Prof Max Birchwood's presentation on early interventions in youth mental health for the CLAHRC WM Scientific Advisory Group meeting, 9th June 2015, Birmingham, UK

1. Early intervention in youth mental
health: where we’ve been and where
we’re going.
12/06/2015
Max Birchwood,
on behalf of theme 2

2. Theme 2: Early intervention in Youth Mental
Health
University of
Birmingham/BSMHFT
• Liz England (Primary Care)
• Stephen Wood (Psychology)
• Tom Marshall (Health and
Population science)
University of Warwick
• Max Birchwood (Lead; Clinical
Psychology
• Swaran Singh (Psychiatry)
• Doug Simkiss (Child Health)
• Andrew Thompson (psychiatry)
• Giovanni Radaelli (Business School)
Research lead: Dr Charlotte Connor
Implementation lead: Dr Paul Patterson (Diffusion Fellow)
RA s : Sunita Channa and Colin Palmer

3. PPI Advisors
Keith Elder
Barry Clark
Richard Grant
Charli Connor 2015 3
– a team of past or current young service
users to provide advice on youth services
and how to improve care for other young
people;
– www.youthspace.me relevant, up-to-date
information and advice on all aspects of
mental health, resilience and emotional
wellbeing;
– working with primary care, Child and
Adolescent Mental Health Services (CAMHS)
to create an effective and appropriate youth
clinical service to meet local needs
Key roles in active dissemination
and knowledge transfer to the
wider community
Youth PPI: ‘RIPPLE’

4. CAMHS/AMHS split at 16/18:
lost in transition; 2 care cultures.
“Adult services don’t do young people”
(so young people don’t engage)
No paradigm of prevention/
resilience
SOS mental health services for young people
Rates of treatment decrease as
need escalates in adolescence

5. www.healthmetricsandevaluation.org/gbd/country-profiles

6. Early intervention
in Youth
Mental
Health
Universal High risk
groups
Indicated
Early
interventio
n
Mental
health
services
‘SchoolSpace’
School interventions
‘NEETs’
YP leaving care
The LYNC project
Eating disorders:
Early detection in schools
Lottery HeadStart: resilience
‘Birmingham
0-25 service: evaluation
Self harm
Psychosis awareness
Identifying YP at
high risk for depression
In primary care
UHR Psychosis
‘Upgrade’ early
Intervention in
psychosis service

7. The story so far

8. Wait times and quality standards for access to early intervention in psychosis teams
arising from CLAHRC DUP research

10. Swaran Singh’s research on transitions
Birmingham 0-25

11. Birmingham’s new 0-25 integrated early intervention and child/youth access pathway
Dr Reeves (lead CCG commissioner)
has described CLAHRC as the ‘key plank
of local, high quality research which
influenced the development and re-
commissioning of youth mental health
services in Birmingham to provide
services to Children, Young People and
Young Adults (CYPYA) from 0-25 years’.

12. Where we’re going: supporting the
implementation and evolution of 0-25,
in Birmingham and across the WM

13. 0-25 integrated child & youth pathway emphasizing early
detection and intervention
October 2015 2019
CAMHS
Young adult services
CLAHRC-WM evaluation
( CCG funded 18 months)
? CLAHRC supported
Staging approaches
to prevention
Eating disorders
Resilience
Self harm
Primary care:
Early detection
and management;
collaborative care.
High risk groups:
YP leaving public care

14. Impact and process evaluation of the
Birmingham 0-25 Mental Health Service:
A proposal from CLAHRC-‐West Midlands and
GIFT and WBS

15. 1. Input – to understand the processes and systems required to
measure the impact of the new service on children and young
people. This should include development of baseline
indicators; reporting on progress of mobilisation and
implementation of new service;

16. 2. Effectiveness of partnerships in the 0-25 consortium – to
understand whether the objectives of partnership working are
being met. To include examination and reflection on evolving
partnerships; facilitation of workshops to develop new ways of
working.

17. Is 0-25 transforming access and equality of access to
interventions’ for those that need it?
To what degree is 0-25 successful in maximizing engagement
of individuals and their families and delivering interventions
following access to an initial assessment?
Is the 0-25 service transforming recovery and resilience
such that further service use is reduced?
3. Impact

18. 18 months, low budget.
Impact using service based performance data.
Emphasis now on formative aspects

19. EU Milestone project: alternative methods of managing the
transition at 16/17
October 2015 2017
CAMHS
Young adult services
Alternative ways of fixing the transition?

20. Managing the Link and Strengthening
Transition from
Child to Adult Mental Health Care:
http://milestone-transitionstudy.eu/
CI: Swaran Singh

21. MILESTONE project: 2014-19

22. MILESTONE project
9 Work packages

23. Aims of MILESTONE study
Cohort study
• To evaluate the baseline mental health of young people who
are CAMHS service users and reach the CAMHS/AMHS
transition boundary in 8 EU countries;
• To evaluate the longitudinal course of mental health, social
care and adult functioning outcomes of young people who
reach the CAMHS/AMHS transition boundary and transition
into young adulthood;
• To compare the outcomes in those CAMHS users who
transition with those who do not transition to AMHS.

24. Aims of MILESTONE study
cRCT
• To determine the effectiveness and cost-effectiveness of a
model of managed transition in improving the health and
social outcomes of young people, and their transition to adult
roles, as compared to treatment as usual, at CAMHS-AMHS
transition boundary in the participating countries

25. 0-25: CLAHRC supporting science

26. Charli Connor 2015 27
Staging approach to the
Early detection of Eating Disorders

27. • 3-year online prospective study of
trajectory and transition to ED
young people aged 13 years
(n=622)
• Self-esteem, depression & anxiety;
body esteem, food rules, dieting
behaviour; emotional
dysregulation; BMI Charli Connor 2015 28
Stage 2: Identifying those at ultra high risk
Stage 1: Exploration of personal
experiences of developing disordered
eating behaviour
Interviews with 30 young people diagnosed with
an ED and 15 carers

28. SchoolSpace
March 2015
N = 622
Mean Scores
Eating Disorder
Status
Gender % of
sample
Eating Disorder
Questionnaire
Adolescent
Dieting
Questionnaire
(Range 0-24)
Food Rules
Measure
(Range 14–84)*
Difficulties
with
Emotional
Regulation
(Range 36–
180)
Hospital
Anxiety &
Depression
Score
(Range 0-42)
Rosenberg’s
Self Esteem
Score
(Range 0-30)
Scoring in
clinical
range (>4)
22
Female 19 (86%)
Male 3 (14%)
3%
0.4%
4.8 14.6 44.6 142.7 24.2 19.7
Scoring in
sub-clinical
range (3-4)
28
Female 22 (79%)
Male 6 (21%)
3.5%
0.9%
3.3 11.0 53.8 115.5 18.8 22.9
Scoring in
non-clinical
range (<3)
572
Female 229 (40%)
Male 343 (60%)
36.8%
55.1%
0.5 2.3 63.6 84.4 12.7 29.6
* Lower score = more adherence to food rules
Charli Connor 2015 29

29. Predicting depression in young people in
primary care based on previous contacts
(with theme 3,TM)
• Matched case-control study using electronic primary care records (98,562 cases and
281,248 controls)
• Primary outcome= episode of depression
• Main predictors: somatic complaints, past history of anxiety, social risk factors
(postcode), number of prior consultations, age, gender,
Charli Connor 2015 30
Main findings
Strongest predictor prior depression symptoms and other psychological conditions.
School problems and social services involvement were prominent predictors in males
aged 15 to 18 years, work stress in females aged 19 to 24 years.
Aims
Derive and investigate discrimination characteristics of a prediction model for a first
diagnosis of depression in young people aged 15-24 years.

30. AIM
The overarching aim of this research programme is to
improve the mental health and wellbeing of young people
leaving the public care system
Research questions:
1. What makes an optimal and effective transition support
service that promotes the mental health and
wellbeing of young people leaving public care?
2. What transition support services are currently provided
across England and what are their outcomes?
3. How can Transition support services be improved?
NIHR LYNC Programme Development Grant
PIs: Simkiss, Singh & Birchwood

31. New front: Self harm and suicide

32. Knowledge exchange /stakeholder event 2016
• Stakeholder event: evaluation of 0-25
service
• Networking
• Improve understanding of youth mental
health research
• Idea sharing
• Encourage research participation
• Conversation ‘menu’
• Open discussion sessions
• Live Twitter feed
• Live streaming
• ‘Ideas’ café/canvas
Charli Connor 2015 35

33. Regional AHSN programmes
Commissioning a 0-25 service
How to reduce DUP

34. Digital Hub – Focus ADHD Smartphone APP
WM-AHSN

35. Digital Hub – elearning modules
WM-AHSN

36. Digital Hub – Youth Board
Experts by experience:
the youthboard allow staff to learn from
young people. Young people share their
experiences and put forward ideas on how
things could be improved for others and this
is something they voice as a very important
outcome of their involvement.
Rights to be involved:
involving young people in decisions regarding
youth care is central to the board and many
of them contributed to the planned re-design
of Birmingham youth services.
Creating a partnership:
partnership working by equally involving
young people and staff is a central outcome.
Several members have since started as
regular volunteers and paid members of staff
within the Trust within various projects.
Be part of something:
regular meetings and events throughout the
year allow young people to participate in
something meaningful, to experience leading
change and to strengthen social networks.
Several young people have forged friendships
which is a positive outcome in this, often
marginalised group.
Youth
Board
WM-AHSN

37. Digital Hub – Google Service Mapping

38. Developing a CLAHRC Institute for
Mental Health with Warwick
University and possibly Birmingham
and Keele and interested
Trusts.(inspired by the Nottingham
Institute for MH).

39. Thank you.
Questions?