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Improving services for children and young people with challenging behaviour

Literature review, assessment tool, case studies | June 2008

This paper was prepared by the Institute of Public Care to support a project aimed at improving services for children and young people with severe challenging behaviour or conduct disorder in a local authority in the South of England. Drawing on available research and best practice literature, it provides guidance in areas including definition and diagnosis of behaviour disorders, prevalence and risk factors, and the relevance and effectiveness of a wide range of existing interventions. It concludes by offering recommendations on the systems that should be in place to ensure the best outcomes for at-risk children.

The paper begins by establishing definitions for different conduct disorders, before examining their prevalence across categories including age, gender, ethnicity and family structure, and within various specific populations, such as young offenders and substance misusers. Risk factors, particularly the social component, are discussed, as is the impact of challenging behaviour on public resources, families and communities, and the individual child’s future health.

Detailed discussion is provided on published criteria for diagnosis, and the limitations of existing guidance, and on assessment tools, including those geared to service-specific assessment, including school and youth justice settings. Current low levels of contact with specialist mental health services are noted, and barriers to access examined.

A large part of the paper is then dedicated to analysis of key interventions, their content, method of delivery, and relevance and likely effectiveness in the context of particular groups of children. Short illustrative case studies of existing local authority projects are provided, and interventions specific to girls are also discussed.

Finally, the paper stresses the importance of clear, multi-disciplinary care pathways, and sets out the national policy context that is driving their development.