Parent/Carer-Reported Experience of Shared Decision Making at Child and Adolescent Mental Health Services: A Multilevel Modelling Approach


Abstract: Shared decision making (SDM) has been associated with positive outcomes at child and adolescent mental health services (CAMHS). However, implementing SDM is sometimes challenging. Understanding the factors associated with parent/carer experience of SDM could provide empirical evidence to support targeted efforts to promote SDM. This study aimed to explore the frequency of parent/carer-reported experience of SDM and examine possible associations between SDM and clinician's perceptions of the (a) children's and young people's psychosocial difficulties, (b) additional complex problems, and (c) impact of the psychosocial difficulties.

Liverpool, S., Hayes, D. & Edbrooke-Childs, J. (2021). Frontiers in Psychiatry, 2021;12. doi:10.3389/fpsyt.2021.676721

A School-Based Mobile App Intervention for Enhancing Emotion Regulation in Children: Exploratory Trial


Abstract: Most mental health disorders are first experienced in childhood. The rising rates of mental health difficulties in children highlight the need for innovative approaches to supporting children and preventing these difficulties. School-based digital interventions that address shared risk factors and symptoms, such as emotion dysregulation, present exciting opportunities to enhance mental health support for children on a larger scale. This study investigates the use of a new app-based intervention designed to support children’s emotion regulation in schools. The aim is to optimize the usability, acceptability, and utility of the app and explore its scope for implementation with the target user in the school context.

Moltrecht, B., Patalay, P., Deighton, J., & Edbrooke-Childs, J. (2021). JMIR Mhealth Uhealth 2021;9(7):e21837 doi: 10.2196/21837

Adolescents' Understanding of What Causes Emotional Distress: A Qualitative Exploration in a Non-clinical Sample Using Ideal-Type Analysis


Abstract: There is increased interest in early intervention and prevention of mental health difficulties during adolescence; thus, we are seeing increased efforts to optimize well-being during this epoch. Positive emotional experiences are a central component of overall well-being. However, research exploring what adolescents perceive to be the cause(s) of their emotional difficulties is lacking. Improving understanding of this issue within non-clinical adolescent groups may provide useful insight into how to develop strategies to support young people as they navigate emotional difficulties.

O’Neill, A., Stapley, E., Stock, S., Merrick, H. & Humphrey, N. (2021). Front. Public Health, 24 May 2021.

Understanding the illness representations of young people with anxiety and depression: A qualitative study


Abstract: Many young people with anxiety or depression drop out of treatment early, and/or leave treatment without showing measurably improved symptom levels. To enhance treatment engagement and effectiveness, it is critical to better understand how young people’s perceptions of the symptoms, causes, consequences, treatability, and course of their anxiety and depression influence engagement. This study aimed to provide a qualitative account of illness perceptions among youth with anxiety and depression by applying the Common Sense Model of Self-Regulation (CSM), which was developed in physical health contexts.

Bear, H.A., Krause, K.R., Edbrooke‐Childs, J. & Wolpert, M. (2021). Psychol Psychother Theory Res Pract. doi: 10.1111/papt.12345

Young People Who Meaningfully Improve Are More Likely to Mutually Agree to End Treatment 


Abstract: Symptom improvement is often examined as an indicator of a good outcome of accessing mental health services. However, there is little evidence of whether symptom improvement is associated with other indicators of a good outcome, such as a mutual agreement to end treatment. The aim of this study was to examine whether young people accessing mental health services who meaningfully improved were more likely to mutually agree to end treatment. Methods: Multilevel multinomial regression analysis controlling for age, gender, ethnicity, and referral source was conducted on N = 8,995 episodes of care [Female = 5,469, 61%; meanAge = 13.66 (SD = 2.87) years] using anonymised administrative data from young people's mental health services. Results: Compared to young people with no change in mental health difficulties, those showing positive meaningful changes in mental health difficulties were less likely to have case closure due to non-mutual agreement (Odds Ratio or OR = 0.58, 95% Confidence Interval or CI = 0.50–0.61). Similarly, they were less likely to transfer (OR = 0.61, 95% CI = 0.49–0.74) or end treatment for other reasons (OR = 0.59, 95% CI = 0.50–0.70) than by case closure due to mutual agreement. Conclusion: The findings suggest that young people accessing mental health services whose symptoms meaningfully improve are more likely to mutually agree to end treatment, adding to the evidence that symptom improvement may be appropriate to examine as an indicator of a good outcome of accessing mental health services.

Edbrooke-Childs, J., Costa da Silva, L., Čuš, A., Liverpool, S., Pinheiro Mota, C., Pietrabissa, G., Bardsley, T., Sales, C.M.D., Ulberg, R., Jacob, J. & Ferreira, N. (2021) Front. Psychol. 12:641770. doi: 10.3389/fpsyg.2021.641770

How to manage endings in unsuccessful therapy: A qualitative comparison of youth and clinician perspectives

Abstract: Approximately half of those who access child and adolescent mental health services do not show measurable improvement in symptoms. This study aimed to provide practice recommendations for managing treatment endings, particularly when outcomes have not improved. Semi-structured interviews were carried out with 26 young people with a history of anxiety and/or depression along with 7 roundtable sessions with 52 mental health clinicians. Data were analyzed using Framework Analysis. 

Holly Alice Bear, Kate Dalzell, Julian Edbrooke-Childs, Lauren Garland & Miranda Wolpert (2021) Psychotherapy Research, DOI: 10.1080/10503307.2021.1921304

What metrics of harm are being captured in clinical trials involving talking treatments for young people? A systematic review of registered studies on the ISRCTN


Abstract: The recording of harm and adverse events in psychological trials is essential, yet the types of harm being captured in trials for talking treatments involving children and young people have not been systematically investigated. The aim of this review was to determine how often harm and adverse events are recorded in talking treatments for children and young people, as well as the metrics that are being collected. The ISRCTN was searched for trials involving talking therapies and young people. Of 355 entries, 69 met inclusion criteria. The authors of these records were contacted for further information, and additional searches were conducted of protocols and papers.

Hayes, D. & Za’ba, N. A systematic review of registered studies on the ISRCTN. Couns Psychother Res. 2021; 00: 1– 22. doi: 10.1002/capr.12407

Associations between child mental health, carer worry and help-seeking

Abstract: Carers may not always express child mental health concerns to health professionals. Therefore, identifying factors delaying help-seeking is important. The aim of this study was to examine the relationship between carer affect and help-seeking. In a secondary analysis of data collected from school-aged children (N = 1,857, mean age = 9.85 years, 51% female), we used logistic regression to examine the associations between carer worry, help-seeking and child mental health. Regarding worry, higher levels of emotional problems (OR = 1.42, 95% CI = 1.33–1.52), conduct problems (OR = 1.24, 95% CI = 1.12, 1.36), peer problems (OR = 1.17, 95% CI = 1.05–1.27) or functional impairment (OR = 1.37, 95% CI = 1.2–.56) were associated with higher levels of carer worry. Regarding help-seeking, higher levels of functional impairment were associated with higher levels of help-seeking (OR = 1.51, 95% CI = 1.09–2.11). After controlling for mental health problems, carers who reported being worried about their child’s mental health were less likely than other carers to seek help (OR = 0.13, 95% CI = 0.05–0.35). Knowledge of these factors may inform early interventions. Alongside implications for future research and practice, limitations of the study are discussed.

Liverpool, S. & Edbrooke-Childs, J. Journal of Child Health Care. April 2021. doi:10.1177/13674935211014750

A qualitative investigation of LGBTQ+ young people’s experiences and perceptions of self-managing their mental health


Abstract: There is evidence that young people generally self-manage their mental health using self-care strategies, coping methods and other self-management techniques, which may better meet their needs or be preferable to attending specialist mental health services. LGBTQ+ young people are more likely than their peers to experience a mental health difficulty and may be less likely to draw on specialist support due to fears of discrimination. However, little is known about LGBTQ+ young people’s experiences and perceptions of self-managing their mental health. Using a multimodal qualitative design, 20 LGBTQ+ young people participated in a telephone interview or an online focus group. A semi-structured schedule was employed to address the research questions, which focussed on LGBTQ+ young people’s experiences and perceptions of self-managing their mental health, what they perceived to stop or help them to self-manage and any perceived challenges to self-management specifically relating to being LGBTQ+ . Reflexive thematic analysis yielded three key themes: (1) self-management strategies and process, (2) barriers to self-management and (3) facilitators to self-management. Participants’ most frequently mentioned self-management strategy was ‘speaking to or meeting up with friends or a partner’. Both barriers and facilitators to self-management were identified which participants perceived to relate to LGBTQ+ identity. Social support, LGBTQ+ youth groups and community support were identified as key facilitators to participants’ self-management of their mental health, which merits further investigation in future research. These findings also have important implications for policy and intervention development concerning LGBTQ+ young people’s mental health.

Town, R., Hayes, D., Fonagy, P. & Stapley, E. (2021) Eur Child Adolesc Psychiatry. doi: 10.1007/s00787-021-01783-w

A narrative review of reviews of interconnecting risks (IR) of mental health problems for young people


Abstract: The aim of this narrative review is to examine the most prevalent multiple or interconnecting risks of mental health problems that have been identified in previous reviews of the literature and to examine those most prevalent for children and young people. Overall, ten databases were searched for published literature reviews, and from 1,556 unique hits, 91 reviews examining individual risks were included, with 35 reviews examining interconnecting risks. The findings suggest that interpersonal connection plays a central role in interconnecting risks, as indicated by the number of interconnections between social groups, interpersonal, parental relationships and family cohesion with other risk themes. Family and systemic approaches have clear value in supporting young people by enabling the development of a secure relational foundation on which to build future protective interpersonal connections.

Edbrooke-Childs, J., & Deighton, J. (2021). Journal of Family Therapy. doi:10.1111/1467-6427.12344

Perspectives of paediatric hospital staff on factors influencing the sustainability and spread of a safety quality improvement programme


Abstract: Situation Awareness For Everyone (SAFE) is a quality improvement programme aiming to improve situation awareness in paediatric clinical teams. The aim of our study was to examine hospital staff perceptions of the facilitators and barriers/challenges to the sustaining and subsequent spread of the huddle, the key intervention of the SAFE programme.

Lachman, P., Gondek, D., Edbrooke-Childs, J., Deighton, J., & Stapley, E. (2021). BMJ Open, 11(3), e042163. doi:10.1136/bmjopen-2020-042163

“Smartphone apps are cool, but do they help me?”: A qualitative interview study of adolescents’ perspectives on using smartphone interventions to manage nonsuicidal self-injury


Abstract: Nonsuicidal self-injury (NSSI) is a major mental health problem associated with negative psychosocial outcomes and it most often starts in early adolescence. Despite this, adolescents are rarely involved in informing the development of interventions designed to address their mental health problems. This study aimed to (1) assess adolescents’ needs and preferences about future interventions that are delivered through smartphones and (2) develop a framework with implications for designing engaging digital mental health interventions. Fifteen adolescent girls, aged 12–18 years, who met diagnostic criteria for a current NSSI disorder and were in contact with mental health services, participated in semi-structured interviews. Following a reflexive thematic analysis approach, this study identified two main themes: (1) Experiences of NSSI (depicts the needs of young people related to their everyday experiences of managing NSSI) and (2) App in Context (portrays preferences of young people about smartphone interventions and reflects adolescents’ views on how technology itself can improve or hinder engaging with these interventions). Adolescent patients expressed interest in using smartphone mental health interventions if they recognize them as helpful, relevant for their life situation and easy to use. The developed framework suggests that digital mental health interventions are embedded in three contexts (i.e., person using the intervention, mental health condition, and technology-related factors) which together need to inform the development of engaging digital resources. To achieve this, the cooperation among people with lived experience, mental health experts, and human computer interaction professionals is vital.

Čuš, A., Edbrooke-Childs, J., Ohmann, S., Plener, P. L., & Akkaya-Kalayci, T. (2021). International Journal of Environmental Research and Public Health, 18(6), 1-15. doi:10.3390/ijerph18063289

A systematic review of shared decision making interventions in child and youth mental health: synthesising the use of theory, intervention functions, and behaviour change techniques


Abstract: Reviews around interventions to improve shared decision making (SDM) for child and youth mental health have produced inconclusive findings on what approaches increase participation. Importantly, the previous reviews did not explore the use of theory, as well as mechanisms of change (intervention functions) and active units of change (behaviour change techniques). The aim of this review was to explore these factors and ascertain how, if at all, these contribute to SDM. Five databases were searched up until April 2020. Studies met inclusion criteria if they were: (a) an intervention to facilitate SDM; (b) aimed at children, adolescence, or young people aged up to 25, with a mental health difficulty, or their parents/guardians; and (c) included a control group. Data were extracted on patient characteristics, study design, intervention, theoretical background, intervention functions, behaviour change techniques, and SDM. Quality assessment of the studies was undertaken using the Effective Public Health Practice Project (EPHPP) quality assessment tool. Eight different interventions met inclusion criteria. The role of theory to increase SDM remains unclear. Specific intervention functions, such as ‘education’ on SDM and treatment options and ‘environmental restructuring’ using decision aids, are being used in SDM interventions, as well as ‘training’ for clinicians. Similarly, behaviour change techniques linked to these, such as ‘adding objects to the environment’, ‘discussing pros/cons’, and clinicians engaging in ‘behavioural practice/rehearsal’. However, as most studies scored low on the quality assessment criteria, as well as a small number of studies included and a low number of behaviour change techniques utilised, links between behaviour change techniques, intervention functions and increased participation remain tentative. Intervention developers and clinicians may wish to consider specific intervention functions and behaviour change techniques to facilitate SDM.

Hayes, D., Edbrooke-Childs, J., Town, R., Wolpert, M. & Midgley, N. (2021) Eur Child Adolesc Psychiatry. doi: 10.1007/s00787-021-01782-x

Are We Comparing Apples with Oranges? Assessing Improvement Across Symptoms, Functioning, and Goal Progress for Adolescent Anxiety and Depression


Abstract: Strategies for comparing routinely collected outcome data across services or systems include focusing on a common indicator (e.g., symptom change) or aggregating results from different measures or outcomes into a comparable core metric. The implications of either approach for judging treatment success are not fully understood. This study drew on naturalistic outcome data from 1641 adolescents with moderate or severe anxiety and/or depression symptoms who received routine specialist care across 60 mental health services in England. The study compared rates of meaningful improvement between the domains of internalizing symptoms, functioning, and progress towards self-defined goals. Consistent cross-domain improvement was observed in only 15.6% of cases. Close to one in four (24.0%) young people with reliably improved symptoms reported no reliable improvement in functioning. Inversely, one in three (34.8%) young people reported meaningful goal progress but no reliable symptom improvement. Monitoring systems that focus exclusively on symptom change risk over- or under-estimating actual impact, while aggregating different outcomes into a single metric can mask informative differences in the number and type of outcomes showing improvement. A move towards harmonized outcome measurement approaches across multiple domains is needed to ensure fair and meaningful comparisons.

Krause, K. R., Edbrooke-Childs, J., Singleton, R. & Wolpert, M. (2021) Child Psychiatry Hum Dev. doi: 10.1007/s10578-021-01149-y

Association between single session service attendance and clinical characteristics in administrative data

Abstract: A large proportion of young people accessing specialist mental health services do so for a single session. The aim of the present study was to examine the characteristics of young people attending specialist mental health services for a single session and to examine associations between single session attendance and clinical characteristics. Secondary analysis of administrative data on N = 23,300 young people (mean age = 12.73 years, 57% female, 64% White British) was conducted. The mean number of sessions attended was 4.33 and 46% (10,669) attended for a single session. Multilevel logistic regression analysis showed that younger children, Black young people (OR = 1.20, 95% CI = 1.01–1.43) or those whose ethnicity was not stated (OR = 1.25, 95% CI = 1.15–1.35), young people with peer relationship difficulties (OR = 1.11, 95% CI = 1.04–1.19) or low frequency problems (OR = 1.06, 95% CI = 0.99–1.14), and those with more complexity factors (OR = 1.07, 95% CI = 1.04–1.10) were more likely to attend services for a single session. The present study sets out research questions to prompt future research: (1) the experience of attending services for a single session, (2) identifying groups of single session attenders who do not require further support compared to those who are not able to sustain engagement with more sessions, and (3) whether new care pathways are needed for these groups who currently access specialist mental health services for a single session.

Edbrooke-Childs, J., Hayes, D., Lane, R., Liverpool, S., Jacob, J. & Deighton, J. (2021) Clinical Child Psychology and Psychiatry. March 2021. doi:10.1177/13591045211002609

Self-management, self-care, and self-help in adolescents with emotional problems: a scoping review protocol


Abstract: The objective of this scoping review is to draw on existing literature to illuminate the ways in which the concepts of self-management, self-care, and self-help are defined in the context of adolescents with emotional problems. The aim is to describe and categorize the definitions of these concepts as well as the strategies or techniques that have been proposed to facilitate self-management, self-care, and self-help for this group, as this may have important implications for policy and intervention development.

Town, R., Hayes, D., Fonagy, P. & Stapley, S. (2021). JBI Evidence Synthesis: February 26, 2021 - Volume Online First - Issue - doi: 10.11124/JBIES-20-00224

Feasibility and acceptability of a digital intervention to support shared decision-making in children’s and young people’s mental health: mixed methods pilot randomized controlled trial


Abstract: Interventions to involve parents in decisions regarding children’s and young people’s mental health are associated with positive outcomes. However, appropriately planning effectiveness studies is critical to ensure that meaningful evidence is collected. It is important to conduct pilot studies to evaluate the feasibility and acceptability of the intervention itself and the feasibility of the protocol to test effectiveness. This paper reports the findings from a feasibility and acceptability study of Power Up for Parents, an intervention to promote shared decision-making (SDM) and support parents and caregivers making decisions regarding children’s and young people’s mental health.

Liverpool, S., & Edbrooke-Childs, J. (2021) JMIR Form Res, 5(3):e25235. doi: 10.2196/25235

An affective-appraisal approach for parental shared decision making in children and young people's mental health settings: a qualitative study


Abstract: The majority of existing shared decision making (SDM) models are yet to explicitly account for emotion as an influencing factor to the SDM process. This study aimed to explore the role of parents' and carers' emotional experiences as a concept that has implications for SDM in children and young people's mental health (CYPMH) settings. A social constructivist grounded theory approach, analyzing data from focus groups (n = 4) and semi-structured interviews (n = 33) with parents and healthcare professionals, was undertaken. Participants were identified and selected at CYPMH sites and through social media platforms or in-person advertising as part of a larger feasibility trial. Interviews and focus groups were audio-recorded and transcribed verbatim. Thematic analysis moved from open to focused coding.

Liverpool, S., Hayes, D. & Edbrooke-Childs, J. (2021). Frontiers in Psychiatry, 12. doi: 10.3389/fpsyt.2021.626848

Behavior change techniques in mobile apps targeting self-harm in young people: a systematic review

Abstract: Despite the high prevalence of self-harm among young people, as well as their extensive use of mobile apps for seeking support with their mental healthcare, it is unclear whether the design of mobile apps aimed at targeting self-harm is underpinned by behavior change techniques (BCTs). To systematically analyze and identify (a) what BCTs and (b) what theories are present in self-harm apps for young people in an attempt to understand their active components. Systematic searches in Apple store, followed by thorough screening, were conducted to identify free mobile apps targeting self-harm in young people. Five apps met the inclusion criteria and were used by trained researchers, who coded identified features against the BCT Taxonomy V1. Despite the majority of apps being underpinned by principles of Dialectical Behavior Therapy (DBT), no other information is available about specific theories underpinning these apps. Nineteen of the 93 BCTs were identified across the five apps. The most frequently used BCT was “Distraction” (54.2%), offering ideas for activities to distract users from self-harming. Other techniques that were used often were “Social Support (unspecified)” (27.0%) and “Behavior Substitution” (10.6%). This study provides the first analysis of BCTs present in mental health apps which are designed to target the reduction of self-harm in young people. Future research is needed to evaluate the effectiveness of the apps, as well as assess the effectiveness of the BCTs present.

Panagiotopoulou, E., Peiris, C. & Hayes, D. (2021) Translational Behavioral Medicine, ibaa131. doi:10.1093/tbm/ibaa131

Measuring Health Outcomes in HIV: Time to Bring in the Patient Experience


Abstract: Over the past decade, the global response to HIV has led to a reduction in the number of new infections, and a decrease in associated mortality. Yet, the number of people living with HIV (PLHIV) is high, with an estimated 38 million infected worldwide. As HIV shifts from being an acute terminal illness to a chronic condition, evaluating programmatic responses to HIV with sole reliance on biological markers (such as viral load or CD4 cell count) as proxies for patient health may no longer be suitable. HIV affects the lives of those infected in myriad ways which should be reflected in programme evaluations by measuring health-related quality of life, in addition to biomarkers.

O'Brien, N., Chi, Y. & Krause, K. R. (2021). Annals of Global Health, 87(1), p.2. doi: 10.5334/aogh.2958

Counseling for young people and families affected by child sexual exploitation and abuse: a qualitative investigation of the perspective of young people, parents, and professionals

Abstract: Despite growing awareness of the negative impact of child sexual exploitation on young people’s psychological, emotional and relational lives, little is known about how counseling can support young people and their families. The aim of this study was to explore the experience of counseling for young people and parents affected by child sexual exploitation and abuse, with a view to examining what facilitates progress, from the perspective of young people, parents and professionals. In-depth semi-structured interviews were conducted with 10 young people, 8 parents and 7 professionals and were analyzed using thematic analysis. Findings suggest that through counseling, young people experienced affective and relational improvements that were attributed to the process. Characteristics of the counseling relationship that facilitated progress included being able to talk openly in a caring, non-judgmental and unpressurized environment, as well as receiving advice, techniques or solutions within a holistic approach. Facets of service delivery were also highlighted, including the provision of confidentiality, flexibility and consistency, along with a multi-agency approach that promoted engagement. Perceived obstacles to progress included resistance at the outset and service location issues.

Farr, J., Edbrooke-Childs, J., Town, R., Pietkiewicz, D., Young, I. & Stapley, E. (2021) Journal of Child Sexual Abuse. doi: 10.1080/10538712.2020.1848959

International consensus on a standard set of outcome measures for child and youth anxiety, depression, obsessive-compulsive disorder, and post-traumatic stress disorder

Abstract: A major barrier to improving care effectiveness for mental health is a lack of consensus on outcomes measurement. The International Consortium for Health Outcomes Measurement (ICHOM) has already developed a consensus-based standard set of outcomes for anxiety and depression in adults (including the Patient Health Questionnaire-9, the Generalised Anxiety Disorder 7-item Scale, and the WHO Disability Schedule). This Position Paper reports on recommendations specifically for anxiety, depression, obsessive-compulsive disorder, and post-traumatic stress disorder in children and young people aged between 6 and 24 years. An international ICHOM working group of 27 clinical, research, and lived experience experts formed a consensus through teleconferences, an exercise using an adapted Delphi technique (a method for reaching group consensus), and iterative anonymous voting, supported by sequential research inputs. A systematic scoping review identified 70 possible outcomes and 107 relevant measurement instruments. Measures were appraised for their feasibility in routine practice (ie, brevity, free availability, validation in children and young people, and language translation) and psychometric performance (ie, validity, reliability, and sensitivity to change). The final standard set recommends tracking symptoms, suicidal thoughts and behaviour, and functioning as a minimum through seven primarily patient-reported outcome measures: the Revised Children's Anxiety and Depression Scale, the Obsessive Compulsive Inventory for Children, the Children's Revised Impact of Events Scale, the Columbia Suicide Severity Rating Scale, the KIDSCREEN-10, the Children's Global Assessment Scale, and the Child Anxiety Life Interference Scale. The set's recommendations were validated through a feedback survey involving 487 participants across 45 countries. The set should be used alongside the anxiety and depression standard set for adults with clinicians selecting age-appropriate measures.

Krause, K. R., Chung, S., Adewuya, A. O.,… Wolpert, M. (2021). The Lancet Psychiatry, 8(1), 76–86. doi: 10.1016/S2215-0366(20)30356-4

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