Vital information is lacking about mental health provision for children and young people with social work involvement (CYPwSW).
Background
We do not know which young people are accepted and rejected when referred to Child and Adolescent Mental Health Services (CAMHS). We also do not know what treatments by CAMHS lead to positive change in these young people, or how much these treatments cost.
This application was co-designed with experts by experience of both CAMHS and social work services. Coming together, we designed a study with six parts. We draw on anonymised health, education and social care records for young people in South London & Maudsley and Cambridgeshire and Peterborough NHS Trusts. The South London dataset also contains anonymised case records including referral documents, assessments, correspondence and progress notes.
We will:
- Examine the socioeconomic and demographic context, clinical needs, and long-term outcomes for CYPwSW whose referral is accepted or rejected by CAMHS in South London
- Distinguish forms of CAMHS treatment, and analyse which forms lead to positive outcomes for CYPwSW and other young people in South London. We will also examine how factors such as poverty and ethnicity impact effectiveness.
- Repeat the analysis in Cambridgeshire and Peterborough, to check and extend our findings.
- Analyse how much the treatments cost and quantify for commissioners and policymakers the positive outcomes achieved through these costs.
- Use close study of clinical notes and interviews to qualify and deepen our understanding.
Project Aims
Aims and objectives
The research questions for our quantitative studies are:
- What are the socioeconomic and demographic factors, clinical needs, and long-term outcomes of CYPwSW whose referral is accepted or rejected by CAMHS? (WP1, WP3)
- What CAMHS interventions predict better outcomes for which CYP? (WP2, WP3)
- What demographic factors and service factors at intake predict better outcomes for which CYP? (WP2, WP3)
- What are the cost effectiveness and cost consequences of these forms of intervention? (WP4)
The objectives for our quantitative studies are to:
1.Characterise the socioeconomic and demographic factors, clinical needs, and long-term educational outcomes and use of emergency care services for
- CYPwSW referred to CAMHs and accepted
- CYPwSW accepted on re-referral after 6 months.
- CYPwSW referred but never accepted by CAMHs (WP1, WP3)
2. Develop a taxonomy of forms of CAMHS interventions (WP2)
3. Identify which forms of CAMHS intervention predict positive outcomes for CYP, and where this differs for CYPwSW (WP2, WP3)
4. Investigate covariates and moderators of treatment effectiveness (WP2, WP3)
5. Analyse the cost-effectiveness and cost-consequences of different forms of intervention (WP4)
Our co-produced qualitative studies (WP5) have two exploratory research questions:
- How are CYPwSW and their social care needs characterised in CAMHS case notes?
- What is the experience of CAMHS among CYPwSW?
This exploratory work will:
- Examine the characterisation of CYPwSW and their care needs in CAMHS case notes
- Interview CYPwSW to understand their experiences of CAMHS
Project Activity
There are five interrelated work packages (WP):
WP1: Examining accepted and rejected referrals - CRIS SLaM
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.
WP2: Assessing interventions - CRIS SLaM
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
WP3: Replication of WP1 and WP2 – CRIS CPFT
We will use data from CPFT to conduct a replication of WP1 and WP2.
WP4: Economic analysis
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.
WP5: Coproduced qualitative studies
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.
Who is involved?
- Dr Robbie Duschinsky1 –Head of the Applied Social Science Group. Corresponding researcher.
- Professor Tamsin Ford1 – Professor of Child and Adolescent Psychiatry
- Professor Rick Hood2 – Professor of Social Work
- Dr. Barry Coughlan1 – Postdoctoral Fellow in the Applied Social Science Group
- Taliah Drayak1 – Expert from experience
- Jack Smith1 – Expert from experience
- Francesca Crozier-Roche1 – Expert from experience
- David Graham3– Director of The Care Leaver’s Association
- Dustin Hutchinson5 – Policy and Public Affairs Manager for The National Children’s Bureau
- Dr. Ayla Humphrey6 – Lead for Children and Young People’s Psychology
- Dr. Matt Woolgar7 –Clinical Psychologist, Lead for National Conduct Problems Clinic
- Dr. Daisy Kornblum7 – Applied Clinical Informatics Lead
- Dr Rudolf Cardinal1 – Associate Professor in Clinical Informatics
- Luke Geoghegan8 – Head of Policy and Research
1. University of Cambridge
2. Kingston University London
3. Care Leaver’s Assocation
4. University College London
5. National Children’s Bureau
6. CPFT NHS Trust
7. SLAM NHS Trust
8. British Association of Social Work
