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Ruphrect-Smith H, Davies S, Jacob J, Edbrooke-Childs J. Ethnic differences in treatment outcome for children and young people accessing mental health support. Eur Child Adolesc Psychiatry 2024; 33:1121-1131. [PMID: 37245162 PMCID: PMC11032270 DOI: 10.1007/s00787-023-02233-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 05/16/2023] [Indexed: 05/29/2023]
Abstract
Children and Young People (CYP) from minoritized ethnic backgrounds experience structural inequalities in Children and Young People's Mental Health Settings (CYPMHS). This mixed methods study explores whether CYP's ethnicity is associated with their treatment outcomes (operationalised as 'measurable change') from CYPMHS. A multilevel multi-nominal regression analysis, controlling for age, gender, referral source, presenting difficulty, case closure reason, suggests that CYP from Asian backgrounds (OR = 0.82, CI [0.70, 0.96]) and Mixed-race (odds ratio (OR) = 0.80; 95% CI [0.69, 0.92]) are less likely to report measurable improvement in mental health difficulties compared to White British CYP. Three themes from a thematic analysis of semi-structured interviews with 15 CYP from minoritized ethnic backgrounds focused on views and experiences of ending mental health support are also presented. CYP view personalised support and the right therapist as conducive to good endings and valued a range of outcomes pertaining to empowerment. Experiences of stigma and inequalities may begin to explain the less positive outcomes experienced by Asian and Mixed-race CYP found in the regression analysis. The implications of these findings and future areas of research are suggested.
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Affiliation(s)
- H Ruphrect-Smith
- Clinical, Educational, and Health Psychology, University College London, London, UK
| | - S Davies
- Evidence Based Practice Unit, University College London and the Anna Freud Centre, Anna Freud, 4-8 Rodney Street, London, N1 9JH, UK
| | - J Jacob
- Clinical, Educational, and Health Psychology, University College London, London, UK
- Child Outcomes Research Consortium, Anna Freud, London, UK
| | - J Edbrooke-Childs
- Clinical, Educational, and Health Psychology, University College London, London, UK.
- Evidence Based Practice Unit, University College London and the Anna Freud Centre, Anna Freud, 4-8 Rodney Street, London, N1 9JH, UK.
- Child Outcomes Research Consortium, Anna Freud, London, UK.
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Lereya ST, Norton S, Crease M, Deighton J, Labno A, Ravaccia GG, Bhui K, Brooks H, English C, Fonagy P, Heslin M, Edbrooke-Childs J. Gender, marginalised groups, and young people's mental health: a longitudinal analysis of trajectories. Child Adolesc Psychiatry Ment Health 2024; 18:29. [PMID: 38419124 PMCID: PMC10902968 DOI: 10.1186/s13034-024-00720-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 02/20/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Individuals from marginalised groups experience higher levels of mental health difficulties and lower levels of wellbeing which may be due to the exposure to stress and adversity. This study explores trajectories of mental health over time for young women and girls and young people with other marginalised identities. METHODS We conducted a secondary analysis on N = 14,215 children and young people (7,501 or 52.8% female, 6,571 or 46.2% male, and 81 or 0.6% non-binary or questioning) who completed a survey at age 11 to 12 years and at least one other annual survey aged 12 to 13 years and/or aged 13 to 14 years. We used group-based trajectory models to examine mental health difficulties. RESULTS Except for behavioural difficulties, young women's and girls' trajectories showed that they consistently had higher levels of mental health difficulties compared to young men and boys. A similar pattern was shown for non-binary and questioning children and young people. Children and young people with economic disadvantage and/or special education needs, and/or for whom there were welfare concerns, were generally more likely to experience higher levels of mental health difficulties. CONCLUSIONS This information could inform public policy, guidance and interventions.
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Affiliation(s)
- Suzet Tanya Lereya
- Evidence-Based Practice Unit, University College London and Anna Freud, London, UK
| | - Sam Norton
- Department of Psychology and Centre for Rheumatic Diseases, King's College London, London, UK
| | | | - Jessica Deighton
- Evidence-Based Practice Unit, University College London and Anna Freud, London, UK
| | - Angelika Labno
- Evidence-Based Practice Unit, University College London and Anna Freud, London, UK
| | - Giulia Gaia Ravaccia
- Evidence-Based Practice Unit, University College London and Anna Freud, London, UK
| | - Kamaldeep Bhui
- Department of Psychiatry & Nuffield Department of Primary Care Health Sciences Senior Research Fellow, Wadham College, University of Oxford, Oxford, UK
| | - Helen Brooks
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Cara English
- College of Arts, University of Glasgow and Gendered Intelligence, London, UK
| | - Peter Fonagy
- Anna Freud Centre & Department of Clinical Educational and Health Psychology, University College London, London, UK
| | - Margaret Heslin
- Health Service & Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Krause KR, Calderón A, Pino VG, Edbrooke-Childs J, Moltrecht B, Wolpert M. What treatment outcomes matter in adolescent depression? A Q-study of priority profiles among mental health practitioners in the UK and Chile. Eur Child Adolesc Psychiatry 2024; 33:151-166. [PMID: 36719524 PMCID: PMC10806045 DOI: 10.1007/s00787-023-02140-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 01/05/2023] [Indexed: 02/01/2023]
Abstract
Evidence-based and person-centred care requires the measurement of treatment outcomes that matter to youth and mental health practitioners. Priorities, however, may vary not just between but also within stakeholder groups. This study used Q-methodology to explore differences in outcome priorities among mental health practitioners from two countries in relation to youth depression. Practitioners from the United Kingdom (UK) (n = 27) and Chile (n = 15) sorted 35 outcome descriptions by importance and completed brief semi-structured interviews about their sorting rationale. By-person principal component analysis (PCA) served to identify distinct priority profiles within each country sample; second-order PCA examined whether these profiles could be further reduced into cross-cultural "super profiles". We identified three UK outcome priority profiles (Reduced symptoms and enhanced well-being; improved individual coping and self-management; improved family coping and support), and two Chilean profiles (Strengthened identity and enhanced insight; symptom reduction and self-management). These could be further reduced into two cross-cultural super profiles: one prioritized outcomes related to reduced depressive symptoms and enhanced well-being; the other prioritized outcomes related to improved resilience resources within youth and families. A practitioner focus on symptom reduction aligns with a long-standing focus on symptomatic change in youth depression treatment studies, and with recent measurement recommendations. Less data and guidance are available to those practitioners who prioritize resilience outcomes. To raise the chances that such practitioners will engage in evidence-based practice and measurement-based care, measurement guidance for a broader set of outcomes may be needed.
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Affiliation(s)
- Karolin Rose Krause
- Research Department for Clinical, Educational and Health Psychology, University College London, Gower Street, Bloomsbury, London, WC1E 6BT, UK.
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.
| | - Ana Calderón
- Facultad de Psicología y Humanidades, Universidad San Sebastián, Sede Santiago, Chile
| | - Victor Gomez Pino
- Facultad de Medicina, Departamento de Psiquiatría Norte, Hospital Clínico, Clínica Psiquiátrica Universitaria, Universidad de Chile, Avenida La Paz 1003, Recoleta, Chile
| | - Julian Edbrooke-Childs
- Research Department for Clinical, Educational and Health Psychology, University College London, Gower Street, Bloomsbury, London, WC1E 6BT, UK
- Evidence-Based Practice Unit, Anna Freud National Centre for Children and Families, 4-8 Rodney Street, London, N1 9JH, UK
| | - Bettina Moltrecht
- Evidence-Based Practice Unit, Anna Freud National Centre for Children and Families, 4-8 Rodney Street, London, N1 9JH, UK
- Centre for Longitudinal Studies, University College London, 55-59 Gordon Square, London, WC1H 0NU, UK
| | - Miranda Wolpert
- Research Department for Clinical, Educational and Health Psychology, University College London, Gower Street, Bloomsbury, London, WC1E 6BT, UK
- Wellcome Trust, 215 Euston Rd, Bloomsbury, London, NW1 2BE, UK
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Santana de Lima E, Preece C, Potter K, Goddard E, Edbrooke-Childs J, Hobbs T, Fonagy P. A community-based approach to identifying and prioritising young people's mental health needs in their local communities. Res Involv Engagem 2023; 9:104. [PMID: 37996912 PMCID: PMC10666450 DOI: 10.1186/s40900-023-00510-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 10/24/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Identifying locally relevant and agreed-upon priorities for improving young people's mental health, aligned with social and environmental factors, is essential for benefiting target communities. This paper describes a participatory approach to engage young people and professionals in identifying such priorities, whilst considering the social determinants related to them. METHODS We utilised a community-based participatory approach to support young people and professionals in identifying, reviewing, refining, and prioritising, locally relevant opportunity areas that are crucial for understanding and addressing social determinants of young people's mental health. We adopted a flexible five-stage process, which enabled greater reflection and adaptation in response to young people's and professionals' feedback and reflections. RESULTS Over seven months, we engaged with young people and professionals in Northern Devon, (a rural area in southwest England), involving over 290 individuals to identify locally relevant priorities for supporting young people's mental health. Three priorities were identified for subsequent exploration using co-design approaches: (1) identity and belonging; (2) mental health awareness and literacy; and (3) diverse opportunities (for education, employment and leisure). The engagements suggested that designing initiatives and strategies in these areas could contribute to improvements in young people's mental health. CONCLUSION Young people in Northern Devon prioritised three themes for the next phase of the Kailo Programme-mental health literacy, access to diverse careers and employment opportunities, and identity and belonging within their communities. Rural communities face unique barriers associated with these issues, related to less diverse populations, lack of access to reliable and affordable transport and local industries, and seasonal working. The perceived neglect by authorities towards rural young people has resulted in a lack of activities and opportunities catering to their specific needs, compared to urban areas. Although the government has recognised the need to address these disparities, community members suggest that there is still more work to be done.
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Affiliation(s)
- Ediane Santana de Lima
- Dartington Service Design Lab, Buckfastleigh, UK
- Dartington Service Design Lab, Bristol, UK
| | - Cristina Preece
- Dartington Service Design Lab, Buckfastleigh, UK
- Dartington Service Design Lab, Hereford, UK
| | - Katie Potter
- Dartington Service Design Lab, Buckfastleigh, UK
- Dartington Service Design Lab, Stoke Gabriel, UK
| | - Ellen Goddard
- Dartington Service Design Lab, Buckfastleigh, UK
- Dartington Service Design Lab, Bangor, UK
| | | | - Tim Hobbs
- Dartington Service Design Lab, Buckfastleigh, UK
- Dartington Service Design Lab, Totnes, UK
| | - Peter Fonagy
- University College London (UCL), London, UK
- Division of Psychology and Language Sciences at University College London (UCL), London, UK
- Anna Freud National Centre for Children and Families, London, UK
- Child and Family Programme at the Menninger Department of Psychiatry and Behavioural Sciences at Baylor College of Medicine, London, UK
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5
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Manning JB, Blandford A, Edbrooke-Childs J. High School Teachers' Experiences of Consumer Technologies for Stress Management During the COVID-19 Pandemic: Qualitative Study. JMIR Form Res 2023; 7:e50460. [PMID: 37966873 PMCID: PMC10687684 DOI: 10.2196/50460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 09/28/2023] [Accepted: 10/04/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Stress in education is an adverse reaction that teachers have to excessive pressures or other types of demands placed on them. Consumer digital technologies are already being used by teachers for stress management, albeit not in a systematic way. Understanding teachers' experiences and the long-term use of technologies to support stress self-management in the educational context is essential for meaningful insight into the value, opportunity, and benefits of use. OBJECTIVE The aim of this study was first to understand teachers' experiences of consumer technologies for stress management. They were chosen by teachers from a taxonomy tailored to their stress management. The second aim was to explore whether their experiences of use evolved over time as teachers transitioned from working at home during lockdown to working full time on school premises. METHODS A longitudinal study intended for 6 weeks in the summer term (2020) was extended because of COVID-19 into the autumn term, lasting up to 27 weeks. Teachers chose to use a Withings smartwatch or the Wysa, Daylio, or Teacher Tapp apps. In total, 2 semistructured interviews and web-based surveys were conducted with 8 teachers in South London in the summer term, and 6 (75%) of them took part in a third interview in the autumn term. The interviews were analyzed by creating case studies and conducting cross-case analysis. RESULTS The teachers described that the data captured or shared by the technology powerfully illustrated the physical and psychosocial toll of their work. This insight gave teachers permission to destress and self-care. The social-emotional confidence generated also led to empathy toward colleagues, and a virtuous cycle of knowledge, self-compassion, permission, and stress management action was demonstrated. Although the COVID-19 pandemic added a new source of stress, it also meant that teachers' stress management experiences could be contrasted between working from home and then back in school. More intentional self-care was demonstrated when back in school, sometimes without the need to refer to the data or technology. CONCLUSIONS The findings of this study demonstrate that taking a situated approach to understand the real-world, existential significance and value of data generates contextually informed insights. Where a strategic personal choice of consumer technology is enabled for high school heads of year, the data generated are perceived as holistic, with personal and professional salience, and are motivational in the educational context. Technology adoption was aided by the pandemic conditions of home working, and this flexibility would otherwise need workplace facilitation. These findings add to the value proposition of technologies for individual stress management and workforce health outcomes pertinent to educators, policy makers, and designers.
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Affiliation(s)
- Julia B Manning
- UCL Interaction Centre, Department of Computer Science, University College London, London, United Kingdom
| | - Ann Blandford
- UCL Interaction Centre, Department of Computer Science, University College London, London, United Kingdom
- UCL Institute of Healthcare Engineering, University College London, London, United Kingdom
| | - Julian Edbrooke-Childs
- Evidence-based Practice Unit, University College London and Anna Freud Centre, London, United Kingdom
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6
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Truscott A, Hayes D, Bardsley T, Choksi D, Edbrooke-Childs J. Defining young people's mental health self-care: a systematic review and co-development approach. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02320-7. [PMID: 37947894 DOI: 10.1007/s00787-023-02320-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 10/23/2023] [Indexed: 11/12/2023]
Abstract
Self-care is among the emerging types of mental health support which operate outside traditional services, although the meaning and practice of self-care for young people with mental health difficulties are currently unclear. This systematic review was pre-registered with PROSPERO (CRD42021282510) and investigated conceptualizations of self-care in academic publications which investigated or discussed self-care for young people's mental health or wellbeing. A Patient and Public Involvement (PPI) workshop facilitated young people with experience of mental health difficulties to respond to the identified concepts and co-develop a definition of self-care. Searches in PsycINFO, MEDLINE, Embase, CINAHL Plus, Scopus, Cochrane Library of Systematic Reviews, and gray literature sources resulted in 90 included publications. Content analysis indicated little conceptual consistency, with health and wellness promotion most commonly used to define self-care. The PPI workshop co-developed a definition of mental health self-care, which attendees felt should emphasize an individual process of self-awareness, self-compassion, and specific strategies to work toward emotional balance. This study highlights the gap between current academic understandings of young people's mental health self-care and young people's experience. The presented definition will enable future research to begin from an understanding of self-care which is relevant to young people with experience of mental health difficulties.
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Affiliation(s)
- Alex Truscott
- Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, 4-8 Rodney St, London, N1 9JH, UK.
| | - Daniel Hayes
- Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, 4-8 Rodney St, London, N1 9JH, UK
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Tom Bardsley
- Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, 4-8 Rodney St, London, N1 9JH, UK
| | - Disha Choksi
- Anna Freud National Centre for Children and Families, 4-8 Rodney St, London, N1 9JH, UK
| | - Julian Edbrooke-Childs
- Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, 4-8 Rodney St, London, N1 9JH, UK
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7
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Edbrooke-Childs J, Rashid A, Ritchie B, Deighton J. Predictors of amounts of child and adolescent mental health service use. Eur Child Adolesc Psychiatry 2023; 32:2335-2342. [PMID: 36114311 PMCID: PMC10576665 DOI: 10.1007/s00787-022-02063-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 08/05/2022] [Indexed: 11/03/2022]
Abstract
The aim of this study was to build evidence about how to tailor services to meet the individual needs of young people by identifying predictors of amounts of child and adolescent mental health service use. We conducted a secondary analysis of a large administrative dataset from services in England was conducted using the Mental Health Services Data Set (years 2016-17 and 2017-18). The final sample included N = 27,362 episodes of care (periods of service use consisting of at least two attended care contacts and less than 180 days between care contacts) from 39 services. There were 50-10,855 episodes per service. The descriptive statistics for episodes of care were: Mage = 13 years, SDage = 4.71, range = 0-25 years; 13,785 or 50% male. Overall, there were high levels of heterogeneity in number of care contacts within episodes of care: M = 11.12, SD = 28.28, range = 2-1529. Certain characteristics predicted differential patterns of service use. For example, young people with substance use (beta = 6.29, 95% CI = 5.06-7.53) or eating disorders (beta = 4.30, 95% CI = 3.29-5.30) were particularly more likely to have higher levels of service use. To build on this, evidence is needed about predictors of child and adolescent mental health treatment outcome and whether the same characteristics predict levels of improvement as well as levels of service use.
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Affiliation(s)
- Julian Edbrooke-Childs
- Evidence Based Practice Unit, UCL and Anna Freud Centre, 4-8 Rodney Street, London, N1 9JH, UK.
| | - Anisatu Rashid
- Child Outcomes Research Consortium, UCL and Anna Freud Centre, London, UK
| | - Benjamin Ritchie
- Child Outcomes Research Consortium, UCL and Anna Freud Centre, London, UK
| | - Jessica Deighton
- Evidence Based Practice Unit, UCL and Anna Freud Centre, 4-8 Rodney Street, London, N1 9JH, UK
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Midgley N, Mortimer R, Carter M, Casey P, Coffman L, Edbrooke-Childs J, Edridge C, Fonagy P, Gomes M, Kapoor A, Marks S, Martin P, Moltrecht B, Morris E, Pokorna N, McFarquhar T. Emotion regulation in children (ERiC): A protocol for a randomised clinical trial to evaluate the clinical and cost effectiveness of Mentalization Based Treatment (MBT) vs Treatment as Usual for school-age children with mixed emotional and behavioural difficulties. PLoS One 2023; 18:e0289503. [PMID: 37590277 PMCID: PMC10434917 DOI: 10.1371/journal.pone.0289503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND The majority of children referred to Child and Adolescent Mental Health Services (CAMHS) in the UK will present with mixed emotional and behavioural difficulties, but most mental health treatments are developed for single disorders. There is a need for research on treatments that are helpful for these mixed difficulties, especially for school-age children. Emotion Regulation (ER) difficulties present across a wide range of mental health disorders and mentalizing may help with regulation. The ability to mentalize one's own experiences and those of others plays a key role in coping with stress, regulation of emotions, and the formation of stable relationships. Mentalization Based Therapy (MBT) is a well-evidenced therapy that aims to promote mentalization, which in turn increases ER capacities, leading to decreased emotional and behavioural difficulties. The aim of this study is to test the clinical- and cost-effectiveness of MBT compared to treatment as usual for school age children with emotional and behavioural difficulties. If effective, we hope this approach can become available to the growing number of children presenting to mental health services with a mix of emotional and behavioural difficulties. MATERIALS AND METHODS Children referred to CAMHS aged 6-12 with mixed mental health problems (emotional and behavioural) as primary problem can take part with their parent/carers. Children will be randomly allocated to receive either MBT or treatment as usual (TAU) within the CAMHS clinic they have been referred to. MBT will be 6-8 sessions offered fortnightly and can flexibly include different family members. TAU is likely to include CBT, parenting groups, and/or children's social skills groups. Parent/carers and children will be asked to complete outcome assessments (questionnaires and tasks) online at the start of treatment, mid treatment (8 weeks), end of treatment (16 weeks) and at follow up (40 weeks). TRIAL REGISTRATION Clinical trial registration: ISRCTN 11620914.
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Affiliation(s)
- Nick Midgley
- The Anna Freud Centre, London, United Kingdom
- University College London, United Kingdom
| | - Rose Mortimer
- The Anna Freud Centre, London, United Kingdom
- University College London, United Kingdom
| | - Mark Carter
- Barnet, Enfield and Haringey NHS Trust, United Kingdom
| | - Polly Casey
- The Anna Freud Centre, London, United Kingdom
- University College London, United Kingdom
| | | | | | - Chloe Edridge
- The Anna Freud Centre, London, United Kingdom
- University College London, United Kingdom
| | - Peter Fonagy
- The Anna Freud Centre, London, United Kingdom
- University College London, United Kingdom
| | | | - Anoushka Kapoor
- The Anna Freud Centre, London, United Kingdom
- University College London, United Kingdom
| | | | | | - Bettina Moltrecht
- The Anna Freud Centre, London, United Kingdom
- University College London, United Kingdom
| | - Emma Morris
- The Anna Freud Centre, London, United Kingdom
- University College London, United Kingdom
| | - Nikola Pokorna
- The Anna Freud Centre, London, United Kingdom
- University College London, United Kingdom
| | - Tara McFarquhar
- The Anna Freud Centre, London, United Kingdom
- University College London, United Kingdom
- University of East Anglia, Norwich, United Kingdom
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Spuerck I, Stankovic M, Fatima SZ, Yilmas E, Morgan N, Jacob J, Edbrooke-Childs J, Vostanis P. International youth mental health case study of peer researchers' experiences. Res Involv Engagem 2023; 9:33. [PMID: 37189172 DOI: 10.1186/s40900-023-00443-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 05/03/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND The involvement of young people as peer researchers, especially with lived experience, is increasingly considered important in youth mental health research. Yet, there is variation in the understanding of the role, and limited evidence on its implementation across different research systems. This case study focusses on the barriers and enablers of implementing peer researcher roles within and across majority world countries contexts. METHODS Based on an international youth mental health project involving different levels of peer researchers and participants from eight countries, peer researchers and a co-ordinating career researcher reflect on lessons regarding enabling and challenging factors. These reflections are captured and integrated by a systematic insight analysis process. RESULTS Building on existing international networks, it was feasible to actively involve peer researchers with lived experience in a multi-country mental health study, who in turn recruited and engaged young participants. Identified challenges include the terminology and definition of the role, cultural differences in mental health concepts, and consistency across countries and sites. DISCUSSION Peer researchers' role could be strengthened and mainstreamed in the future through ongoing international networks, training, sufficient planning, and active influence throughout the research process. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
| | | | | | | | | | - Jenna Jacob
- Anna Freud Centre, London, UK
- University College London, London, UK
| | | | - Panos Vostanis
- University of Leicester, Leicester, UK.
- University of Johannesburg, Johannesburg, South Africa.
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10
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Ruby F, Costa da Silva L, Tait N, Rashid A, Singleton R, Atkins L, Marriot S, Dalzell K, Labno A, Edbrooke-Childs J, Jacob J. Children and young people's mental health outcome measures in paediatrics. Arch Dis Child 2023; 108:271-275. [PMID: 35680404 DOI: 10.1136/archdischild-2020-320852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 05/13/2022] [Indexed: 11/03/2022]
Abstract
Paediatricians are increasingly likely to encounter children and young people with mental health difficulties, either as primary presentations or as comorbidities linked with chronic illnesses. However, paediatricians may have limited training or experience regarding the tools available to identify mental health needs and how to use these tools. The current paper aims to provide a go-to guide for paediatricians when considering the use of mental health and well-being outcome measures, including how to select, administer and interpret measures effectively. It also provides practical guidance on the most common mental health outcome measures used in children and young people's mental health services across the UK and elsewhere, which paediatricians are likely to encounter in their practice. Paediatricians may also find these measures useful in their own practice to screen for potential mental health difficulties, monitor the impact of chronic health conditions on a young person's mental health and well-being, or to provide evidence when referring young people to mental health services.
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Affiliation(s)
- Florence Ruby
- Child Outcomes Research Consortium, Anna Freud Centre, London, UK
| | | | - Nick Tait
- Child Outcomes Research Consortium, Anna Freud Centre, London, UK
| | - Anisatu Rashid
- Child Outcomes Research Consortium, Anna Freud Centre, London, UK
| | - Rosie Singleton
- Child Outcomes Research Consortium, Anna Freud Centre, London, UK
| | - Lee Atkins
- Child Outcomes Research Consortium, Anna Freud Centre, London, UK
| | - Sally Marriot
- Child Outcomes Research Consortium, Anna Freud Centre, London, UK
| | - Kate Dalzell
- Child Outcomes Research Consortium, Anna Freud Centre, London, UK
| | - Angelika Labno
- Evidence Based Practice Unit, Anna Freud Centre and UCL, London, UK
| | - Julian Edbrooke-Childs
- Child Outcomes Research Consortium, Anna Freud Centre, London, UK
- Evidence Based Practice Unit, Anna Freud Centre and UCL, London, UK
| | - Jenna Jacob
- Child Outcomes Research Consortium, Anna Freud Centre, London, UK
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11
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Jacob J, Edbrooke-Childs J, Costa da Silva L, Law D. Notes from the youth mental health field: Using movement towards goals as a potential indicator of service change and quality improvement. J Clin Psychol 2023; 79:697-710. [PMID: 34114660 DOI: 10.1002/jclp.23195] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 02/16/2021] [Accepted: 05/30/2021] [Indexed: 11/09/2022]
Abstract
The aim of this paper is to report our notes from the field on using movement toward goals at an aggregate level as an inference of service effectiveness. Analysis of routinely collected data from UK youth mental health services was conducted (N = 8,172, age M = 13.8, 67% female, 32% male) to explore the impact of including goal-based outcome data in combined calculations of standardized measures based on the principles of reliable change ("measurable change"). Due to the broad nature of standardized measures, inferred validity becomes diluted in any team or service level aggregate analysis. To make inferences that are closer to the person's interpretation of their difficulties, we argue that Idiographic Patient Reported Outcome Measures (I-PROMs) counterbalance these limitations. This is supported by our findings. The measurable change metric is the first step towards enabling national analysis of aggregated I-PROMs. I-PROMs, supplemented by standardized measures should be used to consider service evaluation.
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Affiliation(s)
- Jenna Jacob
- Child Outcomes Research Consortium, Anna Freud Centre, London, UK.,Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Julian Edbrooke-Childs
- Child Outcomes Research Consortium, Anna Freud Centre, London, UK.,Department of Clinical, Educational and Health Psychology, UCL, London, UK.,Evidence Based Practice Unit, Anna Freud Centre, London, UK
| | - Luís Costa da Silva
- Child Outcomes Research Consortium, Anna Freud Centre, London, UK.,Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Duncan Law
- Child Outcomes Research Consortium, Anna Freud Centre, London, UK.,MindMonkey Associates Ltd, London, UK
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12
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Lane R, D'Souza S, Singleton R, Hindley N, Bevington D, White O, Jacob J, Wheeler J, Edbrooke-Childs J. Characteristics of young people accessing recently implemented Community Forensic Child and Adolescent Mental Health Services (F:CAMHS) in England: insights from national service activity data. Eur Child Adolesc Psychiatry 2023; 32:405-417. [PMID: 34519859 PMCID: PMC10038947 DOI: 10.1007/s00787-021-01870-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 09/01/2021] [Indexed: 10/20/2022]
Abstract
Children and young people in contact with forensic child and adolescent mental health services present with more complex needs than young people in the general population. Recent policy in child and adolescent mental health has led to the implementation of new workstreams and programmes to improve service provision. This research examines the characteristics of children and young people referred to recently commissioned Community Forensic Child and Adolescent Services (F:CAMHS) and service activity during the first 24 months of service. The study is a national cohort study to describe the population and investigate service provision and access across England. Secondary data on 1311 advice cases and 1406 referrals are included in analysis. Findings show that 71.9% of the sample had accessed mainstream CAMHS before their referral, 50.9% had experienced/witnessed multiple traumatic events and 58.4% of young people presented with multiple difficulties. The results of the study highlight the complexity of the cohort and a need for interagency trauma-informed working. This is the first study to describe the characteristics of children and young people referred to Community F:CAMHS and provides valuable information on pathways and needs to inform service policy and provision.
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Affiliation(s)
- Rebecca Lane
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, Camberwell, London, SE5 8AB, UK
- Anna Freud Centre, The Kantor Centre of Excellence, 4-8 Rodney Street, London, N1 9JH, UK
- University College London, Gower Street, London, WC1E 6BT, UK
| | - Sophie D'Souza
- University College London, Gower Street, London, WC1E 6BT, UK
- Anna Freud Centre, Child Outcomes Research Consortium, Kantor Centre for Excellence, 4-8 Rodney Street, London, N1 9JH, UK
| | - Rosie Singleton
- Anna Freud Centre, Child Outcomes Research Consortium, Kantor Centre for Excellence, 4-8 Rodney Street, London, N1 9JH, UK
| | - Nick Hindley
- South Central F:CAMHS, Oxford Health NHS Foundation Trust, Maple House, the Slade, Horspath Driftway, Oxford, OX3 7JH, UK
- University of Oxford, Oxford, OX1 2JD, UK
| | - Dickon Bevington
- Anna Freud Centre, The Kantor Centre of Excellence, 4-8 Rodney Street, London, N1 9JH, UK
| | - Oliver White
- South Central F:CAMHS, Oxford Health NHS Foundation Trust, Maple House, the Slade, Horspath Driftway, Oxford, OX3 7JH, UK
- NHS England and NHS Improvement, Skipton House, 90 London Road, London, SE1 6LH, UK
- Southern Health NHS Foundation Trust, Tatchbury Mount, Calmore, Southampton, SO40 2RZ, UK
| | - Jenna Jacob
- Anna Freud Centre, The Kantor Centre of Excellence, 4-8 Rodney Street, London, N1 9JH, UK.
- University College London, Gower Street, London, WC1E 6BT, UK.
- Anna Freud Centre, Child Outcomes Research Consortium, Kantor Centre for Excellence, 4-8 Rodney Street, London, N1 9JH, UK.
| | - James Wheeler
- Anna Freud Centre, The Kantor Centre of Excellence, 4-8 Rodney Street, London, N1 9JH, UK
| | - Julian Edbrooke-Childs
- Anna Freud Centre, The Kantor Centre of Excellence, 4-8 Rodney Street, London, N1 9JH, UK
- University College London, Gower Street, London, WC1E 6BT, UK
- Anna Freud Centre, Child Outcomes Research Consortium, Kantor Centre for Excellence, 4-8 Rodney Street, London, N1 9JH, UK
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13
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Sales CMD, Ashworth M, Ayis S, Barkham M, Edbrooke-Childs J, Faísca L, Jacob J, Xu D, Cooper M. Idiographic patient reported outcome measures (I-PROMs) for routine outcome monitoring in psychological therapies: Position paper. J Clin Psychol 2023; 79:596-621. [PMID: 35194799 DOI: 10.1002/jclp.23319] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 11/26/2021] [Accepted: 01/09/2022] [Indexed: 11/07/2022]
Abstract
Idiographic patient-reported outcome measures (I-PROMs) are a growing set of individualized tools for use in routine outcome monitoring (ROM) in psychological therapies. This paper presents a position statement on their conceptualization, use, and analysis, based on contemporary evidence and clinical practice. Four problem-based, and seven goal-based, I-PROMs, with some evidence of psychometric evaluation and use in psychotherapy, were identified. I-PROMs may be particularly valuable to the evaluation of psychological therapies because of their clinical utility and their alignment with a patient-centered approach. However, there are several challenges for I-PROMs: how to generate items in a robust manner, their measurement model, methods for establishing their reliability and validity, and the meaning of an aggregated I-PROM score. Based on the current state of the literature, we recommend that I-PROMs are used to complement nomothetic measures. Research recommendations are also made regarding the most appropriate methods for analyzing I-PROM data.
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Affiliation(s)
- Célia M D Sales
- Faculty of Psychology and Education Sciences (FPCEUP), Center for Psychology at the Universidade do Porto (CPUP), University of Porto, Porto, Portugal
| | - Mark Ashworth
- School of Life Course and Population Sciences, King's College London, Guy's Campus, London, United Kingdom, SE1 1UL, UK
| | - Salma Ayis
- School of Life Course and Population Sciences, King's College London, Guy's Campus, London, United Kingdom, SE1 1UL, UK
| | - Michael Barkham
- Clinical and Applied Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Julian Edbrooke-Childs
- Anna Freud Centre, Applied Research and Evaluation, The Kantor Centre of Excellence, 4-8 Rodney Street, London, N1 9JH, UK
| | - Luís Faísca
- FCHS & Center for Research in Health Technologies and Information, Universidade do Algarve, Faro, Portugal
| | - Jenna Jacob
- Anna Freud Centre, Applied Research and Evaluation, The Kantor Centre of Excellence, 4-8 Rodney Street, London, N1 9JH, UK
| | - Dan Xu
- Zhejiang University of Technology, Hangzhou, China
| | - Mick Cooper
- Department of Psychology, University of Roehampton, London, UK
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14
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Leibovich L, Mechler J, Lindqvist K, Mortimer R, Edbrooke-Childs J, Midgley N. Unpacking the active ingredients of internet-based psychodynamic therapy for adolescents. Psychother Res 2023; 33:108-117. [PMID: 35297746 DOI: 10.1080/10503307.2022.2050829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Internet-based psychodynamic psychotherapy (iPDT) for adolescents has been found to be effective for treating depression, but not much is known about its active ingredients. OBJECTIVE To explore the techniques used in chat sessions in an iPDT program for depressed adolescents, and to investigate whether they predicted improvement in depression symptoms. METHOD The study uses data collected from a pilot study. The iPDT consisted of 8 modules delivered over 10 weeks that included text, video, exercises, and a weekly text-based chat session with a therapeutic support worker (TSW). The participants were 23 adolescents meeting criteria for depression. The TSWs were 9 psychology master's students. A depression inventory QIDS-A17-SR was filled weekly by the participants, and a self-rated techniques inventory (MULTI-30) was filled by the TSWs after each chat session. RESULTS Common factor techniques were the most widely used techniques in the chat sessions. Both common factors and psychodynamic techniques predicted improvement in depression, with psychodynamic techniques predicting improvement at the following week. CBT techniques were also used but did not predict improvement in depression. CONCLUSION iPDT seem to work in line with theory, where the mechanisms thought to be important for change in treatment were predictive of outcome.
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Affiliation(s)
- Liat Leibovich
- The Clinical Psychology Program, Ruppin Academic Center, Emek-Hefer, Israel
| | - Jakob Mechler
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Karin Lindqvist
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Rose Mortimer
- The Anna Freud National Centre for Children and Families, London, UK
| | | | - Nick Midgley
- The Anna Freud National Centre for Children and Families, London, UK
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15
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De Ossorno Garcia S, Edbrooke-Childs J, Salhi L, Ruby FJM, Sefi A, Jacob J. Examining concurrent validity and item selection of the Session Wants and Needs Outcome Measure (SWAN-OM) in a children and young people web-based therapy service. Front Psychiatry 2023; 14:1067378. [PMID: 36846241 PMCID: PMC9947788 DOI: 10.3389/fpsyt.2023.1067378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/16/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Single-session mental health interventions are frequently attended by children and young people (CYP) in both web-based and face-to-face therapy settings. The Session "Wants" and "Needs" Outcome Measure (SWAN-OM) is an instrument developed in a web-based therapy service to overcome the challenges of collecting outcomes and experiences of single-session therapies (SSTs). It provides pre-defined goals for the session, selected by the young person prior to the intervention, on which progress toward achievement is scored at the end of the session. OBJECTIVE The objective of this study was to evaluate the instrument's psychometric properties, including concurrent validity against three other frequently used outcome and experience measures, at a web-based and text-based mental health service. METHODS The SWAN-OM was administered for a period of 6 months to 1,401 CYP (aged 10-32 years; 79.3% white; 77.59% female) accessing SST on a web-based service. Item correlations with comparator measures and hierarchical logistic regressions to predict item selection were calculated for concurrent validity and psychometric exploration. RESULTS The most frequently selected items were "Feel better" (N = 431; 11.61%) and "Find ways I can help myself" (N = 411; 11.07%); unpopular items were "Feel safe in my relationships" (N = 53; 1.43%) and "Learn the steps to achieve something I want" (N = 58; 1.56%). The SWAN-OM was significantly correlated with the Experience of Service Questionnaire, particularly the item "Feel better" [rs(109) = 0.48, p < 0.001], the Youth Counseling Impact Scale, particularly the item "Learn the steps to achieve something I want" [rs(22) = 0.76, p < 0.001], and the Positive and Negative Affect Schedule, particularly the items "Learn how to feel better" [rs(22) = 0.72, p < 0.001] and "Explore how I feel" [rs(70) = -0.44, p < 0.001]. CONCLUSION The SWAN-OM demonstrates good concurrent validity with common measures of outcome and experience. Analysis suggests that lesser-endorsed items may be removed in future iterations of the measure to improve functionality. Future research is required to explore SWAN-OM's potential to measure meaningful change in a range of therapeutic settings.
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Affiliation(s)
| | - Julian Edbrooke-Childs
- Anna Freud Centre, CORC, London, United Kingdom.,Evidence Base Practice Unit (EBPU), University College London, London, United Kingdom
| | - Louisa Salhi
- Kooth Plc, London, United Kingdom.,School of Psychology, University of Kent, Canterbury, Kent, United Kingdom
| | | | - Aaron Sefi
- Kooth Plc, London, United Kingdom.,Department of Psychology, University of Exeter, Exeter, Devon, United Kingdom
| | - Jenna Jacob
- Anna Freud Centre, CORC, London, United Kingdom
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16
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Krause KR, Edbrooke-Childs J, Bear HA, Calderón A, Wolpert M. What treatment outcomes matter most? A Q-study of outcome priority profiles among youth with lived experience of depression. Eur Child Adolesc Psychiatry 2023; 32:123-137. [PMID: 34273026 PMCID: PMC9908724 DOI: 10.1007/s00787-021-01839-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 06/28/2021] [Indexed: 12/16/2022]
Abstract
Interest in youth perspectives on what constitutes an important outcome in the treatment of depression has been growing, but limited attention has been given to heterogeneity in outcome priorities, and minority viewpoints. These are important to consider for person-centred outcome tracking in clinical practice, or when conducting clinical trials targeting specific populations. This study used Q-methodology to identify outcome priority profiles among youth with lived experience of service use for depression. A purposive sample of 28 youth (aged 16-21 years) rank-ordered 35 outcome statements by importance and completed brief semi-structured interviews eliciting their sorting rationales. By-person principal component analysis was used to identify outcome priority profiles based on all Q-sort configurations. Priority profiles were described and interpreted with reference to the qualitative interview data. Four distinct outcome priority profiles were identified: "Relieving distress and experiencing a happier emotional state"; "Learning to cope with cyclical distressing emotional states"; "Understanding and processing distressing emotional states"; and "Reduced interference of ongoing distressing emotional states with daily life". All four profiles prioritised improvements in mood and the ability to feel pleasure but differed in the level of importance assigned to learning coping skills, processing experiences, and the reduced interference of depression with life and identity. As part of a person-centered approach to care delivery, care providers should routinely engage young people in conversation and shared decision-making about the types of change they would like to prioritise and track during treatment, beyond a common core of consensus outcomes.
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Affiliation(s)
- Karolin Rose Krause
- Evidence Based Practice Unit (EBPU), Anna Freud National Centre for Children and Families, 4-8 Rodney Street, London, N1 9JH, UK. .,Research Department of Clinical, Research Department of Clinical, University College London, Gower Street, London, WC1E 6BT, UK. .,Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health (CAMH), 80 Workman Way, Toronto, ON, M6J 1H4, Canada.
| | - Julian Edbrooke-Childs
- Evidence Based Practice Unit (EBPU), Anna Freud National Centre for Children and Families, 4-8 Rodney Street, London, N1 9JH UK ,Research Department of Clinical, Research Department of Clinical, University College London, Gower Street, London, WC1E 6BT UK
| | - Holly Alice Bear
- Evidence Based Practice Unit (EBPU), Anna Freud National Centre for Children and Families, 4-8 Rodney Street, London, N1 9JH UK ,Research Department of Clinical, Research Department of Clinical, University College London, Gower Street, London, WC1E 6BT UK ,Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, M6J 1H4 UK
| | - Ana Calderón
- School of Psychology, Universidad Gabriela Mistral, Avda. Ricardo Lyon 1177, Providencia, Santiago, Chile
| | - Miranda Wolpert
- Research Department of Clinical, Research Department of Clinical, University College London, Gower Street, London, WC1E 6BT UK ,Wellcome Trust, 215 Euston Rd, Bloomsbury, London, NW1 2BE UK
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17
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Ravaccia GG, Johnson SL, Morgan N, Lereya ST, Edbrooke-Childs J. Experiences of Using the Digital Support Tool MeeToo: Mixed Methods Study. JMIR Pediatr Parent 2022; 5:e37424. [PMID: 36264619 PMCID: PMC9629342 DOI: 10.2196/37424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/20/2022] [Accepted: 06/15/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Digital peer support is an increasingly used form of mental health support for young people. However, there is a need for more research on the impact of digital peer support and why it has an impact. OBJECTIVE The aim of this research is to examine young people's experiences of using a digital peer support tool: MeeToo. After the time of writing, MeeToo has changed their name to Tellmi. MeeToo is an anonymous, fully moderated peer support tool for young people aged 11-25 years. There were two research questions: (1) What impacts did using MeeToo have on young people? (2) Why did using MeeToo have these impacts on young people? METHODS A mixed methods study was conducted. It involved secondary analysis of routinely collected feedback questionnaires, which were completed at two time points (T1 and T2) 2-3 months apart. Questionnaires asked about young people's (N=876) experience of using MeeToo, mental health empowerment, and well-being. Primary data were collected from semistructured interviews with 10 young people. RESULTS Overall, 398 (45.4%) of 876 young people completed the T1 questionnaire, 559 (63.8%) completed the T2 questionnaire, and 81 (9.2%) completed both. Descriptive statistics from the cross-sectional analysis of the questionnaires identified a range of positive impacts of using MeeToo, which included making it easier to talk about difficult things, being part of a supportive community, providing new ways to help oneself, feeling better, and feeling less alone. Subgroup analysis (paired-sample t test) of 58 young females who had completed both T1 and T2 questionnaires showed a small but statistically significant increase in levels of patient activation, one of the subscales of the mental health empowerment scale: time 1 mean=1.83 (95% CI 1.72-1.95), time 2 mean=2.00 (95% CI 1.89-2.11), t59=2.15, and P=.04. Anonymity and the MeeToo sense of community were identified from interviews as possible reasons for why using MeeToo had these impacts. Anonymity helped to create a safe space in which users could express their feelings, thoughts, and experiences freely without the fear of being judged by others. The MeeToo sense of community was described as a valuable form of social connectedness, which in turn had a positive impact on young people's mental health and made them feel less isolated and alone. CONCLUSIONS The findings of this research showed a range of positive impacts and possible processes for young people using MeeToo. Future research is needed to examine how these impacts and processes can be sustained.
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Affiliation(s)
- Giulia Gaia Ravaccia
- Evidence Based Practice Unit, Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Sophie Laura Johnson
- Evidence Based Practice Unit, Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Nicholas Morgan
- Evidence Based Practice Unit, Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Suzet Tanya Lereya
- Evidence Based Practice Unit, Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Julian Edbrooke-Childs
- Evidence Based Practice Unit, Anna Freud National Centre for Children and Families, London, United Kingdom
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18
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Abstract
Carers may not always express child mental health concerns to health professionals. Therefore, identifying factors delaying help-seeking is important. The aim of this study was to examine the relationship between carer affect and help-seeking. In a secondary analysis of data collected from school-aged children (N = 1,857, mean age = 9.85 years, 51% female), we used logistic regression to examine the associations between carer worry, help-seeking and child mental health. Regarding worry, higher levels of emotional problems (OR = 1.42, 95% CI = 1.33-1.52), conduct problems (OR = 1.24, 95% CI = 1.12, 1.36), peer problems (OR = 1.17, 95% CI = 1.05-1.27) or functional impairment (OR = 1.37, 95% CI = 1.2-.56) were associated with higher levels of carer worry. Regarding help-seeking, higher levels of functional impairment were associated with higher levels of help-seeking (OR = 1.51, 95% CI = 1.09-2.11). After controlling for mental health problems, carers who reported being worried about their child's mental health were less likely than other carers to seek help (OR = 0.13, 95% CI = 0.05-0.35). Knowledge of these factors may inform early interventions. Alongside implications for future research and practice, limitations of the study are discussed.
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Affiliation(s)
- Shaun Liverpool
- Evidence Based Practice Unit, 4919Anna Freud National Centre for Children and Families and University College London, UK.,Faculty of Health, Social Care & Medicine, 6249Edge Hill University, UK
| | - Julian Edbrooke-Childs
- Evidence Based Practice Unit, 4919Anna Freud National Centre for Children and Families and University College London, UK
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19
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Mortimer R, Somerville MP, Mechler J, Lindqvist K, Leibovich L, Guerrero-Tates B, Edbrooke-Childs J, Martin P, Midgley N. Connecting over the internet: Establishing the therapeutic alliance in an internet-based treatment for depressed adolescents. Clin Child Psychol Psychiatry 2022; 27:549-568. [PMID: 35333646 DOI: 10.1177/13591045221081193] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Internet-based treatments have been developed for youth mental health difficulties, with promising results. However, little is known about the features of therapeutic alliance, and how it is established and maintained, in text-based interactions between adolescents and therapists in internet-based treatments. This study uses data collected during a pilot evaluation of a psychodynamic internet-based therapy for depressed adolescents. The adolescents had instant-messaging chats with their therapists once a week, over 10 weeks. The adolescents also rated the therapeutic alliance each week, using the Session Alliance Inventory. The present study uses qualitative methods to analyse transcripts of text-based communication between the young people and their therapists. The aim is to identify and describe the key features of therapeutic alliance, and reflect upon the implications for theory and clinical practice. Analysis identified three 'values' that may underpin a strong therapeutic alliance: togetherness, agency and hope. A number of therapist techniques were also found, which seemed to create a sense of these values during text-chat sessions. These findings are discussed, alongside implications for future research.
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Affiliation(s)
- Rose Mortimer
- 4785Anna Freud National Centre for Children and Families, London, UK
| | | | | | | | - Liat Leibovich
- Clinical Psychology, 54619Ruppin Institute, Emek Hefer, Israel
| | | | - Julian Edbrooke-Childs
- 4785Anna Freud National Centre for Children and Families, London, UK.,4919University College London, UK
| | | | - Nick Midgley
- 4785Anna Freud National Centre for Children and Families, London, UK.,4919University College London, UK
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20
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Jacob J, Edbrooke-Childs J, Flannery H, Segal TY, Law D. Goal-based measurement in paediatric settings: implications for practice. Arch Dis Child 2022; 108:344-348. [PMID: 35680402 DOI: 10.1136/archdischild-2021-322761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 05/13/2022] [Indexed: 11/04/2022]
Abstract
There is an observed link between physical illness and mental health difficulties and an increased likelihood of mental health difficulties in young people with chronic health conditions. The main outcome focus in paediatric settings is on physical health outcomes and functioning. In terms of functioning, the focus is on quality of life, measures of emotional well-being and perceptions of personal change, which are likely to be multifaceted and vary between patients. To complement standardised and diagnostically based measures, goal-based outcome measurement may be considered. The aim of this paper is to build on previous research, to provide a reflective commentary based on the authors' clinical and research experience in the use and interpretation of goal-based outcomes, to address what using goal-based measures for outcome purposes in these settings means practically. Examples are provided to demonstrate the importance of considering meaningful outcomes of importance to young people and how professionals may presume that physical 'recovery' is the goal of treatment, but what recovery means to that young person may be very nuanced. Further key considerations and suggested phrasing are given to introduce and work with young people's goals.
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Affiliation(s)
- Jenna Jacob
- Child Outcomes Research Consortium, Anna Freud Centre, London, UK
| | - Julian Edbrooke-Childs
- Child Outcomes Research Consortium, Anna Freud Centre, London, UK.,Clinical, Educational and Health Psychology, UCL, London, UK
| | - Halina Flannery
- Psychological Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - Terry Y Segal
- Paediatric Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Duncan Law
- Clinical, Educational and Health Psychology, UCL, London, UK.,MindMonkey Associates, London, UK
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21
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Vostanis P, Ruby F, Jacob J, Eruyar Ş, Mironga Getanda E, Haffejee S, Krishna M, Edbrooke-Childs J. Youth and professional perspectives of mental health resources across eight countries. Child Youth Serv Rev 2022; 136:106439. [PMID: 35521438 PMCID: PMC8972066 DOI: 10.1016/j.childyouth.2022.106439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 01/25/2022] [Accepted: 02/20/2022] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Youth mental health support and services vary across sociocultural contexts. It is important to capture the perspectives of youth with lived experiences for planning needs-led interventions and services, especially in Global South Countries (GSC), with limited specialist resources and representative literature. METHODS The aim was to establish how youth with lived experiences of anxiety and depression viewed external support in different countries, and how these views were juxtaposed with those of professionals. We involved 121 youth aged 14-24 years and 62 professionals from different disciplines in eight countries, predominantly from the Global South. Two youth and one professional focus group was facilitated in each country. The data were analysed through a codebook thematic approach. RESULTS Youth across all countries largely valued informal support from family, peers and community, whilst those from GSC had limited access to structural support. They related lived experiences to therapeutic engagement and processes, in contrast with professionals who focused on outcomes and service delivery. Mental health awareness and integration of interventions with social support were considered essential by both youth and professionals, especially in disadvantaged communities. CONCLUSION The mental health needs of youth in disadvantaged GSC communities can be best met through multi-modal interventions addressing these needs across their socioecology and positioned within a stepped care model. Youth with lived experiences should be involved in service planning, implementation and monitoring.
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Affiliation(s)
- Panos Vostanis
- University of Leicester, School of Media, Communication and Sociology, University Road, Leicester, UK
| | - Florence Ruby
- Anna Freud Centre, Child Outcomes Research Consortium, 4-8 Rodney Street, London N1 9JH, UK
| | - Jenna Jacob
- Anna Freud Centre, Child Outcomes Research Consortium, 4-8 Rodney Street, London N1 9JH, UK
| | - Şeyda Eruyar
- Necmettin Erbakan University, Department of Psychology, Köyceğiz 42140 Meram, Konya, Turkey
| | | | - Sadiyya Haffejee
- University of Johannesburg, Auckland Park, Johannesburg 2092, South Africa
| | - Murali Krishna
- FRAMe Mysore, New Kanthraj Urs Road, Kuvempunagar, Mysore 570023, India
| | - Julian Edbrooke-Childs
- Anna Freud Centre, Child Outcomes Research Consortium, 4-8 Rodney Street, London N1 9JH, UK
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22
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Edbrooke-Childs J, Rashid A, Ritchie B, Deighton J. Predictors of child and adolescent mental health treatment outcome. BMC Psychiatry 2022; 22:229. [PMID: 35361193 PMCID: PMC8973575 DOI: 10.1186/s12888-022-03837-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 03/07/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND To examine the predictors of treatment outcome or improvement in mental health difficulties for young people accessing child and adolescent mental health services. METHODS We conducted a secondary analysis of routinely collected data from services in England using the Mental Health Services Data Set. We conducted multilevel regressions on N = 5907 episodes from 14 services (Mage = 13.76 years, SDage = 2.45, range = 8-25 years; 3540 or 59.93% female) with complete information on mental health difficulties at baseline. We conduct similar analyses on N = 1805 episodes from 10 services (Mage = 13.59 years, SDage = 2.33, range = 8-24 years; 1120 or 62.05% female) also with complete information on mental health difficulties at follow up. RESULTS Girls had higher levels of mental health difficulties at baseline than boys (β = 0.28, 95% CI = 0.24-0.32). Young people with higher levels of mental health difficulties at baseline also had higher levels of deterioration in mental health difficulties at follow up (β = 0.72, 95% CI = 0.67-0.76), and girls had higher levels of deterioration in mental health difficulties at follow up than boys (β = 0.09, 95% CI = 0.03-0.16). Young people with social anxiety, panic disorder, low mood, or self-harm had higher levels of mental health difficulties at baseline and of deterioration in mental health difficulties at follow up compared to young people without these presenting problems. CONCLUSIONS Services seeing higher proportions of young people with higher levels of mental health difficulties at baseline, social anxiety, panic disorder, low mood, or self-harm may be expected to show lower levels of improvement in mental health difficulties at follow up.
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Affiliation(s)
- Julian Edbrooke-Childs
- Evidence Based Practice Unit, UCL and Anna Freud Centre, 4-8 Rodney Street, London, N1 9JH, UK. .,Child Outcomes Research Consortium, Anna Freud Centre, London, UK.
| | - Anisatu Rashid
- grid.466510.00000 0004 0423 5990Child Outcomes Research Consortium, Anna Freud Centre, London, UK
| | - Benjamin Ritchie
- grid.466510.00000 0004 0423 5990Child Outcomes Research Consortium, Anna Freud Centre, London, UK
| | - Jessica Deighton
- grid.466510.00000 0004 0423 5990Evidence Based Practice Unit, UCL and Anna Freud Centre, 4-8 Rodney Street, London, N1 9JH UK
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23
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Manning JB, Blandford A, Edbrooke-Childs J. Digital Companion Choice to Support Teachers' Stress Self-management: Systematic Approach Through Taxonomy Creation. JMIR Form Res 2022; 6:e32312. [PMID: 35171106 PMCID: PMC8892277 DOI: 10.2196/32312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 11/02/2021] [Accepted: 11/02/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There are thousands of digital companions designed for emotional well-being and stress, including websites, wearables, and smartphone apps. Although public evaluation frameworks and ratings exist, they do not facilitate digital companion choice based on contextual or individual information, such as occupation or personal management strategies. OBJECTIVE The aim of this study is to establish a process for creating a taxonomy to support systematic choice of digital companions for teachers' stress self-management. METHODS We used a 4-step study design. In step 1, we identified the dimension of stress self-management and strategic classifications. In step 2, we identified the dimension of the digital techniques and conceptual descriptions. In step 3, we created 6 criteria for the inclusion of digital companions. In step 4, we used the taxonomy framework created by steps 1 and 2 and populated it with digital companions for stress self-management, as identified in step 3. RESULTS First, in the dimension of stress self-management, we identified four classes of strategies: educational, physiological, cognitive, and social. Second, in the digital techniques dimension, we derived four conceptual descriptions for the digital companions' mechanisms of action: fostering reflection, suggesting treatment, peer-to-peer support, and entertainment. Third, we created six criteria for digital companion inclusion in the taxonomy: suitability, availability, evaluation, security, validity, and cost. Using the taxonomy framework and criteria, we populated it with digital companions for stress management ahead of presentation to teachers in a stress study workshop. CONCLUSIONS The elements of our approach can be generalized as principles for the creation of taxonomies for other occupations or conditions. Taxonomies such as this could be a valuable resource for individuals to understand which digital companion could be of help in their personal context.
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Affiliation(s)
- Julia B Manning
- Interaction Centre, Department of Computer Science, University College London, London, United Kingdom
| | - Ann Blandford
- Institute of Healthcare Engineering, University College London, London, United Kingdom
| | - Julian Edbrooke-Childs
- Evidence-based Practice Unit, University College London and Anna Freud Centre, London, United Kingdom
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24
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Moltrecht B, Patalay P, Bear HA, Deighton J, Edbrooke-Childs J. A Transdiagnostic, Emotion Regulation App (Eda) for Children: Design, Development, and Lessons Learned. JMIR Form Res 2022; 6:e28300. [PMID: 35044312 PMCID: PMC8811693 DOI: 10.2196/28300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 10/04/2021] [Accepted: 11/16/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Digital interventions, including mobile apps, represent a promising means of providing effective mental health support to children and young people. Despite the increased availability of mental health apps, there is a significant gap for this age group, especially for children (aged 10-12 years). Research investigating the effectiveness and development process of child mental health apps is limited, and the field faces persistent issues in relation to low user uptake and engagement, which is assumed to be a result of limited user involvement in the design process. OBJECTIVE This study aims to present the development and design process of a new mental health app for children that targets their emotion regulation abilities. We describe the creation of a new interdisciplinary development framework to guide the design process and explain how each activity informed different app features. METHODS The first 2 stages of the framework used a variety of methods, including weekly classroom observations over a 6-month period (20 in total); public engagement events with the target group (N=21); synthesis of the existing evidence as part of a meta-analysis; a series of co-design and participatory workshops with young users (N=33), clinicians (N=7), researchers (N=12), app developers (N=1), and designers (N=2); and finally, testing of the first high-tech prototype (N=15). RESULTS For the interdisciplinary framework, we drew on methods derived from the Medical Research Council framework for complex interventions, the patient-clinician framework, and the Druin cooperative inquiry. The classroom observations, public engagement events, and synthesis of the existing evidence informed the first key pillars of the app and wireframes. Subsequently, a series of workshops shaped and reshaped the content and app features, including games, psychoeducational films, and practice modules. On the basis of the prototype testing sessions, we made further adjustments to improve the app. CONCLUSIONS Although mobile apps could be highly suitable to support children's mental health on a wider scale, there is little guidance on how these interventions could be designed and developed. The involvement of young users across different design activities is very valuable. We hope that our interdisciplinary framework and description of the used methods will be helpful to others who are hoping to develop mental health apps for children and young people.
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Affiliation(s)
- Bettina Moltrecht
- Evidence-based practice unit, Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom.,Centre for Longitudinal Studies, Institute of Education, University College London, London, United Kingdom
| | - Praveetha Patalay
- Centre for Longitudinal Studies, Institute of Education, University College London, London, United Kingdom
| | - Holly Alice Bear
- Evidence-based practice unit, Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom.,Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Jessica Deighton
- Evidence-based practice unit, Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Julian Edbrooke-Childs
- Evidence-based practice unit, Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
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25
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Vera San Juan N, Oram S, Pinfold V, Temple R, Foye U, Simpson A, Johnson S, Hardt S, Abdinasir K, Edbrooke-Childs J. Priorities for Future Research About Screen Use and Adolescent Mental Health: A Participatory Prioritization Study. Front Psychiatry 2022; 13:697346. [PMID: 35599756 PMCID: PMC9120839 DOI: 10.3389/fpsyt.2022.697346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 04/06/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION This study aimed to identify research priorities for future research on screen use and adolescent mental health, from the perspectives of young people, parents/carers, and teachers. METHODS The study design was informed by the James Lind Alliance Priority Setting Partnership approach. A three-stage consensus-based process of consultation to identify research priorities using qualitative and quantitative methods. Research was guided by a steering group comprising researchers, third sector partners, clinicians, parents/carers and young people. A Young People's Advisory Group contributed at each stage. RESULTS Initial steps generated 26 research questions of importance to children and young people; these were ranked by 357 participants (229 children and young people and 128 adults). Consensus was reached for the prioritization of four topics for future research: (i) the impact of exposure to adult content on young people's mental health and relationships; (ii) the relationship between screen use and the well-being of young people from vulnerable groups; (iii) the impact of screen use on brain development; and (iv) the relationship between screen use and sleep.Additionally, young participants prioritized questions about online bullying, advertisements targeting young people, and the relationship between social media and specific mental health conditions. Research topics of interest arising specifically during the pandemic included the effects on adolescent mental health of exposure to constant news updates and online racial bias, and how young people take part in activism online. CONCLUSION These findings will enable researchers and funders to conduct research that is needs-oriented and relevant to the target audience.
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Affiliation(s)
- Norha Vera San Juan
- Health Service and Population Research Department, King's College London, London, United Kingdom.,NIHR Mental Health Policy Research Unit, London, United Kingdom
| | - Sian Oram
- Health Service and Population Research Department, King's College London, London, United Kingdom.,NIHR Mental Health Policy Research Unit, London, United Kingdom
| | | | | | - Una Foye
- Health Service and Population Research Department, King's College London, London, United Kingdom
| | - Alan Simpson
- Health Service and Population Research Department, King's College London, London, United Kingdom.,NIHR Mental Health Policy Research Unit, London, United Kingdom
| | - Sonia Johnson
- NIHR Mental Health Policy Research Unit, London, United Kingdom.,Division of Psychiatry, University College London, London, United Kingdom
| | - Selina Hardt
- Health Service and Population Research Department, King's College London, London, United Kingdom
| | | | - Julian Edbrooke-Childs
- NIHR Mental Health Policy Research Unit, London, United Kingdom.,Anna Freud National Centre for Children and Families, London, United Kingdom
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26
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Krause KR, Edbrooke-Childs J, Singleton R, Wolpert M. Are We Comparing Apples with Oranges? Assessing Improvement Across Symptoms, Functioning, and Goal Progress for Adolescent Anxiety and Depression. Child Psychiatry Hum Dev 2022; 53:737-753. [PMID: 33826029 PMCID: PMC9287244 DOI: 10.1007/s10578-021-01149-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2021] [Indexed: 12/16/2022]
Abstract
Strategies for comparing routinely collected outcome data across services or systems include focusing on a common indicator (e.g., symptom change) or aggregating results from different measures or outcomes into a comparable core metric. The implications of either approach for judging treatment success are not fully understood. This study drew on naturalistic outcome data from 1641 adolescents with moderate or severe anxiety and/or depression symptoms who received routine specialist care across 60 mental health services in England. The study compared rates of meaningful improvement between the domains of internalizing symptoms, functioning, and progress towards self-defined goals. Consistent cross-domain improvement was observed in only 15.6% of cases. Close to one in four (24.0%) young people with reliably improved symptoms reported no reliable improvement in functioning. Inversely, one in three (34.8%) young people reported meaningful goal progress but no reliable symptom improvement. Monitoring systems that focus exclusively on symptom change risk over- or under-estimating actual impact, while aggregating different outcomes into a single metric can mask informative differences in the number and type of outcomes showing improvement. A move towards harmonized outcome measurement approaches across multiple domains is needed to ensure fair and meaningful comparisons.
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Affiliation(s)
- Karolin Rose Krause
- Research Department for Clinical, Educational and Health Psychology, University College London, Gower Street, Bloomsbury, London, WC1E 6BT, UK.
- Evidence-Based Practice Unit, Anna Freud National Centre for Children and Families, 4-8 Rodney Street, London, N1 9JH, UK.
| | - Julian Edbrooke-Childs
- Research Department for Clinical, Educational and Health Psychology, University College London, Gower Street, Bloomsbury, London, WC1E 6BT, UK
- Evidence-Based Practice Unit, Anna Freud National Centre for Children and Families, 4-8 Rodney Street, London, N1 9JH, UK
| | - Rosie Singleton
- Research Department for Clinical, Educational and Health Psychology, University College London, Gower Street, Bloomsbury, London, WC1E 6BT, UK
- Evidence-Based Practice Unit, Anna Freud National Centre for Children and Families, 4-8 Rodney Street, London, N1 9JH, UK
| | - Miranda Wolpert
- Research Department for Clinical, Educational and Health Psychology, University College London, Gower Street, Bloomsbury, London, WC1E 6BT, UK
- Wellcome Trust, 215 Euston Rd, Bloomsbury, London, NW1 2BE, UK
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27
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Bear HA, Krause KR, Edbrooke-Childs J, Wolpert M. Understanding the illness representations of young people with anxiety and depression: A qualitative study. Psychol Psychother 2021; 94:1036-1058. [PMID: 33960606 DOI: 10.1111/papt.12345] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/26/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Many young people with anxiety or depression drop out of treatment early, and/or leave treatment without showing measurably improved symptom levels. To enhance treatment engagement and effectiveness, it is critical to better understand how young people's perceptions of the symptoms, causes, consequences, treatability, and course of their anxiety and depression influence engagement. AIM This study aimed to provide a qualitative account of illness perceptions among youth with anxiety and depression by applying the Common Sense Model of Self-Regulation (CSM), which was developed in physical health contexts. METHODS Semi-structured interviews were conducted with 26 young people (aged 16-24, 73% female) with a history of anxiety and/or depression. Interviews were analysed using a combination of theory- and data-driven analysis techniques, consisting primarily of deductive thematic analysis. RESULTS The five themes broadly mapped onto the dimensions of the CSM, suggesting parallels in how mental and physical health problems are perceived. Anxiety and depression were viewed as non-linear, relapsing and remitting, but lifelong conditions, with a fluctuating and complex path to recovery and coping. Youth described pervasive negative impacts on their lives, but also described some positive aspects. IMPLICATIONS Better understanding of young people's illness beliefs has the potential to open a range of intervention possibilities by prioritizing young people's illness perceptions over the clinician's understanding and the supposed objective condition severity and trajectory. Although this study supported a common structure of illness beliefs, the content of these beliefs was idiosyncratic and specific to anxiety and depression, suggesting the need to develop a valid tool to measure illness perceptions in this group. PRACTITIONER POINTS Our findings suggest that illness perceptions are complex, highly idiosyncratic, and specific to youth anxiety and depression. Given the complexity of these beliefs and the known association with important treatment- and health-related outcomes, it is important that clinical formulation incorporates young people's illness belief models, including their perceptions of symptoms, cause, timeline to recovery, consequences, and personal and treatment control. To increase help-seeking, treatment engagement and adaptive coping strategies, therapy should work to a shared understanding of illness beliefs. Increasing congruence between the belief models of young people, families, and clinicians may serve to improve treatment benefits and address the unmet mental health needs of young people.
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Affiliation(s)
- Holly Alice Bear
- Evidence-Based Practice Unit (EBPU), University College London and Anna Freud National Centre for Children and Families, UK.,Department of Psychiatry, Warneford Hospital, University of Oxford, UK
| | - Karolin Rose Krause
- Evidence-Based Practice Unit (EBPU), University College London and Anna Freud National Centre for Children and Families, UK.,Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
| | - Julian Edbrooke-Childs
- Evidence-Based Practice Unit (EBPU), University College London and Anna Freud National Centre for Children and Families, UK
| | - Miranda Wolpert
- Evidence-Based Practice Unit (EBPU), University College London and Anna Freud National Centre for Children and Families, UK.,Wellcome Trust, London, UK
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Sales CMD, Martins F, Alves MM, Carletto S, Conejo-Cerón S, da Silva LC, Čuš A, Edridge C, Ferreira N, Hancheva C, Lima EMA, Liverpool S, Midgley N, Moltrecht B, Moreno-Peral P, Morgan N, Mortimer R, Mota CP, Pietrabissa G, Sousa S, Ulberg R, Edbrooke-Childs J. Patient and Public Involvement in Youth Mental Health Research: Protocol for a Systematic Review of Practices and Impact. Front Psychol 2021; 12:703624. [PMID: 34803797 PMCID: PMC8603822 DOI: 10.3389/fpsyg.2021.703624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 09/28/2021] [Indexed: 12/03/2022] Open
Abstract
Various health settings have advocated for involving patients and members of the public (PPI) in research as a means to increase quality and relevance of the produced knowledge. However, youth PPI has been an understudied area. This protocol paper describes a new project that aims to summarize what is known about PPI with young people in mental health research. In line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses Statement guidelines we will identify and appraise suitable articles and extract and synthesize relevant information including at least two reviewers at each stage of the process. Results will be presented in two systematic reviews that will describe (a) how youth PPI has been conducted (Review1) and (b) what impact youth PPI had on the subsequent research and on stakeholders (Review2). To our knowledge, this is the first set of reviews that uses a critical appraisal tool, which is co-developed with children and young people. Findings from this project will provide valuable insights and set out the key steps to adopting adequate PPI methods when involving children and young people in mental health research.
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Affiliation(s)
- Célia M D Sales
- Faculty of Psychology and Education Science, University of Porto, Porto, Portugal.,Center for Psychology, University of Porto (CPUP), Porto, Portugal
| | - Filipa Martins
- Faculty of Psychology and Education Science, University of Porto, Porto, Portugal
| | - Marisa M Alves
- Faculty of Psychology and Education Science, University of Porto, Porto, Portugal
| | - Sara Carletto
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Turin, Italy
| | | | - Luis Costa da Silva
- Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, Clinical, Educational and Health Psychology, London, United Kingdom.,Child Outcomes Research Consortium, Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Anja Čuš
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Chloe Edridge
- Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, Clinical, Educational and Health Psychology, London, United Kingdom.,Child Outcomes Research Consortium, Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Nuno Ferreira
- Department of Social Sciences, University of Nicosia, Nicosia, Cyprus
| | | | - Esperanca M A Lima
- Faculty of Psychology and Education Science, University of Porto, Porto, Portugal
| | - Shaun Liverpool
- Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, Clinical, Educational and Health Psychology, London, United Kingdom.,Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, United Kingdom
| | - Nick Midgley
- Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, Clinical, Educational and Health Psychology, London, United Kingdom
| | - Bettina Moltrecht
- Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, Clinical, Educational and Health Psychology, London, United Kingdom
| | | | - Nicholas Morgan
- Child Outcomes Research Consortium, Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Rose Mortimer
- Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, Clinical, Educational and Health Psychology, London, United Kingdom
| | - Catarina Pinheiro Mota
- Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, Clinical, Educational and Health Psychology, London, United Kingdom.,University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
| | - Giada Pietrabissa
- Department of Psychology, Catholic University of Milan, Milan, Italy.,Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory, Milan, Italy
| | - Sonia Sousa
- School of Digital Technologies, Tallinn University, Tallinn, Estonia
| | - Randi Ulberg
- Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatry at Diakonhjemmet Hospital, Oslo, Norway
| | - Julian Edbrooke-Childs
- Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, Clinical, Educational and Health Psychology, London, United Kingdom.,Child Outcomes Research Consortium, Anna Freud National Centre for Children and Families, London, United Kingdom
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Bear HA, Dalzell K, Edbrooke-Childs J, Wolpert M. Applying behaviour change theory to understand the barriers to implementing routine outcome monitoring. Br J Clin Psychol 2021; 61:557-578. [PMID: 34319602 DOI: 10.1111/bjc.12322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 06/29/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Routine outcome monitoring (ROM) is a valuable tool for monitoring client progress and pre-empting deterioration, however, there is considerable variation in how data are collected and recorded and uptake in clinical practice remains low. The aim of this study was to develop a self-report measure of practitioner attitudes to ROM in order to better understand the barriers to successful implementation in Child and Adolescent Mental Health Services (CAMHS). METHODS An anonymous survey was completed by 184 CAMHS practitioners in the United Kingdom. The survey was designed using the Capability, Opportunity, and Motivation Model of Behaviour (COM-B). Practitioners who reported using ROM frequently in their clinical work (53%) were compared to those who used ROM infrequently (47%) across dimensions of the COM-B survey subscales. RESULTS Confirmatory factor analysis confirmed the proposed four-factor structure, showing acceptable model fit, with high factor loadings and good reliability for all subscales. Frequent users of ROM exhibited significantly higher psychological capability, physical opportunity, social opportunity, and motivation, compared to infrequent users F (4, 140) = 14.76, p < .0001; Pillai's Trace = .297, partial η2 = .30. Results highlight several barriers to ROM, including the belief that there is not a strong evidence base for ROM, not receiving external training, and not discussing feedback and outcome data in supervision. IMPLICATIONS In the hope of improving the successful implementation of ROM, this research provides an evidence-based tool for assessing practitioners' attitudes to ROM, which map on to intervention functions and represent targets for future implementation efforts. PRACTITIONER POINTS The value of routine outcome monitoring (ROM) as a means to measure client progress and to elevate the efficiency and quality of mental health care is well-documented in the research literature, however, uptake in practice remains relatively low. This study applied behaviour change theory to develop a psychometrically sound self-report measure of practitioners' perspectives and practices to understand the barriers to implementation in child and adolescent mental health services in the United Kingdom. The complex and multifaceted nature of the barriers to implementation requires multilevel behaviour change strategies at the client, clinician, and organisational level. Recommendations for practice include the need for integrated, multilevel strategies aimed at improving practitioners' capabilities and motivations, strong organisational leadership and a culture of data gathering and sharing, and implementation interventions, which are tailored to target local barriers.
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Affiliation(s)
- Holly Alice Bear
- Research Department for Clinical, Educational and Health Psychology, University College London, UK.,Evidence-Based Practice Unit, Anna Freud National Centre for Children and Families, The Kantor Centre of Excellence, London, UK.,Department of Psychiatry, Warneford Hospital, University of Oxford, UK
| | - Kate Dalzell
- Child Outcomes Research Consortium, The Kantor Centre of Excellence, London, UK
| | - Julian Edbrooke-Childs
- Research Department for Clinical, Educational and Health Psychology, University College London, UK.,Evidence-Based Practice Unit, Anna Freud National Centre for Children and Families, The Kantor Centre of Excellence, London, UK.,Child Outcomes Research Consortium, The Kantor Centre of Excellence, London, UK
| | - Miranda Wolpert
- Research Department for Clinical, Educational and Health Psychology, University College London, UK.,Wellcome Trust, London, UK
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Yoon Y, Deighton J, Wickersham A, Edbrooke-Childs J, Osborn D, Viding E, Downs J. The role of mental health symptomology and quality of life in predicting referrals to special child and adolescent mental health services. BMC Psychiatry 2021; 21:366. [PMID: 34301207 PMCID: PMC8299665 DOI: 10.1186/s12888-021-03364-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 07/07/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Children and adolescents' mental health problems have been largely assessed with conventional symptom scales, for example, Strengths and Difficulties Questionnaire (SDQ) given that it is one of the mostly widely used measures in specialist Child and Adolescent Mental Health Services (CAMHS). However, this emphasis on symptom scales might have missed some important features of the mental health challenges that children and young people experience including day to day functioning and life satisfaction aspect (i.e. qualify of life). METHOD The study examined longitudinal association between a young person's self-perceptions of quality of life and mental health difficulties and referral to specialist CAMHS service using a population cohort study (Targeted Mental Health in Schools service data) nested within a large-scale linkage between school (National Pupil Data base) and child mental health service administrative data (South London and Maudsley NHS Foundation Trust children and adolescent mental health services health records). Cox proportional hazard regression to estimate crude and adjusted hazard ratios (HRs) for the association between participant psychopathology, and incidence of CAMHS referral. RESULTS Pupils experiencing more behavioural difficulties, had an increased incidence of CAMHS referral (adjusted hazard ratio 1.1, 95% confidence interval 1.0-1.2). However, pupils who reported higher health related quality of life had a lower incidence of CAMHS referral over the follow-up period (adjusted hazard hario 0.94, 95% confidence interval 0.9-0.98). CONCLUSION Children and young people's perception of their quality of life should be considered at the stages of a clinical needs assessment.
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Affiliation(s)
- Yeosun Yoon
- EBPU (Evidence Based Practice Unit), UCL and Anna Freud Centre, London, UK.
| | - Jessica Deighton
- grid.466510.00000 0004 0423 5990EBPU (Evidence Based Practice Unit), UCL and Anna Freud Centre, London, UK
| | - Alice Wickersham
- grid.13097.3c0000 0001 2322 6764Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Julian Edbrooke-Childs
- grid.466510.00000 0004 0423 5990EBPU (Evidence Based Practice Unit), UCL and Anna Freud Centre, London, UK
| | - David Osborn
- grid.83440.3b0000000121901201Division of Psychiatry, University College London, London, UK
| | - Essi Viding
- grid.83440.3b0000000121901201Psychology and Language Sciences, University College London, London, UK
| | - Johnny Downs
- grid.13097.3c0000 0001 2322 6764Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King’s College London; and South London and Maudsley NHS Foundation Trust, London, UK
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Moltrecht B, Patalay P, Deighton J, Edbrooke-Childs J. A School-Based Mobile App Intervention for Enhancing Emotion Regulation in Children: Exploratory Trial. JMIR Mhealth Uhealth 2021; 9:e21837. [PMID: 34259642 PMCID: PMC8319776 DOI: 10.2196/21837] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 03/03/2021] [Accepted: 04/28/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Most mental health disorders are first experienced in childhood. The rising rates of mental health difficulties in children highlight the need for innovative approaches to supporting children and preventing these difficulties. School-based digital interventions that address shared risk factors and symptoms, such as emotion dysregulation, present exciting opportunities to enhance mental health support for children on a larger scale. OBJECTIVE This study investigates the use of a new app-based intervention designed to support children's emotion regulation in schools. The aim is to optimize the usability, acceptability, and utility of the app and explore its scope for implementation with the target user in the school context. METHODS As part of an interdisciplinary development framework, the app is being evaluated in a 3-month trial across 4 primary schools. In total, 144 children (aged 10-12 years) took part and accessed the intervention app in the classroom or at home. Outcomes regarding usability, acceptability, and implementation opportunities were assessed through digital user data, self-report questionnaires (132/144, 91.6%), and semistructured interviews with children (19/144, 13.2%) and teachers (6/8, 75%). RESULTS The app usage data showed that 30% (128/426) of the users were returning users. Self-report data indicated that 40.1% (53/132) of the children had not used the app, whereas 57.5% (76/132) had used it once or more. Of the children who had used the app, 67% (51/76) reported that the app was helpful. Interviews with children and teachers suggested positive experiences with the app and that it helped them to calm down and relax. Children reported that they perceived the app as acceptable, usable, and helpful. In terms of the intervention's usability, most features functioned well; however, certain technical issues were reported, which may have led to reduced engagement levels. Teachers not only reported overall positive experiences but also discussed access difficulties and reported a lack of content as one of the main barriers to implementing the app. Having a web-based app significantly enhanced accessibility across devices and settings and provided teachers with more opportunities to use it. We identified the need for new, activating app features in addition to the existing, primarily relaxing ones. The findings indicated that it is possible to use and evaluate an app intervention in the school context and that the app could help enhance children's emotion regulation. We discuss areas for improvement regarding the app, study design, and future implementation strategies. CONCLUSIONS We share important insights with regard to the development, implementation, and evaluation of a new app for supporting children's emotion regulation in schools. Our results demonstrate that mental health apps represent a promising means to facilitate effective mental health service provision in and outside of the school context. Important lessons learned are shared to support other researchers and clinicians on similar journeys.
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Affiliation(s)
- Bettina Moltrecht
- Evidence-based Practice Unit, University College London & Anna Freud National Centre, London, United Kingdom.,Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Praveetha Patalay
- MRC Unit for Lifelong Health and Ageing, University College London, London, United Kingdom
| | - Jessica Deighton
- Evidence-based Practice Unit, University College London & Anna Freud National Centre, London, United Kingdom
| | - Julian Edbrooke-Childs
- Evidence-based Practice Unit, University College London & Anna Freud National Centre, London, United Kingdom
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Edbrooke-Childs J, Hayes D, Lane R, Liverpool S, Jacob J, Deighton J. Association between single session service attendance and clinical characteristics in administrative data. Clin Child Psychol Psychiatry 2021; 26:770-782. [PMID: 33775168 DOI: 10.1177/13591045211002609] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A large proportion of young people accessing specialist mental health services do so for a single session. The aim of the present study was to examine the characteristics of young people attending specialist mental health services for a single session and to examine associations between single session attendance and clinical characteristics. Secondary analysis of administrative data on N = 23,300 young people (mean age = 12.73 years, 57% female, 64% White British) was conducted. The mean number of sessions attended was 4.33 and 46% (10,669) attended for a single session. Multilevel logistic regression analysis showed that younger children, Black young people (OR = 1.20, 95% CI = 1.01-1.43) or those whose ethnicity was not stated (OR = 1.25, 95% CI = 1.15-1.35), young people with peer relationship difficulties (OR = 1.11, 95% CI = 1.04-1.19) or low frequency problems (OR = 1.06, 95% CI = 0.99-1.14), and those with more complexity factors (OR = 1.07, 95% CI = 1.04-1.10) were more likely to attend services for a single session. The present study sets out research questions to prompt future research: (1) the experience of attending services for a single session, (2) identifying groups of single session attenders who do not require further support compared to those who are not able to sustain engagement with more sessions, and (3) whether new care pathways are needed for these groups who currently access specialist mental health services for a single session.
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Affiliation(s)
- Julian Edbrooke-Childs
- Evidence Based Practice Unit, Anna Freud National Centre for Children and Families & University College London, Clinical, Educational and Health Psychology, London, UK.,Child Outcomes Research Consortium, Anna Freud National Centre for Children and Families, London, UK
| | - Daniel Hayes
- Evidence Based Practice Unit, Anna Freud National Centre for Children and Families & University College London, Clinical, Educational and Health Psychology, London, UK
| | - Rebecca Lane
- Evidence Based Practice Unit, Anna Freud National Centre for Children and Families & University College London, Clinical, Educational and Health Psychology, London, UK
| | - Shaun Liverpool
- Evidence Based Practice Unit, Anna Freud National Centre for Children and Families & University College London, Clinical, Educational and Health Psychology, London, UK
| | - Jenna Jacob
- Evidence Based Practice Unit, Anna Freud National Centre for Children and Families & University College London, Clinical, Educational and Health Psychology, London, UK.,Child Outcomes Research Consortium, Anna Freud National Centre for Children and Families, London, UK
| | - Jessica Deighton
- Evidence Based Practice Unit, Anna Freud National Centre for Children and Families & University College London, Clinical, Educational and Health Psychology, London, UK
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33
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Liverpool S, Edbrooke-Childs J. A Caregiver Digital Intervention to Support Shared Decision Making in Child and Adolescent Mental Health Services: Development Process and Stakeholder Involvement Analysis. JMIR Form Res 2021; 5:e24896. [PMID: 34128821 PMCID: PMC8277368 DOI: 10.2196/24896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 04/14/2021] [Accepted: 05/05/2021] [Indexed: 12/01/2022] Open
Abstract
Background Parents and caregivers are generally recognized by literature and the law as key to child and adolescent mental health decisions. Digital interventions are increasingly being used to support care and treatment in child and adolescent mental health services (CAMHS). However, evidence of the design and development process is generally not made available. Objective In light of calls for more transparency, this paper aims to describe the development of an evidence-based, theoretically informed digital decision support intervention for parents and caregivers of young people accessing CAMHS. Methods The intervention was developed in line with the UK Medical Research Council framework for developing complex interventions. The process incorporated the steps for developing patient decision aids, as follows: assessing need, assessing feasibility; defining objectives; identifying the framework of decision support; and selecting the methods, designs, and dissemination approach. We synthesized theory, research, international guidelines, and input from relevant stakeholders using an iterative design approach. Results The development steps resulted in Power Up for Parents, a decision support intervention, with five key features (ie, decisions, goals, journey, support, and resources). The intervention aims to encourage discussion, allow parents to ask questions during sessions or seek further information between sessions, and allow service providers to tailor the shared decision-making process to accommodate the needs of the parent and child. Conclusions We confirmed that it is possible to use input from end users—integrated with theory and evidence—to create digital interventions to be used in CAMHS. Key lessons with implications for practice, policy, and implementation science, along with preliminary findings, are presented. International Registered Report Identifier (IRRID) RR2-10.2196/14571
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Affiliation(s)
- Shaun Liverpool
- Anna Freud National Centre for Children & Families, London, United Kingdom.,Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, United Kingdom
| | - Julian Edbrooke-Childs
- Anna Freud National Centre for Children & Families, London, United Kingdom.,University College London, London, United Kingdom
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34
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Moltrecht B, Deighton J, Patalay P, Edbrooke-Childs J. Effectiveness of current psychological interventions to improve emotion regulation in youth: a meta-analysis. Eur Child Adolesc Psychiatry 2021; 30:829-848. [PMID: 32108914 PMCID: PMC8140974 DOI: 10.1007/s00787-020-01498-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 02/14/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Research investigating the role of emotion regulation (ER) in the development and treatment of psychopathology has increased in recent years. Evidence suggests that an increased focus on ER in treatment can improve existing interventions. Most ER research has neglected young people, therefore the present meta-analysis summarizes the evidence for existing psychosocial intervention and their effectiveness to improve ER in youth. A systematic review and meta-analysis was conducted according to the PRISMA guidelines. Twenty-one randomized-control-trials (RCTs) assessed changes in ER following a psychological intervention in youth exhibiting various psychopathological symptoms. We found moderate effect sizes for current interventions to decrease emotion dysregulation in youth (g = - 0.46) and small effect sizes to improve emotion regulation (g = 0.36). Significant differences between studies including intervention components, ER measures and populations studied resulted in large heterogeneity. This is the first meta-analysis that summarizes the effectiveness for existing interventions to improve ER in youth. The results suggest that interventions can enhance ER in youth, and that these improvements correlate with improvements in psychopathology. More RCTs including larger sample sizes, different age groups and psychopathologies are needed to increase our understanding of what works for who and when.
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Affiliation(s)
- Bettina Moltrecht
- Division of Psychology and Language Sciences, University College London, 26 Bedford Way, Bloomsbury, London, WC1H 0AP, UK.
- Anna Freud National Centre for Children and Families, London, UK.
| | - Jessica Deighton
- Division of Psychology and Language Sciences, University College London, 26 Bedford Way, Bloomsbury, London, WC1H 0AP, UK
- Anna Freud National Centre for Children and Families, London, UK
| | - Praveetha Patalay
- Centre for Longitudinal Studies and MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Julian Edbrooke-Childs
- Division of Psychology and Language Sciences, University College London, 26 Bedford Way, Bloomsbury, London, WC1H 0AP, UK
- Anna Freud National Centre for Children and Families, London, UK
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D'Souza S, Lane R, Jacob J, Livanou M, Riches W, Rogers A, Ullman R, Rashid A, Singleton R, Wheeler J, Bevington D, Deighton J, Fonagy P, Fuggle P, Law D, Edbrooke-Childs J. Realist Process Evaluation of the implementation and impact of an organisational cultural transformation programme in the Children and Young People's Secure Estate (CYPSE) in England: study protocol. BMJ Open 2021; 11:e045680. [PMID: 34049914 PMCID: PMC8166603 DOI: 10.1136/bmjopen-2020-045680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 05/18/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Young people in contact with the youth justice system are more likely to present with complex ongoing needs than young people in the general population. To address this, the Framework for Integrated Care (SECURE STAIRS) is being implemented in the Children and Young People's Secure Estate: a 'whole systems' approach to support secure settings to develop trauma-informed and relationally based environments, supporting staff to provide consistent, therapeutic care. This paper aims to present the protocol for a national cohort study examining the impact and implementation of this cultural transformation programme. METHODS AND ANALYSIS A mixed-methods realist evaluation will be conducted. Data collection will take place between August 2018 and December 2020. Eighteen sites will collect routine service activity data and questionnaires completed by young people, parents/guardians and staff. Semi-structured interviews and non-participant observations will be conducted across five qualitative focus sites with young people and staff. An economic evaluation will examine value for money. The results will be triangulated at the analysis stage to gain an in-depth understanding of experiences. ETHICS AND DISSEMINATION Ethical approval was granted by the Health Research Authority, Her Majesty's Prison and Probation Service and UCL Ethics Committee. Findings will be disseminated via project reports, site feedback, peer-reviewed journal publications and conference presentations.
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Affiliation(s)
- Sophie D'Souza
- Child Outcomes Research Consortium, Anna Freud Centre, London, UK
- Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | - Rebecca Lane
- Department of Clinical, Educational and Health Psychology, UCL, London, UK
- Anna Freud Centre, London, UK
| | - Jenna Jacob
- Child Outcomes Research Consortium, Anna Freud Centre, London, UK
- Department of Clinical, Educational and Health Psychology, UCL, London, UK
- Anna Freud Centre, London, UK
| | - Maria Livanou
- Anna Freud Centre, London, UK
- Department of Psychology, Kingston University, Kingston-Upon-Thames, UK
| | | | | | | | - Anisatu Rashid
- Child Outcomes Research Consortium, Anna Freud Centre, London, UK
- Department of Clinical, Educational and Health Psychology, UCL, London, UK
- Anna Freud Centre, London, UK
| | - Rosie Singleton
- Child Outcomes Research Consortium, Anna Freud Centre, London, UK
- Anna Freud Centre, London, UK
| | | | | | - Jessica Deighton
- Department of Clinical, Educational and Health Psychology, UCL, London, UK
- Anna Freud Centre, London, UK
| | - Peter Fonagy
- Department of Clinical, Educational and Health Psychology, UCL, London, UK
- Anna Freud Centre, London, UK
| | | | - Duncan Law
- Child Outcomes Research Consortium, Anna Freud Centre, London, UK
- Anna Freud Centre, London, UK
- MindMonkey Associates Ltd, London, UK
| | - Julian Edbrooke-Childs
- Child Outcomes Research Consortium, Anna Freud Centre, London, UK
- Department of Clinical, Educational and Health Psychology, UCL, London, UK
- Anna Freud Centre, London, UK
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Bear HA, Dalzell K, Edbrooke-Childs J, Garland L, Wolpert M. How to manage endings in unsuccessful therapy: A qualitative comparison of youth and clinician perspectives. Psychother Res 2021; 32:249-262. [PMID: 33950789 DOI: 10.1080/10503307.2021.1921304] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Background: Approximately half of those who access child and adolescent mental health services do not show measurable improvement in symptoms. This study aimed to provide practice recommendations for managing treatment endings, particularly when outcomes have not improved. Method: Semi-structured interviews were carried out with 26 young people with a history of anxiety and/or depression along with 7 roundtable sessions with 52 mental health clinicians. Data were analyzed using Framework Analysis. Results: A common experience for young people when outcomes did not improve was a poor experience of the treatment ending, which often resulted in setbacks in their mental health and feelings of loss and abandonment. Clinicians agreed that ending was hard for young people and reported that they found managing ending hard on a personal and professional level. This was compounded by unrealistically high public expectations about the impact of therapy on outcomes and trying to strike a balance between fostering hope and managing expectations, within a context of inflexible service structures and resource constraint. Implications: Recommendations include establishing expectations from the outset and a shared understanding of what outcomes matter most to the young person. This can be achieved through communicating honestly about likely outcomes, while also providing hope.
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Affiliation(s)
- Holly Alice Bear
- Research Department for Clinical, Educational and Health Psychology, University College London, London, UK.,Evidence-Based Practice Unit, Anna Freud National Centre for Children and Families, The Kantor Centre of Excellence, London, UK.,Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Kate Dalzell
- Child Outcomes Research Consortium, The Kantor Centre of Excellence, London, UK
| | - Julian Edbrooke-Childs
- Research Department for Clinical, Educational and Health Psychology, University College London, London, UK.,Evidence-Based Practice Unit, Anna Freud National Centre for Children and Families, The Kantor Centre of Excellence, London, UK.,Child Outcomes Research Consortium, The Kantor Centre of Excellence, London, UK
| | - Lauren Garland
- Evidence-Based Practice Unit, Anna Freud National Centre for Children and Families, The Kantor Centre of Excellence, London, UK
| | - Miranda Wolpert
- Research Department for Clinical, Educational and Health Psychology, University College London, London, UK.,Wellcome Trust, London, UK
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Edbrooke-Childs J, Costa da Silva L, Čuš A, Liverpool S, Pinheiro Mota C, Pietrabissa G, Bardsley T, Sales CMD, Ulberg R, Jacob J, Ferreira N. Young People Who Meaningfully Improve Are More Likely to Mutually Agree to End Treatment. Front Psychol 2021; 12:641770. [PMID: 33889114 PMCID: PMC8055848 DOI: 10.3389/fpsyg.2021.641770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/08/2021] [Indexed: 12/19/2022] Open
Abstract
Objective: Symptom improvement is often examined as an indicator of a good outcome of accessing mental health services. However, there is little evidence of whether symptom improvement is associated with other indicators of a good outcome, such as a mutual agreement to end treatment. The aim of this study was to examine whether young people accessing mental health services who meaningfully improved were more likely to mutually agree to end treatment. Methods: Multilevel multinomial regression analysis controlling for age, gender, ethnicity, and referral source was conducted on N = 8,995 episodes of care [Female = 5,469, 61%; meanAge = 13.66 (SD = 2.87) years] using anonymised administrative data from young people's mental health services. Results: Compared to young people with no change in mental health difficulties, those showing positive meaningful changes in mental health difficulties were less likely to have case closure due to non-mutual agreement (Odds Ratio or OR = 0.58, 95% Confidence Interval or CI = 0.50–0.61). Similarly, they were less likely to transfer (OR = 0.61, 95% CI = 0.49–0.74) or end treatment for other reasons (OR = 0.59, 95% CI = 0.50–0.70) than by case closure due to mutual agreement. Conclusion: The findings suggest that young people accessing mental health services whose symptoms meaningfully improve are more likely to mutually agree to end treatment, adding to the evidence that symptom improvement may be appropriate to examine as an indicator of a good outcome of accessing mental health services.
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Affiliation(s)
- Julian Edbrooke-Childs
- Evidence Based Practice Unit, University College London & Anna Freud National Centre for Children and Families, Clinical, Educational and Health Psychology, London, United Kingdom.,Child Outcomes Research Consortium, Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Luís Costa da Silva
- Evidence Based Practice Unit, University College London & Anna Freud National Centre for Children and Families, Clinical, Educational and Health Psychology, London, United Kingdom.,Child Outcomes Research Consortium, Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Anja Čuš
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Shaun Liverpool
- Evidence Based Practice Unit, University College London & Anna Freud National Centre for Children and Families, Clinical, Educational and Health Psychology, London, United Kingdom.,Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, United Kingdom
| | - Catarina Pinheiro Mota
- Center for Psychology, University of Porto, Porto, Portugal.,Departamento de Educação e Psicologia, University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
| | - Giada Pietrabissa
- Department of Psychology, Catholic University of Milan, Milan, Italy.,Istituto Auxologico Italiano Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Psychology Research Laboratory, Milan, Italy
| | - Thomas Bardsley
- Evidence Based Practice Unit, University College London & Anna Freud National Centre for Children and Families, Clinical, Educational and Health Psychology, London, United Kingdom
| | - Celia M D Sales
- Center for Psychology, University of Porto, Porto, Portugal.,Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Randi Ulberg
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatry, Diakonhjemmet Hospital, Oslo, Norway
| | - Jenna Jacob
- Evidence Based Practice Unit, University College London & Anna Freud National Centre for Children and Families, Clinical, Educational and Health Psychology, London, United Kingdom.,Child Outcomes Research Consortium, Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Nuno Ferreira
- Department of Social Sciences, University of Nicosia, Nicosia, Cyprus
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Lachman P, Gondek D, Edbrooke-Childs J, Deighton J, Stapley E. Perspectives of paediatric hospital staff on factors influencing the sustainability and spread of a safety quality improvement programme. BMJ Open 2021; 11:e042163. [PMID: 33753434 PMCID: PMC7986768 DOI: 10.1136/bmjopen-2020-042163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Situation Awareness For Everyone (SAFE) is a quality improvement programme aiming to improve situation awareness in paediatric clinical teams. The aim of our study was to examine hospital staff perceptions of the facilitators and barriers/challenges to the sustaining and subsequent spread of the huddle, the key intervention of the SAFE programme. SETTING Interviews were held on two wards in two children hospitals and on two children wards in two district general hospitals. METHOD Semistructured interviews were conducted with 23 staff members from four National Health Service paediatric wards. A deductive thematic analysis was conducted, drawing on an existing framework, which groups the factors influencing programme sustainability into four categories: innovation, leadership, process and context. PARTICIPANTS 23 staff in two children's hospitals and two children's wards across four UK hospitals, comprising of nurses and doctors, administration or housekeeping staff, ward managers and matrons, and allied professionals. PRIMARY OUTCOMES Understanding factors contributing to the sustaining and spread of a quality improvement intervention. RESULTS Perceptions of the benefits, purpose and fit of the huddle, team commitment, sharing learning, adaptation of the method and senior leadership were identified as facilitators. High staff turnover, large multiple specialty medical staff teams, lack of senior leadership and dislike of change were identified as barriers/challenges. CONCLUSIONS Sustaining and spreading quality improvement interventions in a complex clinical setting requires understanding of the interplay between the actual innovation and existing leadership, process and contextual factors. These must be considered at the planning stage of an innovation to maximise the potential for sustainability and spread to other settings.
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Affiliation(s)
- Peter Lachman
- Quality Improvement, Royal College of Physicians of Ireland, Dublin, Ireland
| | - Dawid Gondek
- Evidence Based Practice Unit, University College London and the Anna Freud National Centre for Children and families, London, UK, London, UK
| | - Julian Edbrooke-Childs
- Evidence Based Practice Unit, University College London and the Anna Freud National Centre for Children and families, London, UK, London, UK
| | - Jessica Deighton
- Evidence Based Practice Unit, University College London and the Anna Freud National Centre for Children and families, London, UK, London, UK
| | - Emily Stapley
- Evidence Based Practice Unit, University College London and the Anna Freud National Centre for Children and families, London, UK, London, UK
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39
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Liverpool S, Edbrooke-Childs J. Feasibility and Acceptability of a Digital Intervention to Support Shared Decision-making in Children's and Young People's Mental Health: Mixed Methods Pilot Randomized Controlled Trial. JMIR Form Res 2021; 5:e25235. [PMID: 33650973 PMCID: PMC7967225 DOI: 10.2196/25235] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/27/2020] [Accepted: 01/17/2021] [Indexed: 01/19/2023] Open
Abstract
Background Interventions to involve parents in decisions regarding children’s and young people’s mental health are associated with positive outcomes. However, appropriately planning effectiveness studies is critical to ensure that meaningful evidence is collected. It is important to conduct pilot studies to evaluate the feasibility and acceptability of the intervention itself and the feasibility of the protocol to test effectiveness. Objective This paper reports the findings from a feasibility and acceptability study of Power Up for Parents, an intervention to promote shared decision-making (SDM) and support parents and caregivers making decisions regarding children’s and young people’s mental health. Methods A mixed method study design was adopted. In stage 1, health care professionals and parents provided feedback on acceptability, usefulness, and suggestions for further development. Stage 2 was a multicenter, 3-arm, individual, and cluster randomized controlled pilot feasibility trial with parents accessing services related to children’s and young people’s mental health. Outcome measures collected data on demographics, participation rates, SDM, satisfaction, and parents’ anxiety. Qualitative data were analyzed using thematic analysis. Google Analytics estimates were used to report engagement with the prototype. Outcomes from both stages were tested against a published set of criteria for proceeding to a randomized controlled trial. Results Despite evidence suggesting the acceptability of Power Up for Parents, the findings suggest that recruitment modifications are needed to enhance the feasibility of collecting follow-up data before scaling up to a fully powered randomized controlled trial. On the basis of the Go or No-Go criteria, only 50% (6/12) of the sites successfully recruited participants, and only 38% (16/42) of parents completed follow-up measures. Nonetheless, health care practitioners and parents generally accessed and used the intervention. Themes describing appearance and functionality, perceived need and general helpfulness, accessibility and appropriateness, and a wish list for improvement emerged, providing valuable information to inform future development and refinement of the intervention. Conclusions Owing to the high attrition observed in the trial, proceeding directly to a full randomized controlled trial may not be feasible with this recruitment strategy. Nonetheless, with some minor adjustments and upgrades to the intervention, this pilot study provides a platform for future evaluations of Power Up for Parents. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN) 39238984; http://www.isrctn.com/ISRCTN39238984. International Registered Report Identifier (IRRID) RR2-10.2196/14571
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Affiliation(s)
- Shaun Liverpool
- Evidence-Based Practice Unit, Anna Freud National Centre for Children and Families, University College London, London, United Kingdom.,Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, United Kingdom
| | - Julian Edbrooke-Childs
- Evidence-Based Practice Unit, Anna Freud National Centre for Children and Families, University College London, London, United Kingdom
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40
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Lane R, D'Souza S, Livanou M, Jacob J, Riches W, Ullman R, Rashid A, Singleton R, Wheeler J, Fuggle P, Bevington D, Deighton J, Law D, Fonagy P, Hindley N, White O, Edbrooke-Childs J. A Mixed-Methods Realist Evaluation of the Implementation and Impact of Community Forensic CAMHS to Manage Risk for Young People With Forensic and Mental Health Needs: Study Protocol. Front Psychiatry 2021; 12:697041. [PMID: 34803750 PMCID: PMC8600183 DOI: 10.3389/fpsyt.2021.697041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 10/08/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction: Young people in contact with forensic child and adolescent mental health services present with more complex needs than young people in the general population. Recent policy has led to the implementation of new workstreams and programmes to improve service provision for this cohort. This paper aims to present the protocol for a national study examining the impact and implementation of Community Forensic Child and Adolescent Mental Health Services (F:CAMHS). Methods and analysis: The study will use a mixed-methods Realist Evaluation design. Quantitative service activity and feedback data will be collected from all 13 sites, as well as questionnaires from staff. Non-participant observations and qualitative interviews will be conducted with staff, young people and parents/guardians from four focus study sites. An economic evaluation will examine whether Community F:CAMHS provides good value for money. The results will be triangulated to gain an in-depth understanding of young people's, parents/guardians' and staff experiences of the service. Ethics and dissemination: Ethical approval was granted by the Health Research Association and UCL Ethics. The results will be disseminated via project reports, feedback to sites, peer-reviewed journal publications and conference presentations.
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Affiliation(s)
- Rebecca Lane
- Anna Freud National Centre for Children and Families, Kantor Centre for Excellence, London, United Kingdom.,Clinical, Educational, and Health Psychology, University College London, London, United Kingdom
| | - Sophie D'Souza
- Anna Freud National Centre for Children and Families, Kantor Centre for Excellence, London, United Kingdom.,Clinical, Educational, and Health Psychology, University College London, London, United Kingdom.,Child Outcomes Research Consortium, Evidence Based Practice Unit, Kantor Centre for Excellence, University College London and the Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Maria Livanou
- Department of Psychology, School of Law, Social and Behavioural Sciences, Kingston University, London, United Kingdom
| | - Jenna Jacob
- Anna Freud National Centre for Children and Families, Kantor Centre for Excellence, London, United Kingdom.,Clinical, Educational, and Health Psychology, University College London, London, United Kingdom.,Child Outcomes Research Consortium, Evidence Based Practice Unit, Kantor Centre for Excellence, University College London and the Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Wendy Riches
- Riches and Ullman Limited Liability Partnership (LPP), Wallington, United Kingdom
| | - Roz Ullman
- Riches and Ullman Limited Liability Partnership (LPP), Wallington, United Kingdom
| | - Anisatu Rashid
- Anna Freud National Centre for Children and Families, Kantor Centre for Excellence, London, United Kingdom.,Clinical, Educational, and Health Psychology, University College London, London, United Kingdom.,Child Outcomes Research Consortium, Evidence Based Practice Unit, Kantor Centre for Excellence, University College London and the Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Rosie Singleton
- Anna Freud National Centre for Children and Families, Kantor Centre for Excellence, London, United Kingdom.,Clinical, Educational, and Health Psychology, University College London, London, United Kingdom.,Child Outcomes Research Consortium, Evidence Based Practice Unit, Kantor Centre for Excellence, University College London and the Anna Freud National Centre for Children and Families, London, United Kingdom
| | - James Wheeler
- Anna Freud National Centre for Children and Families, Kantor Centre for Excellence, London, United Kingdom
| | - Peter Fuggle
- Anna Freud National Centre for Children and Families, Kantor Centre for Excellence, London, United Kingdom.,Clinical, Educational, and Health Psychology, University College London, London, United Kingdom
| | - Dickon Bevington
- Anna Freud National Centre for Children and Families, Kantor Centre for Excellence, London, United Kingdom
| | - Jessica Deighton
- Anna Freud National Centre for Children and Families, Kantor Centre for Excellence, London, United Kingdom.,Clinical, Educational, and Health Psychology, University College London, London, United Kingdom
| | - Duncan Law
- Anna Freud National Centre for Children and Families, Kantor Centre for Excellence, London, United Kingdom.,Child Outcomes Research Consortium, Evidence Based Practice Unit, Kantor Centre for Excellence, University College London and the Anna Freud National Centre for Children and Families, London, United Kingdom.,MindMonkey Associates Ltd., London, United Kingdom
| | - Peter Fonagy
- Anna Freud National Centre for Children and Families, Kantor Centre for Excellence, London, United Kingdom.,Clinical, Educational, and Health Psychology, University College London, London, United Kingdom
| | - Nick Hindley
- South Central Forensic Child and Adolescent Mental Health Services (F:CAMHS), Oxford Health National Health Service (NHS) Foundation Trust, Oxford, United Kingdom.,Former National Community Forensic Child and Adolescent Mental Health Services (F:CAMHS) Clinical Lead, National Health Service (NHS) England and NHS Improvement, London, United Kingdom
| | - Oliver White
- Southern Health National Health Service (NHS) Foundation Trust, Calmore, United Kingdom.,South West (North) Community Forensic Child and Adolescent Mental Health Services (F:CAMHS), Oxford Health National Health Service (NHS) Foundation Trust, Keynsham, United Kingdom.,National Community Forensic Child and Adolescent Mental Health Services (F:CAMHS) Clinical Lead, NHS England and NHS Improvement, London, United Kingdom
| | - Julian Edbrooke-Childs
- Anna Freud National Centre for Children and Families, Kantor Centre for Excellence, London, United Kingdom.,Clinical, Educational, and Health Psychology, University College London, London, United Kingdom.,Child Outcomes Research Consortium, Evidence Based Practice Unit, Kantor Centre for Excellence, University College London and the Anna Freud National Centre for Children and Families, London, United Kingdom
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41
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Liverpool S, Hayes D, Edbrooke-Childs J. An Affective-Appraisal Approach for Parental Shared Decision Making in Children and Young People's Mental Health Settings: A Qualitative Study. Front Psychiatry 2021; 12:626848. [PMID: 33633610 PMCID: PMC7899973 DOI: 10.3389/fpsyt.2021.626848] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/13/2021] [Indexed: 12/14/2022] Open
Abstract
Background: The majority of existing shared decision making (SDM) models are yet to explicitly account for emotion as an influencing factor to the SDM process. This study aimed to explore the role of parents' and carers' emotional experiences as a concept that has implications for SDM in children and young people's mental health (CYPMH) settings. Methods: A social constructivist grounded theory approach, analyzing data from focus groups (n = 4) and semi-structured interviews (n = 33) with parents and healthcare professionals, was undertaken. Participants were identified and selected at CYPMH sites and through social media platforms or in-person advertising as part of a larger feasibility trial. Interviews and focus groups were audio-recorded and transcribed verbatim. Thematic analysis moved from open to focused coding. Results: The majority of the sample consisted of mothers of adolescent girls. Healthcare professionals had an average of 7.54 (SD = 6.24) years of work experience in CYPMH outpatient capacities. Findings suggested that parents are "expected to, but not always able to" engage in SDM. Themes and subthemes described an affective-appraisal SDM process capturing: (1) views and experiences of SDM, (2) parents' emotional states, (3) the influence of emotions on SDM, and (4) key support systems accessed. The emerging affective-appraisal framework highlighted that negative emotional states hindered parents' active involvement in SDM, and positive emotions encouraged involvement in SDM. Conclusion: The current findings describe an SDM model specific to CYPMH. This new understanding contributes to addressing a possible theory to practice gap opening new challenges and opportunities for academic enquiry.
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Affiliation(s)
- Shaun Liverpool
- Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, London, United Kingdom.,Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, United Kingdom
| | - Daniel Hayes
- Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Julian Edbrooke-Childs
- Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, London, United Kingdom
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42
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Sheridan Rains L, Johnson S, Barnett P, Steare T, Needle JJ, Carr S, Lever Taylor B, Bentivegna F, Edbrooke-Childs J, Scott HR, Rees J, Shah P, Lomani J, Chipp B, Barber N, Dedat Z, Oram S, Morant N, Simpson A. Early impacts of the COVID-19 pandemic on mental health care and on people with mental health conditions: framework synthesis of international experiences and responses. Soc Psychiatry Psychiatr Epidemiol 2021; 56:13-24. [PMID: 32804258 PMCID: PMC7429938 DOI: 10.1007/s00127-020-01924-7] [Citation(s) in RCA: 106] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 08/06/2020] [Indexed: 10/27/2022]
Abstract
PURPOSE The COVID-19 pandemic has many potential impacts on people with mental health conditions and on mental health care, including direct consequences of infection, effects of infection control measures and subsequent societal changes. We aimed to map early impacts of the pandemic on people with pre-existing mental health conditions and services they use, and to identify individual and service-level strategies adopted to manage these. METHODS We searched for relevant material in the public domain published before 30 April 2020, including papers in scientific and professional journals, published first person accounts, media articles, and publications by governments, charities and professional associations. Search languages were English, French, German, Italian, Spanish, and Mandarin Chinese. Relevant content was retrieved and summarised via a rapid qualitative framework synthesis approach. RESULTS We found 872 eligible sources from 28 countries. Most documented observations and experiences rather than reporting research data. We found many reports of deteriorations in symptoms, and of impacts of loneliness and social isolation and of lack of access to services and resources, but sometimes also of resilience, effective self-management and peer support. Immediate service challenges related to controlling infection, especially in inpatient and residential settings, and establishing remote working, especially in the community. We summarise reports of swiftly implemented adaptations and innovations, but also of pressing ethical challenges and concerns for the future. CONCLUSION Our analysis captures the range of stakeholder perspectives and experiences publicly reported in the early stages of the COVID-19 pandemic in several countries. We identify potential foci for service planning and research.
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Affiliation(s)
- Luke Sheridan Rains
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Sonia Johnson
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK.
- Camden and Islington NHS Foundation Trust, London, UK.
| | - Phoebe Barnett
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Thomas Steare
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Justin J Needle
- Centre for Health Services Research, School of Health Sciences, City, University of London, London, UK
| | - Sarah Carr
- School of Social Policy/Institute for Mental Health, University of Birmingham, Birmingham, UK
- Division of Psychiatry (NIHR Mental Health Policy Research Unit Covid-19 Co-Production Group), University College London, London, UK
| | - Billie Lever Taylor
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Francesca Bentivegna
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Julian Edbrooke-Childs
- Evidence-Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, London, UK
| | - Hannah Rachel Scott
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Jessica Rees
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Prisha Shah
- Division of Psychiatry (NIHR Mental Health Policy Research Unit Covid-19 Co-Production Group), University College London, London, UK
| | - Jo Lomani
- Division of Psychiatry (NIHR Mental Health Policy Research Unit Covid-19 Co-Production Group), University College London, London, UK
- Population Health Research Institute, St George's, University of London, London, UK
| | - Beverley Chipp
- Division of Psychiatry (NIHR Mental Health Policy Research Unit Covid-19 Co-Production Group), University College London, London, UK
| | - Nick Barber
- Division of Psychiatry (NIHR Mental Health Policy Research Unit Covid-19 Co-Production Group), University College London, London, UK
| | - Zainab Dedat
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Sian Oram
- NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Nicola Morant
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Alan Simpson
- NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Mental Health Nursing, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, London, UK
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43
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Liverpool S, Pereira B, Hayes D, Wolpert M, Edbrooke-Childs J. A scoping review and assessment of essential elements of shared decision-making of parent-involved interventions in child and adolescent mental health. Eur Child Adolesc Psychiatry 2021; 30:1319-1338. [PMID: 32300893 PMCID: PMC8440241 DOI: 10.1007/s00787-020-01530-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 04/06/2020] [Indexed: 12/14/2022]
Abstract
Parents play a critical role in child and adolescent mental health care and treatment. With the increasing implementation of shared decision-making (SDM) across health settings, there is a growing need to understand the decision support interventions used to promote SDM in child and adolescent mental health services (CAMHS). The overall aim of this review is to identify and examine the existing decision support interventions available for parents. A broad search was conducted using the key concepts "shared decision-making", "parents" and "child and adolescent mental health". Five electronic databases were searched: PsycInfo, Embase, Medline, Web of Science and the Cochrane Library. In addition to these relevant databases, we searched the Ottawa's Inventory of Decision Aids, Children's Hospital of Eastern Ontario website, Google, Google Play and known CAMHS' websites. The search identified 23 interventions available for use with parents. These interventions targeted parents providing care for children with ADHD, ASD, emotional and behavioural problems including depression (EBD), self-harm or universal mental health care. Various modalities including face-to-face, digital and paper-based versions were adopted. The majority of the interventions were able to "present options" (87%) and "discuss the pros and cons" (83%) of treatment. Time, accessibility and appropriateness of the intervention emerged as factors influencing usage and implementation of interventions. Our findings suggest that SDM interventions involving parents have been implemented differently across various presenting mental health difficulties in CAMHS. This review brings awareness of existing parent-involved interventions and has implications for the development, implementation and usage of new interventions.
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Affiliation(s)
- Shaun Liverpool
- Evidence-Based Practice Unit, Anna Freud National Centre for Children and Families, 4-8 Rodney Street, London, UK.
- University College London, London, UK.
| | - Brent Pereira
- The Chicago School of Professional Psychology, Chicago, USA
| | - Daniel Hayes
- Evidence-Based Practice Unit, Anna Freud National Centre for Children and Families, 4-8 Rodney Street, London, UK
- University College London, London, UK
| | | | - Julian Edbrooke-Childs
- Evidence-Based Practice Unit, Anna Freud National Centre for Children and Families, 4-8 Rodney Street, London, UK
- University College London, London, UK
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44
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Farr J, Edbrooke-Childs J, Town R, Pietkiewicz D, Young I, Stapley E. Counseling for Young People and Families Affected by Child Sexual Exploitation and Abuse: A Qualitative Investigation of the Perspective of Young People, Parents, and Professionals. J Child Sex Abus 2021; 30:102-123. [PMID: 33427106 DOI: 10.1080/10538712.2020.1848959] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/24/2020] [Accepted: 10/31/2020] [Indexed: 06/12/2023]
Abstract
Despite growing awareness of the negative impact of child sexual exploitation on young people's psychological, emotional and relational lives, little is known about how counseling can support young people and their families. The aim of this study was to explore the experience of counseling for young people and parents affected by child sexual exploitation and abuse, with a view to examining what facilitates progress, from the perspective of young people, parents and professionals. In-depth semi-structured interviews were conducted with 10 young people, 8 parents and 7 professionals and were analyzed using thematic analysis. Findings suggest that through counseling, young people experienced affective and relational improvements that were attributed to the process. Characteristics of the counseling relationship that facilitated progress included being able to talk openly in a caring, non-judgmental and unpressurized environment, as well as receiving advice, techniques or solutions within a holistic approach. Facets of service delivery were also highlighted, including the provision of confidentiality, flexibility and consistency, along with a multi-agency approach that promoted engagement. Perceived obstacles to progress included resistance at the outset and service location issues.
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Affiliation(s)
- Joanna Farr
- Anna Freud National Centre for Children and Families and University College London, London, UK
| | - Julian Edbrooke-Childs
- Anna Freud National Centre for Children and Families and University College London, London, UK
| | - Rosa Town
- Anna Freud National Centre for Children and Families and University College London, London, UK
| | | | | | - Emily Stapley
- Anna Freud National Centre for Children and Families and University College London, London, UK
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45
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Liverpool S, Hayes D, Edbrooke-Childs J. Parent/Carer-Reported Experience of Shared Decision Making at Child and Adolescent Mental Health Services: A Multilevel Modelling Approach. Front Psychiatry 2021; 12:676721. [PMID: 34335328 PMCID: PMC8319641 DOI: 10.3389/fpsyt.2021.676721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 06/22/2021] [Indexed: 01/14/2023] Open
Abstract
Background and Objective: Shared decision making (SDM) has been associated with positive outcomes at child and adolescent mental health services (CAMHS). However, implementing SDM is sometimes challenging. Understanding the factors associated with parent/carer experience of SDM could provide empirical evidence to support targeted efforts to promote SDM. This study aimed to explore the frequency of parent/carer-reported experience of SDM and examine possible associations between SDM and clinician's perceptions of the (a) children's and young people's psychosocial difficulties, (b) additional complex problems, and (c) impact of the psychosocial difficulties. Methods: Secondary analysis was conducted on administrative data collected from CAMHS between 2011 and 2015. The sample was composed of 3,175 cases across 58 sites in England. Frequencies were recorded and associations were explored between clinician-reported measures and parent/carer-reported experiences of SDM using a two-level mixed-effect logistic regression analytic approach. Results: Almost 70% of parents/carers reported experiencing higher levels of SDM. Individual-level variables in model one revealed statistically significant (p <0.05) associations suggesting Asian parents/carers (OR = 1.95, 95% CI [1.4, 2.73]) and parents/carers having children with learning difficulties (OR = 1.45, 95% CI [1.06, 1.97]) were more likely to report higher levels of SDM. However, having two parents/carers involved in the child's care and treatment decisions (OR = 0.3, 95% CI [0.21, 0.44]) and being a parent/carer of a child or young person experiencing conduct problems (OR = 0.78, 95% CI [0.63, 0.98]) were associated with lower levels of SDM. When adjusting for service level data (model two) the presence of conduct problems was the only variable found to be significant and predicted lower levels of SDM (OR = 0.29, 95% CI [0.52, 0.58]). Conclusion: Multilevel modelling of CAMHS administrative data may help identify potential influencing factors to SDM. The current findings may inform useful models to better predict and support SDM.
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Affiliation(s)
- Shaun Liverpool
- Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, London, United Kingdom.,Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, United Kingdom
| | - Daniel Hayes
- Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, London, United Kingdom.,Health Services and Population Research Department, King's College London Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - Julian Edbrooke-Childs
- Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, London, United Kingdom
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46
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Abstract
BACKGROUND Access to timely care is a quality standard underpinning many international healthcare models, and long waiting times for child and adolescent mental health services are often reported as a barrier to help-seeking. AIMS The aim of this study was to examine whether young people with more severe problems have shorter waiting times for mental health services. METHOD Multilevel multinomial regression analysis controlling for service-area deprivation, age, gender, ethnicity, referral source and contextual factors was conducted on N = 21 419 episodes of care (mean age 12.37 years (s.d. = 3.71), 11 712 (55%) female) using data from child and adolescent mental health services. RESULTS There was high variation in waiting times, which ranged from 0 days to 1629 days (mean 50.65 days (s.d. = 78.03), median 32 days). Compared with young people with less severe problems young people with severe problems, self-harm, psychosis or eating disorders were less likely to experience longer waiting times. Moreover, referrals from sources other than primary care were generally less likely to have longer waiting times than referrals from primary care sources, especially referral from accident and emergency services. CONCLUSIONS The findings suggest that young people with more severe problems had shorter waiting times. Intermediary information and resources for support before access to services is needed to prevent escalation of problems and to support individuals and families while waiting for care. Interventions to reduce waiting times should be considered without compromising on the quality and experience of care that young people and families deserve when seeking help.
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Affiliation(s)
- Julian Edbrooke-Childs
- Evidence Based Practice Unit, University College London & Anna Freud National Centre for Children and Families, Clinical, Educational and Health Psychology, UK
| | - Jessica Deighton
- Evidence Based Practice Unit, University College London & Anna Freud National Centre for Children and Families, Clinical, Educational and Health Psychology, UK
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47
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Edridge C, Wolpert M, Deighton J, Edbrooke-Childs J. An mHealth Intervention (ReZone) to Help Young People Self-Manage Overwhelming Feelings: Cluster-Randomized Controlled Trial. J Med Internet Res 2020; 22:e14223. [PMID: 32716299 PMCID: PMC7418005 DOI: 10.2196/14223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 10/31/2019] [Accepted: 03/23/2020] [Indexed: 11/25/2022] Open
Abstract
Background Mental health difficulties in young people are increasing, and there is a need for evidence on the effectiveness of digital interventions to increase opportunities for supporting mental health in young people. Such studies are complicated due to issues of implementation and adoption, outcome measurement, and appropriate study designs. Objective The objective of this study was to examine the effectiveness of an mHealth intervention (ReZone) in reducing mental health difficulties in young people. Methods The cluster-randomized controlled trial enrolled 409 participants aged 10-15 years, and classes were allocated to ReZone or management as usual. Self-reported questionnaires were completed at baseline and 3-month follow-up. Results There were no significant differences between the ReZone condition and management as usual in the self-reported outcome measures. However, there were 3467 usage sessions, which corresponds to 16.9 times per student (total of 205 students) in classes allocated to ReZone. Conclusions It is essential to publish studies that do not show significant differences, as these findings can still contribute to the literature, help in learning, and inform the direction of future work. The results reported in this paper could be due to a range of reasons, including whether ReZone has the scope to impact change or limitations related to the setting, context, and appropriateness of an RCT. The findings of this study suggest that ReZone was implemented and adopted. International Registered Report Identifier (IRRID) RR2-10.2196/resprot.7019
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Affiliation(s)
- Chloe Edridge
- Clinical, Educational and Health Psychology, University College London, London, United Kingdom.,Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Miranda Wolpert
- Clinical, Educational and Health Psychology, University College London, London, United Kingdom.,Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Jessica Deighton
- Clinical, Educational and Health Psychology, University College London, London, United Kingdom.,Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Julian Edbrooke-Childs
- Clinical, Educational and Health Psychology, University College London, London, United Kingdom.,Anna Freud National Centre for Children and Families, London, United Kingdom
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48
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Abstract
Objective: Decision-tree methods are machine-learning methods which provide results that are relatively easy to interpret and apply by human decision makers. The resulting decision trees show how baseline patient characteristics can be combined to predict treatment outcomes for individual patients, for example. This paper introduces GLMM trees, a decision-tree method for multilevel and longitudinal data. Method: To illustrate, we apply GLMM trees to a dataset of 3,256 young people (mean age 11.33, 48% girls) receiving treatment at one of several mental-health service providers in the UK. Two treatment outcomes (mental-health difficulties scores corrected for baseline) were regressed on 18 demographic, case and severity characteristics at baseline. We compared the performance of GLMM trees with that of traditional GLMMs and random forests. Results: GLMM trees yielded modest predictive accuracy, with cross-validated multiple R values of .18 and .25. Predictive accuracy did not differ significantly from that of traditional GLMMs and random forests, while GLMM trees required evaluation of a lower number of variables. Conclusion: GLMM trees provide a useful data-analytic tool for clinical prediction problems. The supplemental material provides a tutorial for replicating the GLMM tree analyses in R.
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Affiliation(s)
- Marjolein Fokkema
- Department of Methods & Statistics, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | | | - Miranda Wolpert
- Evidence Based Practice Unit, Anna Freud Centre/UCL, London, UK
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Bear HA, Edbrooke-Childs J, Norton S, Krause KR, Wolpert M. Systematic Review and Meta-analysis: Outcomes of Routine Specialist Mental Health Care for Young People With Depression and/or Anxiety. J Am Acad Child Adolesc Psychiatry 2020; 59:810-841. [PMID: 31881268 DOI: 10.1016/j.jaac.2019.12.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 11/30/2019] [Accepted: 12/19/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Depression and anxiety are the most prevalent mental health problems in youth, yet almost nothing is known about what outcomes are to be expected at the individual level following routine treatment. This paper sets out to address this gap by undertaking a systematic review of outcomes following treatment as usual (TAU) with a particular focus on individual-level outcomes. METHOD MEDLINE, Embase and PsycInfo were searched for articles published between 1980 and January 2019 that assessed TAU outcomes for youth depression and anxiety accessing specialist mental health care. Meta-analysis considered change at both group-level pre-post effect size (ES) and individual-level recovery, reliable change, and reliable recovery. Temporal analysis considered stability of primary and secondary outcomes over time. Subgroup analysis considered the moderating effect of informant; presenting problem; study design; study year; mean age of youth; use of medication; intervention dosage and type of treatment offered on outcomes. A protocol was preregistered on PROSPERO (CRD42017063914). RESULTS Initial screening of 6,350 publications resulted in 38 that met the inclusion criteria, and that were subsequently included in meta-analyses. This resulted in a final full pooled sample of 11,739 young people (61% of whom were female, mean age 13.8 years). The pre-post ES (Hedges' g) at first/final outcome (13/26 weeks) was -0.74/-0.87. The individual-level change on measures of self-report was 38% reliable improvement, 44% no reliable change, and 6% reliable deterioration. Outcomes varied according to moderators, informant, problem type and dosage. CONCLUSION Poor data quantity and quality are limitations, but this is the first study that indicates likely rates of reliable improvement for those accessing TAU. We propose the need for improved reporting of both individual-level metrics and details of TAU to enable greater understanding of likely current outcomes from routine care for youths with depression and anxiety in order to allow the potential for further improvement of impact.
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Affiliation(s)
- Holly Alice Bear
- University College London, UK; Anna Freud National Centre for Children and Families; The Kantor Centre of Excellence, London, UK.
| | - Julian Edbrooke-Childs
- University College London, UK; Anna Freud National Centre for Children and Families; The Kantor Centre of Excellence, London, UK; Child Outcomes Research Consortium, Brunswick Place London, UK
| | - Sam Norton
- Health Psychology Section at the Institute of Psychiatry, Psychology & Neuroscience, King's College London, Guy's Hospital Campus, London Bridge, London, UK
| | - Karolin Rose Krause
- University College London, UK; Anna Freud National Centre for Children and Families; The Kantor Centre of Excellence, London, UK
| | - Miranda Wolpert
- University College London, UK; Anna Freud National Centre for Children and Families; The Kantor Centre of Excellence, London, UK; Child Outcomes Research Consortium, Brunswick Place London, UK
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50
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Mechler J, Lindqvist K, Carlbring P, Lilliengren P, Falkenström F, Andersson G, Topooco N, Johansson R, Midgley N, Edbrooke-Childs J, J Dahl HS, Sandell R, Thorén A, Ulberg R, Lindert Bergsten K, Philips B. Internet-based psychodynamic versus cognitive behaviour therapy for adolescents with depression: study protocol for a non-inferiority randomized controlled trial (the ERiCA study). Trials 2020; 21:587. [PMID: 32600400 PMCID: PMC7322832 DOI: 10.1186/s13063-020-04491-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 06/08/2020] [Indexed: 11/21/2022] Open
Abstract
Background Adolescent depression is a common mental health problem and there is an urgent need for effective and accessible treatments. Internet-based interventions solve many obstacles for seeking and receiving treatment, thus increasing access to effective treatments. Internet-based cognitive behavioural therapy (ICBT) for adolescent depression has demonstrated efficacy in previous trials. In order to broaden the range of evidence-based treatments for young people, we evaluated a newly developed affect-focused Internet-based psychodynamic treatment (IPDT) in a previous study with promising results. The purpose of the planned study is to evaluate the efficacy of IPDT for adolescent depression in a non-inferiority trial, comparing it to ICBT. Methods The study will employ a parallel randomized non-inferiority design (ratio 1:1; n = 270). Eligible participants are adolescents 15–19 years suffering from depression. The primary hypothesis is that IPDT will be non-inferior to ICBT in reducing depressive symptoms from pre-treatment to end of treatment. Secondary research questions include comparing outcomes of IPDT and ICBT regarding anxiety symptoms, emotion regulation and self-compassion. Additional data will be collected to evaluate cost-effectiveness as well as investigating predictors, moderators and mediators of outcome. In addition, we will examine long-term outcome up to 1 year after end of treatment. Diagnostic interviews with MINI 7.0 will be used to establish primary diagnosis of depression as well as ruling out any exclusion criteria. Both treatments consist of eight modules over 10 weeks, complemented with therapist support through text messages and weekly chat sessions. Primary outcome measure is the Quick Inventory of Depressive Symptomatology in Adolescents Self-Rated (QIDS-A17-SR). Primary outcome will be analysed using data from all participants entering the study using a multilevel growth curve strategy based on the weekly measurements of QIDS-A17-SR. The non-inferiority margin is defined as d = 0.30. Discussion This trial will demonstrate whether IPDT is non-inferior to ICBT in the treatment of adolescent depression. The study might therefore broaden the range of evidence-based treatment alternatives for young people struggling with depression. Further analyses of data from this trial may increase our knowledge about “what works for whom” and the pathways of change for two distinct types of interventions. Trial registration ISRCTN12552584, Registered on 13 August 2019.
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Affiliation(s)
- Jakob Mechler
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Karin Lindqvist
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | | | - Fredrik Falkenström
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Naira Topooco
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.,Center for m2Health, Palo Alto, CA, USA
| | - Robert Johansson
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Nick Midgley
- Child Attachment and Psychological Therapies Research Unit (ChAPTRe), Anna Freud Centre, London, UK.,Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Julian Edbrooke-Childs
- Department of Clinical, Educational and Health Psychology, University College London, London, UK.,Evidence Based Practice Unit, Anna Freud National Centre for Children and Families, London, UK
| | - Hanne-Sofie J Dahl
- Vestfold Hospital Trust, Tønsberg, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Rolf Sandell
- Department of Psychology, Lund University, Lund, Sweden
| | | | - Randi Ulberg
- Division of Mental Health and Addiction, University of Oslo, Oslo, Norway.,Department of Psychology, Uppsala University, Uppsala, Sweden.,Department of Department of Psychiatric Research, Department of Adult Psychiatry, Diakonhjemmet Hospital, Oslo, Norway
| | | | - Björn Philips
- Department of Psychology, Stockholm University, Stockholm, Sweden.
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