'By listening hard' developing a service-user feedback system for adopted and fostered children in receipt of mental health services.

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'By listening hard' developing a service-user feedback system for adopted and fostered children in receipt of mental health services.

Introduction

The need to understand children's perceptions of services is increasingly emphasised by professional bodies such as the British Psychological Society (Wolpert et al, 2001) and the Department of Health (2002, 2004a, b), and is enshrined in UK and international law (Children Act 1989; United Nations Convention on the Rights of the Child 1989). The importance of listening to children is especially relevant for those who are adopted and looked after, with the latter highlighted as a 'frequently excluded group' (Department of Health, 2004a; Department for Education and Skills, 2007). The difficulties of obtaining views on mental health services are particularly pertinent for these children, given their increased likelihood of experiencing mental health difficulties (Mental Health Foundation, 2002). However, children are not always asked for their views by those making decisions (Aubrey and Dahl, 2006) and are rarely represented in service evaluations (Cavet and Sloper, 2004).

Methods to elicit children's views on mental health services are a developing practice area. One recent review identified 13 rigorous studies and the key themes expressed by the young people about services as relevant to therapy (Davies and Wright, 2008). These included the personal qualities, skills and attitudes of staff; therapy process where non-verbal interactions were consistently perceived to be particularly helpful; the importance of practical arrangements and physical surroundings; meaningful involvement in treatment decisions; and the social context. Only two of these studies specifically elicited the views of children with a trauma history or disrupted attachment. Emergent themes in this section were ambivalence towards professional intervention and talking in therapy, and an appreciation of non-verbal communication (Davies and Wright, 2008).

There is a tendency for adolescents to be over-represented in studies eliciting children's views of services, probably because younger children are less articulate and reflective. This is likely to be confounded by trauma history which affects socio-emotional development, including reflective capacity and willingness to trust adults (Golding et al, 2006). An attempted solution is to rely on parents' reports of children's perceptions, although the assumption that parents accurately represent their children's views of mental health services has not been consistently supported. Neither does the accuracy with which foster or adoptive parents are able to do ...

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