Elevated teenage conception risk amongst looked after children; a national audit

Craine, Noel; Midgley, Corinna; Zou, Li‐Ping; Evans, Helen; Whitaker, Rhiannon; Lyons, Malcolm A.

doi:10.1016/j.puhe.2014.05.008

Cited by 28 publications

(39 citation statements)

References 3 publications

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“…Like participants in Chase and colleagues' (2006) UK study, the young people experienced feelings of rejection and abandonment that they believed had repercussions into their adult lives. The participants conveyed very clearly stories of poor intimate relationships and sexual health that are consistent with other studies of young people in care (Craine, et al, 2014;Matta Oshima, Carter Narendorf and McMillen, 2013). Their stories also evidence the relationship between disconnectedness from family and increased risk of sexual health problems reported in the literature (Gordon-Simons, Harbin-Burt and Blyskal-Tambling, 2013;Wight and Fullerton, 2013).…”

Section: Discussionsupporting

confidence: 82%

Young people’s views on the impact of care experiences on their ability to form positive intimate relationships

Hyde

Fullerton

Dunne

et al. 2017

Adoption & Fostering

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Existing literature tells us that one of the factors important to the sexual health and intimate relationships of adolescents is the extent to which teenagers feel emotionally connected and supported by their families. In this article, we analyse the experiences of disconnectedness from their families and transience during childhood reported by a sample of young adults formerly in care, and the influence they believed this had on their sense of security and later intimate relationships. The sample comprised 19 young adults aged 18–22 years who were interviewed about experiences associated both directly and indirectly with sexual health, during which childhood experiences of transience emerged as an issue. Findings indicated that disconnectedness and transience were experienced as distressing for participants, generating feelings of rejection and compromising their sense of trust in others. Feelings of insecurity and mistrust were reported by some to influence their adult relationships. We conclude that while not always possible, social care professionals should endeavour to support enduring relationships with trusted adults and continuity of carer among young people in care.

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Section: Discussionsupporting

confidence: 82%

Young people’s views on the impact of care experiences on their ability to form positive intimate relationships

Hyde

Fullerton

Dunne

et al. 2017

Adoption & Fostering

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“…There is anecdotal and some audit evidence to suggest that children who leave the care system are particularly vulnerable to multiple early conceptions; however, we found no studies which examined this group in detail so it was impossible for us to assess their excess risk. 177 There is very little evidence directly addressing repeat conceptions in young women who have substance abuse problems. Young women may feel pressured in two ways which influence their social and sexual behaviours: (1) within the family structure and (2) by peers.…”

Section: Gaps In the Evidencementioning

confidence: 99%

Intervention Now to Eliminate Repeat Unintended Pregnancy in Teenagers (INTERUPT): a systematic review of intervention effectiveness and cost-effectiveness, and qualitative and realist synthesis of implementation factors and user engagement

Whitaker¹,

Hendry

Aslam

et al. 2016

Health Technol Assess

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BackgroundThe UK has one of the highest rates of teenage pregnancies in Western Europe. One-fifth of these are repeat pregnancies. Unintended conceptions can cause substantial emotional, psychological and educational harm to teenagers, often with enduring implications for life chances. Babies of teenage mothers have increased mortality and are at a significantly increased risk of poverty, educational underachievement and unemployment later in life, with associated costs to society. It is important to identify effective, cost-effective and acceptable interventions.ObjectivesTo identify who is at the greatest risk of repeat unintended pregnancies; which interventions are effective and cost-effective; and what the barriers to and facilitators of the uptake of these interventions are.Data sourcesWe conducted a multistreamed, mixed-methods systematic review informed by service user and provider consultation to examine worldwide peer-reviewed evidence and UK-generated grey literature to find and evaluate interventions to reduce repeat unintended teenage pregnancies. We searched the following electronic databases: MEDLINE and MEDLINE In-Process & Other Non-Indexed Citations, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, The Cochrane Library (Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects and the Health Technology Assessment Database), EMBASE (Excerpta Medicadatabase), British Nursing Index, Educational Resources Information Center, Sociological Abstracts, Applied Social Sciences Index and Abstracts, BiblioMap (the Evidence for Policy and Practice Information and Co-ordinating Centre register of health promotion and public health research), Social Sciences Citation Index (supported by Web of Knowledge), Research Papers in Economics, EconLit (American Economic Association’s electronic bibliography), OpenGrey, Scopus, Scirus, Social Care Online, National Research Register, National Institute for Health Research Clinical Research Network Portfolio and Index to THESES. Searches were conducted in May 2013 and updated in June 2014. In addition, we conducted a systematic search of Google (Google Inc., Mountain View, CA, USA) in January 2014. Database searches were guided by an advisory group of stakeholders.Review methodsTo address the topic’s complexities, we used a structured, innovative and iterative approach combining methods tailored to each evidence stream. Quantitative data (effectiveness, cost-effectiveness, risk factors and effect modifiers) were synthesised with reference to Cochrane guidelines for evaluating evidence on public health interventions. Qualitative evidence addressing facilitators of and barriers to the uptake of interventions, experience and acceptability of interventions was synthesised thematically. We applied the principles of realist synthesis to uncover theories and mechanisms underpinning interventions (what works, for whom and in what context). Finally, we conducted an overarching narrative of synthesis of evidence and gathered service user feedback.ResultsWe identified 8664 documents initially, and 816 in repeat searches. We filtered these to 12 randomised controlled trials (RCTs), four quasi-RCTs, 10 qualitative studies and 53 other quantitative studies published between 1996 and 2012. None of the RCTs was based in the UK. The RCTs evaluated an emergency contraception programme and psychosocial interventions. We found no evidence for effectiveness with regard to condom use, contraceptive use or rates of unprotected sex or use of birth control. Our primary outcome was repeat conception rate: the event rate was 132 of 308 (43%) in the intervention group versus 140 of 289 (48%) for the control goup, with a non-significant risk ratio (RR) of 0.92 [95% confidence interval (CI) 0.78 to 1.08]. Four studies reported subsequent birth rates: 29 of 237 (12%) events for the intervention arm versus 46 out of 224 (21%) for the control arm, with a RR of 0.60 (95% CI 0.39 to 0.93). Many repeat conceptions occurred in the context of poverty, low expectations and aspirations, and negligible opportunities. Service user feedback suggested that there were specific motivations for many repeat conceptions, for example to replace loss or to please a partner. Realist synthesis highlighted that context, motivation, planning for the future and letting young women take control with connectedness and tailoring provide a conceptual framework for future research.LimitationsIncluded studies rarely characterised adolescent pregnancy as intended or unintended, that is interventions to reduce repeat conceptions rarely addressed whether or not pregnancies were intended. Furthermore, interventions were often not clearly defined, had multiple aims and did not indicate which elements were intended to address which aims. Nearly all of the studies were conducted in the USA and focused largely on African American or Hispanic and Latina American populations.ConclusionsWe found no evidence to indicate that existing interventions to reduce repeat teenage pregnancy were effective; however, subsequent births were reduced by home-based interventions. Qualitative and realist evidence helped to explain gaps in intervention design that should be addressed. More theory-based, rigorously evaluated programmes need to be developed to reduce repeat teenage pregnancy in the UK.Study registrationThis study is registered as PROSPERO CRD42012003168. Cochrane registration number: i=fertility/0068.FundingThe National Institute for Health Research Health Technology Assessment programme.

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“…There is consistent evidence internationally that young people in state care (YPISC) experience poor sexual health compared to their counterparts in the wider population (Craine at al., 2014;MacDonald, 2006). A number of studies have found YPISC to be at greater risk of early sexual initiation than those not in care (Croker & Carlin, 2002;Jones et al, 2011) with young people in residential care particularly at risk (Carpenter, Clyman, Davidson, & Steiner, 2001).…”

Section: Introductionmentioning

confidence: 99%

The perceived impact of interprofessional information sharing on young people about their sexual healthcare

Hyde

Fullerton

McKeown

et al. 2016

Journal of Interprofessional Care

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This paper presents the results from an analysis of data from service-providers and young adults who were formerly in state care about how information about the sexual health of young people in state care (YPISC) is managed. In particular, the analysis focuses on the perceived impact of information sharing between professionals on young people. Twentytwo service-providers from a range of professions including social work, nursing and psychology, and 19 young people aged 18-22 years who were formerly in state care participated in the study. A qualitative approach was employed in which participants were interviewed in depth and data were analysed using modified analytical induction (Bogdan & Biklen 2007). Findings suggest that within the care system in which service provider participants worked, it was standard practice that sensitive information about a young person's sexual health would be shared across team members, even where there appeared to be no child protection issues. However, the accounts of the young people indicated that they experienced the sharing of information in this way as an invasion of their privacy. An unintended outcome of a high level of information-sharing within teams is that the privacy of the young person in care is compromised in a way that is not likely to arise in the case of young people who are not in care. This may deter young people from availing themselves of the sexual health services.

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Elevated teenage conception risk amongst looked after children; a national audit

Cited by 28 publications

References 3 publications

Young people’s views on the impact of care experiences on their ability to form positive intimate relationships

Young people’s views on the impact of care experiences on their ability to form positive intimate relationships

Intervention Now to Eliminate Repeat Unintended Pregnancy in Teenagers (INTERUPT): a systematic review of intervention effectiveness and cost-effectiveness, and qualitative and realist synthesis of implementation factors and user engagement

The perceived impact of interprofessional information sharing on young people about their sexual healthcare

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