Award Title: Developing a model for high quality service design for children and young people with common mental health problems
Funder: Department of Health and Social Care

Abstract: The mental health of children and young people (CYP) is a national and international priority, with around one in ten UK CYP having a mental health difficulty that requires professional help. Most of this need lies with CYP experiencing a ‘common’ mental health problem (CMHP). These are commonly occurring problems like anxiety, depression, obsessive-compulsive disorder (OCD), self-harm, psychological trauma, issues relating to gender, sex and sexuality, and problems with emotions and behaviour that are often called  ‘personality disorder’. CYP with these problems typically do not need to be admitted to hospital; if they do, it tends to be for a very short time or a very severe form of the problem. _x000D_
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More CYP with CMHPs are asking for help (or their parents, carers or teachers are) but it is often difficult to get help because services do not exist, are oversubscribed or depend on where the service user lives.  When a service is available and used, it may turn out to be poor quality or unsuitable for the service user._x000D_
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We want to explore the services available to these CYP in England & Wales. Most of these services will be community or out-patient services. We want to find out what services exist, how CYP and their families/carers find out about and access these services, what the services actually do, whether they are any good, and whether they offer value for money. _x000D_
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Our study has 4 work streams. In Stream 1 we will conduct ‘evidence syntheses’. This involves us looking at the literature on services for CYP with CMHPs. This helps identify what services exist, what CYP and their families like about these services and what seems to work. In Stream 2, we will use a survey and the literature from Stream 1 to try to map all of the available services for CYP with CMHPs in England & Wales. Streams 1 & 2 combined will help us group services according to things they have in common or things they differ on, eg who provides the service (NHS or other), who it is for (a general service for CMHPs or one for a specific condition), how it is delivered (face-to-face, telephone or online, etc), whether appointments are required or whether you can simply drop in._x000D_
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In Stream 3, we will pick 8-10 services from our Stream 2 service map and visit each one, talking to 6-8 CYP, 2-3 parents, carers and/or siblings, and 2-3 staff members in each service. We plan to take some young service users, who we will train as ‘co-researchers’, with us when we visit these services. We will ask users of the services we visit to tell us their stories of trying to get help. We will also try to speak to people who couldn’t get help or didn’t want the particular help offered. We will look at relevant documents (eg policies and procedures) and, if possible and with permission from those involved, observe team or referral meetings. We will analyse our data using an approach called ‘framework’ to get some insights into how CYP and their families/carers find and access help and whether they found that help useful or not._x000D_
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In Stream 4, the analyses from Streams 1-3 will be explored, compared and contrasted in order to create a model (or models) of effective and acceptable services for CYP with CMHPs that takes into account how these services are accessed, navigated and used._x000D_
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Throughout our study, we will talk to young people and their parents/carers and to those who commission and provide services for them to ensure what we are doing remains relevant to them.

Lay Abstract: The mental health of children and young people (CYP) is a national and international priority, with around 1 in 10 UK CYP having a mental health difficulty. Most of the need lies with CYP experiencing ‘common’ mental health problems (CMHPs). CMHPs are a range of psychological, emotional and behavioural problems that includes anxiety, depression, OCD, self-harm, PTSD, gender identity issues and emerging personality disorders. While health needs for this population group are rising, services across the UK tend to be fragmented, uncoordinated and variable, and most struggle to meet demand._x000D_
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This study aims to develop a model of effective service design for CYP with CMHPs by examining the factors that facilitate access to, and navigation of, services for CYP with CMHPs and the effectiveness and acceptability of those services. CYP with CMHPs typically do not require hospitalisation so the services investigated will be out-of-hospital services providing primarily assessment/triage, early intervention and supported self-care. This evidence-based model will help inform the NHS and assist commissioners and providers in the design and transformation of out-of-hospital services for this population group. _x000D_
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The study has 4 work streams. In Stream 1, a series of systematic reviews of the international literature will be conducted, specifically: (a) a descriptive review identifying the range of service models; (b) an effectiveness review that identifies and evaluates those service models where comparative effectiveness data are available; (c) an acceptability review that identifies and evaluates those service models where acceptability data are available; and (d) an economic review that considers provider and user costs/benefits associated with specific service models. The reviews will be synthesised using EPPI-Centre meta-synthesis principles. In Stream 2, a survey and the literature from Stream 1 will be used to map services in England & Wales across a range of different service dimensions (theoretical underpinnings, location, staffing, provider, delivery platform, etc). A typology of service provision for CYP with CMHPs will be derived from Streams 1 and 2. In Stream 3 (a collective case study), 8-10 services will be purposively sampled from Stream 2's service map to reflect the various dimensions of the typology. At each site, in line with the principles of case study research, we will: (a) conduct interviews with key stakeholders, ie providers, managers & users (including those who could not or did not access services); (b) obtain relevant documents; and (c) observe, where possible, key interactions. The three case study data sets will be analysed using Framework. We will also collect economic data (time spent delivering services, equipment costs and user out-of-pocket expenses) in Stream 3 for which bottom-up estimates of costs associated with services will be calculated from NHS and PSSRU sources._x000D_
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In Stream 4, data from Streams 1-3 will be synthesised to elicit a model (or models) of effective and acceptable service design for CYP experiencing CMHPs that integrates all of the factors associated with accessing, navigating and receiving help from services for this population group._x000D_
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Service user & provider perspectives will permeate the entire study via an advisory group (which will include commissioners of services), having an NHS manager & service user group as co-applicants, and via employing young service users as co-researchers.

Research Activity Codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health Categories: MENTAL HEALTH