Title: How can health services effectively improve the mental health and wellbeing of young people leaving public care? The LYNC Study
Funder: Department of Health (England)

Abstract: The PDG work will consist of 4 stages: Stage 1: What makes an excellent transition support service that promotes the mental health and wellbeing of young people leaving public care ? In stage 1 we will conduct a mapping exercise on the current public care system in Birmingham and identify key stakeholders who will be critical for the success of data collection and project completion. We will collaborate with the group of care leavers recruited as young researchers on this project for this aspect of the project. We will use Birmingham as a pilot site for this PDG as this is the local authority for our group of care leavers and it is the largest local authority in the country and therefore should model the degree of complexity we will find in other local authorities. The research team has a range of professional roles in the city including designated doctor for looked after children, head of the adult mental health service for care leavers and access to the Children in Care Council. In addition, the Chair of the Corporate Parenting Board, the Head of Children's Services and the Head of Adult Services in the Local Authority support this application meaning that we can move quickly to test our programme. We will develop a strategy to enlist stakeholder buy-in, e.g. Designated Health Professionals, Child and Adolescent Mental Health Services, Primary Care Health Services, Adult Mental Health Services and Social Care provision. We will contact the established networks of designated staff for looked after children through the Royal College of Nursing, the Royal College of Paediatrics and Child Health, the Royal College of Psychiatry and the British Agencies for Adoption and Fostering’s Health Group. Stage 2: What transition support services are currently provided across England? To allow a full description of TSS's we will follow LAYP through a transition process. In the PDG we will estimate the participant pool, develop and test a case finding technique so that we can demonstrate that looked after young people can be identified and tracked in the project. Both of these can form a part of the site specification, i.e. transferability of procedures required / identified in Birmingham to other regions. We developed criteria to describe optimal transition in our previous study [17] including tools to identify: Information continuity – evidence that a referral letter, summary of CAMHS care, or CAMHS case notes were transferred to AMHS along with a contemporaneous risk assessment. Relational continuity – a period of joint working between CAMHS and AMHS during transfer. Cross-boundary and team continuity – at least one meeting involving the service user and / or carer and a key professional from both CAMHS and AMHS prior to transfer of care. Long term continuity – the young person either engaged with AMHS 3 months after transition or appropriately discharged by AMHS following transition. In the PDG we will test these methodological tools in this context and revise and adapt the tools as necessary. We have already discussed recruitment and retention strategies with care leavers; we know that contact by a range of means including text, e-mail, social networking such as Facebook and Twitter may be effective. Retention will be encouraged with incentives, though cash or vouchers above £15 may have an impact on benefits and may be a disincentive. Phone credit may be a suitable incentive. Stage 3: How can Transition support services be improved? Feasibility study: In Birmingham we have support from the Children in Care Council, the Chair and members of the Corporate Parenting Board, the Service Director for Children’s Social Care, the Service Director for Adult Social Care and the Manager of the CAMHS LAC team and BSMHFT, the adult mental health NHS trust, to run a feasibility study on transitions for looked after young people with mental health problems In the PDG we will pilot and test the criteria describing optimal transition in Birmingham and adapt them if necessary. In addition we will pilot the seven diagnostic criteria used to describe the mental health problems [17]. We will also pilot topic guides developed for use with service users in the TRACK study and adapt them accordingly. We will also test whether follow up at 6 monthly intervals is feasible or whether we should track using case notes with one face to face follow up interview. We plan in the PDG to continue to develop care leavers as young researchers. Training and support is necessary for young people, who may have limited knowledge of research. Training will be offered by one of the co-applicants (ZI) who teaches on a Research Methods course at the University of Birmingham. The course has been designed for current/ex mental health services users. We will address aspects of research including - what is my role, what is research, what is mental health, what are the obstacles to mental health and wellbeing for LAYP and continue to seek their ideas on overcoming these obstacles. Care leavers will be involved in all stages of the research, including synthesis and interpretation of study findings and dissemination. The feasibility / development phase will involve parallel data collection to gather user perspective on the project. Users will be involved closely in this process, and will participate in data capture, analysis and interpretation. We will explore the potential use of a conversation café approach (CCA, conversationcafe.org) in comparison to others methods of accessing user perspectives. Stage 4. Development of the Programme Team The current research group includes child and adult psychiatrists (clinical academics), a designated doctor for looked after children, a psychologist (internationally renowned for early interventions in mental health), a public health scientist, a social scientist and the adult mental health service lead for care leavers. In addition expertise in statistics and health economics has been identified in the Warwick Clincal Trials Unit. This team needs to be extended by developing the participation of looked after young people. This will aid the development of standardised, valid and reliable measures and robust tools to evaluate quality of life measures for use with looked after young people. In addition, this will allow us to explore how quantitative and qualitative methods can be combined in research to reflect the differential impact of the context, process, content and experience of those involved as well as the impact (cost and health effects) of the intervention to be developed [17] . The research team will be developed by: Meetings every 2 months with progress updates and action plans Sharing knowledge and expertise within the group Communication with members of a collaborative network Development of the Full Programme Grant This funding will allow us to develop a high quality proposal for a full Programme Grant in an under researched but key priority area within the NHS and Social Care.


Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MENTAL HEALTH;DISPUTED AETIOLOGY AND OTHER