IntroductionChildren and young people (CYP) with long-term physical health conditions (LTCs) are at increased risk of emotional and behavioural difficulties, yet barriers to psychological support remain, particularly for families from ethnic minority backgrounds. Mental health drop-in services were set up and evaluated at 6 paediatric healthcare settings, aiming to provide a more accessible route to care.MethodsThis study conducted a secondary analysis of quantitative and qualitative data collected as part of the multi-site roll-out of mental health drop-in services in paediatric healthcare settings to explore their accessibility and acceptability. The services provided short-term psychological interventions delivered by child wellbeing practitioners or equivalent, under supervision of a clinical psychologist 120 families provided quantitative data, and 104 families shared qualitative feedback. Differences in access routes and mental health symptoms were compared across White British families and those from different ethnicities. Inductive, latent content analysis of the open text feedback was conducted to understand families' experiences of the drop-in services.ResultsCYP from ethnic minority backgrounds were over-represented in the present study (32%), when compared with nationwide CAMHs users that identify as non-white British (21%). Families from ethnic minority backgrounds reported comparable mental health outcomes and satisfaction levels to White British families. There was a significant difference in mental health change scores, with ethnic minority families showing greater improvements after accessing the service, t (46) = -3.05, p < .01, d = -1.08. Qualitative analysis found that the services were highly acceptable across ethnicities, highlighting themes of life-changing support, therapeutic relationships, and improved parent and family wellbeing.DiscussionDrop-in services embedded in paediatric healthcare settings are both accessible and acceptable, demonstrating positive clinical outcomes, and positive family feedback across different ethnic groups. This model may help reduce inequalities by improving access to psychological support for ethnic minority families with CYP living with LTCs.

Introduction:Breathlessness is a global, transdiagnostic problem, contributing to disability, reduced quality of life and higher healthcare costs. As the global population ages and multimorbidity increases, the prevalence of breathlessness is expected to rise. Therefore, there is an urgent need to co-design new services and treatments for breathlessness. To achieve this, it is essential to understand the lived experience of breathlessness. This study aimed to explore the lived experience of chronic breathlessness, focusing on its impact and contributing factors that exacerbate breathlessness. Methods:Semi-structured telephone interviews were conducted with adults experiencing chronic breathlessness caused by advanced malignant and nonmalignant diseases (July to November 2020). The interviews were analysed using conventional content analysis. Results:25 patients with advanced respiratory disease and chronic breathlessness ((COPD, 13; lung cancer, 8; interstitial lung disease, 3; and bronchiectasis, 1), 17 male, median age 70 years (range 47-86), Medical Research Council dyspnoea score 3 (2 -5)) were interviewed. Four key themes were identified: 1) the impact of breathlessness on daily activities, leading to increased dependence on others; 2) the effect of breathlessness on social interactions and personal relationships, resulting in isolation; 3) the impact of living with multiple long-term conditions and environmental factors that worsen breathlessness; and 4) cognitive, affective and behavioural responses to breathlessness. Conclusion:Breathlessness significantly disrupts daily life, limiting independence and social engagement, with psychological and behavioural responses further restricting activity. An integrated, public health approach, collaborating with housing and environmental agencies is essential to address modifiable factors and reduce the burden on individuals and healthcare systems.

Despite the high prevalence of mental health disorders in children and young people with long-term health conditions, access to timely and effective treatment is often difficult. This study aimed to evaluate the clinical effectiveness of drop-in mental health services for young people with long-term health conditions and their families at six paediatric healthcare settings in England. This was a prospective non-randomised single-arm multi-centre interventional study. Young people up to 25 years old with a long-term health condition, and their families were eligible. The primary outcome was the change in the total difficulties score on the Strengths and Difficulties Questionnaire between baseline and 6 months. Interventions provided were standard evidence-based low intensity cognitive-behaviour therapy, onward referral or signposting. Secondary outcomes included quality of life, depression, anxiety, satisfaction with services and cost. Accessing the drop-in services led to significant reductions in emotional and behavioural symptoms (p < 0.01; Cohen’s d = 0.39) and improved quality of life (p < 0.01; Cohen’s d = 0.44). Parental depression and anxiety significantly improved (p < 0.01; Cohen’s d = 0.30 and d = 0.34). The average waiting time for an initial assessment was 13.42 days. High levels of satisfaction were reported. The cost per patient was approximately half the estimated cost of a typical course of psychological therapy. Drop-in mental health services are effective and acceptable and can be delivered at low cost per patient for young people with long term conditions. This model of care is a feasible approach for increasing access to evidence-based mental health treatment in paediatric healthcare settings. ISRCTN15063954, Registered on 9 December 2022.

Doctoral (PhD) students experience high rates of mental health challenges, including high rates of anxiety, depression, loneliness, and isolation. While universities offer mental health services, these may not fully address the specific needs of doctoral students. Peer support has emerged as a promising adjunct to existing service provision, drawing on shared experiences to provide emotional and practical guidance. This study aimed to explore doctoral students' perceptions of peer support, identifying their needs and preferences for a peer support programme tailored to the doctoral experience. Nineteen doctoral students were recruited from a university in the south of England and participated in focus groups or semi-structured interviews. Thematic analysis yielded four overarching themes: (1) Barriers to seeking support; (2) Value of peer support for doctoral students; (3) Tailored peer support needs; and (4) Diversity and accessibility. Findings indicate that doctoral students value peer support as a flexible, informal space to share experiences and gain advice from those with similar backgrounds. However, they also emphasised the need for diverse representation among peer supporters, adaptable training to meet neurodiverse needs, and formal recognition of peer supporters' contributions. Study findings suggest that universities should consider implementing tailored peer support programmes to address the specific challenges faced by doctoral students, incorporating flexibility, cultural sensitivity, and accessibility to create a supportive academic environment. Future research should evaluate the effectiveness of such programs in improving doctoral students' mental health and well-being.

BACKGROUND:Globally, over 21 million children need palliative care each year. Although guidelines exist to support paediatric palliative care delivery, they are not informed by the experiences of children themselves. OBJECTIVE:We aimed to determine what constitutes good quality palliative care from the perspectives of children with life-limiting or life-threatening conditions and their parents. METHODS:We analysed semi-structured qualitative interviews using reflexive thematic analysis informed by the European Association for Palliative Care charter of palliative care for children and young people, and Bronfenbrenner's bioecological model. Participants included 26 children aged 5-17 years, and 40 parents of children aged 0-17 years, with a range of cancer and non-cancer diagnoses in nine UK paediatric palliative care services (hospitals and hospices). RESULTS:Quality paediatric palliative care can be both enacted or interrupted across the five domains of the bioecological model. Honest timely communication with the child and family (microsystem), and collaborative relationships between care teams and others in the child's life (mesosystem), are vital. Care experiences are negatively affected by inequities in care provision (exosystems), and society's reluctance to discuss mortality in childhood (macrosystem). Children need to enjoy what matters to them, and maintain social connections, and plan for the future, even if facing a shortened life (chronosystem). CONCLUSIONS:Children and parents are experts in their condition and should be actively involved in care discussions, through communication tailored to the child's pace and preferences, and support advocating for and coordinating care services. Fostering strong and collaborative relationships builds trust and helps children and families to feel safe, included and supported.

RATIONALE:Parents of children with long-term physical health conditions (LTC) experience elevated rates of stress and mental health problems. Existing psychological interventions targeting this population may be effective in improving their mental health, but accessibility is a concern. AIMS AND OBJECTIVES:Given the increasing effectiveness and accessibility of single-session interventions (SSIs) across diverse populations, this qualitative study aimed to understand parents' need for psychological interventions and their opinions on SSIs. METHODS:Qualitative data were collected from 12 semi-structured interviews with 13 parents or primary carers of children with LTCs. RESULTS:Data were analysed using thematic analysis and four key themes, including (i) Mental health impact and coping mechanisms; (ii) Experience of psychological support; (iii) Format of psychological support and (iv) Opinions on single-session interventions, were identified. Participants described the impact their child's health condition had on their own mental health and outlined coping mechanisms. They talked about their previous and current experiences of psychological support to date, their expectations of psychological support and the elements they considered crucial in psychological interventions. Participants also shared their initial opinions about SSIs as a feasible treatment option. CONCLUSION:Overall, tailored interventions, the development of a professional therapeutic relationship, having choice and control were deemed important by parents. Future development of psychological interventions for this population should consider these aspects. Positive opinions on SSIs also revealed their potential applicability, and future studies should be conducted to assess their feasibility and effectiveness.

OBJECTIVE:Despite children and young people (CYP) with cancer having elevated mental health needs, accessing evidence-based psychological support remains difficult. Delivering low-intensity cognitive behavioural therapy (LICBT) to CYP with cancer could increase access to support. This qualitative study aimed to understand the views of key clinician stakeholders regarding the potential facilitators and barriers to implementation of LICBT in paediatric cancer services. METHODS:Semi-structured interviews were conducted with 39 professionals working in paediatric hospital cancer services. Interviews were transcribed and analysed using framework analysis informed by the Consolidated Framework for Implementation Research. RESULTS:Professionals indicated a potential need and utility for LICBT, and saw it as distinct from existing provision, addressing patient needs and filling a gap in services. Integration into the service and existing pathways was considered a key facilitator to successful implementation. Anticipated potential barriers included scepticism of LICBT efficacy due to the perceived high complexity of patient presentations and concerns about the relevance and suitability of existing manualized interventions for this population. LICBT practitioner ability to independently assess patient suitability for the intervention and to deliver LICBT effectively was also questioned. CONCLUSIONS:Cancer professionals' perceptions of LICBT indicate its potential use for the CYP cancer population to improve access to evidence-based psychological interventions. Incorporating the identified facilitators and barriers into implementation strategies, including information about the effectiveness of LICBT for young people with chronic illness will help to ensure effective integration of LICBT into routine paediatric healthcare settings.

BACKGROUND:A dearth of evidence exists on how to include children and young people in palliative care research. AIM:We aimed to identify successful practices in involvement, recruitment and data collection with children and young people with life-limiting illness in research. DESIGN:We synthesised methods from five primary studies from three geographical regions in which children with life-limiting conditions were recruited and interviewed. Using Expert Elicitation Methodology we identified successful practices in the three areas of involvement, recruitment and data collection. We established consensus on methodological challenges and solutions, and developed 10 recommendations for inclusion in research protocols. SETTING:Primary cross-national research in three regions; Middle East (one study), sub-Saharan Africa (one study), Europe (three studies), reporting on studies that recruited N = 244 children aged 5-18 years. RESULTS:Recommendations are: (1) research team supported by advisory group of children for entire research process; (2) appropriate distress protocol tailored to population; (3) opt not to use term 'palliative care' in study materials if significant distress is a risk; (4) be deliberate in purposive sampling to ensure diagnoses heterogeneity where appropriate; (5) age-appropriate information materials pre-tested by children; (6) clinical teams receive training in recruitment; (7) time to build rapport before starting data collection; (8) consider potential biases and advantages of having parent/carer present during interview; (9) use age-appropriate toys/games during interviews; (10) selfcare for researchers to manage distress. CONCLUSIONS:These recommendations can guide design and conduct of research, enabling children with life-limiting illness to meaningfully participate and express their views.

BACKGROUND AND AIMS:Low-intensity psychological interventions are effective for children and young people (CYP) with mental health difficulties and can help bridge the demand-capacity gap. Despite increasing awareness, training and use of low-intensity psychological interventions, it is not yet understood what is being implemented in clinical practice in the UK and the associated evidence base. METHOD:This paper presents two studies; first, a national survey (n=102) of practitioners to identify low-intensity psychological interventions currently delivered in practice and second, an exploration of the availability and the strength of empirical support (characterised as 'gold', 'silver' and 'bronze') of low-intensity CBT interventions for CYP. RESULTS:The first study found a wide variety of interventions being used across different services; 101/102 respondents reported using routine outcome measures. The second study identified 44 different low-intensity interventions, 28 of which were rated as having gold empirical support. However, only 13 of the gold interventions were considered accessible for practitioners and only two were reported being used in routine practice. CONCLUSION:These findings highlight that these interventions have been developed and empirically tested, but many are not easily accessible, highlighting the 'research-practice' gap in the provision of low-intensity interventions. There is a need for an increase in standardisation of care and accessibility of gold interventions. This paper hopes to begin the process of creating a hub of low-intensity interventions that are accessible and empirically supported to improve equity of access and outcomes of low-intensity psychological interventions for CYP.

Background: Development of a paediatric palliative care child and family centred outcome measure is a priority for health care professionals, researchers and advocates. It is methodologically challenging to develop a measure relevant for such a heterogenous population with complex needs. Involving children in measuring development is vital. Objective: To develop C-POS:UK (Children’s Palliative Care Outcome Scale, UK), a person-centred outcome measure (PCOM) for children with life-limiting conditions and their families, and to test its psychometric properties. Design: Sequential mixed-methods approach to PCOM development, guided by Rothrock’s measure development process and COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) methodology. Methods: (i) Qualitative interviews about priority symptoms and concerns, with embedded exploration of measure design for children with life-limiting conditions; (ii) systematic review of measure design for children; (iii) modified Delphi survey, and consultation with children, on priority items for new measure; (iv) expert item generation meeting to develop C-POS:UK; (v) cognitive testing to refine C-POS:UK; (vi) psychometric validation. Results: (i) 106 participants described physical, emotional/psychological, spiritual/existential, social and practical concerns. Measure design was discussed by 79 participants comprising preferred response format, recall period and measure administration for children with life-limiting conditions; (ii) systematic review highlighted need for: different versions of measure accounting for child’s developmental stage and cognitive ability; parent/carer involvement as proxies for very young children; and testing to clarify recall periods and response formats at different developmental stages; (iii) Delphi survey: 82 participants (in the first round), with a move towards consensus, but with some differing priorities in stakeholder groups: professionals prioritised physical symptoms, parents prioritised psychosocial and practical matters, while consulted children prioritised normality; (iv) 22 experts contributed to item generation meeting, resulting in five versions of C-POS:UK accounting for child’s developmental stage and cognitive ability, and proxy involvement; (v) 48 participants cognitively tested initial C-POS:UK, informing comprehension, comprehensiveness and acceptability; (vi) psychometric validation is ongoing. Conclusion: A sequential approach informed by Rothrock and COSMIN has supported development of the first version of C-POS:UK. Psychometric validation is underway and will be followed by implementation planning.

Background Despite the high prevalence of mental health difficulties in children and young people with long-term health conditions (LTCs), these difficulties and experiences are often overlooked and untreated. Previous research demonstrated the effectiveness of psychological support provided via a drop-in mental health centre located in a paediatric hospital. The aim of this prospective non-randomised single-arm multi-centre interventional study is to determine the clinical effectiveness of drop-in mental health services when implemented at paediatric hospitals in England. Methods It is hypothesised that families who receive psychological interventions through the drop-in services will show improved emotional and behavioural symptoms. Outcomes will be measured at baseline and at 6-month follow-up. The primary outcome is the difference in the total difficulties score on the Strengths and Difficulties Questionnaire (SDQ) reported by parent or child at 6 months. Secondary outcomes include self and parent reported Paediatric Quality of Life Inventory (PedsQL), self-reported depression (PHQ-9) and anxiety measures (GAD-7) and family satisfaction (CSQ-8). Discussion This trial aims to determine the clinical effectiveness of providing psychological support in the context of LTCs through drop-in mental health services at paediatric hospitals in England. These findings will contribute to policies and practice addressing mental health needs in children and young people with other long-term health conditions. Trial registration ISRCTN15063954, Registered on 9 December 2022.

Background: Children and young people with life-limiting and life-threatening conditions have multidimensional needs and heterogenous cognitive and communicative abilities. There is limited evidence to support clinicians to tailor their communication to each individual child.Aim: To explore the language children and young people use to describe their own condition, to inform strategies for discussing needs and priorities.Design: Positioned within a social constructivist paradigm, a secondary discourse analysis of semi-structured interview data was conducted incorporating the discourse dynamics approach for figurative language.Setting/participants: A total of 26 children and young people aged 5-17 years with life-limiting or life-threatening conditions (6 cancer; 20 non-cancer) were recruited from nine clinical services (six hospitals and three hospices) across two UK nations.Results: The language children and young people use positions them as 'experts in their condition'. They combine medical terminology with their preferred terms for their body to describe symptoms and treatments, and use comparatives and superlatives to communicate their health status. Their language depicts their condition as a 'series of (functional and social) losses', which single them out from their peers as 'the sick one'. Older children and young people also incorporate figurative language to expand their descriptions.Conclusion/discussion: Children and young people can provide rich descriptions of their condition. Paying attention to their lexical choices, and converging one's language towards theirs, may enable more child-centred discussions. Expanding discussions about 'what matters most' with consideration of the losses and differences they have experienced may facilitate a fuller assessment of their concerns, preferences and priorities.

Background: There is a growing evidence-base underpinning implementation of person-centred outcome measures into adult palliative care. However evidence on how best to achieve this with children facing life-threatening and life-limiting conditions is limited. Aim: To identify the anticipated benefits, risks, barriers and facilitators to implementing person-centred outcome measures for children with life-limiting and life-threatening conditions. Design: Cross-sectional qualitative semi-structured interview study with key stakeholders analysed using Framework analysis informed by the adapted-Consolidated Framework for Implementation Research. Setting/participants: A total of n = 26 children with life-limiting or life-threatening conditions, n = 40 parents/carers, n = 13 siblings and n = 15 health and social care professionals recruited from six hospitals and three children’s hospices and n = 12 Commissioners of health services. Results: All participants were supportive of future implementation of person-centred outcome measures into care. Anticipated benefits included: better understanding of patient and family priorities, improved communication and collaborative working between professionals and families and standardisation in data collection and reporting. Anticipated risks included increased workload for staff and measures not being used as intended. Implementation barriers included: acceptability and usability of outcome measures by children; burden and capacity of parents/carers regarding completion; privacy concerns; and language barriers. Implementation facilitators included designing measures using language that is meaningful to children and families, ensuring potential benefits of person-centred outcome measures are communicated to encourage ‘buy-in’ and administering measures with known and trusted professional. Conclusions: Implementation of person-centred outcome measures offer potential benefits for children with life-limiting and life-threatening conditions. Eight recommendations are made to maximise benefits and minimise risks in implementation.

Aims Despite the high prevalence of mental health disorders in children and young people (CYP) with long-term health conditions (LTCs), these difficulties are often overlooked and untreated. Previous research demonstrated the effectiveness of low intensity psychological support provided via a drop-in mental health centre in a single specialist paediatric hospital. The aim of this study is to determine the effectiveness and acceptability of accessible low intensity mental health services for CYP attending a general hospital. Methods This project was part of a wider prospective non-randomised single-arm multi-centre interventional study (Trial registration: ISRCTN15063954). CYP aged up to 25 years old with a LTC, who had been receiving care for their LTC for 6 months or more, and their parent/carer were eligible to be referred by their clinician or self-refer to the trial. The primary outcome is the difference in the total difficulties score on the Strengths and Difficulties Questionnaire (SDQ) reported by parent or CYP between baseline and 6 months. Interventions provided were: low intensity CBT, onward referral or signposting. Results 53 families were recruited at this hospital which made up 44% of the total study sample (120 families). Patients recruited were made up of 34 females, 18 males and one young person who identified as non-binary. The mean age of the CYP was 16.13 years and they were living with a range of different LTCs including cancer, asthma and diabetes. At baseline the average self-reported and parent reported SDQ scores were within the “very high” range (21.52 and 22.03, respectively). All participants were offered an initial assessment within 3 weeks of consenting (average 19.6 days) and treatment began within a month. Qualitative feedback from families has identified how the service “fills a gap” between physical and mental health and their satisfaction with how “time-sensitive” support was available. Conclusion There is significant demand for this service and CYP living with different LTCs are accessing and utilising the service provided. This model of intervention allows timely access to evidence-based mental health support for CYP attending a general hospital for their physical health needs, compared with standard waiting times in other services.

A recent national survey of bereaved partners found high levels of complicated grief and psychological distress, with evidence that loneliness and isolation may contribute to these outcomes. However, the mechanisms of action for this have not been explored. To advance grief theory this paper reports analysis of the survey free -text data to examine the relationship between social support and emotional responses to bereavement. Individuals bereaved of a civil partner or spouse 6-10 months previously were identified through death registration data. 569/1945 (29 %) completed surveys were received. Of those, 311 participants (55 %) provided responses to two free -text questions which asked about their 'feelings since the death of their partner or spouse', and 'about the support around' them. Data were analysed using corpus -assisted discourse analysis and the discourse dynamics approach for figurative language. Participants described diverse emotional responses to the bereavement (e.g. sadness, anger, denial, acceptance), and the value of formal and informal bereavement support. Although many of the experiences described are accounted for in existing grief theory, some participants described a liminal experience not recognised within these theories. They felt trapped, unable to engage with loss or restoration, and unable to move forward as their planned future no longer existed. They sought out 'communitas' (solidarity in experiences), but often found support from their social networks had diminished. Metaphors were used to describe this liminality, with partner grief expressed as a dark agentic force, a monster, an abyss, and as water. The findings of this study offer original insights into experiences and trajectories of bereavement, and our understandings of prolonged or complicated grief. A novel model 'Between Loss and Restoration' is presented to include these experiences. Recognition of the place for liminality within the spectrum of grief experiences could enhance grief literacy and improve formal and informal bereavement support provision.

Objectives To systematically review 1-year recovery rates for young people experiencing depression and/or anxiety who are not receiving any specific mental health treatment. Design Systematic review and meta-analysis. Data sources MEDLINE, Embase, PsycINFO, Web of Science and Global Health were searched for articles published from 1980 through to August 2022. Eligibility criteria Articles were peer-reviewed, published in English and had baseline and 1-year follow-up depression and/or anxiety outcomes for young people aged 10–24 years without specific treatment. Data extraction and synthesis Three reviewers extracted relevant data. Meta-analysis was conducted to calculate the proportion of individuals classified as recovered after 1 year. The quality of evidence was assessed by the Newcastle-Ottawa Scale. Results Of the 17 250 references screened for inclusion, five articles with 1011 participants in total were included. Studies reported a 1-year recovery rate of between 47% and 64%. In the meta-analysis, the overall pooled proportion of recovered young people is 0.54 (0.45 to 0.63). Conclusions The findings suggest that after 1 year about 54% of young people with symptoms of anxiety and/or depression recover without any specific mental health treatment. Future research should identify individual characteristics predicting recovery and explore resources and activities which may help young people recover from depression and/or anxiety. PROSPERO registration number CRD42021251556.

Background: Despite being a core domain of palliative care, primary data on spiritual and existential concerns has rarely been collected among children with life-limiting and life-threatening conditions and their families. Existing evidence has tended to focus on the religious aspects among children with cancer. Aim: To identify the spiritual needs of children with life-limiting and life-threatening conditions. Design: Cross-sectional semi-structured, qualitative interview study with children, families and health and social care professionals. Verbatim transcripts were analysed using Framework analysis Setting/participants: Purposively sampled children with life-limiting and life-threatening conditions, their parents and siblings, health and social care professionals recruited from six hospitals and three children’s hospices in the UK, and commissioners of paediatric palliative care services recruited through networks and a national charity. Results: One hundred six participants were interviewed: 26 children (5–17 years), 53 family members (parents/carers of children 0–17 years and siblings (5–17 years)), 27 professionals (health and social care professionals and commissioners of paediatric palliative care). Themes included: living life to the fullest, meaning of life and leaving a legacy, uncertainty about the future, determination to survive, accepting or fighting the future and role of religion. Children as young as 5 years old identified needs or concerns in the spiritual domain of care. Conclusions: Addressing spiritual concerns is essential to providing child- and family-centred palliative care. Eliciting spiritual concerns may enable health and social care professionals to identify the things that can support and enhance a meaningful life and legacy for children and their families.

BACKGROUND:Support from social networks is vital after the death of a partner. Lesbian, gay, bisexual and/or transgender (LGBT+) people can face disenfranchisement and isolation in bereavement. The Acceptance-Disclosure Model (of LGBT+ bereavement) posits that experiences are shaped by the extent to which individuals feel able to disclose their bereavement to others, and whether that loss is acknowledged appropriately. AIM:To explore LGBT+ specific experiences of partner bereavement; determine decision-making processes regarding disclosure of relationships/identities; and appraise the Acceptance-Disclosure Model using primary qualitative data. DESIGN:Exploratory in-depth qualitative interview study positioned within a social constructivist paradigm. Data were analysed using inductive and deductive reflexive thematic analysis. SETTING/PARTICIPANTS:21 LGBT+ people from across England bereaved of their civil partner/spouse. RESULTS:Participants described LGBT+ specific stressors in bereavement: lack of recognition of their loss; inappropriate questioning; unwanted disclosure of gender history; and fears of discrimination when accessing support. Disclosure of LGBT+ identities varied across social networks. Some participants described hiding their identities and bereavement to preserve relationships, and challenging intersections between LGBT+ identities and other aspects of culture or self. These findings provide primary evidence to support the Acceptance-Disclosure Model. CONCLUSIONS:LGBT+ people face additional stressors in bereavement. Not all LGBT+ people want to talk directly about their relationships/identities. Sensitive exploration of support needs, aligned with preferences around disclosure of identities, can help foster trust. Five recommendations for inclusive practice are presented. Further research should consider whether the Acceptance-Disclosure Model has utility to explain bereavement experiences for other isolated or disenfranchised groups.

Introduction Despite children and young people (CYP) with long term conditions (LTCs) having significantly elevated mental health needs, accessing evidence-based psychological support remains difficult. Previous work suggests low-intensity CBT (LICBT) interventions are effective for CYP with mental health needs in the context of LTCs. If embedded in hospitals LICBT may increase access and better integrate physical and mental health care. This new provision is currently being implemented in paediatric hospitals across the UK. A vital part of successful implementation is effective training. The current paper describes hybrid training in LICBT interventions delivered to staff from a range of health care settings. The aim of the study was to analyse the effectiveness of, and satisfaction with, this training. Methods Two days of hybrid training in LICBT for mental health needs in the context of LTCs were delivered to staff. Attendees were introduced to LICBT strategies to support CYP with anxiety, depression and challenging behaviour. A brief questionnaire and evaluation form were completed before and after training on attendees’ understanding of the topics covered and their views of the training (usefulness, relevance, preparedness). Results Thirteen attendees completed the questionnaire before and after training was completed. Total scores significantly increased from pre-training to post-training. Qualitative feedback indicated the majority found the training highly relevant to their work and enjoyed the hybrid model. Conclusion These findings support the acceptability and effectiveness of two-day hybrid training as part of enabling a paediatric hospital workforce to deliver psychological support for CYP with LTCs. Future training could consider this format to help overcome barriers to successful implementation. This work highlights the opportunity a new or existing workforce holds in integrating psychological therapies into existing physical health care pathways, coordinating care and ensuring equitable access to mental health support for CYPs, irrespective of their LTCs.