Background; Psychosocial interventions are recommended as first-line approaches for children and young people (CYP) experiencing mental health (MH) difficulties. However, evidence on outcomes of routinely provided psychosocial interventions in real-world settings remains limited. This study examined associations between four commonly used therapies - Cognitive Behavioural Therapy, Dialectical Behaviour Therapy, creative therapy, and psychodynamic/counselling-based therapy, and MH outcomes among CYP receiving specialist MH services. We also examined whether these associations differed by sociodemographic characteristics, including, ethnicity, socioeconomic deprivation, and social work involvement. Methods: Data were extracted from anonymised clinical records (k=9,793) of CYP attending state MH services in a large NHS Trust. Natural language processing (NLP) identified intervention exposure from clinical case notes. Multilevel mixed-effects regression models examined changes in MH difficulties following psychosocial intervention and whether these associations differed by sociodemographic characteristics. Findings: Psychosocial interventions were consistently associated with improvements in MH outcomes over time (β = –1·69, 95% CI [–2·37, –1·00]). Positive associations were observed across intervention types, and trajectories of change did not differ meaningfully by ethnicity, socioeconomic deprivation and social work involvement, despite differences in baseline difficulty levels. Interpretation: Psychosocial interventions delivered in MH services are associated with reduction in MH difficulties among CYP. This provides important real-world evidence supporting the value of psychosocial intervention in routine care and highlights the need for adequate resourcing to expand their delivery.

BACKGROUND:In England, 18% of children and young people (CYP) experience clinical levels of mental health difficulties. CYP who are involved in children's social care, either receiving in-home care (i.e. child protection plans; CPP) or out-of-home care (i.e. children looked after; CLA), may experience higher prevlance than peers. Less is known about actual contacts with mental health services. This study aimed to provide an account of the contacts with mental health services for children with and without CPP and CLA, and reasons for referral. METHODS:Data were extracted from NHS Digital for all CYP in England in contact (e.g. through referral, appointment, support) with mental health services between April 2016 and March 2021, and included sociodemographic information, CPP or CLA status and referral reason. RESULTS:In total, 1,984,827 CYP were in contact with mental health services. The most common referral reasons were anxiety (13%), 'in crisis' (10%) and depression (7%). Contacts tended to increase each year for all groups. Overall, CPP and CLA were between 2 and 3 times more likely to be in contact with mental health services compared to peers. However, this represented between 9% and 18% of CPP and CLA. CONCLUSION:The findings suggest that there are wide discrepancies between mental health needs and contacts with services. CPP and CLA have particularly high levels of unmet need. While these data indicate escalating demand, service contacts have not increased significantly, suggesting an increased threshold for access in a stretched clinical service.

There has been a growing consensus that health and social care research with seldom heard communities on sensitive topics must be co-produced alongside Experts-by-Experience. While scholarly attention has focused on promoting the wellbeing of learned experience researchers engaged in emotionally demanding research, less consideration has been paid to strategies for those with lived experience working on sensitive topics. This co-produced systematic review identified and synthesised the literature relating to strategies for emotional safety with expert-by-experience co-production with seldom heard groups on sensitive topics. This systematic review was co-produced by four Experts-by-Experience with lived experience of both mental health and social care. Extensive consultation with Experts-by-Experience, academics and practitioners informed the analysis and recommendations. Five electronic databases were searched (Medline & Embase, PubMed, Web of Knowledge, Scopus, and ProQuest) from January 2015 to February 2025. Reference lists of eligible studies were also hand-searched. Twenty-two studies met the inclusion criteria. A framework analysis identified six themes relating to emotional safety: navigating power dynamics, scaffolding emotional distress, nurturing relationships, flexibility in research processes, maximising joy and empowerment, and supporting endings to projects. Emotional safety should be understood as an ongoing relational process in co-produced research. Effective co-production requires structures that both scaffold distress and cultivate empowerment, alongside clearer planning for support throughout and after research projects. We conclude by offering recommendations for embedding emotional safety in coproduction with seldom heard groups on sensitive topics. Funding: Three NIHR Research Schools' Mental Health Programme (Grant Reference Number MH093) Protocol Registration: PROSPERO ID CRD420251066669

This paper systematically reviews literature to date about how child welfare workers’ decisions about neglect are influenced by their environments. We conducted a systematic search of Web of Science, Embase, PsycInfo, Scopus, and Applied Social Sciences Index & Abstracts, looking for studies in English of any methodology, published since the 1989 Children Act, in which statutory thresholds in England are defined. We used child welfare workers’ definitions of neglect or, in the absence of this, defined “neglect” as harmful acts of omission by a caregiver (failure to do something necessary for a child’s well-being). We included the views of child welfare practitioners with or working toward a social work qualification and those completing statutory child protection investigations, whatever their qualifications. Thirty-nine studies met the criteria for review. Quality was assessed using the Mixed Methods Appraisal Tool and Gough’s Weight of Evidence framework. Themes were identified iteratively and synthesized using a narrative method. The review found evidence that high caseloads and work-related stress might result in neglect receiving lower priority for intervention. The threshold for statutory intervention also appears to be influenced by the availability of non-statutory support services. These findings suggest that greater investment in services, particularly early intervention, may help children experiencing neglect receive sufficient, timely, and proportionate support. We also found that practitioners find it challenging to evidence neglect, and this can result in delays intervening, suggesting that practitioners may benefit from training and support in court skills.

In Donzelot's landmark The Policing of Families, he traced the rise of the "social" sector in the 18th century, where institutions like social work, education, and healthcare regulated families, shaping norms of deviance to justify intervention. Social scientists continue to debate the impact of post-2008 austerity measures on the relationship between the social sector and family life in contemporary society. This study aims to contribute to these discussions through a critical discourse analysis of how the social needs of 70 young people with social work involvement have been characterised in their Child and Adolescent Mental Health Service case notes. This analysis was co-produced alongside three experts-by-experience with lived experience of both mental health and social care. Results of this analysis indicate that the social needs of our sample were a) rejected from mental health services for being too social, too chaotic and lacking a stable base; b) accepted but secondary to psychological concerns c) outsourced to other services or to families or young people themselves. Where young people's social needs were sufficiently high risk in the community they were d) contained in mental health facilities or under deprivation of liberty orders by social services. We contend that in the contemporary context, rather than the social comprising an ever-expanding entity designed to govern the conduct of family life, we identified ways in which the social sector was also governing through neglect and containment. This analysis offers important insights into inequalities faced by young people with social care involvement who seek mental health support.

Background: Childhood adversity is robustly associated with mental ill-health. Yet questions remain about how different conceptualisations of adversity relate to psychiatric diagnoses and service activity. This research aims to examine associations between typological and cumulative conceptualisations of adversity, and psychiatric diagnosis and service activity. Methods: We analysed risk assessment data from 21,072 young people attending mental health services in South London. These assessments include items relating to maltreatment, parental mental health difficulties, substance misuse, self-harm, and violent behaviour. Using latent class analysis, we identified the following risk typologies: ‘Maltreatment and externalising behaviours’ (n = 971, 4·6%), ‘Maltreatment but low risk to self and others’ (n = 2,526, 12·0%), ‘Anti-social behaviour’ (n = 2,669, 12·7%), ‘Inadequate caregiver supervision and risk to self and others’ (n = 907, 4·3%), ‘Risk to self but not to others’ (n = 1,725, 8·2%), and ‘Mental health needs but low risk to self and others’ (n = 12,274, 58·2%).Two cumulative risk models were created: 1) all risk items 2) Adverse Childhood Experiences-related cumulative risk (ACES-CR). Controlling for gender, ethnicity, age, and deprivation, we examined associations between risk typologies, cumulative risk, and the following outcomes: 1) psychiatric diagnosis 2) face-to-face appointments 3) missed appointments 4) referral to social services.Outcomes: Risk in its various conceptualisations was consistently and robustly associated with conduct disorder. Risk also tended to be associated with more face-to-face appointments, missed appointments, and referral to social services. Associations between individual risk typologies and psychiatric diagnosis and service activity are discussed.Interpretation: Our findings suggest that typological and cumulative approaches to risk and adversity can produce unique insights about diagnostic practices and service activity. This work provides further evidence for the contribution of contextual factors to mental ill-health and further work is required to explore the longer-term trajectories of these young people.

Abstract Background Children and young people (CYP) seen by child and adolescent mental health services (CAMHS) often experience safeguarding issues. Yet little is known about the volume and nature of these risks, including how different adversities or risks relate to one another. This exploratory study aims to bridge this gap, examining rates at entry to services and profiles of risk using a latent class analysis. Methods Data were extracted for CYP who received at least one risk assessment at CAMHs in South London between January 2007 and December 2017. In total, there were 21,688 risk assessments. Latent class analysis was used to identify profiles of risk from the risk assessments. Results Concerns about parent mental health (n = 5274; 24%), emotional abuse (n = 4487; 21%), violence towards others (n = 4210; 19%), destructive behaviour (n = 4005; 18%), and not attending school (n = 3762; 17%) were the most commonly identified risks. Six distinct profiles of risk were identified from the latent class analyses: (1) maltreatment and externalising behaviours, (2) maltreatment but low risk to self and others, (3) antisocial behaviour, (4) inadequate caregiver supervision and risk to self and others, (5) risk to self but not others, and (6) mental health needs but low risk. Conclusions These findings provide fresh insights into adverse experiences and risks identified by CAMHS. For professionals, the profiles identified in this study might provide insights into profiles of identified risks, in contrast to traditional cumulative approaches to risk. For researchers, these profiles may be fertile ground for hypothesis‐driven work on the association between adversity and later outcomes.

Neglect is the most common form of child maltreatment in the UK and the USA. This article reviews research about how child neglect is perceived by social workers. We conducted a systematic review and identified fifty relevant studies, using a range of methodologies, published since the 1989 Children Act. The themes were identified iteratively and synthesised using a narrative method. The review found that despite evidence that neglect is associated with several adverse outcomes, neglect is a lower priority for social work intervention compared to other forms of maltreatment. This is particularly true for emotional neglect and neglect of older children. The review found that social workers conceptualise poverty and neglect as being distinctly different and try to address poverty through practical, non-punitive interventions. However, assessments could better recognise how deprivation exacerbates other risk factors for neglect. The review found a lack of knowledge about perceptions of neglect in adolescents and children with a disability and about the threshold for intervention when neglect is cumulative. Practice may be improved by better recognising and addressing the societal context to neglect allegations and the risk of long-term harm. Achieving this may have resource and training implications. Every year, many children are referred to children's services due to concerns about neglect. Social workers play a key role in deciding what action should be taken. This article discusses what we know about how social workers define child neglect. It summarises research done on this topic since 1989 when the current legal thresholds in the UK were defined. The study found evidence that social workers do not consider neglect to be as high a priority as other forms of maltreatment, particularly when the neglect is of emotional, rather than physical needs, or when the victims are older children. This is concerning given the association between childhood neglect and mental ill health in adulthood. Existing research also suggested that social workers conceptualise poverty as distinct from neglect but could get better at recognising how poverty contributes to other risk factors.

Children and young people with a social worker (CYPwSW) have particular mental health profiles and needs. Research indicates that despite having higher levels of mental health distress this group tend to experience inequitable access to specialist mental health services. Therefore, much of their mental health support currently falls to generalists including paediatricians. We are currently undertaking a four-year study the CAMHS Referrals and Outcomes for Adolescents and Children with Social Workers (COACHES). Here we present initial insights from an analysis of 20,166 unique case notes which identified 1) High thresholds for entry to CAMHS 2) A requirement that young people must be perceived as stable prior to accessing services 3) that young people often did not feel that their voices were taken seriously 4) the importance of time for trust. Based off these findings and expert-by-experience's insights, we conclude by suggesting ways that paediatricians and health care professionals can best support CYPwSW. These include being the ‘connective tissue’ around young people's support network, gently and proactively building relationships, redressing power imbalances and supporting transitions to adulthood.

ObjectiveIn order to address the lack of data on the health and healthcare needs of trans and non-binary adults, NHS England includes questions asking about both gender and trans status in its surveys to support quality improvement programmes.We used self-reported data from the GP Patient Survey to answer the research question: what are the demographic characteristics, health conditions and healthcare experiences of trans and non-binary adults in England?Design/settingNationally representative, population-based cross-sectional survey in England with survey data collection from January to March 2021.Participants840 691 survey respondents including 6333 trans and non-binary adults.OutcomesWe calculated weighted descriptive statistics, and using logistic regression explored 15 long-term physical and mental health conditions, and 18 patient experience items, covering overall experience, access, communication and continuity.ResultsTrans and non-binary adults were younger, more likely to be from Asian, black, mixed or other ethnic groups and more likely to live in more deprived parts of the country. Age-specific patterns of long-term conditions were broadly similar among trans and non-binary adults compared with all other survey respondents, with some variation by condition. Overall, inequalities in long-term health conditions were largest for autism: OR (95% CI), 5.8 (5.0 to 6.6), dementia: 3.1 (2.5 to 3.9), learning disabilities: 2.8 (2.4 to 3.2) and mental health: 2.0 (1.9 to 2.2), with variation by age. In healthcare experience, disparities are much greater for interpersonal communication (OR for reporting a positive experience, range 0.4 to 0.7 across items) than access (OR range 0.8 to 1.2). Additionally, trans and non-binary adults report much higher preference for continuity 1.7 (1.6 to 1.8), with no evidence of any differences in being able to see or speak to a preferred general practitioner.ConclusionThis research adds up to date evidence about population demographics, health and healthcare needs to support healthcare improvement for trans and non-binary adults.

Background: The large-scale quantitative evidence base to understand and improve health and healthcare outcomes for people who are trans and/or non-binary is still developing, although what research there is suggests that risk of poor health is high, and experiences of healthcare services are often poor. In 2021 the GP Patient Survey, which is carried out annually to measure patient experience in primary care in England, added inclusive questions about gender identity and trans status for the first time. Methods: This protocol paper pre-registers the methods that we will use for this work for a secondary analysis of these data, including both the statistical analysis protocol and early patient and public involvement work, to answer the following three research questions: (1) What are the (a) demographic characteristics, (b) health conditions, and (c) healthcare experiences of trans and/or non-binary adults in England? (2) Was there any difference in whether people who are trans and/or non-binary had been asked to shield during the COVID-19 pandemic or not compared with all other survey responders? (3) Does the relationship between being trans and/or non-binary, and self-reported long-term mental health problems, autism and autistic spectrum disorder and learning disability vary by age, gender, ethnicity, deprivation, sexual orientation or region?