Articles and publications 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).
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.
Service- and practitioner-level variation in non-consensual dropout from child mental health services
Abstract: In the UK, the estimated cost of non-attendance in child mental health services is over £45 million per year. This study aimed to examine whether there were service- and practitioner-level variation in non-consensual dropout in child mental health services, by analysing routinely collected data. 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, and were two-and-a-half times more likely to drop out depending on which practitioner they saw. The findings therefore 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
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.
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.
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.
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.
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.
Evaluation of reliable improvement rates in depression and anxiety at the end of treatment in adolescents
Abstract: Literature has focused on effect sizes rather than individual-level improvement rates to determine how effectively services address burgeoning numbers of adolescents with anxiety and depression. The aim was to consider how many adolescents report reliable improvement in anxiety, depression and comorbid depression and anxiety by end of treatment.
Edbrooke-Childs, J., Wolpert, M., Zamperoni, V., Napoleone, E., Bear, H. (2018). Evaluation of reliable improvement rates in depression and anxiety at the end of treatment in adolescents. BJPsych Open, 4, 250-255.
Strategies not accompanied by a mental health professional to address anxiety and depression in children and young people: a scoping review of range and a systematic review of effectiveness
Abstract: This Review reports on a scoping review followed by a systematic review to consider interventions designed to address or manage depression or anxiety in children and young people up to the age of 25 years without the need to involve mental health professionals. Evidence suggested that light therapy could be effective for season depression and that digital interventions based on attention bias modification are ineffective for anxiety. Mixed evidence was available on the effectiveness of computerised cognitive behavioural therapy for depression and anxiety, and of physical exercise for depression. All other studies had insufficient certainty to obtain even tentative conclusions about effectiveness. These results highlight the disparity between the extensive range of approaches identified in the scoping review and the restricted number and focus found in the systematic review of effectiveness of these approaches. We call for an expanded research agenda that brings evaluation rigour to a wide range of self or community approaches.
Wolpert, M., Dalzell, K., Ullman, R., Garland, L., Cortina, M., Hayes, D., Patalay, P., & Law, D. (2018) Strategies not accompanied by a mental health professional to address anxiety and depression in children and young people: a scoping review of range and a systematic review of effectiveness. The Lancet Psychiatry, doi: 10.1016/S2215-0366(18)30465-6.
Abstract: Measurement of treatment outcomes in childhood depression has traditionally focused on assessing symptoms from the clinician’s perspective, without exploring other outcome domains or considering young people’s perspectives. This systematic review explored the extent to which multidimensional and multi-informant outcome measurements have been used in clinical research for adolescent depression in the past decade and how patterns have evolved over time.
Krause, K., Bear, H., Edbrooke-Childs, J., & Wolpert, M. (2018) What Outcomes Count? A Review of Outcomes Measured for Adolescent Depression Between 2007 and 2017. Journal of the American Academy of Child and Adolescent Psychiatry. doi: 10.1016/j.jaac.2018.07.893
Barriers and facilitators to shared decision making in child and youth mental health: clinician perspectives using the Theoretical Domains Framework
Hayes, D., Edbrooke-Childs, J., Town, R., Wolpert, M., & Midgley, N. (2018). Barriers and facilitators to shared decision making in child and youth mental health: clinician perspectives using the Theoretical Domains Framework. European Child & Adolescent Psychiatry. doi: 10.1007/s00787-018-1230-0
A qualitative exploration of the role of leadership in service transformation in child and adolescent mental health services
Edbrooke-Childs, J., Calderon, A., McDonnell, M., Hirvonen, H., Deighton, J., & Wolpert, M. (2018) A qualitative exploration of the role of leadership in service transformation in child and adolescent mental health services. Child and Adolescent Mental Health. doi: 10.1111/camh.12303
Mental health and well-being trends among children and young people in the UK, 1995–2014: analysis of repeated cross-sectional national health surveys
Background: There is a growing concern about the mental health of children and young people (CYP) in the UK, with increasing demand for counselling services, admissions for self-harm and referrals to mental health services. We investigated whether there have been similar recent trends in selected mental health outcomes among CYP in national health surveys from England, Scotland and Wales.
Pitchforth, J., Fahy, K., Ford, T., Wolpert, M., Viner, R., & Hargreaves, D. (2018). Mental health and well-being trends among children and young people in the UK, 1995–2014: Analysis of repeated cross-sectional national health surveys. Psychological Medicine, 1-11.
Using flawed, uncertain, proximate and sparse (FUPS) data in the context of complexity: learning from the case of child mental health
Abstract: The use of routinely collected data that are flawed and limited to inform service development in healthcare systems needs to be considered, both theoretically and practically, given the reality in many areas of healthcare that only poor-quality data are available for use in complex adaptive systems. Data may be compromised in a range of ways. The term ‘FUPS’ is proposed to describe these flawed, uncertain, proximate and sparse datasets. Many of the systems that seek to use FUPS data may be characterised as dynamic and complex, involving a wide range of agents whose actions impact on each other in reverberating ways, leading to feedback and adaptation. This paper presents an example of the use of a FUPS dataset in the complex system of child mental healthcare. The dataset comprised routinely collected data from services that were part of a national service transformation initiative in child mental health from 2011 to 2015.
Wolpert, M., Rutter, H. (2018). Using flawed, uncertain, proximate and sparse (FUPS) data in the context of complexity: learning from the case of child mental health. BMC Medicine, 16(82).
Power Up: Patient and public involvement in developing a shared decision-making app for mental health
Abstract: Young people as active partners in the design of interventions is increasingly considered an integral part of research. This article presents results from a project involving young people as co-designers in a digital intervention for shared decision-making in mental health services.
Edridge, C. L., Edbrooke-Childs, J., Martin, K., Delane, L., Averill, P., Feltham, A., Rees, J., Jeremy, G., Chapman, L., Craven, M.P., Wolpert, M. (2018). Power Up: Patient and public involvement in developing a shared decision-making app for mental health. The Journal of Health Design, 3(1), 63–74.
Abstract: The Strengths and Difficulties Questionnaire (SDQ) is one of the most widely used measures in child and adolescent mental health in clinical practice, community-based screening and research. Assessing the readability of such questionnaires is important as young people may not comprehend items above their reading ability when self-reporting. Analyses of readability in the present study indicate that the self-report SDQ might not be suitable for young people with a reading age below 13–14 years and highlight differences in readability between subscales. The findings suggest a need for caution in using the SDQ as a self-report measure for children below the age of 13, and highlight considerations of readability in measure development, selection and interpretation.
Patalay, P., Hayes, D., & Wolpert, M. (2018). Assessing the readability of the self-reported Strengths and Difficulties Questionnaire. BJPsych Open, 4(2), 55–57.
Abstract: Stanley J Ulijaszek’s new book Models of Obesity (published October, 2017) might be thought to be primarily of interest to obesity researchers, but in fact it offers potential applications beyond obesity, in the field of public mental health.1 Parallels between public health responses to obesity and mental health issues are already apparent. In both cases, concern about their rising levels has increased, what constitutes normality is contested, the extent to which they are socially constructed or appropriately medicalised is debated, and the focus on intervening during childhood is increasing. But parallels also exist that, although less immediately obvious, might be of crucial importance in understanding and advancing the practice of public mental health.
Wolpert, M. (2018). Rethinking public mental health: learning from obesity. The Lancet Psychiatry, 5(6), 458–60.
Background: ‘Situation Awareness For Everyone’ (SAFE) was a 3-year project which aimed to improve situation awareness in clinical teams in order to detect potential deterioration and other potential risks to children on hospital wards. The key intervention was the ‘huddle’, a structured case management discussion which is central to facilitating situation awareness. This study aimed to develop an observational assessment tool to assess the team processes occurring during huddles, including the effectiveness of the huddle.
Edbrooke-Childs, J., Hayes, J., Sharples, E., Gondek, D., Stapley, E., Sevdalis, N., Lachman, P. & Deighton, J. (2017). Development of the Huddle Observation Tool for structured case management discussions to improve situation awareness on inpatient clinical wards. BMJ. doi: 10.1136/bmjqs-2017-00651
Developing a case mix classification for child and adolescent mental health services: the influence of presenting problems, complexity factors and service providers on number of appointments
Background: Case-mix classification is a focus of international attention in considering how best to manage and fund services, by providing a basis for fairer comparison of resource utilization. Yet there is little evidence of the best ways to establish case mix for child and adolescent mental health services (CAMHS).
Martin, P., Davies, R., Macdougall, A., Ritchie, B., Vostanis, P., Whale, A., & Wolpert, M. (2017). Developing a case mix classification for child and adolescent mental health services: the influence of presenting problems, complexity factors and service providers on number of missed appointments. Journal of Mental Health, 1-8.
Commentary: Why measuring clinical change at the individual level is challenging but crucial – commentary on Jensen and Corralejo (2017)
Abstract: Jensen and Corralejo highlight that most mental health intervention research focuses on the group level rather than individual level. They looked at parent‐reported outcomes for up to 24 children and found that individual‐level findings appear to tell a less positive story than the more traditional group‐level finding. They call for more reporting of outcomes at individual level.
Wolpert, M. Commentary: Why measuring clinical change at the individual level is challenging but crucial - commentary on Jensen and Corralejo (2017). (2017). Child and Adolescent Mental Health. 22(3), 167-169.
Edbrooke-Childs, J., Deighton, J., & Wolpert, M. (2017). Changes in severity of psychosocial difficulties in adolescents accessing specialist mental healthcare in England (2009-2014). Journal of Adolescence, 60, 47-5
Background: Around 1 in 10 children and young people worldwide have mental health difficulties that substantially affect their lives. Even in high income countries only a small minority of these people access specialist support, which has led to demands for more mental health specialists.1 We support these calls but think that focusing exclusively on the need for more healthcare professionals is not enough. We need to move away from approaches led by professionals that focus on problems towards care that is person centred and focused on progress.
Wolpert, M., Vostanis, P., Martin, K., Munk, S., Norman, R., Fonagy, P., & Feltham, A. (2017). High integrity mental health services for children: focusing on the person, not the problem. BMJ. doi:10.1136/bmj.j1500
Background: Healthcare economies across the globe are in crisis. High income countries—whether their healthcare economies are market driven like the US or tax funded like the UK—are struggling with relentless demand for more services that are increasingly costly to deliver. Low and middle income countries are struggling to provide better and more equitable access to potentially lifesaving interventions while wisely allocating scarce resources across all sectors that affect human and social development. In rich and poor countries alike, policy makers, citizens, and health professionals are drawn to technology but are not learning how to use it most effectively or from mistakes made when its limits go unrecognised or unheeded.1
Mulley, A., Coulter, A., Wolpert, M., Richards, T., & Abbasi, K. (2017). New approaches to measurement and management for high integrity health systems. BMJ. doi:10.1136/bmj.j1401
Using patient‐reported outcome measures to improve service effectiveness for supervisors: a mixed‐methods evaluation of supervisors' attitudes and self‐efficacy after training to use outcome measures in child mental health
Background: Patient‐reported outcome measures (PROMs) are recommended by healthcare systems internationally, but there are a number of barriers to implementation. The aim of this research was to examine the impact of training supervisors in using PROMs on clinical practice, given the importance of leadership when changing behaviour.
Fullerton, M., Edbrooke-Childs, J., Law, D., Martin, K., Whelan, I., & Wolpert, M. (2017). Using patient-reported outcome measures to improve service effectiveness for supervisors: a mixed-methods evaluation of supervisors' attitudes and self-efficacy after training to use outcome measures in child mental health. Child and Adolescent Mental Health. doi: 10.1111/camh.12206
Goal formulation and tracking in child mental health settings: when is it more likely and is it associated with satisfaction with care?
Abstract: Goal formulation and tracking may support preference-based care. Little is known about the likelihood of goal formulation and tracking and associations with care satisfaction. Findings of the present research suggest that goal formulation and tracking may be an important part of patient satisfaction with care. Clinicians should be encouraged to consider goal formulation and tracking when it is clinically meaningful as a means of promoting collaborative practice.
Jacob, J., De Francesco, D., Deighton, J., Law, D., Wolpert, M., & Edbrooke-Childs, J. (2017). Goal formulation and tracking in child mental health settings: when is it more likely and is it associated with satisfaction with care? European Child & Adolescent Psychiatry. doi:10.1007/s00787-016-0938-y
Service-level variation, patient-level factors, and treatment outcome in those seen by child mental health services
Abstract: Service comparison is a policy priority but is not without controversy. This paper aims to investigate the amount of service-level variation in outcomes in child mental health, whether it differed when examining outcomes unadjusted vs. adjusted for expected change over time, and which patient-level characteristics were associated with the difference observed between services. Comparison of services with high proportions of young people with autism or infrequent case characteristics requiring specialist input needs particular caution as these young people may be at greater risk of poor outcomes.
Edbrooke-Childs, J., Macdougall, A., Hayes, D., Jacob, J., Wolpert, M., & Deighton, J. (2017). Service-level variation, patient-level factors, and treatment outcome in those seen by child mental health services. European Child & Adolescent Psychiatry. doi:10.1007/s00787-016-0939-x
Facilitators and Barriers to Person-centred Care in Child and Young People Mental Health Services: A Systematic Review
Abstract: Implementation of person-centred care has been widely advocated across various health settings and patient populations, including recent policy for child and family services. Nonetheless, evidence suggests that service users are rarely involved in decision-making, whilst their preferences and goals may be often unheard. The aim of the present research was to systematically review factors influencing person-centred care in mental health services for children, young people and families examining perspectives from professionals, service users and carers. This was conducted according to best practice guidelines, and seven academic databases were searched. Overall, 23 qualitative studies were included. Findings from the narrative synthesis of the facilitators and barriers are discussed in light of a recently published systematic review examining person-centred care in mental health services for adults. Facilitators and barriers were broadly similar across both settings. Training professionals in person-centred care, supporting them to use it flexibly to meet the unique needs of service users whilst also being responsive to times when it may be less appropriate and improving both the quantity and quality of information for service users and carers are key recommendations to facilitate person-centred care in mental health services with children, young people and families.
Gondek, D. Edbrooke-Childs, J., Velikonja, T., Chapman, L., Saunders, F., Hayes, D., & Wolpert, M. (2017). Facilitators and barriers to person-centred care in child and young people mental health services: A systematic review.
Abstract: I believe that there is an ethical imperative to be more explicit in our communal recognition of the limits of treatment, and on the definition of treatment failure and appropriate response to it. Being unrealistic with service users about possibilities of treatment failure may mean that all too many are left feeling to blame for not having succeeded in therapy. Remaining silent on the levels of treatment failure stops service-level discussion of what should be done for these individuals. It reduces rational use of resources, stunts service development, and might contribute to forms of both therapist-blaming and patient-blaming. For these reasons, I would argue that there is a pressing need for greater research into and discussion of the limits of treatment and treatment failure, which I hope this Essay might play some part in stimulating.
Wolpert, M. (2016). Failure is an option. The Lancet Psychiatry. doi: 10.1016/s2215-0366(16)30075-x
A Qualitative Exploration of Patient and Clinician Views on Patient Reported Outcome Measures in Child Mental Health and Diabetes Services
Abstract: Patient Reported Outcome Measures (PROMs) are increasingly being recommended for use in both mental and physical health services. The present study is a qualitative exploration of the views of young people, mothers, and clinicians on PROMs. Semi-structured interviews were conducted with a sample of n = 10 participants (6 young people, 4 clinicians) from mental health services and n = 14 participants (4 young people, 7 mothers, 3 clinicians) from a diabetes service. For different reasons, young people, mothers, and clinicians saw feedback from PROMs as having the potential to alter the scope of clinical discussions.
Wolpert, M., Curtis-Tyler, K., & Edbrooke-Childs, J. (2016). A qualitative exploration of patient and clinician views on patient-reported outcome measures in child mental health and diabetes services.
Achieving Precision Mental Health through Effective Assessment, Monitoring, and Feedback Processes : Introduction to the Special Issue
Abstract: Although much of the focus of medicine to date has been on biomarkers and genetics (McCarty et al. 2011), the concept is not limited to those factors. Just as critical, but less widely elaborated, are psychosocial variables that also fit under the umbrella of precision and personalized medicine. Increasing discussion has also focused on the relevance of precision medicine to mental health.
Bickman, L., Lyon, A., & Wolpert, M. (2016). Achieving Precision Mental Health through Effective Assessment, Monitoring and Feedback Processes: Introduction to the Special Issue.
A qualitative exploration of attitudes towards the use of outcome measures in child and adolescent mental health services
Abstract: The aim of the present research was to explore clinician attitudes to outcome measures and, in particular, the facilitators and barriers to implementing outcome measures. An up-to-date exploration of clinician attitudes is especially needed in the context of recent policies on the implementation of outcome measures in child and adolescent mental health services (CAMHS), and because evidence suggests that there is a disparity between policy recommendations and the use of outcome measures in clinical practice. Semi-structured interviews were conducted with nine CAMHS clinicians from a Mental Health Trust in South London.
Sharples, E., Qin, C., Goveas, V., Gondek, D., Deighton, J., & Edbrooke-Childs, J. (2016). A qualitative exploration of attitudes towards the use of outcome measures in child and adolescent mental health services.
Feedback from Outcome Measures and Treatment Effectiveness, Treatment Efficiency, and Collaborative Practice: A Systematic Review
Abstract: Due to recent increases in the use of feedback from outcome measures in mental health settings, we systematically reviewed evidence regarding the impact of feedback from outcome measures on treatment effectiveness, treatment efficiency, and collaborative practice. In over half of 32 studies reviewed, the feedback condition had significantly higher levels of treatment effectiveness on at least one treatment outcome variable. Feedback was particularly effective for not-on-track patients or when it was provided to both clinicians and patients. The findings for treatment efficiency and collaborative practice were less consistent. Given the heterogeneity of studies, more research is needed to determine when and for whom feedback is most effective.
Gondek, D., Edbrooke-Childs, J., Fink, E., Deighton, J., & Wolpert, M. (2016). Feedback from Outcome Measures and Treatment Effectiveness, Treatment Efficiency, and Collaborative Practice: A Systematic Review. Administration and Policy in Mental Health and Mental Health Services Research. Online first January 2016. DOI: 10.1007/s10488-015-0710-5
Abstract: Personalised care requires personalised outcomes and ways of feeding back clinically useful information to clinicians and practitioners, but it is not clear how to best personalise outcome measurement and feedback using existing standardised outcome measures.
Jacob, J., Edbrooke-Childs, J., Law, D., & Wolpert, M. (2015). Measuring what matters to patients: using goal content to inform measure choice and development. Clinical Child Psychology and Psychiatry. Online first December 2015. DOI: 10.1177/1359104515615642
Abstract: The Strengths and Difficulties Questionnaire (SDQ) is one of the most widely used measures of young people’s mental health difficulties in research and clinical decision-making. Although the SDQ is available in both paper and computer survey formats, cross-format equivalences have yet to be established. The current study aimed to assess the measure’s equivalence across paper- and computer-based survey formats in a community-based school setting. The study examined self-reported measures completed by a matched sample of 11–14 year olds in secondary schools in England (589 completed paper version; 589 online version). Analyses demonstrate that the factor structure, although did not vary by survey format, resulted in poorly fitting models limiting the use of model based invariance testing. Results indicate that the measure does not operate similarly across different formats, with scale-level mean differences observed for the hyperactivity scale, which also affects the total difficulties score, with higher scores seen in the paper version.
Patalay, P., Hayes, D., Deighton, J., & Wolpert, M. (2015). A Comparison of Paper and Computer Administered Strengths and Difficulties Questionnaire. Journal of Psychopathology and Behavioral Assessment. Online first August 2015. DOI: 10.1007/s10862-015-9507-9
The relationship between child- and parent-reported shared decision making and child-, parent-, and clinician-reported treatment outcome in routinely collected child mental health services data
Edbrooke-Childs, J., Jacob, J., Argent, R., Patalay, P., Deighton, J., & Wolpert, M. (2015). The relationship between child- and parent-reported shared decision making and child-, parent-, and clinician-reported treatment outcome in routinely collected child mental health services data. Clinical Child Psychology and Psychiatry.Online first June 2015. DOI: 1359104515591226
Associations between evidence-based practice and mental health outcomes in child and adolescent mental health services
Abstract: The effectiveness of evidence-based practice in the treatment of children with conduct disorder (n = 186) or emotional disorders (n = 490) in routine care was examined using naturalistic, previously collected data from 30 child and adolescent mental health services. Repeated measures analysis of covariance was used to compare the outcomes of children who received parent training for conduct disorder and cognitive behavioural therapy for emotional disorders (evidence-based practice) with children who did not receive these treatments (non-evidence-based practice). There was a relatively low occurrence of evidence-based practice, particularly for children with conduct disorder. Both the evidence-based practice and non-evidence-based practice groups improve over time, with moderate effect sizes, and there were greater improvements associated with evidence-based practice for children with emotional disorders, based on child self-reported symptoms but not on parent report. In the present sample, significant differences were not found for conduct disorder. Findings provide tentative support for evidence-based practice for the treatment of emotional disorders in routine care settings.
Deighton, J., Argent, R., De Francesco, D., Edbrooke‐Childs, J., Jacob, J., Fleming, I., Ford, T. & Wolpert, M. (2015) Associations between evidence-based practice and mental health outcomes in child and adolescent mental health services. Clinical Child Psychology and Psychiatry, DOI: 10.1177/1359104515589637
Interpreting standardized and idiographic outcome measures in CAMHS: what does change mean and how does it relate to functioning and experience?
Background: Patient Reported Outcome Measures (PROMs) are increasingly being used in Child and Adolescent Mental Health Services (CAMHS). The aim of this research was to explore change in standardized and idiographic outcome measures in CAMHS using naturalistic, routinely collected data.
Edbrooke‐Childs, J., Jacob, J., Law, D., Deighton, J., & Wolpert, M. (2015). Interpreting standardized and idiographic outcome measures in CAMHS: what does change mean and how does it relate to functioning and experience? Child and Adolescent Mental Health.
Horses for courses? A qualitative exploration of goals formulated in mental health settings by young people, parents, and clinicians
Abstract: This research sought to explore and categorise goals set by children and young people, parents/caregivers and jointly by a combination of children/young people, parents/caregivers and/or clinicians within mental health settings across the United Kingdom.
Jacob, J., Edbrooke-Childs, J., Holley, S., Law, D. & Wolpert, M. (2015) Horses for courses? A qualitative exploration of goals formulated in mental health settings by young people, parents, and clinicians. Clinical Child Psychology and Psychiatry, 1-6. DOI: 10.1177/1359104515577487
Mental Health Difficulties in Early Adolescence: A Comparison of Two Cross-Sectional Studies in England From 2009 to 2014
Abstract: To examine the changes in mental health difficulties in early adolescence between 2009 and 2014 in England. Overall, there were similar levels of mental health difficulties experienced by adolescents in 2009 and 2014. Notable exceptions were a significant increase in emotional problems in girls and a decrease in total difficulties in boys in 2014 compared to 2009. The increased prevalence of emotional problems in girls mirrors a trend found in other similar studies, and the results are discussed in the context of recent economic and societal changes. The small decrease in total difficulties in boys, although promising, clearly warrants further research.
Fink, E., Patalay, P., Sharpe, H., Holley, S., Deighton, J. & Wolpert, M. (2015). Mental health difficulties in early adolescence: A comparison of two cross-sectional studies in England from 2009 to 2014. Journal of Adolescent Mental Health, 56, 502-507.
2012 - 2014
Learning from a Learning Collaboration: The CORC Approach to Combining Research, Evaluation and Practice in Child Mental Health
Abstract: This paper outlines the experience of the Child Outcomes Research Consortium—formerly known as the CAMHS Outcomes Research Consortium; the named changed in 2014 in recognition of the widening scope of the work of the collaboration; a learning collaboration of service providers, funders, service user groups and researchers across the UK and beyond, jointly committed to collecting and using routinely collected outcome data to improve and enhance service provision and improve understanding of how best to help young people with mental health issues and their families.
Fleming, I., Jones, M., Bradley, J., & Wolpert, M. (2014). Learning from a learning collaboration: The CORC approach to combining research, evaluation and practice in child mental health. Administration and Policy in Mental Health and Mental Health Services Research, 1-5.
From ‘reckless’ to ‘mindful’ in the use of outcome data to inform service-level performance management: perspectives from child mental health
Abstract: In the recent report on patient safety in the National Health Service (NHS) in England, Don Berwick calls on the NHS to align the necessity for increased ‘accountability’ with the necessity to ‘abandon blame as a tool’ in order to develop a ‘transparent learning culture’.1 Sir Bruce Keogh, Medical Director NHS, and colleagues’ recent analysis of outlier hospitals based on mortality data marks a key step on this journey, but has led to high-profile debate about the risk of possible ‘reckless’ (Sir Bruce Keogh's term) use of data if appropriate parameters are not established.2 ,3 If these and other equivalent proxies for outcomes are to be used safely and effectively to support performance management and quality improvement in the ways envisioned by both Keogh and Berwick, it is crucial to establish clearly agreed operational procedures. Drawing on our experience of collecting and interpreting outcome data in the challenging context of child mental health across the UK, we suggest adoption of a MINDFUL framework.
Wolpert, M., Deighton, J., De Francesco, D., Martin, P., Fonagy, P., & Ford, T. (2014). From ‘reckless’ to ‘mindful’in the use of outcome data to inform service-level performance management: perspectives from child mental health. BMJ quality & safety, bmjqs-2013.
Abstract: The possibility of harm from mental health provision, and in particular harm from youth mental health provision, has been largely overlooked. We contend that if we continue to assume youth mental health services can do no harm, and all that is needed is more services, we continue to risk the possibility that the safety of children and young people is unintentionally compromised. We propose a three level framework for considering harm from youth mental health provision (1. ineffective engagement, 2. ineffective practice and 3. adverse events) and suggest how this framework could be used to support quality improvement in services.
Wolpert, M., Deighton, J., Fleming, I., & Lachman, P. (2014). Considering Harm and Safety in Youth Mental Health: A Call for Attention and Action. Administration and Policy in Mental Health and Mental Health Services Research, 1-4.
Measurement Issues: Review of four patient reported outcome measures: SDQ, RCADS, C/ORS and GBO – their strengths and limitations for clinical use and service evaluation
Background: There is an international drive for routine use of Patient Reported Outcome Measures (PROMs) across all health services including in relation to Child and Adolescent Mental Health Services (CAMHS). A number of reviews have summarized the validity and reliability of well‐being and mental health measures for children but there are fewer attempts to consider utility for routine use.
Wolpert, M., Cheng, H., & Deighton, J. (2014). Measurement Issues: Review of four patient reported outcome measures: SDQ, RCADS, C/ORS and GBO–their strengths and limitations for clinical use and service evaluation. Child and Adolescent Mental Health. Doi: 10.1111/camh.12065
Comparison of indices of clinically meaningful change in child and adolescent mental health services: difference scores, reliable change, crossing clinical thresholds and ‘added value’ – an exploration using parent rated scores on the SDQ
Background: Establishing what constitutes clinically significant change is important both for reviewing the function of services and for reflecting on individual clinical practice. A range of methods for assessing change exist, but it remains unclear which are best to use and under which circumstances.
Wolpert, M., Görzig, A., Deighton, J., Fugard, A, J, B., Newman, R. & Ford, T. (2014) Comparison of indices of clinically meaningful change in Child and Adolescent Mental Health Services (CAMHS): difference scores, reliable change, crossing clinical thresholds and “added value”; an exploration using parent rated scores on the SDQ. Child and Adolescent Mental Health.
What kinds of goals do children and young people set for themselves in therapy? Developing a goals framework using CORC data
Abstract: Agreement on goals is thought to be central in successfully building a good therapeutic alliance which in turn improves outcomes. The qualitative idiosyncratic nature of goals set by children and young people in therapy has been relatively unexplored. We investigated service users’ account of the goals they set for them- selves in UK child and adolescent mental health services (CAMHS) using data collated by CAMHS Out- comes Research Consortium (CORC) members. Six services supplied their goals data for analysis: NHS targeted, specialist, and highly specialist services; a modality specific professional body; and a therapeutic community. Service users were 80 children and young people who had visited the services between 2007 and 2011. Emerging themes arising from key aspects of 241 goals from the participants (as agreed with and recorded by the clinician) were analysed using thematic analysis. The resulting taxonomy of goals consisted of three overarching themes and 25 lower level categories. Inter-rater reliability between two researchers was substantial for major themes (Cohen’s kappas from 0.78 to 0.88 and statistically significantly above 0.6) and 14 of the 25 subthemes had substantial agreement. The top five goals mainly concerned personal growth, functioning, and coping with specific symptoms and problems. We discuss these results and differences with a large analysis done in the USA on the inverse ‘top problems’.
Bradley, J., Murphy, S., Fugard, A. J., Nolas, S. M., & Law, D. (2013). What kinds of goals do children and young people set for themselves in therapy? Developing a goals framework using CORC data. Child & Family Clinical Psychology Review, 1(1), 8-18.
Satisfaction in Child and Adolescent Mental Health Services: Translating Users’ Feedback into Measurement
Abstract: The present research addressed gaps in our current understanding of validity and quality of measurement provided by patient reported experience measures. We established the psychometric properties of a freely available experience of service questionnaire (ESQ), based on responses from 7,067 families of patients across 41 UK providers of child and adolescent mental health services, using the two-level latent trait modeling. Responses to the ESQ were subject to strong ‘halo’ effects, which were thought to represent the overall positive or negative affect towards one’s treatment. Two strongly related constructs measured by the ESQ were interpreted as specific aspects of global satisfaction, namely satisfaction with care, and with environment. The Care construct was sensitive to differences between less satisfied patients, facilitating individual and service-level problem evaluation. The effects of nesting within service providers were strong, with parental reports being the most reliable source of data for the between-provider comparisons. We provide a scoring protocol for converting the hand-scored ESQ to the model-based population-referenced scores with supplied standard errors, which can be used for benchmarking services as well as individual evaluations.
Brown, A., Ford, T., Deighton, J., & Wolpert, M. (2012). Satisfaction in child and adolescent mental health services: Translating users’ feedback into measurement. Administration and Policy in Mental Health and Mental Health Services Research, 1-13.
Routine outcomes monitoring as part of children and young people's Improving Access to Psychological Therapies (CYP IAPT) – improving care or unhelpful burden?
Abstract: This brief commentary article considers the implications of intensive outcome monitoring which is central to children and young people's Improving Access to Psychological Therapies (CYP IAPT) in England and Wales. Services are being provided with a range of free software solutions to enable data collection, and guidance on interpretation of the measures, but there will still be some burden of data entry and collation for already overstretched services. It may be that the utility of the feedback will go some way to offset the sense of burden but this remains to be seen. Whether commissioners and others will rise to the challenge of supporting this aspect may prove crucial to the success or otherwise of such intensive ROM use. Many aspects of the CYP IAPT approach are new and whilst drawing on experience from earlier pilots of session by session monitoring in CAMHS both in the UK and abroad, and from Adult IAPT, there is likely to be much for us to learn. Time will tell whether the approach helps to improve the care children and young people receive but we are cautiously optimistic.
Wolpert, M., Fugard, A.J.B., Deighton, J., & Gorzig, A. (2012). Routine outcomes monitoring as part of children and young people's Improving Access to Psychological Therapies (CYP IAPT) - improving care or unhelpful burden? Child and Adolescent Mental Health, 17(3), 129-30
Patient-reported outcomes in child and adolescent mental health services (CAMHS): Use of idiographic and standardized measures
Abstract: There is increasing emphasis on use of patient-reported outcome measures (PROMs) in mental health but little research on the best approach, especially where there are multiple perspectives.
Wolpert, M., Ford, T., Trustam, E., Law, D., Deighton, J., Flannery, H., & Fugard, A.J.B. (2012). Patient-reported outcomes in child and adolescent mental health services (CAMHS): use of idiographic and standardized measures. Journal of Mental Health, 21(2), 165-173.
CORC's Survey of Routine Outcome Monitoring and National CAMHS Dataset Developments: A Response to Johnston and Gower
Abstract: The CAMHS Outcome Research Consortium has 44 members across Great Britain who are collaborating to introduce routine outcome monitoring into clinical practice. We discuss the constraints brought up by our members and by Johnston and Gowers, as well as recent work in relation to the development of a national CAMHS dataset.
Ford, T., Tingay, K., & Wolpert, M. (2006). CORC’s survey of routine outcome monitoring and national CAMHS dataset developments: A response to Johnston and Gower. Child and Adolescent Mental Health, 11(1), 50-52.