In this study, we will co-produce a digital self-service version of Brief Psychosocial Intervention (BPI) with young people, parents and health professionals. We want to find out if digital BPI offers rapid relief from suffering for young people with depression and mood related problems on the Children and Young People's Mental Health Services (CYPMHS) waiting list.
Background
Children and Young People’s Mental Health Services (CYPMHS) provide treatment for young people with poor mental health. CYPMHS are receiving more referrals, leading to very long waiting times. The increasing waiting lists for CYPMHS are a major barrier for young people trying to access mental health care. Young people on the waiting list will include some who self-harm, feel suicidal, and struggle with several types of difficulties. Whilst some receive a first assessment in 9 weeks, many others will wait over 20 weeks for their first assessment, often followed by a further 20 weeks wait for treatment. There are also big differences in the length of wait between clinics. Interestingly, 1 in 3 young people are seen only once or twice in CYPMHS despite waiting for so long. Access to support earlier might reduce their distress and free up CYPMHS capacity for those who need more treatment.
Brief Psychosocial Intervention (BPI) is an evidence-based face-to-face intervention which is recommended for the treatment of adolescent depression by NICE (National Institute for Health and Care Excellence). It is the first psychotherapy developed specifically for young people with input from young people and parents. Others are all based on treatments that were first designed for adults. Previous research has shown that face-to-face BPI works well and is value for money.
In this study, we will co-produce a digital self-service version of BPI with young people, parents and health professionals. We want to find out if digital BPI offers rapid relief from suffering for young people with depression and mood related problems on the CYPMHS waiting list. This may mean some need less or even no further treatment.
Project Aims
We aim to test the feasibility, acceptability, and potential utility of digital BPI, as well as to explore its potential to reduce suffering among adolescents on the specialist CYPMHS waitlists. If digital BPI can offer rapid relief with depression, anxiety, and mood related presentations some patients may not need further face-to-face treatment.
Our specific objectives are to:
i) understand the experience of young people, parents /carers and clinicians in managing waitlists and how digital BPI could be safely offered to those waiting
ii) Codesign digital BPI as an intervention, as well as establish the safety and standardised operational procedures to support its evaluation in NHS CYPMHS
iii) determine if digital BPI warrants a fully powered RCT to robustly establish clinical and cost effectiveness.
Project Activity
We have invited young people and a parents/carers to join two advisory groups to support the researchers in this work. The advisory panels will help to design and deliver the study, including co-developing study materials, reviewing results, and working with the research team to communicate our findings in an engaging way.
We have four work packages (WP):
• WP1 will explore young people and parents/carers’ experiences of waitlists and evolve the clinical governance for digital BPI through interviews with NHS managers and clinicians working with young people who are waiting for treatment;
• WP2 will codesign a low intensity digital BPI treatment basing the content and process on the existing evidence for face-to-face BPI, iteratively incorporating feedback from young people, parents, clinicians, working with software engineers:
• WP3 will evaluate the digital BPI prototype for clinical usability, feasibility, safety and managerial acceptability with between 5 young people each in two NHS clinics;
• WP4 will undertake a pilot trial of digital BPI versus waiting as usual in 10 NHS CYPMHS within two NHS Foundation Trusts to test recruitment, retention, and research processes. The trial will recruit 80 young people, aged between 12 and17 years (40 in each arm) randomised to digital BPI or waiting as usual.
Anticipated or actual outputs
Outputs and anticipated impact will include:
• A novel digital BPI platform that could support treatment for young people on waitlists.
• Standardised operating procedures for the safe delivery of digital BPI within specialist CYPMHS that could provide a template for other studies.
• Knowledge about waitlist trajectories and reasons for leaving or staying on the waitlist and the impact of being on a waitlist on young people and their families that could inform service provision, commissioning, and policy; we will support this by producing policy briefings for commissioners and service providers, supplemented by blogs and podcasts for young people and families.
• Protocol of a definitive RCT to support application for subsequent study.
• Enhanced knowledge of recruitment and retention to improve the efficiency of mental health intervention trials in clinical populations of young people.
• Each WP will lead to at least one conference presentation, such as the British Association of Behaviour Cognitive Therapists and the European Society for Child and Adolescent Psychiatry.
• At least two academic papers for peer reviewed publication; the first from WPs 1,2 and 3 on the coproduction of digital BPI will be submitted to Journal of Medical Internet Research; Formative Research and the second from WP4 will be submitted to Lancet Psychiatry. A further paper about strategies to maximise recruitment and retention and the impact (if any) of data collection intensity will be written if data permit.
Papers/resources associated with this project
Goodyer, I. and Kelvin, R. (2023) Brief Psychosocial Intervention for Adolescents: Keep it Simple; Do it Well. Cambridge: Cambridge University Press.
Who is involved?
The WAIT LESS study is being coordinated by Tamsin Ford (University of Cambridge) as Chief Investigator.
Contact
Anne-Marie Burn (amb278@medschl.cam.ac.uk)
Rasanat Fatima Nawaz (rfn22@cam.ac.uk)
