Title: What CAMHS interventions predict positive outcomes for which young people with a social worker: A mixed-methods study of clinical support and cost-effectiveness utilising linked operational data
Funder: Department of Health and Social Care

Abstract: Background_x000D_ _x000D_ Many children and young people with social work involvement (CYPwSW) experience mental health difficulties. Yet we know too little about the mental health care they receive from Child and Adolescent Mental Health Services (CAMHS). We do not know which young people get accepted or rejected for treatment. We do not know what treatments lead to positive change for these young people. We also do not know how much these treatments cost. _x000D_ _x000D_ Methods_x000D_ _x000D_ Our team will study anonymised administrative records for young people from two NHS Trusts._x000D_ _x000D_ What counts as a good result from treatment for young people has various aspects. We will focus on four outcomes in evaluating treatments. These are: i) mental health; ii) education; iii) self-harm, suicidal thoughts, and suicide; iv) general wellbeing._x000D_ _x000D_ Objectives_x000D_ _x000D_ We will:_x000D_ 1) Examine the profile, needs, and long-term outcomes for CYPwSW accepted or rejected by CAMHS in South London_x000D_ 2) Distinguish forms of CAMHS treatment, and analyse which forms lead to positive outcomes for CYPwSW in South London. We will also examine how factors such as poverty and ethnicity impact how well treatments work._x000D_ 3) Repeat the analysis in Cambridgeshire and Peterborough, to check our findings._x000D_ 4) Analyse how much the treatments cost and quantify how much positive outcomes cost._x000D_ 5) Look at clinical notes and conduct interviews to understand the experiences and treatment of CYPwSW. _x000D_ 6) Spread word of our findings and recommendations._x000D_ _x000D_ Experts by Experience involvement_x000D_ _x000D_ Experts by experience will have a core role across the project. This will include co-leading the qualitative studies and co-organising workshops and roundtables. _x000D_ _x000D_ Outputs_x000D_ _x000D_ We will publish a report focused on practice implications, and create training for professionals. We will write these together with practitioner organisations._x000D_ _x000D_ This study is jointly-funded by the NIHR HSDR Programme and What Works for Children's Social Care (WWCSC).

Lay abstract: Children and young people with social work involvement (CYPwSW) often experience an array of adversities and complex mental health needs. Yet little is known about factors affecting access to Child & Adolescent Mental Health Services (CAMHS) for CYPwSW, what interventions they find helpful, and in what ways they improve function. _x000D_ _x000D_ This project aims to address these questions by providing an account of profiles and trajectories of CYPwSW leading to and following from CAMHS treatment. We will explore what interventions and supports are provided to CYPwSW, which are linked to positive outcomes, and the lived experience of access to and involvement with these services. In addition, we will provide an economic analysis identifying the cost effectiveness of CAMHS provision for CYPwSW._x000D_ _x000D_ To address these questions we will combine quantitative analysis of linked administrative health and education records, and co-produced qualitative analysis of case notes and semi-structured interviews. _x000D_ _x000D_ Data will be analysed from two large administrative datasets: Clinical Record Interactive Search (CRIS) at South London and Maudsley NHS Foundation Trust (SLaM) and Cambridgeshire and Peterborough NHS Foundation Trust (CPFT). We will utilise existing data linkages between each of these datasets and data held by the Office for National Statistics (ONS), Hospital Episode Statistics (HES) and the National Pupil database (NPD). Participants for the Delphi study will be recruited using professional networks in the UK. _x000D_ _x000D_ There are five interrelated work packages (WP): _x000D_ WP1: Examining accepted and rejected referrals - CRIS SLaM_x000D_ Using data from CRIS SLaM, we will examine sociodemographic and referral characteristics associated with accepted and rejected referrals in CAMHS and the longer term outcomes for these young people. _x000D_ _x000D_ WP2: Assessing interventions - CRIS SLaM_x000D_ A Delphi study will be conducted to create a typology of CAMHS interventions. Using CRIS SLaM, propensity score matching will compare CYPwSW to a group of CYP without a social worker. We will study the services provided to different CYPwSW, and explore the relationship between the interventions identified in the Delphi and outcomes for CYPwSW in terms of mental health, education, suicidality and self-harm, and wellbeing_x000D_ _x000D_ WP3: Replication of WP1 and WP2 – CRIS CPFT_x000D_ We will use data from CPFT to conduct a replication of WP1 and WP2. _x000D_ _x000D_ WP4: Economic analysis _x000D_ We will conduct an economic analysis to determine the economic impact and downstream public costs of the interventions and supports identified in WP2 and WP3. _x000D_ _x000D_ WP5: Coproduced qualitative studies_x000D_ With experts by experience, we will undertake co-produced research looking at clinical case notes in CRIS SLaM, and using the ‘consent for contact’ register to aid recruitment for an interview study. _x000D_ _x000D_ Academic outputs will include peer reviewed journal articles and a practice-focused report. We anticipate that the findings from this project will feed into updates to practice guidance._x000D_ _x000D_ This study is jointly-funded by the NIHR HSDR Programme and What Works for Children's Social Care (WWCSC).

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