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 the mental health needs of this group, and prevent some of these wide-ranging consequences.
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 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, and 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 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 (ie., those specifically for young people in care), and social care based mental health teams. Following training in congitive 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 futher understand assessments and treatment decisions.
This project has produced detailed guidance on what helps and hinders individual professions 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.
Over the next year (2024) findings will be disseminated via academic publications and conferences; free in-person workshops for professionals; webinars and newsletters. We will also aim to host an event for service commissioners to consider the role of commissioning as a help or hindrance to high quality delivery.
From 2024-2025 we will be running the second phase of ADaPT, where we are working with a small number of geographically diverse services to optimise the delivery of cognitive therapy for PTSD to young people in care. This involves linking up social care and mental health services, to work together to understand how to improve access to this treatment and other best-evidenced treatments.
- Principal Investigator: Rachel Hiller, NIHR ARC West /ARC North Thames
- Co-investigator: Gretchen Bjornstad, University of Exeter
- 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 ARC North East and North Cumbria ARC
- Co-investigator: Richard Meiser-Stedman, University of East Anglia
- Co-investigator: Sara Morgan, NIHR ARC Wessex
- Consultant: Patrick Smith, King’s College London