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Effectiveness Of Camhs On Schoolchildren’s Ability To Handle Bereavement

Effectiveness Of Camhs On Schoolchildren’s Ability To Handle Bereavement

Abstract

This paper entails a literature review and research proposal aimed at covering the two and a half decades that the Child and Adolescent Mental Health Services has been functional in regard to childhood bereavement. They lay out how a research will be conducted to determine whether the CAMHS program has been effective in building the necessary physical, emotional, mental and social ability of children to cope with loss of their loved ones. From the literature review, the researcher created a proposal for a study aimed at establishing the needs and expectations of patients who participate in CAMHS programs after undergoing bereavement. The study is aimed at revealing whether the program is effective in meeting the emotional, psychosocial and physiological needs of the children created through the death of a loved family member. These objectives are based on the findings that there exist major gaps in communities and families in regard to giving attention to bereaved children. Since adults are equally affected by the death of a close family member and friend, they often concentrate on their own problems; forgetting that children do not fully understand the concepts of life and death and thus are predisposed to stress as a result of the eventuality. The first part of this proposal is an explanation of why the ability of children to cope with bereavement is an issue of major concern among stakeholders in the UK healthcare sector. The second part is a review of literature on the effectiveness of CAMHS in helping school going children cope with bereavement. The proposal is made up of the introduction, literature review and methods section. The introduction section explains the problem, objectives and research questions to be met. The literature review section provides critical analysis of the approaches and findings in existing literature. The studies analysed in this section are linked to the aims established in the introduction. The methods section is a description of how the researcher will approach data collection, analysis and inferencing. It is based on the information collected in the literature review and the needs of the current study.

Keywords: child, adolescent, mental health, childhood bereavement, Child and Adolescent Mental Health Services (CAMHS)

Chapter 1: Introduction

1.1 Background

Besides being of young age, schoolchildren have sophisticated behavioural systems. The most popular system that has been studied over time extra-uterine maturity where a child becomes attached to their caretakers for a long period. Therefore, a separation from caregiver whom the child has developed emotional attachment is likely to attract psychological complications that limit their healthy mental growth (Arthur and Kemme, 1964). Metel and Barnes (2011), mentions that although interventions by peer groups, parents, and or teachers can help affected children to developing coping mechanisms, their approaches tend to become inconsistent. In essence, it is not conclusive on whether all the involved children would benefit from that type of support and care. As a result, the utilisation of professional bodies professional bodies such as CAMHS to handle bereavement in school children has become an important point of consideration in schools as well as homes (Osterweis, Solomon and Green, 1984).

Nonetheless, efficient utilisation of CAMHS is insignificant among the involved stakeholders of the process.  NHS and other institutions involved in the implementation of programs under CAMHS have limitations in funding, number of personnel and equipment; meaning that adjustments must be made to ensure that the services provided within this scarcity are effective (Macpherson, 2018). One of the leading advantages of CAMHS is that since its inception, NHS has created and implemented variety of programs that provide counselling lessons that can be effectively utilised in promoting children health especially when faced with bereavement at a young age (Rolls and Payne, 2003). Most of the previous studies relating to CAMHS, have focused on the monetary allocations and the number of beneficiaries covered by the programs rather than the impact of their interventions on the different categories people facing health problems. As a result, this study is based on an evaluation of the effective ways through which CAMHS related interventions can be applied with children who experience grief due to the loss of a loved one. This way, it is possible to determine the type of impact CAMHS would have on mental development of young schoolchildren.

1.2 Statement of Problem

To the best of the researcher’s knowledge, there is virtually no information relating to the impacts of CAMHS on helping schoolchildren to handle bereavement in their young age. Most of the studies evaluating the role of CAMHS are associated with evaluating the role of parents and teachers in ensuring that children receive the best care after the occurrence of grief. There is need for studies that examine whether the nursing roles and intervention in the programs are effective towards enhancing the ability of the bereaved children to adapt and effectively meet their emotional, psychosocial and physiological needs after losing their close family members. However, there is no sufficient data and information that shows whether these changes are based on the outcomes or simply necessitated by the growing capabilities of the system. CAMHS programs have undergone many changes over the years (Pedrini et al., 2015). The best way to determine whether the programs are effective is to do a follow up on the beneficiaries and establish how they ended up after some time. Many healthcare goals are set at the macro level; where stakeholders, who are decision-makers, try to establish the needs of the population and the best way to meet them. One of the key challenges with these models is that these needs are not always universal. Every patient has their own expectations and gaps that they hope to fill by the end of the treatment program.

1.3 General Objective

Overall, the study is aimed at evaluating the roles of CAMHS in the society and the mechanism through which they be utilised to support school children who are undergoing bereavement. This evaluation will assist in determining the effects of CAMHS as well as the best approaches that would be utilised in supporting children to have the required support with regards to bereavement.

1.4 Objectives

  • To establish whether there exist essential nursing competencies to meet the needs and expectations of patients who enrol in CAMHS programs after loss of close family members.
  • To determine whether nursing staff hired under CAMHS has played its role in establishing the psychosocial, emotional and physiological needs of children who suffer bereavement.
  • To determine the needs that CAMHS interventions meet among bereaved children and their families.
  • What are the expectations on nurses by bereaved children who enrol for mental health intervention programs under CAMHS?
  • How does CAMHS programs affect children in regard to their adaptation to changes caused by the loss of a family member?

1.5 Research Questions

1.6 Justification of Research

Families that lose their members have difficulties accepting and adapting to the changes. Most of the time, children count on older family members for support. However, challenges emerge in these scenarios because every person is trying to come to terms with the loss. However, it is important to note that children are affected more by the death of a parent or sibling because some of them are yet to fully understand the concept of losing a loved one and the fact that it may have a lasting effect on their lives. NHS created CAMHS with the aim of mitigating on the knowledge gaps and mental health support that children get in the event of loss of a loved one. There is need for research that follows up on the beneficiaries of the programs under CAMHS with the aim of establishing whether they met the needs and expectations of the beneficiaries. This research is aimed at filling the existing gaps on the effectiveness of nursing interventions on children’s mental healthcare. The findings and inferences from this study can be used in modifying future programs to ensure that they respond to the needs and expectations of the beneficiaries and their families.

1.7 Scope of the Study

This study will focus on assessing opinions of schoolchildren towards the use of mental health interventions under CAMHS in helping them to deal with bereavement. NHS’ CAMHS covers children and adolescents in England and the Republic of Ireland. As a result, the assessed population in this study is expected to be living from schooling institutions in the country. The research will look at the effect of the program on children who were beneficiaries when they got bereaved while in school. However, there is need for a research to compare with others systems with the aim of determining whether there are any desirable features that can be borrowed or unwanted ones that should be discarded.

Chapter 2: Literature Review

2.1 Introduction

Lowton and Higginson (2003), mentions that there is need to focus on the most efficient mechanisms that assist in routinely supporting bereaved children. This aspect is based on the fact that the status can trigger significant negative impacts in a child’s behaviour ranging from experiencing nightmares and the alteration of sleeping patterns for the young person. In some cases, bereavement in young children has been associated with causing a child to lack energy and become lethargic (Shaw, 2003). This section provides an empirical review of previous studies on the mechanisms used to cope with bereavement at young age. The section also evaluates the role of CAMHS to illustrate how their functionalities relate to the need for supporting school children going through bereavement.

Some children get bereaved before they learn about human existence and discover their physical and mental abilities as well as limitations; complicating the process of helping them understand, accept and heal from the process (Macpherson, 2018). In view of this experience, developed services that aims to support their emotional and mental ability to cope with loss of close family members (Magnus et al., 2018). This section is an analysis of the existing literature with the aim of establishing how childhood bereavement affects children and adolescents, identifying strategies employed under NHS Child and Adolescent Mental Health Services programmes across Wales and England, and the effectiveness of these approaches in ensuring that bereaved young people recover from the event and lead normal lives (Rolls, 2019).

2.2 Theoretical Framework

Despite their young age, school children constitute of sophisticated behavioural systems that would drastically affect their health when they are not properly managed. One of the behavioural systems that has been extensively studied with regards to young children is known as the mutual attachment character. In this case, a child is expected to have a change in character whenever they become separated from their caregivers. In essence, for normal development to take place in a child’s life in terms of social, psychosexual, and emotional standards, there needs to be consistent supplication of warmth, security, affection, and continuous provision of care from the surrounding guardians (Arthur and Kemme, 1964).

Nonetheless, bereavement is one of the major limitation to these developmental needs in school children. According to Abdelnoor and Hollins (2004), learning institutions in have inconsistency in supporting and understanding young children suffering from this status. As a result, the child’s performance in school as well as in their growth stages become negatively affected by the set conditions. Suggests that educational systems tend to provide minimal support to the children suffering from grief due to the levels of diversity found in the institutions. Basically, children are attributed to having unique approaches to managing the loss of loved ones.

The kind of child’s reaction to bereavement is usually based on the cause and level of exposure to the death of a loved one. Therefore, it is due to this condition that the study aims at evaluating the most effective mechanisms that would assist in supporting the young children that experience bereavement. The use of institutions that specialise in quality developmental approaches in young children is placed to be the most effective mechanism for assisting young children from experiencing negative outcomes with regards to loss (Dowdney, 2000).

Given that psychological results for children who have experienced loss are similar (Mannarino and Cohen, 2011), it is therefore possible to manage the way a children would react to an intervention. Moreover, this argument further indicates that the use of specialised institutions that utilise customised models in supporting children suffering from the conditions would likely provide more positive impacts as compared to relying on schooling institutions to prevent negative outcomes for the young children experiencing loss of a loved one (KRANZLER et al., 1990). In essence, children who experience such losses tend to behave better whenever they are provided with a platform where they can share their grieving emotions with an expert.   

With regards to this study, CAMHS is depicted as an efficient body that would meaningfully assist school children in positively dealing with bereavement. The main reason for considering this body in the study is because it concentrates on the psychological needs of the young people. The body constitutes of variety of professionals that range from psychologists, social workers, nurses, and therapist who have the capacity to deal with any type of negative impacts that arise from deaths (Hay et al., 2015). The nature of this study of also effective because there has been no research conducted on the mechanisms that could be utilised by CAMHS in managing the emotional behaviours of school children that suffer bereavement.

2.3 The Role of CAMHS in Supporting Young Children

The Children Adolescent and Mental Health Service has a main responsibility of evaluating and treating young people who are experiencing emotional, character, and mental health challenges. Over the years, the institutions has only been effective at working with the children that get directly registered with them for their services (Barratt, 2012). However, very minimal studies illustrate the cooperation of CAMHS with schooling institutions to improve the psychological health of young children. In most cases, children who suffer from loss of a loved one are expected to cope with their circumstance and eventually overgrow the emotional turmoil. A study that was conducted by Pedrini et al. (2015), showed that very minimal children are provided with the appropriate psychological support whenever a death of a close person takes place. The outcomes of the study showed that the amount of people who had seek help with their mental health were more collaborative towards seeking assistance from CAMHS as compared to the one had never utilised the service.

This outcome further illustrate that a significant amount of people are not aware of the services that are provided by the CAMHS body. This study also aims at illustrating the levels of awareness that important institutions such as schools should have towards the need for cooperating with the CAMHS in establishing quality psychological health in the schools through the utilisation of this professional body. Basically, there is need to improve the mental health conditions of schoolchildren. In the past, there has been arising dilemmas and ambiguities towards the provision of bereavement services for the UK children. The main difficult that has arisen over the years with regards to the issue is that the many intervention providers tend to generalise their clients’ conditions (Rolls and Payne, 2007). As a result, it becomes a challenge to properly address the specific factors that may be affecting individualised cases. It is critical to note that the type of bereavement being addressed in this case does not only relate to losing a relative. It also involves a child grieving due to the loss of a close companion (Bugge et al., 2014).

2.4 Impact of Bereavement to Young School Children

The need to address the effective ways of managing impact of bereavement among young children is because they have minimal understanding at this age on how to manage loss and overcome loss of a close person. As a result, they tend to become susceptible to stress and altered behaviours as a result of the situation. It is due to such scenarios that the children require fast professional attendance to their issue so that they may respond to the critical issues that may affect their growth.

Kristensen, Weisaeth and Heir (2012), mentions that there certain personal developmental aspects that should evaluated in children especially when they experience grief due to the loss of a loved one. This type of intervention is best offered by professionals as opposed to parents or teachers. On the other hand, Akerman and Statham (2014), illustrates that there is need to have unique approaches in the manner which children counselling is approached with regards to bereavement. It is also critical to evaluate the efficiency levels of the psychological services provided in the short term to children experiencing mental issues relating to the loss of a loved one. Some of the important areas to address in this case their ability to meet personal needs as well as improving the ability to complete and participate in school activities (Akerman and Statham, 2011). Basically, the study illustrates that the involved stakeholders should not be concerned about the involved expenses in a child’s treatment but the patient centred care that would assist in in improving the child’s ability to cope with the apparent losses.

Most of the previous studies attribute that counselling should not be generalised the mechanism in helping school children to cope with the loss of loved ones at young age. Nonetheless, very few have provided specific model that would assist in ensuring that a psychological intervention is customised to a child based on the type of grief a child may be experiencing after the loss. A study done by Coombs et al. (2017), establishes that professionals have the ability to customise counselling to fit the needs of the child and their case of grief. The outcomes illustrate that it would be critical to have a professional body that helps with managing the grief cases that arise from loss of a loved especially among young children.

Akerman and Statham (2011) conducted a study aimed at determining the educational and psychological outcomes among children who lose a member of the nuclear family. The researchers also sought to determine the effectiveness of psychological services offered as short-term solutions to mental issues. The main factors applied in determining the wellbeing of the affected parties were the ability of children to meet their needs and complete the work allocated to them in school. The findings of this research were similar to those in Rolls (2007) study that sought to establish the dilemmas and ambiguities in provision of UK childhood bereavement services.

2.5 Care Models relating to Childhood Bereavement

McDermott and Cobham (2014), illustrates some of the effective mechanisms that could be utilised in the management of the mental health among young children. The researcher provides a description of a stepped care model that works effectively in post-disaster control especially with regards to mental health status of young children and adolescents. The study further depicts that most of the young children are likely to experience mental impairments especially after the occurrence of death of a close family member. The main advantage of this model is that it assists experts to customize their solution so that it fits the exact need facing the child. In essence, the utilisation of this model would assist the child to have the best service whilst they undergo the counselling sessions with the related experts. On the other hand, this model is effective as it assist it relates to the traditional approach that was utilised elaborated by CAMHS. The model allows the involved clients to share their exact feelings with relation to the emotional issues that they may be experiencing due to the occurrence of a loss. During the counselling process, the experts have an opportunity to interact with the child and understand the fears that may alter they current health status.

In this case, the incorporation of CAMHS in learning institutions would significantly promote the elimination of the emotional difficulties that do not only limit a child from studying, but also lead towards other developmental challenges that limit their ability to have the required levels of mental health in classroom.

2.6 Study Approaches

The main study approach that will be utilised in the research involves the utilisation of questionnaires towards the related parties, where in this case the consideration will be teachers as well as guardians who have children in learning institutions. The main aim is to assess how the processes would impact the growth and development of a child once they are exposed to the CAMHS treatment. The utilised data collection method will be as follows:

 

The constructed question will address the ability for the schools to incorporate CAMHS professional in the counselling of young children who may be facing the psychological issues related to bereavement. As observed in the stepwise approach the CAMHS model will assist in ensuring the there is a goal achieved from each of the issues on the left that relate to the required counselling. For instance, the CAMHS expert would evaluate control over future with regards to an incident for the purpose of achieving optimism in the child. As mentioned in the study, previous literature has illustrated that the characteristics that surround the bereavement cases especially among the young the children.

Care models and Child and Adolescent Mental Health Services and Childhood Bereavement

McDermott and Cobhan (2014) focused on establishing the effectiveness of stepped-care model in post-disaster management of mental health among children and adolescents. The researchers noted that this model is traditionally applied under CAMHS in cases where there are large numbers of children requiring mental health interventions. According to the study, many children undergo near-permanent functional impairment because of unmet needs that result from disasters. One of the key effects of disasters is the loss of close family members and people within the community where the child lives. The surge in clinical demand for interventions often overwhelms the system, which results in the need for stakeholders to become innovative in regard to how the limited resources and personnel can be used to serve a large number of people. This research entailed application of the narrative review approach. Under this approach, they examined whether the model by CAMHS has any advantages in relation to public health solutions and community recovery. The findings of the study showed that the stepped-care model is appropriate for cases where there is a sudden surge in the demand for mental care among young people and adolescents. Findings in a study conducted by Kransler et al. (1990) seem to contradict McDermott and Cobhan’s (2014) findings on stepped-care model. Kransler et al. (1990) noted that relying on patient-reported symptoms was not a sustainable approach to management of childhood bereavement. His findings showed that adolescents most affected by loss of close relatives, especially parents, were less likely to talk about their feelings and experiences. Functional impairment has a major negative impact on the social skills of the affected children. Frances and Job (2004) examined the effectiveness of the use of pastoral support where guidance, information and advice are provided to the entire predisposed population. This introduces the aspect of the role of nurses in patient education. In applying the proposal by Frances and Job, nurses working under CAMHS in schools will be mandated to provide information about symptoms of mental health conditions that emanate from childhood bereavement. The findings by the studies by Kransler and Frances show that patient education by nurses is the key to determining whether there is a surge in the number of cases and severity of mental conditions that result from childhood bereavement.

Gerralda and Slaveska-Hollis (2016) conducted a study aimed at describing the clinical activity of community and general CAMHS practices within the mainstream healthcare system. The researchers collected information from patients who had used the services within two years before the study. A total of 800 patients, with a mean age of around 12 years, were involved in the research. The findings showed that the comorbidity of physical health conditions and traumatic experiences such as bereavement had a long-term effect on the wellbeing of the affected children and adolescents. Wolfe et al. (2016) conducted an analysis of child health systems in the UK with the aim of determining their availability, accessibility, efficacy, and effectiveness of treatment. Under children palliative care, the authors noted that about 32 people in a population of 10,000 individuals under the age of 19 have a life-threatening mental health condition. Bereavement at early life stages was pointed out as a cause of almost 30% of these cases. According to the researchers, there have been intensive efforts to balance interventions on mental management between clinical practice and holistic family care. These two studies were aimed at revealing the vulnerability of children to mental health conditions. In both cases, researchers collected data on individuals who were actively undergoing mental health conditions. The findings revealed how holistic care and family care interact to influence the outcome of interventions on the effect of bereavement on the mental health of children and adolescents. The findings show growing preference for clinical intervention and a departure from application of social remedies. Renzenbrink (2011), noted that preference for clinical interventions can be attributed to sustainable nursing practice. In the UK, the financial aspect of sustainability is covered by the government through NHS. It is, therefore, the responsibility of nurses and other healthcare practitioners to account for the social and environmental aspects. Cassidy and Jellinek (1998), research led to the observation that education institutions and surviving relatives have immense potential towards supporting nurses working under CAMHS to ensure that these two factors are aligned with the patient’s recovery journey.

Scheid (2001), published a mental health handbook for schools that was aimed at guiding mental health providers within institutions on various issues that cause major problems for the students. The text extensively covers bereavement as one of the factors that result in fatal cases of mental health conditions among children. The researcher notes that one of the key limitations associated with this factor is that it first drew the attention of mental health practitioners about 50 years ago, which means that research and practice protocol satisfactorily covers the way how bereavement manifests in children and results in mental health problems. The researcher outlined the manifestation of negative effects of bereavement on mental wellbeing of the child as withdrawal, panic, anxiety, guilt, denial, sleep disturbances, bed wetting, eating disorders and an attempt to replace the deceased. The manual effectively describes the manifestation of these conditions with case studies from the author’s clinical practice experiences. The findings of this study resonate with observations by Burns et al. (2020) based on data collected in the US. Both studies show that there is a need for more nursing interventions that are based on appreciation for versatility in how the symptoms manifest in the lives of different children. This means that nursing staff implementing childhood bereavement and mental health interventions in the two countries should appreciate the position of patient-centred treatment through close collaboration with bereaved students, their surviving relatives, and their teachers. Siegel and Gorey’s (1998) book makes recommendations that include the need to provide crucial information that can help the patients in diagnosing their problems or simply appreciating the potential of interventions to enhance their well-being.

Access to Child and Adolescent Mental Health Services and Childhood Bereavement

Pedrini et al. (2015) sought to understand the pathways through which children and adolescents seek mental health consultations for the first time. The researchers noted that the study was motivated by the low number of people seeking mental health assistance from the mainstream healthcare system compared to individuals who actually needed it. The researcher found out that people who had utilised mental health assistance before in their lives are more likely to seek these interventions again in case of a problem such as bereavement compared to those who have never had a mental health practitioner appointment.

The research was informed by the fact that this transition was an indicator of both effectiveness of mental health services offered under CAMHS and the ability of the population to utilise the available mental health assistance. The researcher tracked 62 individuals who had utilised CAMHS during their childhood with test results showing that all the patients moved to adult mental health services. The findings showed that about 33% of the respondents were referred by their childhood and adolescent psychiatrists and counsellors while the rest felt that there was need to continue seeing mental health practitioners to manage their conditions. It is important to note that mental health issues span the lifetime of many patients.

2.7 Summary

The main research gap identified in the study is that most of the mechanisms used to deal with counselling for young children are mainly generalised. This study aims to evaluate a mechanism that would assist school children to deal with bereavement through individualised approaches. The best approach analysed in the study is the use of CAMHS model. Moreover, the study also determines the role of teachers and close relatives to children in dealing with the bereavement cases that affect the healthy development of the young children. Overall, the establishment of a effective method especially through the use of the CAMHS model, is main objective in the paper. Due to the nature of the paper, the considered model for data collection will be the use of questionnaires as well as the survey of previous literature. This way, the researcher has the ability to illustrate the importance of integrating CAMHS to learning institutions for the purpose of helping young children had stable mental health.

Abdelnoor and Hollins (2004b), used a survey based on GCSE exam results on children who lost immediate family members to determine whether bereavement had a long-term effect on the performance of children. The research involved 97 participants who had lost a sibling or a parent in the years preceding their GCSE examination. The findings of the research showed that bereaved participants attained lower marks than the general population of candidates. Such studies are instrumental since they introduce quantitative measures that are more objective and comparable. The subjective answers given by patients in most of the other studies described above can be biased on the basis of the memory of the child. A related study was conducted by Draper and Hancock (2011) where quantitative reports on childhood delinquency were utilised to determine the vulnerability and resilience of children who faced parental bereavement.

Most of the studies above merely compare bereavement with certain impacts. By introducing the aspect of vulnerability, this research provides tools through which mental health practitioners can trace changes and introduce factors that can intervene or enhance the child’s attributes and the environment depending on their effect on their ability to manage bereavement. 

How the Child’s Social Environment Affects Bereavement and Their Experience with Mental Health Services

Some of the widely utilised alternatives to mental health interventions fall under community systems. Wright (2016) conducted a research aimed at establishing the effectiveness of a community-based model that has been recently adopted under CAMHS. The researcher noted that the new model was aimed at introducing voluntary and statutory agencies with the target of integrating collaboration to reinforce social, emotional and psychosocial functioning that can help meet the affected child’s needs. In a narrative overview by Lytje and Dyregrov (2019), it was observed that communities are becoming concerned about their sustainability in relation to how children handle bereavement. In the contemporary world, the traditional community has been replaced with institutions within which many people spend most of their time. This leads scholars into studying the role of schools in helping children manage mental health issues because they spend a significant percentage of their active day within these institutions. Another conducted research aimed at determining the role of the primary school practitioner in promoting the mental health of the child. The researcher argued that systems put in place by the NHS should only supplement the efforts of these individuals since they are in contact with the child most of the time and can easily notice the impact of events such as bereavement on physical and mental health. The researcher collected data from two primary schools with the aim of determining how primary school practitioners perceive, support, and promote mental health among students in their schools. The findings showed that these practitioners hold crucial information that can be utilised to make These studies show that nurses should start giving more attention to schools as tools that can be harnessed to provide psychosocial support to children recovering from bereavement under CAMHS.

Ayyash-Abdo (2001), research was aimed at establishing the risk of development of behavioural and psychosocial dysfunctions among children who are bereaved. The researchers also sought to determine the ease with which children in these circumstances express their thoughts and feelings to both professionals and their peers. The researcher found out that many problems that children face during bereavement can be prevented if adult members of their families gave considerable attention to the young ones. Brewer and Sparkes (2011), noted that support by surviving parents and other relatives must be supplemented with professional help to mitigate the effect of bereavement on the mental well-being of the children. However, many obstacles are faced in transitioning or linking family support with professional interventions. The findings in these two studies bring out the role of nurses that entails linking family interventions and strengths with evidence-based clinical solutions. Markusen and Fulton, (1971), noted that the disconnection between the evidence at family level and professional approaches emanates from barriers to research. Research that focuses on special groups, especially minors, presents many logistical and ethical challenges.

The literature analysed above shows that through the two and a half decades the Child and Adolescent Mental Health Services have been operational, the NHS through the National Institute for Health Research have faced many challenges in identifying reliable approaches to various mental health issues affecting young people. While children in schools are predisposed to serious mental health outcomes in the event of bereavement, there have been challenges in the process of coming up with a holistic system that incorporates both the national and institutional support towards upholding the wellbeing of the affected child. While the National Institute for Health Research tries to find out better ways of approaching the problem, there is need to investigate the immense potential that lies with what has already been implemented in the past.

 

 

 

Chapter 3: Methodology

3.1 Introduction

This section provides approaches used analyse the impacts of using CAMHS to counsel schoolchildren who undergoing bereavement. The data gathered from the chosen participants in the section will be utilised in illustrating the some of the effects of utilising CAMHS in helping schoolchildren to handle bereavement at an early age.

3.2 Research Design

This study began with identification of the problem through an analysis of literature in the section above. This research will entail the survey method at the data collection phase. This approach entails creation of questions that participants have to respond to ensure that the researcher receives maximum insights on the issue being covered. The researcher will break down the study questions, aims and hypothesis into separate inquiries that are meant to solicit information from participants on their experiences and perspectives regarding the effectiveness of CAMHS in helping schoolchildren cope with bereavement. The designing of the survey tool will be followed by selection of participants; who are individuals who have benefitted from the CAMHS program in the past. The process of collecting data will entail sending out of questionnaires and following up on the chosen participants to ensure that their response rate is high.

3.3 Population

The population under study consists of former and existing beneficiaries of mental health interventions for bereavement under the NHS’ CAMHS programmes found in learning institutions.  It is important to note that for a person to qualify as a respondent in this research, they must have been bereaved during their schooling time and should have been admitted into CAMHS as a result of their loss of a loved one. However, the current age of the participants will not be considered as part of the inclusion criterion since the program is about 25 years old and beneficiaries are expected to be as old as 39. The minimum age of participants will be limited at 13 years to ensure that those who participate can understand the prompts within the questionnaire and provide appropriate answers.

3.4 Sampling Techniques

The researcher will utilise input from any person who meets the criteria for selection and are willing to participate in the study. Convenience sampling is commonly used where there is no necessity for a randomised sample. The researcher will also employ aspects of snowball sampling. This is where one respondent leads the researcher to another. Snowballing is convenient for this research because CAMHS interventions involve group therapy where the participants are put in groups and helped to figure out issues facing them jointly. The assumption made in the application of snowballing is that the participants have maintained contact with some of the people who they met in these groups. Therefore, they can link the researcher with other potential participants. Another viable option for the researcher is to use data from NHS on individuals who have participated in the CAMHS programs. The people can be traced through contacts within the institutions that they attended. The researcher will get a list of at least 25 contacts with the expectation that the response rate will surpass the 60% mark.

3.5 Data Collection Procedure

Collection of primary data is often a complex process because the researcher must get in touch with the respondents and have them commit to participate. In the current research, questionnaires will be used to collect data from the participants. The researcher utilised the online platforms to provide distribute the survey questions to all the chosen participants. This way, it was possible to save on the resources that would make the process expensive.

 Although interviews would have been a better tool for collection of more detailed data, the fact that the respondents will be spread over a large geographical region necessitates that questionnaires be utilised. One of the key advantages with a questionnaire is that it mitigates on the time and distance gaps between the researcher and the participants. Questionnaires can be mailed to the respondents who will then identify the appropriate time to fill and return them within the window allowed by the researcher. This research will entail leveraging on technology to minimise the cost of collecting data and induce convenience for both the collector and the respondents. The questionnaire will be typed into a google document and the link sent to the recruited participants. The researcher can monitor the process of filling the questionnaires and take the responses for analysis when convenient.

3.6 Data Analysis

The researcher will use the empowerment scale to measure the effects of the interventions of the patients. The scale was developed by Rogers et al. in 1997 with the aim of measuring empowerment among consumers of mental health services. The scale uses data collected directly from the patient with the aim of establishing whether the treatment program responded to their needs and inner fears that made them eligible for the intervention. The participants will fill the questionnaires in qualitative form. The empowerment scale is usually used to measure the outcomes of a mental health intervention by converting qualitative responses into quantitative forms for comparison purposes.

3.6 Ethical Issues

Any nursing involving minors must adhere to the existing legal and ethical standards to ensure that the interest and wellbeing of the children are guaranteed. NHS prohibits researchers from basing their data collection process on consent given by children under the age of 16 (Health Research Authority, 2017). This means that the researcher will have to obtain consent from people with parental responsibility over the participants, legal representatives in cases where the parent or guardian cannot be reached or professional legal representatives such as doctors who have been treating the child in case the other two above are not available. Some of the conditions that must be met when obtaining consent for all the participants in this study include a clear understanding that one is being asked for consent, a clear explanation of the risks, objectives and inconveniences of the research and information about right to withdraw. After fulfilling these requirements, the researcher will present evidence to the relevant committee within the department for analysis and permission before they can proceed with data collection.

3.7 Ethics of Study

All the participants that were considered in the study were first made aware of the requirements of the study. Given that the study is dependent upon a qualitative approach in data collection and analysis, they were required to provide responses to the provided questions constructed for the survey. Each participant was required to provide responses to each of the questions evaluating the study. Nonetheless, given the data collection was optional, they were made aware that they could skip or leave the survey at any given time.

Before participating the survey, each participant had to agree to the terms and conditions provided in the consent form that was provided together with the survey. Nonetheless, it is important to note that the each survey was set to take place for a maximum of fifteen minutes. The questionnaires presented in the survey were open ended to allow the participant to provide the best opinion in the subject.

3.7 Limitations of Study

Based on the nature of the study and the current conditions global condition of COVID19, it was difficult to choose a large sample population that would assist in strengthening the outputs of the study. On the other hand, given that the participants had the option either skipping or leaving the interview, the gathered outcomes may have not completely supported the current study. Also, given that the work is based on a qualitative study, it was also important to gather data secondary sources for the purpose of properly supporting the aims and objectives of the study.   

3.7 Summary

This research will involve collection of qualitative data from the participants. Some of the data will be converted into quantitative form using the empowerment scale to determine how the CAMHS mental health interventions impacted the participants.

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