Young people in care have substantially 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 their mental health needs and prevent some of these wide-ranging consequences.
To begin to address this complex issue, we are undertaking a pilot implementation project, working with CAMHS, social care, and third-sector mental health services across four NIHR Applied Research Collaborations, spanning South West, West, East, and North England. The primary goal of this work is 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.
We will focus on post-traumatic stress disorder (PTSD) which is a key mental health difficulty experienced by this group, with rates 12x higher than those of their peers. There is a good evidence base for successfully treating PTSD in young people using trauma-focused cognitive behaviour therapies (tf-CBTs). Manualised tf-CBTs are the first-line recommended treatment for PTSD, including following maltreatment. 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.
Our pilot project aims to address this issue via four overlapping stages that form the essential framework for a full-scale implementation trial. These are:
- A scoping review and consultation with care-experienced young people (CEYP), carers, and services to develop an initial implementation framework, based on the consolidated framework for implementation research (CFIR).
- Development of implementation resources, including training materials.
- To pilot our implementation strategy in four regions (South West, West, East, North), including qualitative interviews with young people and service providers and assessing the feasibility of our recruitment and consent procedures for collecting quantitative data from young people.
- Mapping of mental health service provisions available to CEYP across England to support the next step; a full implementation project.
Our pilot project will focus on the implementation of routine assessments for PTSD and the delivery of cognitive therapy for PTSD (a type of tf-CBT). Services who might already be using a different version of tf-CBT or a different NICE-recommended PTSD treatment (e.g., EMDR), will still be invited to participate so that we can learn what helped that service to deliver those particular interventions.
The primary outcome of this 3-year project is identifying what hinders and facilitates the implementation of tf-CBT across sectors. The project will provide the necessary framework for supporting the wider-scale full implementation of tf-CBT, with the potential for wider reach to other CBT-based NICE-recommended mental health treatments such as anxiety and depression.
Understanding what prevents services from delivering NICE-recommended treatments and how to overcome this, stands to have significant impact. Our team has strong existing networks to support impact at a local, regional and national level. We will run free workshops to services at a local and regional level, to disseminate findings and support integration into practice.
At a national level, we have existing links with relevant third-sector organisations that regularly advocate for CEYP at a policy level. To disseminate to these groups, alongside meetings and policy briefing summaries, we will provide case studies from early in Year 2, and later idiographic and video summaries and workshops.
- Principal Investigator: Rachel Hiller, NIHR ARC West
- Co-investigator: Timothy Clarke, NIHR ARC East of England
- Co-investigators: Kristian Hudson, Beverley Slater, Improvement Academy Bradford Teaching Hospital NHS Trust
- Co-investigators: John Macleod, Hugh McLeod, Paul Stallard, Rebecca Davis, NIHR ARC West
- Co-investigator: Ruth McGovern, NIHR North East and North Cumbria ARC
- Co-investigator: Richard Meiser-Stedman, University of East Anglia
- Co-investigator: Sara Morgan, NIHR ARC Wessex
- Co-investigator: John Wright, NIHR ARC Yorkshire and Humber
- Consultant: Patrick Smith, King’s College London