Title: An evidence synthesis of risk identification assessment and management for young people using tier 4 inpatient child and adolescent mental health services
Funder: Division for Social Care and Health Research (Wales)

Abstract: An evidence synthesis guided by the EPPI-Centre framework will be conducted (Evidence for Policy and Practice Information and Co-ordinating Centre 2007). The approach is two-stage supporting the searching appraisal and synthesis of the research and other evidence in ways which are transparent rigorous and sensitive to the priorities of stakeholders but which also reflect the complexity of the field.The overarching research question in this proposed project is: ‘What is known about the identification assessment and management of risk (where ‘risk’ is broadly conceived) in young people (aged 11-18) with complex mental health needs entering using and exiting inpatient child and adolescent mental health services in the UK?’Specific objectives are: (1) To summarise and appraise the evidence for the identification assessment and management of ‘risk’ for young people: as they make the transition into inpatient CAMHS; as they are cared for in inpatient CAMHS; as they make the transition from inpatient CAMHS to the community; and as they make the transition from inpatient CAMHS to adult mental health services (2) To identify and describe any underlying theoretical explanations for approaches used in the identification assessment and management of risk (3) To understand the views and experiences of ‘risk’ of young people (11-18 years) with complex mental health needs using inpatient mental health services and of those involved in the identification assessment and management of risk in these settings (4) To synthesize the evidence for the identification assessment and management of risk in young people (aged 11-18) with complex mental health needs entering using and exiting inpatient services (5) To synthesize the evidence on the costs and cost effectiveness to the NHS of different approaches to identifying assessing and managing these risks (6) To identify the future priorities for commissioning service development and research for young people (aged 11-18) with complex mental health needs entering using and exiting tier 4 inpatient services.Mapping exercise: An initial scoping search will be conducted using the databases Medline and PsycINFO. At this stage no attempts will be made to define the meaning/s of the word ‘risk’ in order to support as comprehensive a scoping as possible. A broad descriptive map will be produced of the different ways in which ‘risk’ has been conceptualised investigated and otherwise written about in the international literature and what is currently known in the risk identification assessment and management field in the inpatient CAMHS area. In depth review: Working with stakeholder representatives key areas to take forward for the second phase of the review will be determined. A particular concern at this juncture will be to listen to the priorities for in-depth review identified by members of the project advisory group. Having agreed the focus for this second phase of the project initial electronic searches and the broad descriptive mapping will be supplemented by other methods. A second extensive search will be undertaken using all keywords and index terms identified as relevant (including for the economic analysis component – see below). Materials published in the English language since the introduction of the tiered system in CAMHS in 1995 will first be sought through searches of bibliographic databases. Sources will also be searched for relevant unpublished (‘grey’) material and calls for evidence will be made through relevant online lists and through professional networks. Titles and abstracts will be read by 2 members of the research team and considered against the topic inclusion criteria developed in consultation with the advisory group. Studies identified from reference list searches will be assessed for relevance based on publication titles. Reports of service developments case studies and non-research materials found in the grey literature will also be read by 2 members of the project team and considered against the topic inclusion criteria. Each research report that passes the initial topic inclusion screening will be read and assessed independently for quality (using agreed appraisal checklists) by 2 team members. Studies will be assessed for methodological quality and data will be extracted using the design-appropriate checklists available from the Critical Appraisal Skills Programme (CASP) (www.casp-uk.net). Resolution of discrepancies in the independent assessments of quality will be resolved where possible through pair discussion. Research reports identified through searches of the grey literature will be assessed in the same way as those identified through database searching. Other types of (non-research) knowledge identified through the in-depth search will be appraised using the generic checklist developed by Wallace and Wray (2006).Economic analysis: The way the economic analysis develops will be met will largely depend on the amount and type of evidence retrieved. Where evidence of effectiveness is accompanied by robust costing and/or cost effectiveness analyses the Drummond checklist (Drummond and Jefferson 1996) will be used to assess the quality of the economic evidence. If little or no such economic evidence is found an attempt will be made to estimate the cost of the most effective alternative approaches using resource data from the published/grey sources together with the most appropriate unit costs. Costs will be differentiated according to objectives 1 to 4 above and for each a further analysis will be carried out to identify key cost drivers and how they vary across the NHS and the private sector. Relevant cost and economic terms will be added to the search strategy to identify documents which include an economic component. In terms of identifying grey literature the economist team will contact key research centres such as the PSSRU at the University of Kent and will contact key informants in the economics of mental health.Syntheses of evidence: Materials reflecting each of the agreed project team/advisory group priorities will be brought together in a series of separate parallel narrative syntheses. These syntheses will be prepared by members of the project team working together in sub-groups and will be discussed and finally approved within the whole project team before being presented for further discussion and recommended refinement with the project advisory group. In a final


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES;7.3 MANAGEMENT AND DECISION MAKING
Health categories: MENTAL HEALTH