Title: Children’s and adolescents’ experience of emergency department and CAMHS Crisis Liaison Team service provision following presentation for self-harm: Systematic review and qualitative study
Funder: Health and Care Research Wales (Welsh Government)

Abstract: Background: Self-harm in children and adolescents is a growing problem. Hospital admissions reached 18,788 in England and Wales during 2015-2016, a 14% increase on 2013-2014. NICE guidance on the short-term prevention and management of recurrent self harm in individuals aged from 8 yrs recommends that those who present to an emergency department (ED) receive a psychosocial assessment. Evidence reports that assessments are only delivered in 60% of cases. In 2016 the Cwm Taf UHB established the CAMHS Crisis Liaison Team to provide timely psychosocial assessment to individuals aged under 18 yrs presenting to the University Hospital of Wales. To date there is no mechanism for capturing service user experiences. Positive encounters with health car professionals are important in preventing recurrent self-harm and ensuring future help-seeking behaviour. However, professionals report largely negative attitudes towards individuals who self-harm. NICE recommends the conduct of research exploring service user experiences through the application of rigorously applied qualitative methodology. There has been limited consideration of the experiences of EDs or psychosocial assessments amongst children, adolescents, and their carers. Aims: The project aims to: understand the experiences of children and adolescents, and their carers, who present to an ED for self-harm and receive an assessment by a CAMHS Crisis Liaison Team; understand the role of ED and CAMHS Crisis Liaison Teams in children’s and adolescent’s selfharming journeys; and provide recommendations for service improvement. Design and methods: We will conduct a two-phase project: 1) systematic review and 2) qualitative study. The systematic review will synthesise qualitative data reporting individuals’ and carers’ experiences of presenting to ED for self-harm and/or receiving a psychosocial assessment. The qualitative study will recruit children and adolescents (aged under 18 yrs) who have presented to the University Hospital of Wales’s ED and been referred for psychosocial assessment by the CAMHS Crisis Liaison Team. Semi-structured interviews will be undertaken with 20 children and adolescents to explore their experiences of service provision. We will interview carers (n=20) and health care and affiliated professionals responsible for service delivery (n=13). Patient and public involvement: The research design is co-produced by a multidisciplinary team of researchers and health care practitioners. We will establish a Project Steering Committee, which will include: a young person who has presented to an ED for self-harm; a carer of a child or adolescent who presented to an ED for self-harm; and a health care professional. The ALPHA (Advice Leading to Public Health Advancement) research advisory group of young people will advise on the research process. Outputs and dissemination: Project results will contribute to the improvement of service organisation and delivery in the management and prevention of recurrent self-harm in the child and adolescent population, and inform the CAMHS Crisis Liaison Team model as it is rolled out in Wales. Key findings will be presented at stakeholder and service user knowledge exchange events. Reports and recommendations will be issued to relevant policy-makers, health care and affiliated professionals, and service users. Results will be communicated to the academic community through conferences, pre-existing networks, and journal publications.


Research activity codes: 4.1 DISCOVERY AND PRECLINICAL TESTING OF MARKERS AND TECHNOLOGIES
Health categories: MENTAL HEALTH