Title: Understanding young people's engagement with psychological therapies through a social inequalities lens
Funder: Economic and Social Research Council

Abstract: Aim 1: To conduct additional analysis of my PhD data and advance my inequalities knowledge Objectives: a) Re-analyse qualitative data from a social inequalities perspective: I will use Behavioural Activation (BA), a 'talking' therapy for depression, as an exemplar treatment to explore how manualised psychological therapies more generally might be adapted to improve engagement by disadvantaged young people. b) Receive mentorship: I will receive mentoring from Dr Prady, an expert in the social epidemiology of mental health, to facilitate my advanced understanding about the social determinants of health and the application of inequalities theory to my dataset. c) Undertake training: I will attend the UCL Health and Society summer school to learn about social determinants of health from a global government and policy perspective. Aim 2: To publish my findings Objectives: a) Publish in high-impact, peer-reviewed academic journals Building on the findings detailed in the three papers already produced from my thesis, I will: i) Use a social inequalities framework to explore engagement with BA from the viewpoint of young people, their parents and clinicians. A paper will be submitted to Social Science & Medicine (impact factor [if]: 3.087). ii) Develop a 'logic model' based on the relationship between disadvantage and psychological therapies. A paper will be submitted to Child & Adolescent Mental Health (if: 1.439). b) Publish for a non-specialist audience i) In collaboration with academic and NHS colleagues, I will write a lay commentary on the potential exclusion of disadvantaged youth during psychological therapies research, for The Conversation (monthly audience of 10.7 million). ii) A blog post will be written in the Fuse Open Science Blog, for The Centre for Translational Research in Public Health, discussing re-analysis of existing qualitative datasets in response to unanticipated findings (such as those relating to social inequalities during my PhD). Aim 3: To network and develop impact opportunities Objectives: a) Stakeholder mapping: I will attend training and then undertake a network mapping exercise to seek out appropriate patient and public stakeholders to develop future partnerships around social inequalities in psychological therapies. b) Engaging with researchers, practitioners and stakeholders: I will host a workshop at the Society for Social Medicine & Population Health Annual Scientific Meeting, a key national event for health inequalities researchers, and the Health Services Research UK Conference, with key policy and academic stakeholders. I will also present my findings at the local mental health trust's annual conference, the University of York and via a webinar for a broader audience. c) Engagement within the White Rose Doctoral Training Partnership: Towards the end of the Fellowship, I will design and present an inter-disciplinary workshop on social inequalities in health (primarily aimed at PhD students but open to other academics), to share acquired knowledge of social inequalities and stimulate discussion on future research directions. Aim 4: To advance my research and statistical skills, and develop funding proposals Objectives: a) Funding applications: I will attend grant writing training and apply for a Fellowship writing retreat. Following this and with support from my mentor, I will apply for a Wellcome Trust Postdoctoral Research Fellowship in Humanities and Social Science and/or ESRC New Investigator Grant focusing on understanding how young people's social and economic situations may facilitate or obstruct psychological treatment. This will be key to establishing myself as a research leader, and aiding my longer-term goal of a career in academia focused on equitable access to psychological treatment. b) Statistical training: I will undertake training to improve my readiness to undertake the quantitative analyses that I will incorporate into future Fellowship applications.

Lay abstract: The ultimate aim of future Fellowships is to ensure psychological treatment is appropriately and sensitively adapted to the population it is being delivered to; evidence suggests that this results in improved outcomes at a personal and societal level. This Fellowship, will further this aim by: 1. Reconsidering data already collected from a different perspective Psychological or talking therapies are increasingly used to help people with common mental health problems, such as depression. There is a need for treatments that can be delivered to greater numbers of people; one way to increase reach, is through delivery by less-specialist staff. Behavioural Activation (BA) is one such simple, brief talking therapy that uses a manual to guide practitioners. My PhD explored whether BA was helpful to young people with depression attending Child and Adolescent Mental Health Services (CAMHS) and whether it could be delivered by staff with limited psychotherapies experience. Whilst researching BA, a theme from the data revealed that some patients' and families' experienced unanticipated difficulties in engaging with therapy. Rather than being related to mental health problems, these barriers seemed instead to be rooted in social, environmental or economic circumstance. My PhD was not designed to investigate this further. During the Fellowship, I will re-examine this data. Through focused reading of the literature and guidance from my mentor, I will build an analysis 'framework' of factors indicating disadvantage that I will apply to existing data from: - A focused ethnography in CAMHS (documents/interviews/observation) and interviews (with those delivering BA) to understand staff perspectives of how inequalities experienced by patients may interfere with treatment. - Interviews with young people receiving BA (and accompanying parents) to assess whether experiences differ based upon socioeconomic position. Families living in more affluent areas will be analysed together, and compared with those from more deprived communities (based upon partial postcodes). As an additional measure of deprivation, I will explore adverse childhood experiences between groups. If families from disadvantaged social groups did encounter greater challenges during treatment, it would be particularly concerning because mental health difficulties are over-represented in these groups. 2. Publishing my findings Following advanced training on these social issues, I will use the findings from the re-analysis to design a 'logic' model detailing the resources, activities, outputs, outcomes and impact of addressing barriers to CAMHS treatment for disadvantaged youth. This is a visual way to present and share understanding of these relationships in a policy context; illuminating gaps in knowledge and identifying ways clinical services could respond. I will write about my work in different publications, and publicise the research using social media. 3. Making and maintaining connections Alongside clinical networks built during my PhD, I will identify and communicate with interested stakeholders, to support the work undertaken during and after the Fellowship. I will share acquired knowledge and findings via in-person workshops (utilising existing conferences and networks such as the White Rose Doctoral Training Partnership [WRDTP]) and virtually (by hosting a webinar). This will increase the visibility of my research and foster shared problem-solving. 4. Developing funding proposals Returning to my data will maximise the value of the publicly-funded research already undertaken and the logic model will determine future research directions. Statistical training will expand my personal skillset, providing greater breadth of opportunities for exploring these research questions. With the support of identified stakeholders, I will submit an application to external funders aimed at providing equitable care and timely patient benefit; positioning myself as a future leader.

Research activity codes: 5.6 PSYCHOLOGICAL AND BEHAVIOURAL;7.1 INDIVIDUAL CARE NEEDS
Health categories: MENTAL HEALTH