Title: Evolving the Evidence for Paediatric Liaison Psychiatry Services in England: Where are they, how do they work, and what do young people, families and staff think of them?
Funder: Health Education England

Abstract: Background. Young people presenting with both physical and psychological symptoms are commonly seen in paediatric wards and emergency departments. Examples of this include eating disorders, self-harm and medically unexplained symptoms (MUS). Young people in these groups report poor health service experiences, whilst paediatric staff report feeling ill-equipped to support them. Paediatric liaison psychiatry (PLP) services are recommended as one way to improve care. Adult liaison psychiatry (LP) services are well-established in England, and some evidence suggests that they may improve identification and management of similar problems. Ongoing large-scale research is investigating adult LP services, including staff and service user experiences. There is little corresponding evidence for PLP services; it is unclear how many acute hospitals in England provide them, how they integrate mental and physical healthcare, or their acceptability to young people, families, and professionals. Research is needed to generate knowledge about PLP to aid decisions about accessible, effective and appropriate service development. Research Question: 'How do PLP services in England support integrated healthcare for young people with physical and psychological symptoms?' Research Aims: (1) Map and describe characteristics of PLP services in hospitals in England. (2) Investigate how PLP services integrate physical and mental healthcare. (3) Examine key stakeholder views about accessible and appropriate PLP service delivery. Research Objectives: (1) Review PLP service literature to provide an overview of current available evidence. (2) Survey PLP services in England to determine key characteristics. E.g. structure, function, funding. (3) Case study 3 different PLP services, focusing on mechanisms of care integration and key stakeholder views on accessibility and appropriateness. (4) Synthesise and analyse data, comparing findings from different services with each other and scoping review findings. (5) Report findings; disseminate to key stakeholders and interested parties. Methods. A sequential mixed-methods exploratory approach, involving a systematic review, a survey, and a case study of PLP services. The case-study design will enable services to be studied in-depth in their real-life context. This will be achieved by collecting data illuminating service delivery, e.g. policies; observational notes on working practices, e.g. multidisciplinary meetings; and key stakeholder interview/focus group data. Descriptive statistics and thematic analysis will allow synthesis of findings to produce detailed reports and accessible outputs, e.g. shareable digital media content. Timelines for Delivery. Work will be conducted during a three-year PhD programme. Findings will be submitted to a high-impact peer reviewed journal at three time-points. 1. Mixed methods review (year one). 2. Survey findings (year two). 3. Case study findings (on completion). Anticipated Impact/Dissemination. Given the lack of knowledge on this topic, significant interest in findings is anticipated. Dissemination and project updates will happen throughout and following the project completion via conferences, publications and with collaborators via social media channels. The impact will be improved knowledge about PLP service provision in England, insights into stakeholder experiences of PLP services, and transferrable knowledge regarding how services which aim to integrate young people's healthcare work to do this. This will inform development of standards ensuring acceptable, accessible and appropriate health services for young people and families.

Lay abstract: Background. Many young people in England experience conditions that have both physical and psychological aspects, e.g. eating disorders, self-harm, and 'medically unexplained' symptoms (MUS). These conditions can be complex and may have serious consequences if untreated. Recommended treatments may be both psychological (e.g cognitive behavioural therapy for MUS) and/or physical (e.g. weight restoration in eating disorders). Guidelines recommend treatment provided by professionals who understand both psychological and physical aspects of health conditions. Young people with these conditions often see professionals with limited mental health training, e.g. children's nurses. Research indicates that children's nurses do not feel confident providing care to this group of young people, and that this group of young people often have negative healthcare experiences including delays in getting the right treatment. One solution to this problem is bringing mental and physical health services together. Government guidelines recommend that by now all hospitals should have services to help people of all ages with both mental and physical health problems. These are known as psychosomatic or psychological medicine services or, more commonly, liaison psychiatry (LP) services. Although research indicates that adult services of this kind are common in England and that they help some adults receive treatment more quickly, the evidence about this is limited. The NIHR is currently funding research investigating how these services run. Evidence about paediatric liaison psychiatry (PLP) services in England is virtually non-existent. In order to investigate whether PLP services are helpful in joining up physical and mental healthcare for young people, research is needed about how PLP services work and to find out stakeholder's opinions. Stakeholders are people who may have an interest in PLP services, e.g. young people and families who might use PLP services, and professionals involved in planning or providing PLP services. Aims. The research question is: 'How do PLP services in England bring together mental and physical healthcare to support young people with physical and psychological symptoms?' The research will: a. Map and describe PLP services in England. b. Investigate how PLP services work to ensure young people receive psychological treatments. c. Find out what young people, families, and professionals think about PLP services. Methods. A literature review to find out what is already known about PLP services. A survey of PLP services in England to give an overview of key characteristics e.g. statistics about service structures or funding. Case studies of three different PLP services looking at how they link physical and mental healthcare and to find out what key stakeholders think about them, e.g. interviews with young people. Data analysis to look for patterns and themes in the data. This will tell us more about how different PLP services support young people with psychological problems, which aspects of them work well, and which may need improvement.Patient and Public Involvement (PPI). A young person's research advisory group was involved in developing the project and helped shape decisions about research question, methods, and future PPI. A similar group will be involved throughout the research to help develop participant materials, e.g. information sheets, and contribute to analysis and dissemination plan. Dissemination. Project updates and findings summaries will be sent out regularly during the project via social media to reach young people and families who may use PLP services, and professionals who provide healthcare services. Results will be published in academic journals and presented at conferences for health professionals, researchers and lay audiences. Once finished, the research will be submitted as a PhD thesis.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MENTAL HEALTH