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Title: Developing the capacity to respond to child and adolescent mental health needs : exploring how transferable nursing skills are to parents whose children have challenging behaviours
Author: Croom, Susan
ISNI:       0000 0004 2705 9395
Awarding Body: Northumbria University
Current Institution: Northumbria University
Date of Award: 2006
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This thesis focuses on child and adolescent mental health. Epidemiological studies show that in order to manage the high prevalence of Child and Adolescent Mental Health (CAMH) problems within the finite resources of CAMH services, it is necessary to develop innovative practice research and development. Research and literature in CAMH is dominated by the quantitative paradigm rather than participative and qualitative approaches. However, research indicates that although evidence based strategies, derived from this research perspective, such as manualised parenting programmes, can be effective for children with challenging behaviours, that the most vulnerable parents are the most difficult to engage and maintain within community parenting programmes. This thesis takes a practitioner research perspective in order to work collaboratively with a small population of vulnerable parents, whose children have challenging behaviours that are interfering with the family's everyday life and impacting on the child's ability to meet their social, emotional and developmental goals. It builds upon a previous research project with nurses in a residential setting. The nursing project identified a specialist set of knowledge and skills, which were found to be useful in informing 24 hour care provision for children in a residential CAMH Unit and improving the behavioural outcomes for the children being looked after. The nurses' role overlaps with parents in the provision of 24 hour care, but the extent to which this nursing knowledge learnt in the previous study can be used by parents to maintain improvements in children's behaviour was not known. This thesis used a combination of qualitative methods within a participative action research approach and a critical theory perspective to engage in emancipatory research with parents as co-researchers. Action research starts from the premise that the solution to our problems are in our own hands and knowledge and understanding can only be developed through an exploration and learning from our everyday experiences. This thesis set out to learn:(1) Whether the nursing knowledge, derived from the nursing project, is transferable to parents in their community setting, and useful to parents when Caring for their children with challenging behaviours in maintaining and improving behavioural outcomes.(2) Whether parents can refine and develop the nursing knowledge and so add to a cumulative body of practice knowledge related to the 24 hour care of children with challenging behaviours(3) Whether gaining access to this knowledge as participants within the research process can increase the potential capacity of parents to be able to respond to their children(4) Whether the knowledge and potential capacity of the wider system providers and policy makers can be increased through access to the parents' knowledge, expertise and experiences in caring for children with challenging behaviours. In undertaking this research it is important to distinguish between the practice development and the research process. Action research is used to distinguish the two processes. The practice development incorporates an action research cycle which enables a learning process to occur in which new knowledge can be produced that can be subsequently theorised. Theorisation is used to critique the oppressive care processes produced by the medical model and to theorise alternative practice processes that can be used to overcome the oppression inherent in the medical model and increase the effectiveness of CAMH services. Twenty-five parents met the sampling criteria by engaging in at least one action research cycle. The action research cycles were used to explore extent to which the nursing knowledge and skills were transferable to parents in a community setting. Critical incidents were used to explore the parents' experiences of knowledge transfer. The findings illustrated that the transfer of the nursing knowledge to parents was useful, but not sufficient to increase the parents' capacity to respond to their child's needs because of a complex range of socio-political factors that differentially impacted on the parents' lives, compared to the nurses in the residential setting. This included isolation, guilt, housing and socioeconomic factors. In addition, the parents identified that they were subject to a range of oppressive forces that potentially reduced their capacity to respond to their children. Many of these tacit forces were found to be embedded in the medical discourse around CAMH practice and include a tendency to engage in the professional hegemony of knowledge, which legitimates the power of professionals to define the norms of behaviour in ways that can be oppressive towards and pathologising of vulnerable groups of children, who may not conform to a narrow construction of behavioural norms and the tacit idealisation and devaluation of carers. Together these can provide a rationale for blaming parents and for investing in services designed to improve parenting competencies whilst not having to address the wider socio-political determinants of child behaviour. The research findings indicate that challenging these oppressive assumptions within a supportive group setting, in which the parents actively participated in the research process, helped the parents to challenge and in some cases to transform their situation and that of their child. In keeping with a participative action research, the findings from the collaborative research with the parents are synthesised into a practice framework, which represents the emerging action plan. A critical analysis of the opportunities and constraints for implementing this action plan is provided. The research demonstrates that engaging in participative research with clients whilst also engaged in practice is a complex and problematic process, which requires an innovative combination of methods but which can produce new and innovative ways of theorising practice processes and outcomes. Through the research process described in this thesis the oppressive nature of many well-intentioned aspects of CAMH practice are revealed and theorised. In taking this analysis forward practice processes and outcomes are theorised in the context of both the medical and social models of health. The research demonstrates how these two models can be integrated in practice and how the process of integration has the potential to enable the development of a cumulative and integrative body of emancipatory practice knowledge, which acknowledges and addresses the complexity, uncertainly and unpredictability of clients 24 hour experiences but at the same time maximises the total set of resources available to both support families and also to widen the capacity of professionals and service providers to develop insightful and non-oppressive solutions.
Supervisor: Chandler, Colin S. Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: B700 Nursing