety and depression.
There are also a number of experimental treatments that have shown promise in treating the symptoms of anxiety. Here we include a brief description of a few of those, including brain stimulation neurostimulation , acupuncture, and psychoactive drugs marijuana and ecstasy. Anxiety is associated with abnormal patterns of activity in the brain. One way to treat anxiety is to directly target abnormal nerve cell activity. Neuromodulation or brain stimulation therapy is a non-invasive and painless therapy that stimulates the human brain.
In some recent clinical trials, patients that did not respond to more traditional forms of treatment i. There are two main types of neuromodulation:. A large brief current is passed through a wire coil that is placed on the front of the head which is near the areas that regulate mood. The transient current creates a magnetic field that produces an electric current in the brain and stimulates nerve cells in the targeted region. The current typically only affects brain regions that are 5 centimeters deep into the brain which allows doctors to selectively target which brain regions to treat.
Typical sessions lasts minutes and do not require anesthesia. Sessions are administered times a week for about 6 weeks. Although the procedure is painless, patients may experience a gentle tapping in the area of the head where the current is being administered. Neuromodulation has very few side effects but they may include headaches, slight tingling or discomfort in the area in which the coil is placed. Specialized coils that targetes deeper brain regions than rTMS.
A patient wears a cushioned helmet similar to the type of helmet worn during an fMRI. The procedue is administered for 20 minutes for weeks. Patients can resume their daily lives right after each treatment. Acupuncture is a treatment derived from traditional Chinese medicine. It consists of inserting very thin needles into the body in targeted areas.
To date there is very little evidence that acupuncture can significantly treat generalized anxiety, although there are currently ongoing research trials for PTSD. One study did find that acupuncture can reduce pre-operative anxiety. There has been recent interest in using psychoactive substances in conjunction with psychotherapy; the two that have received increased attention have been cannabis marijuana and methylenedioxymethamfetamine MDMA, known as ecstasy or molly.
These drugs are somewhat controversial, given that they also have psychoactive, i. However, with increasing legalization of marijuana it is important to address whether these substances could be used to alleviate clinical symptoms of anxiety. While there have been only a few randomized clinical trials for these drugs, certain forms of cannabis have demonstrated positive effects on anxiety. However, the plant form of cannabis has not shown great efficacy and has potential to worsen symptoms, so should be used with caution and only under supervision of a provider. There are a number of different types of licensed mental health providers that can treat the range of anxiety and other related disorders.