Doing Mental Health Research with Children and Adolescents: A Guide to Qualitative Methods

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Michelle O'Reilly & Nicola Parker

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    List of Figures and Tables

    Figures
    • 1.1 Concepts and theory 8
    • 4.1 Process of ethics 42
    • 4.2 Assent form 46
    • 4.3 Section of an information sheet 47
    • 4.4 Confidentiality and the parent information sheet 51
    • 5.1 Generating a research topic 60
    • 6.1 Access process 81
    • 9.1 Communication aids: Faces 140
    • 10.1 Flowchart for naturally occurring data 149
    • 13.1 Guide to doing thematic analysis 201
    • 13.2 Steps in grounded theory 203
    • 13.3 Steps involved in IPA 206
    • 13.4 Decision-making about NVivo 213
    • 14.1 Supervision notes 225
    • 15.1 Press release 242
    Tables
    • 1.1 Audit, service evaluation and research 4
    • 1.2 Differences 6
    • 2.1 Practical hints for performing literature searches 19
    • 2.2 Initial steps for critiquing a paper 23
    • 2.3 Main steps for critiquing a paper 23
    • 2.4 Final steps for critiquing a paper 24
    • 3.1 Four issues of dual role 30
    • 3.2 Potential problems in the dual relationship 31
    • 3.3 Power relationships 34
    • 4.1 Approaches to ethics 43
    • 4.2 Consent 45
    • 4.3 Designing an information sheet for children 47
    • 5.1 Possible audiences 65
    • 5.2 Tips for proposals 70
    • 5.3 Benefits of a pilot study 75
    • 6.1 Forms of communication 83
    • 6.2 Barriers to getting through the ‘gate’ related to the institution 84
    • 6.3 Barriers to getting through the ‘gate’ related to research 85
    • 6.4 Communicating with children 88
    • 6.5 Communicating with children with physical impairments (Benjamin & MacKinlay, 2010) 89
    • 6.6 Children who may have difficulty understanding/concentrating 89
    • 7.1 Planning recruitment through schools 99
    • 7.2 Recruiting through schools 99
    • 7.3 Protecting physical safety when planning 109
    • 7.4 Protecting physical safety when preparing data collection 109
    • 7.5 Protecting physical safety when collecting the data 109
    • 7.6 Protecting emotional safety 111
    • 8.1 Administering questionnaires to children 116
    • 8.2 Tips for designing your questionnaire 118
    • 8.3 Tips for designing your questions 118
    • 8.4 Benefits and limitations of questionnaires with children 121
    • 8.5 Four types of observation 122
    • 8.6 Types of researcher notes (Willig, 2001) 123
    • 9.1 Types of interview 128
    • 9.2 Tips for planning 131
    • 9.3 Tips for getting started 132
    • 9.4 Tips for conducting your qualitative interview with children 132
    • 9.5 Tips for preparing focus groups with children 133
    • 9.6 Tips for starting focus groups with children 134
    • 9.7 Practical tips for conducting focus groups with children 134
    • 9.8 Tips for developing an interview/group schedule 136
    • 10.1 The advantages and disadvantages of using solicited diaries 158
    • 11.1 The advantages and disadvantages of using internet questionnaires with children 166
    • 11.2 Asynchronous and synchronous methods 166
    • 11.3 Practical tips for using email methods with children 168
    • 11.4 The advantages and disadvantages of using Instant Messaging 169
    • 11.5 Discussion boards, blogs and chat rooms 171
    • 11.6 Ethical challenges of social networking site research 175
    • 11.7 Practical ethical considerations for chat rooms, blogs and discussion boards 176
    • 12.1 The benefits and limitations of audio 180
    • 12.2 The benefits and limitations of video 181
    • 12.3 Emotional challenges of using video with children 184
    • 12.4 Practical challenges of using video with children 185
    • 13.1 The three core concepts 209
    • 14.1 Lousy research supervision (Magnuson et al., 2000) 223
    • 15.1 Practical tips for planning (Creswell, 2005) 229
    • 15.2 Practical tips for writing 230
    • 15.3 Specific writing issues for a paper 230
    • 15.4 Preparing slides (Ranse & Hayes, 2009) 234
    • 15.5 Some dos and don'ts of presenting 235
    • 15.6 First sections 238
    • 15.7 Main body 238
    • 15.8 Final sections 239

    About the Authors

    Dr Michelle O'Reilly is a Senior Lecturer at the University of Leicester, for the Greenwood Institute of Child Health. Michelle has an interest in various areas of child mental health, undertaking research in autism, self-harm, family therapy and mental health assessments. She favours the methods of discourse and conversation analysis. Michelle is the director of two language-based research groups. The Language and Interaction Research Assembly (LIRA) is a University of Leicester interdisciplinary group who utilise a range of qualitative language-based approaches. Conversation Analysis Research in Autism (CARA) is an international group who utilise discourse and conversation analytic approaches in the study of autism. Michelle has recently published two books: Research with Children: Theory and Practice (Sage) and A Practical Guide to Mental Health Problems in Children with Autistic Spectrum Disorder (JKP).

    Dr Nicola Parker is a Senior Clinical Psychologist currently working for the Cheshire and Wirral Partnership NHS Foundation Trust. She has clinical experience in the assessment and implementation of therapeutic interventions with children and families, particularly those in Looked After settings including foster care and adoptive families. Nicola also has a wealth of practical experience working with children and young people for more than two decades as a Youth Worker, School Governor, Business Mentor and Prison Volunteer. In addition she has worked for Relate UK and Samaritans as a project manager developing curriculum for children and training counsellors in working with young people. Before embarking on a Clinical career, Nicola completed a PhD in Psychology to further her research interest in the interactions between adults and children in therapeutic settings. Her research is informed by a social constructionist perspective favouring the analysis of intergenerational interactions in therapy environments using discursive approaches.

    Preface

    This book is an introductory text to illustrate the key issues faced when undertaking a child mental health research project. It provides an accessible guide through each element of the research process from inception to dissemination/application. It is designed to help students, trainees, researchers, academics and others in health, mental health, social care, education, or other disciplines to plan and undertake a qualitative project. This is a timely text given the growing emphasis within mental health services on evidence-based practice.

    The focus of this book is on doing research with rather than about children, which is congruent with the contemporary perspective of giving children their own ‘voice’ through research. Nonetheless, the importance of doing research with significant adults, including parents and professionals involved in caring for or working with children with mental health difficulties, is considered alongside this. The need for systematic and practical advice for researchers has dictated the focus of each chapter; each of which is filled with helpful tips and advice.

    Definitions

    Throughout the book a number of concepts/terms are employed. To assist you we outline the ways in which these are utilised. For example, where the pronoun ‘we’ is used, we refer to the authors and the pronoun ‘you’ refers to the reader.

    As this book focuses on child mental health research, we recognise the importance of defining the way in which we use the term ‘mental health’. The definition utilised by the World Health Organization (WHO) which is most widely accepted defines mental health as:

    … a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community. (WHO, 2011: 1)

    Whilst this applies to mental health in all populations, for children there are some additional specific indicators related to chronological and developmental age. One widely cited definition of child mental health is offered by the Mental Health Foundation (1999) and is used here as a benchmark against which mental health and mental health difficulties are demarcated in this book. The key elements are: to develop psychologically, creatively, spiritually, emotionally and intellectually; to initiate, develop and sustain personal relationships; to enjoy and use solitude; to be aware of others and express empathy; to learn and play; to develop a sense of right and wrong; and to be able to resolve problems and setbacks and learn from them.

    We acknowledge there are a range of different terms used when referring to the absence of positive mental health, including mental illness, mental disorder, mental health problem, mental health difficulty, mental health conditions and mental ill health. Each of these terms tend to be underpinned by different models which dictate the terms favoured, for example, the medical profession may prefer terminology such as ‘illness’. For the purpose of clarity and consistency in relation to conducting research we employ the general term ‘mental health difficulty’.

    Unless otherwise specified, we use the term ‘child/children’ throughout the book as an overarching category which encompasses children of all ages from 0–18 years. Where it is required to differentiate age groups we employ the categories of ‘younger child’, ‘young child’ and ‘older child’ to distinguish chronological age groups, 0–4 years, 5–11 years and 12–18 years respectively.

    The term ‘parent/parents’ is used throughout the book to refer to all adults who have legal responsibility for children, this includes foster parents, adoptive parents, biological parents, step-parents, carers, legal guardians and local authorities.

    Acknowledgements

    We would like to offer our appreciation to several people who have helped to make this book happen. Nadzeya Svirydzenka made an important contribution to the information on transcription by translating Russian data into English and contributed to the interview in the chapter on dissemination. Panos Vostanis also contributed to the transcription detail by translating data into Greek and provided useful comments for the research setting chapter by discussing his work with homeless children. We are very grateful for their time. Nisha Dogra contributed to the interview for the dissemination chapter, discussing the challenges relevant to disseminating to children and we thank her for these insights. Tom Muskett and Jessica Lester also contributed interviews for the book. Tom made a useful contribution in discussing the challenges of occupying dual roles and Jessica talked about her experiences of being reflexive in the research process. We very much appreciate these important discussions. We also thank Victoria Stafford for sharing her insights in conducting pilot studies and offering practical comments on this aspect of the chapter on planning. We thank Arthritis Research UK and Elizabeth Hale for allowing us to copy their press release in the dissemination chapter as this is an especially useful example of this form of dissemination. We want to extend our appreciation and give special thanks to Khalid Karim and Claire Bone for their useful and insightful comments on the book as a whole as we feel that the book is much improved because of it. We also thank the two anonymous reviewers for their suggestions to develop areas within the book and all of their ideas. Of course we thank our partners and families for their personal support during the process of writing, for their patience and understanding. Finally we thank SAGE, for facilitating this book from inception to publication.

    List of Abbreviations

    • CA Conversation analysis
    • CAMHS Child and Adolescent Mental Health Services
    • CBT Cognitive behaviour therapy
    • CRB Criminal Records Bureau (now referred to as DBS – see below)
    • DA Discourse analysis
    • DBS Disclosure and Barring Service
    • DP Discursive psychology
    • GP General Practitioner
    • IPA Interpretative phenomenological analysis
    • OCD Obsessive compulsive disorder
    • RCT Randomised controlled trial
    • SRA Social Research Association
    • UK United Kingdom
    • WHO World Health Organization
  • Glossary

    • Altruism refers to putting the needs of another before one's own; selflessness.
    • Asymmetry refers to two parts not being the same or equal. This links with a power imbalance.
    • Audit a process whereby the auditor measures current practice against a set of standards which have been predefined. Its aim is to establish the extent to which actual practice compares with best practice.
    • Autonomy refers to the individual having independence to make their own choices.
    • Beneficence refers to the act or quality of being kind or doing good.
    • Capacity refers to an individual's ability to make decisions, usually in relation to their developmental and intellectual abilities.
    • Coercion the act of persuading an individual, or forcing them through unethical means.
    • Deductive disclosure this refers to the risk in qualitative research of friends or colleagues of the participants in the data recognising those participants despite the quotations being anonymous.
    • Demographics refers to the statistical data regarding the characteristics of your sample, such as their age, gender and race.
    • Dissemination to disseminate your work means to distribute it so that others may read it.
    • Encryption refers to the process of coding information so that it cannot be viewed by unauthorised persons. Typically this is achieved through passwords.
    • Epistemology epistemology refers to the theory of knowledge and is concerned with what we know, how we know it and who knows it.
    • Exclusion criteria the specific criteria the researcher decides to use to determine whether particular participants should be excluded from the study.
    • Exploitation refers to the act of treating people unfairly or taking advantage of them.
    • Gatekeepers the individuals who have some authority over the children the researcher may want to access. They have the power to grant or refuse access.
    • Generalisability relates to the extent to which the findings are relevant and applicable to other members of the population.
    • Ideology a set of ideas or beliefs that are considered important by a particular group or culture.
    • Inclusion criteria the criteria that are specified by the research which must be present in the participant sample. These are the criteria by which the researcher decides whether a participant is eligible to be included in the study.
    • Likert scale this is a form of asking questions on a questionnaire so that respondents rate their answers in terms of the strength of their agreement. This is a psychometric scale where respondents specify their level of agreement with a statement to capture the intensity of feelings.
    • Mental health a state of being mentally healthy. Mental health refers to a general state of well-being and a freedom from mental illness.
    • Mental illness an impairment of the person's capacity to function; the presence of a mental disorder or condition.
    • Mixed methods a mixed methods design is one whereby the researcher uses both quantitative and qualitative methods in their approach. The results/findings from these two aspects are then combined, integrated or triangulated.
    • Naturally occurring refers to collecting data from natural contexts whereby the event would continue to occur regardless of the involvement of the researcher.
    • Non-maleficence the ethical principle referring to doing no harm to research participants.
    • Ontology an underpinning philosophy, referring to the nature of reality.
    • Paradigm a complicated term which is understood to have various meanings, but can be characterised as a set of beliefs which represent a particular world view.
    • Positivism a position which assumes a relationship between the world and the understanding the research holds of it. It relates to the natural sciences, assuming that there is an objective reality which can be measured.
    • Qualitative research qualitative research is used to explore people's beliefs, experiences and perceptions and is usually conducted with smaller sample sizes. It is concerned with depth of information.
    • Quantitative research quantitative research is based upon scientific principles with an aim to generate large-scale numerical data so that the researcher may predict trends. Quantitative research starts with a hypothesis and seeks to generalise results to wider populations.
    • Rapport the building of a positive relationship between two or more people.
    • Reflexivity refers to the process of actively reflecting upon the role and impact that the researcher has had on the research process. This means that the researcher has to consider the influences upon the data collection and data analysis.
    • Reliability refers to the extent to which the research study could be easily replicated by another researcher.
    • Social constructionism a position that believes things do not pre-exist but that they are co-created in a social, historical and political context.
    • Therapeutic misconception relates to when the participant is not able to understand the difference between the goals of the research and the goals of their treatment and may misunderstand that research does not necessarily have therapeutic benefit. This is particularly concerning in medical trials.
    • Transferability the extent to which the findings from one qualitative research study can be transferred to other settings.
    • Validity refers to the extent to which the researcher has managed to measure what they intended to measure in the study.

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