Title: The ‘SAPhE Pathway’ Study: Co-creating a prototype digital risk mitigation pathway for Children and Young People admitted with mental health crisis to acute paediatric NHS care
Funder: Department of Health and Social Care

Abstract: What is the problem? Across the UK there are increasing admissions to Emergency Departments and hospitals of children and young people (CYP), aged up to 18 years old, experiencing mental health crisis. Whilst in hospital these CYP often experience severe and changing emotional states which can be accompanied by repeated urge to harm themselves or attempt suicide. During this time, care is predominantly provided by non-mental health specialists who may lack expertise and experience in comprehensive risk assessment and management. This can lead to reduced safety and poorer experiences for CYP, which can negatively impact on immediate and longer-term outcomes. Currently, there are no standardised tools used in the National Health Service (NHS) to recognise and respond to risks associated with self-harm and suicidality. What have we done so far? We have developed, in partnership with CYP, their families and health professionals, a valid and reliable tool called the CYP-MH SAPhETM to assess suicidality and self-harm risk in CYP for use in Emergency departments and children s ward areas. We have digitalised CYP-MH SAPhETM at Nottingham Children s Hospital as part of our electronic assessments with a locally agreed processes for reducing level of risk and making CYP feel safer. Whilst we have demonstrated that this risk reduction pathway can work at Nottingham Children s Hospital, we do not know whether it can be used in other hospitals across the NHS. What are we going to do? Working in partnership with CYP, health professionals and other experts we will further develop, and understand how to implement, a prototype digital reducing risk pathway for CYP admitted to NHS care (Emergency departments and children s wards) in mental health crisis across different NHS settings. How are we going to do it? We will: Develop best practice recommendations for reducing risk of CYP in mental health crisis through gathering and prioritising evidence from multiple sources (published literature, CYP, expert professionals and other key stakeholders) Understand barriers and enablers of implementing a digital reducing risk pathway by collecting information about systems, processes and services from three hospitals in the East Midlands and Northeast of England. Co-create a prototype digital reducing risk pathway with CYP, professionals and other stakeholders. What will we do with the results? Our aim is to have a prototype digital risk mitigation pathway and guidance on how it can be implemented at different hospitals in the NHS. We will share our results with CYP and families, national organisations, healthcare commissioners, and policy makers through a project summary (co-created with our PPIE and Expert Reference Group), conference presentations, peer review papers, and funders report. The results will inform an application for future funding (NIHR) to test feasibility and effectiveness.

Lay abstract: What is the problem? Across the UK there are increasing admissions to Emergency Departments and hospitals of children and young people (CYP), aged up to 18 years old, experiencing mental health crisis. Whilst in hospital these CYP often experience severe and changing emotional states which can be accompanied by repeated urge to harm themselves or attempt suicide. During this time, care is predominantly provided by non-mental health specialists who may lack expertise and experience in comprehensive risk assessment and management. This can lead to reduced safety and poorer experiences for CYP, which can negatively impact on immediate and longer-term outcomes. Currently, there are no standardised tools used in the National Health Service (NHS) to recognise and respond to risks associated with self-harm and suicidality. What have we done so far? We have developed, in partnership with CYP, their families and health professionals, a valid and reliable tool called the CYP-MH SAPhETM to assess suicidality and self-harm risk in CYP for use in Emergency departments and children s ward areas. We have digitalised CYP-MH SAPhETM at Nottingham Children s Hospital as part of our electronic assessments with a locally agreed processes for reducing level of risk and making CYP feel safer. Whilst we have demonstrated that this risk reduction pathway can work at Nottingham Children s Hospital, we do not know whether it can be used in other hospitals across the NHS. What are we going to do? Working in partnership with CYP, health professionals and other experts we will further develop, and understand how to implement, a prototype digital reducing risk pathway for CYP admitted to NHS care (Emergency departments and children s wards) in mental health crisis across different NHS settings. How are we going to do it? We will: Develop best practice recommendations for reducing risk of CYP in mental health crisis through gathering and prioritising evidence from multiple sources (published literature, CYP, expert professionals and other key stakeholders) Understand barriers and enablers of implementing a digital reducing risk pathway by collecting information about systems, processes and services from three hospitals in the East Midlands and Northeast of England. Co-create a prototype digital reducing risk pathway with CYP, professionals and other stakeholders. What will we do with the results? Our aim is to have a prototype digital risk mitigation pathway and guidance on how it can be implemented at different hospitals in the NHS. We will share our results with CYP and families, national organisations, healthcare commissioners, and policy makers through a project summary (co-created with our PPIE and Expert Reference Group), conference presentations, peer review papers, and funders report. The results will inform an application for future funding (NIHR) to test feasibility and effectiveness.

Research activity codes: 7.3 MANAGEMENT AND DECISION MAKING
Health categories: MENTAL HEALTH