Systemic Review and Meta-Analysis: Outcomes of Routine Specialist Mental Health Care for Young People with Depression and/or Anxiety
Abstract: 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.
Bear, H., Edbrooke-Childs, J., Norton, S., Krause, K. & Wolpert, M. (2019). Systematic Review and Meta-Analysis: Outcomes of Routine Specialist Mental Health Care for Young People With Depression and/or Anxiety. Journal of the American Academy of Child & Adolescent Psychiatry. doi: 10.1016/j.jaac.2019.12.002
Promoting mental health and wellbeing in schools: examining Mindfulness, Relaxation and Strategies for Safety and Wellbeing in English primary and secondary schools: study protocol for a multi-school, cluster randomised controlled trial (INSPIRE)
Abstract: There are increasing rates of internalising difficulties, particularly anxiety and depression, being reported in children and young people in England. School-based, universal prevention programmes are thought to be one way of helping tackle such difficulties. This protocol describes a four-arm cluster randomised controlled trial, investigating the effectiveness of three different interventions when compared to usual provision, in English primary and secondary pupils. The primary outcome for Mindfulness and Relaxation interventions is a measure of internalising difficulties, while Strategies for Safety and Wellbeing will be examined in relation to intended help-seeking. In addition to the effectiveness analysis, a process and implementation evaluation and a cost-effectiveness evaluation will be undertaken.
Hayes, D., Moore, A., Stapley, E., Humphrey, N., Mansfield, R., Santos, J., Ashworth, E., Patalay, P., Bonin, E. M., Moltrecht, B., Boehnke, J. R. & Deighton, J. (2019). Promoting mental health and wellbeing in schools: examining Mindfulness, Relaxation and Strategies for Safety and Wellbeing in English primary and secondary schools: study protocol for a multi-school, cluster randomised controlled trial (INSPIRE). Trials 20, 640 doi: 10.1186/s13063-019-3762-0
Increasing person‐centred care in paediatrics
Abstract: Paediatric patients (PPs) often feel that they are not involved in care and treatment decisions. Although training clinicians may help, there is a lack of evaluated training programmes specifically for work with PPs. The aim of this article is to evaluate ‘Me first’, a training programme aimed at improving clinicians’ attitudes and communication skills when working with PPs.
Hayes, D., Edbrooke-Childs, J., Martin, K., Reid, J., Brown, R., McCulloch, J. & Morton, L. (2019). Increasing person‐centred care in paediatrics. The Clinical Teacher 2019; 16: 1–6 doi:10.1111/tct.13100
Associations between mental health competence and indicators of physical health and cognitive development in eleven year olds: findings from the UK Millennium Cohort Study
Abstract: Positive mental health may support healthy development in childhood, although few studies have investigated this at a population level. We aimed to construct a measure of mental health competence (MHC), a skills-based assessment of positive mental health, using existing survey items in a representative sample of UK children, and to investigate its overlap with mental health difficulties (MHD), socio-demographic patterning, and relationships with physical health and cognitive development.
Hope, S., Rougeaux, E., Deighton, J., Law, C. & Pearce, A. (2019). Associations between mental health competence and indicators of physical health and cognitive development in eleven year olds: findings from the UK Millennium Cohort Study. BMC Public Health 19, 1461 doi:10.1186/s12889-019-7789-7
The Child Outcome Rating Scale: validating a four-item measure of psychosocial functioning in community and clinic samples of children aged 10–15
Abstract: Psychosocial functioning is considered an important and valued outcome in relation to young people’s mental health as a construct distinct from psychiatric symptomology, especially in the light of an increasing focus on transdiagnostic approaches. Yet, the level of psychosocial functioning is rarely directly asked of young people themselves, despite the widespread recognition that the young person’s perspective is valuable and is often at odds with those of other reporters, such as parents or professionals. One possible reason for this is that the field lacks a clear agreed tool to capture this information in a non-burdensome way. To begin to address this gap, this paper describes psychometric analysis of the Child Outcome Rating Scale (CORS), a brief and highly accessible self-report measure of young people’s psychosocial functioning already used extensively by mental health professionals around the world but with only limited data on psychometric robustness. Using large community (n = 7822) and clinic (n = 2604) samples, we explore the factor structure, construct validity, internal consistency, differential item functioning, and sensitivity of the CORS. We found that the CORS stands up to psychometric scrutiny, having found satisfactory levels of reliability, validity, and sensitivity in this sample. We also found that the CORS is suitable for use with young people as old as 15 years old. That the CORS has been found to be psychometrically robust while being highly feasible (brief, simple, easy to administer) for use in busy clinical settings, combined with the fact that the CORS has already been widely adopted by clinicians and young people, suggests CORS may be an important tool for international use.
Casey, P., Patalay, P., Deighton, J., Miller, S. D. & Wolpert, M. (2019). The Child Outcome Rating Scale: validating a four-item measure of psychosocial functioning in community and clinic samples of children aged 10–15. Eur Child Adolesc Psychiatry. doi: 10.1007/s00787-019-01423-4
Service- and practitioner-level variation in non-consensual dropout from child mental health services
Abstract: Non-attendance of mental health service appointments is an international problem. In the UK, for example, the estimated cost of non-attendance in child mental health services is over £45 million (US dollar 60.94 million) per annum. The objective of this study was to examine whether there were service- and practitioner-level variation in non-consensual dropout in child mental health services. This was an analysis of routinely collected data. Service-level variation (as services covered different geographic areas) and practitioner-level variation were examined in N = 3622 children (mean age 12.70 years; SD 3.62, 57% female, 50% white or white British) seen by 896 practitioners across 39 services. Overall, 35% of the variation in non-consensual dropout was explained at the service level and 15% at the practitioner level. Children were almost four times more likely to drop out depending on which service they attended (median odds ratio = 3.92) and were two-and-a-half times more likely to drop out depending on which practitioner they saw (median odds ratio = 2.53). These levels of variation were not explained by levels of deprivation in areas covered by services or by children’s demographic and case characteristics. The findings of the present research may suggest that, beyond service-level variation, there is also practitioner-level variation in non-consensual dropout in child mental health services.
Edbrooke-Childs, J., Boehnke, J. R., Zamperoni, V., Calderon, A. & Whale, A. (2019). Service- and practitioner-level variation in non-consensual dropout from child mental health services. Eur Child Adolesc Psychiatry. doi: 10.1007/s00787-019-01405-6
School-based intervention study examining approaches for well-being and mental health literacy of pupils in Year 9 in England: study protocol for a multischool, parallel group cluster randomised controlled trial (AWARE).
Abstract: In response to the rising prevalence of emotional difficulties in young people, there is increasing emphasis on universal prevention programmes delivered in school settings. This protocol describes a randomised controlled trial, investigating the effectiveness and cost-effectiveness of two interventions (Youth Aware of Mental Health, also known as YAM, and The Guide), alongside a process and implementation evaluation, to improve mental health and well-being of Year 9 pupils in English secondary schools. Overall, 144 secondary schools in England will be recruited, involving 8600 Year 9 pupils.
Hayes, D., Moore, A., Stapley E., Humphrey, N., Mansfield, R., Santos, J., Ashworth, A., Patalay, P., Bonin, E., Boehnke, J. R. & Deighton, J. (2019). School-based intervention study examining approaches for well-being and mental health literacy of pupils in Year 9 in England: study protocol for a multischool, parallel group cluster randomised controlled trial (AWARE). BMJ Open, 9, e029044. doi: 10.1136/bmjopen-2019-029044.
Barriers and facilitators to shared decision‐making in child and youth mental health: Exploring young person and parent perspectives using the Theoretical Domains Framework
Abstract: Young people and parents want to be more active in treatment decisions. Using the Theoretical Domains Framework (TDF), which segments behaviour change into barriers and facilitators across fourteen domains, the aim of this study is to explore the barriers and facilitators to shared decision‐making (SDM) from young people and their parents’ perspectives.
Hayes, D., Edbrooke-Childs, J., Town, R., Wolpert, M. & Midgley, N. (2019). Barriers and facilitators to shared decision‐making in child and youth mental health: Exploring young person and parent perspectives using the Theoretical Domains Framework. Counselling and Psychotherapy Research doi: 10.1002/capr.12257.
Coping with the stresses of daily life in England: A qualitative study of self-care strategies and social and professional support in early adolescence
Abstract: The aim of our study was to examine early adolescents’ perspectives on and experiences of coping with the problems, difficult situations, and feelings that can arise in daily life in England. Our study draws on the first time point of semistructured interviews (N = 82) conducted with 9 to 12 year olds across six regions of England as part of HeadStart, a mental health and well-being program. Using thematic analysis, eight main themes were derived from the dataset relating to participants’ coping behavior: activities and strategies, disengaging from problems, standing up for yourself, acceptance of problems, social support, HeadStart support, other professional support, and hiding feelings or problems. The findings enhance our understanding of how early adolescents manage their problems outside of professional input, highlight where professional input could seek to influence or bolster early adolescents’ coping strategies, and could be used to inform existing taxonomies of coping behavior.
Stapley, E., Demkowicz, O., Eisenstadt, M., Wolpert, M. & Deighton, J. (2019). Coping with the stresses of daily life in England: A qualitative study of self-care strategies and social and professional support in early adolescence. Journal of Adolescence doi: 10.1177/0272431619858420
A feasibility trial of Power Up: Smartphone app to support patient activation and shared decision making for mental health in young people
Abstract: Digital tools have the potential to support patient activation and shared decision making in the face of increasing levels of mental health problems in young people. There is a need for feasibility trials of digital interventions to determine the usage and acceptability of interventions. In addition, there is a need to determine the ability to recruit and retain research participants to plan rigorous effectiveness trials and, therefore, develop evidence-based recommendations for practice. This study aimed to determine the feasibility of undertaking a cluster randomized controlled trial to test the effectiveness of a smartphone app, Power Up, co-designed with young people to support patient activation and shared decision making for mental health.
Edbrooke-Childs, J., Edridge, C., Averill, P., Delane, L., Hollis, C., Craven, M. P., Martin, K., Feltham, A., Jeremy, G., Deighton, J., & Wolpert, M. (2019). A feasibility trial of Power Up: Smartphone app to support patient activation and shared decision making for mental health in young people. JMIR mHealth and uHealth, 7(6), e11677.
Assessing risks to paediatric patients: conversation analysis of situation awareness in huddle meetings in England
Abstract: To analyse the language and conversation used in huddles to gain a deeper understanding of exactly how huddles proceed in practice and to examine the methods by which staff members identify at-risk patients.
Hayes, J., Lachman, P., Edbrooke-Childs, J., Stapley, E., Wolpert, M., & Deighton, J. (2019). Assessing risks to paediatric patients: conversation analysis of situation awareness in huddle meetings in England. BMJ Open, 9, e023437.
Embedding interagency working between schools and mental health specialists: A service evaluation of the Mental Health Services and Schools and Colleges Link Programme workshops
Abstract: There is increasing focus on the need for schools to work more effectively with specialist mental health providers, but there have been historic challenges in embedding closer interagency working. This article reports the results of a service evaluation of a 2-day workshop designed to facilitate improved working between schools and children and young people’s mental health services (CYPMHS). Mental health leads from 255 schools, mental health professionals and other key stakeholders all took part in one of 26 two-day workshops across the United Kingdom. The impact on interagency working was examined using changes in pre- and post-survey results, changes in self-reported aspects of interagency working and 10 local reviews of practice. The pre–post questionnaires showed improvements in interagency working (e.g. 55% of school leads reported being in ‘monthly’ or ‘continuous’ contact with the National Health Service (NHS) CYPMHS1 at follow-up, compared with 24% at baseline). The group-completed CASCADE framework showed an overall increase in collaborative working, although some areas continued to report significant challenges such as in relation to common outcome measures. The local reviews found positive changes in interagency working, in terms of building relationships, improved communication and sharing good practice. This service evaluation of the workshops found some evidence of improved interagency working between schools and CYPMHS, but more controlled research is needed to consider generalisability and scalability.
Cortina, M., Shipman, J., Saunders, F., Day, L., Blades, R., Smith, J., & Wolpert, M. (2019). Embedding interagency working between schools and mental health specialists: A service evaluation of the Mental Health Services and Schools and Colleges Link Programme workshops. Clinical Child Psychology and Psychiatry, doi: 10.1177/1359104519849640.
Predicting mental health improvement and deterioration in a large community sample of 11- to 13-year-olds
Abstract: Of children with mental health problems who access specialist help, 50% show reliable improvement on self-report measures at case closure and 10% reliable deterioration. To contextualise these figures it is necessary to consider rates of improvement for those in the general population. This study examined rates of reliable improvement/deterioration for children in a school sample over time. N = 9074 children (mean age 12; 52% female; 79% white) from 118 secondary schools across England provided self-report mental health (SDQ), quality of life and demographic data (age, ethnicity and free school meals (FSM) at baseline and 1 year and self-report data on access to mental health support at 1 year). Multinomial logistic regressions and classification trees were used to analyse the data.
Wolpert, M., Zamperoni, V., Napoleone, E., Patalay, P., Jacob, J., Fokkema, M., Promberger, M., Costa da Silva, L., Patel, M., & Edbrooke-Childs, J. (2019). Predicting mental health improvement and deterioration in a large community sample of 11- to 13-year-olds. European Child & Adolescent Psychiatry, doi: 10.1007/s00787-019-01334-4.
The implementation of an mHealth intervention (ReZone) for the self-management of overwhelming feelings among young people
Abstract: The association between mental health difficulties and academic attainment is well established. There is increasing research on mobile health (mHealth) interventions to provide support for the mental health and education of young people. However, nonadoption and inadequate implementation of mHealth interventions are prevalent barriers to such trials. The aim of this study was to bridge this gap and examine the implementation of an mHealth intervention, ReZone, for young people in schools.
Edridge, C., Deighton, J., Wolpert, M., & Edbrooke-Childs, J. (2019). The implementation of an mHealth intervention (ReZone) for the self-management of overwhelming feelings among young people. JMIR Formative Research, 3(2), e11958.
Trajectories of change of youth depressive symptoms in routine care: shape, predictors, and service-use implications
Abstract: Depression is one of the main reasons for youth accessing mental health services, yet we know little about how symptoms change once youth are in routine care. This study used multilevel modeling to examine the average trajectory of change and the factors associated with change in depressive symptoms in a large sample of youth seen in routine mental health care services in England. Participants were 2336 youth aged 8–18 (mean age 14.52; 77% females; 88% white ethnic background) who tracked depressive symptoms over a period of up to 32 weeks while in contact with mental health services. Explanatory variables were age, gender, whether the case was closed, total length of contact with services, and baseline severity in depression scores. Faster rates of improvement were found in older adolescents, males, those with shorter time in contact with services, closed cases, and those with more severe symptoms at baseline. This study demonstrates that when youth self-report their depressive symptoms during psychotherapy, symptoms decrease in a linear trajectory. Attention should be paid to younger people, females, and those with lower than average baseline scores, as their symptoms decrease at a slower pace compared to others.
Napoleone, E., Evans, C., Patalay, P., Edbrooke-Childs, J., & Wolpert, M. (2019) Trajectories of change of youth depressive symptoms in routine care: shape, predictors, and service-use implications. European Child & Adolescent Psychiatry, doi: 10.1007/s00787-019-01317-5.
Supporting emotional well-being in schools in the context of austerity: An ecologically informed humanistic perspective
Abstract: Schools are commonly asked to take on roles that support the emotional well‐being of students. These practices are in line with humanistic education theory and can be difficult to fulfil by schools. Broader ecological pressures, such as periods of austerity, are likely to add to the difficulty in meeting students’ needs. The aim was to explore whether professionals in schools believe that their work supporting pupils’ emotional well‐being has changed as a consequence of the current period of austerity.
Hanley, T., Winter, L.A., & Burrell, K. (2019). Supporting emotional well-being in schools in the context of austerity: An ecologically informed humanistic perspective. British Journal of Educational Psychology, doi: 10.1111/bjep.12275.
Structure and Connectivity of Depressive Symptom Networks Corresponding to Early Treatment Response
Abstract: There are suggestions that denser network connectivity (i.e., the strength of associations between individual symptoms) may be a prognostic indicator of poor treatment response in depression. We sought to examine this aspect of depressive symptom networks in the context of early responses to treatment in adolescents.
McElroy, E., Napoleone, E., Wolpert, M., & Patalay, P. (2019). Structure and connectivity of depressive symptom networks corresponding to early treatment response. EClinicalMedicine, doi: 10.1016/j.eclinm.2019.02.009.
Ethnic differences in referral routes to youth mental health services.
Abstract: This was an analysis of national, routinely collected data from 14,588 young people (mean [SD] age = 12.28 [3.75] years, 54% female; 64% white British) accessing mental health services in the United Kingdom. Ethnicity was self-reported by young people and carers, and referral route was recorded by services. There are ethnic differences in referral route to youth mental health services in the United Kingdom, and young people from minority ethnic backgrounds are more likely to be referred through routes that are less likely to be voluntary. Understanding the reasons for these differences is critical for reducing inequalities and improving pathways to mental health care access.
Edbrooke-Childs, J., & Patalay, P. (2019). Ethnic differences in referral routes to youth mental health services. Journal of the American Academy of Child and Adolescent Psychiatry, 58(3), 368–375.
An approach to linking education, social care and electronic health records for children and young people in South London: a linkage study of child and adolescent mental health service data
Abstract: The work described sets a precedent for education data being used for medical benefit in England. Linkage between health and education records offers a powerful tool for evaluating the impact of mental health on school function, but biases due to linkage error may produce misleading results. Collaborative research with data providers is needed to develop linkage methods that minimise potential biases in analyses of linked data.
Downs, J. M., Ford, T., Stewart, R., Epstein, S., Shetty, H., Little, R., Jewell, A., Broadbent, M., Deighton, J., Mostafa, Gilbert, T., Hotopf, M., & Hayes, R. (2019). An approach to linking education, social care and electronic health records for children and young people in South London: a linkage study of child and adolescent mental health service data. BMJ Open, 9, e024355.
Prevalence of mental health problems in schools: poverty and other risk factors amongst 28,000 adolescents in England
Abstract: Current mental health provision for children is based on estimates of one in ten children experiencing mental health problems. This study analyses a large-scale community-based dataset of 28 160 adolescents to explore school-based prevalence of mental health problems and characteristics that predict increased odds of experiencing them. Findings indicate the scale of mental health problems in England is much higher than previous estimates, with two in five young people scoring above thresholds for emotional problems, conduct problems or hyperactivity. Gender, deprivation, child in need status, ethnicity and age were all associated with increased odds of experiencing mental health difficulties.
Deighton, J., Lereya, T. L., Casey, P., Patalay, P., Humphrey, N., & Wolpert, M. (2019). Prevalence of mental health problems in schools: poverty and other risk factors amongst 28,000 adolescents in England. British Journal of Psychiatry, doi: 10.1192/bjp.2019.19.
Mental health difficulties, attainment and attendance: a cross-sectional study
Abstract: Evidence for the association between mental health difficulties and academic outcomes is sparse and shows mixed results. The aim of this study was to investigate the association between educational attainment, absenteeism and mental health difficulties while controlling for various child characteristics such as special educational needs and socioeconomic background. 15,301 Year 7 pupils (mean age 11.91; SD = 0.28) from England completed the Strengths and Difficulties Questionnaire. Attainment, persistent absenteeism and child characteristics were derived from the National Pupil Database. Multilevel regression analysis showed that mental health difficulties were negatively associated with attainment and positively associated with persistent absenteeism. When all mental health difficulties were modelled simultaneously, behavioural difficulties, hyperactivity/attention difficulties and difficulties with peers were negatively associated with attainment. Emotional difficulties and hyperactivity/attention difficulties were positively associated with persistent absenteeism. The results of the current study highlight the importance of integration between mental health support and policy creation in relation to mental health difficulties and wellbeing in schools.
Lereya, S. T., Patel, M., dos Santos, J.P.G.A., & Deighton, J. (2019). Mental health difficulties, attainment and attendance: a cross-sectional study. European Child & Adolescent Psychiatry, doi: 10.1007/s00787-018-01273-6.
Evaluating the Peer Education Project in secondary schools
Abstract: The purpose of this paper is to determine the efficacy of the Peer Education Project (PEP), a school-based, peer-led intervention designed to support secondary school students to develop the skills and knowledge they need to safeguard their mental health and that of their peers. Results indicate that participation in the PEP is associated with significant improvement in key skills among both peer educators and student trainees, and in understanding of key terms and readiness to support others among trainees. Most students would recommend participation in the programme to other students.
Eisenstein, C., Zamperoni, V., Humphrey, N., Deighton, J., Wolpert, M., Rosan, C., Bohan, H., Kousoulis, A., Promberger, M., & Edbrooke-Childs, J. (2019). Evaluating the Peer Education Project in secondary schools. Journal of Public Mental Health, doi: 10.1108/JPMH-07-2018-0048.