Trauma-focused Cognitive Behavioural Therapy for children in care (ADaPT)

Background

Young people in care have much higher rates of mental health difficulties compared to their peers. Their unaddressed mental health needs have been identified as a key driver of a range of poor outcomes. For example, they are more likely than peers to be excluded from school and are over-represented in prison and homeless populations. Such outcomes are not inevitable, and with the right support young people in care can thrive. However, services often struggle to effectively address the mental health needs of this group.

To begin to address this complex issue, we have conducted an England-wide implementation project, working with general CAMHS, specialist or targeted CAMHS and social care based mental health teams, spanning South West, West, East, and North of England, and London. The primary goal of this work was to identify the key barriers and facilitators to services providing best-evidenced cognitive-behavioural based mental health treatments to children and young people with experience of the care system. The project explored this through the lens of posttraumatic stress disorder (PTSD) and trauma-focused cognitive behaviour therapy (tf-CBT), given we know rates of PTSD are much higher in care-experienced young people and that tf-CBT is the best-evidenced intervention, including for complex PTSD. Despite the evidence base, most children in public care with the potential to benefit don’t have access to it, adding to an accumulation of health and service inequalities.

Aims and Overview

The primary aim of the first phase of this project (called the ADaPT study), was to work alongside cross-sector mental health teams, to develop a detailed understanding of what helps and hinders professionals in the use of evidence based individual psychological interventions, like trauma-focused CBTs.

To do this, we worked with 28 mental health teams across 14 regions in England. This included general CAMHS teams, targeted CAMHS teams (i.e., those specifically for young people in care), and social care based mental health teams. Following training in cognitive therapy for PTSD (a type of trauma-focussed CBTI) we followed teams for 12-18 months. Teams took part in focus groups every 3-months, and we also ran cross-team focus groups with managers and service leads. We also collated service data to further understand assessments and treatment decisions. From 2024 we have been running the second phase of ADaPT (ADaPT-2), working closely with local authority and CAMHS teams in four different regions of England to optimise the delivery of trauma-focused CBT and other best-evidenced direct psychotherapies, and to develop case studies of ‘ideal’ service structures, to support better access to best-evidenced mental health care for care-experienced young people.

Anticipated Outputs

This project has produced detailed guidance on what helps and hinders individual professionals and mental health teams in the delivery of best-evidenced NICE recommended treatments, like trauma-focused CBT. This includes the role of commissioning, pathways between services, team structures, leadership, beliefs around CBT-based interventions for care-experienced young people, and the challenges of delivering treatment to young people who can have very complex needs. Findings have wider implications for other CBT-based interventions and for the screening of mental health difficulties in young people in care.

We have begun disseminating findings via academic publications (e.g., Access to best-evidenced mental health support for care-experienced young people: Learnings from the implementation of cognitive therapy for PTSD) and conferences; free in-person workshops for professionals; newsletters; and webinars (e.g., for via Trauma Council; British Social Work Week; CoramBAAF); and via roundtables with ICB and local authority commissioners. We are also inputting into the DfE and DHSC updating of statutory guidance for mental health support for looked-after children, and are preparing a report on practice recommendations for mental health provision for looked-after children, supported by CoramBAAF.