The Influence of Comorbidity and Perceived Complexity on Outcomes of Referrals to Children and Young Person Mental Health Services (UK): A Mixed Methods Vignette Study

Abstract

Children and young people (CYP) with long-term physical conditions (LTCs) are four times more likely to develop mental health disorders yet many cannot access Children and Young People’s Mental Health Services (CYPMHS) or evidence-based interventions. This study aimed to understand the reasons for this; presence of an LTC neurodevelopmental disorder, or service requirements. 79 CYP mental health practitioners were randomly assigned to read vignettes depicting a hypothetical referral letter for a child with a mental health condition alone ( n = 27), mental health condition and LTC ( n = 25), or mental health condition and neurodevelopmental disorder (Autism Spectrum Disorder-ASD) ( n = 27), answering questions about their likelihood of accepting the referral and proposed treatment plan. There were no significant differences between accessing CYPMHS or being offered first line evidence-based interventions in those with a LTC or ASD compared to those without. However, additional perceived complexity was frequently provided as a reason for rejecting referrals and not offering evidence-based intervention, with clinicians’ predicted success of intervention significantly lower for these CYP. Clinicians were significantly more likely to suggest adapting the intervention in the LTC and the ASD groups to account for additional perceived complexity. The research suggests a need for additional services for CYP with LTCs and those with neurodevelopmental disorders, as well as training/awareness for clinicians.

Mental health interventions for children and young people with long-term health conditions in Children and Young People’s Mental Health Services in England

“…Previous research in other clinical populations has found that treatments labelled as CBT often lack the fundamental components required by the evidence base (Cowdrey & Waller, 2015 ; Stobie et al, 2007 ; Waller et al, 2012 ). Also of note was that those CYP with a physical health condition were less likely to be given CBT than those without, which is consistent with previous research and may reflect clinicians’ lack of confidence in using CBT with this group ( Byrne et al, 2023 ; Carroll et al, 2021 ). Behavioural parenting interventions are the NICE recommended treatment for disruptive behaviour disorders ( NICE, 2013b ) and these are frequently seen in CYP with neurological disorders ( Davies et al, 2003 ).…”

Clinical effectiveness of drop-in mental health services at paediatric hospitals: A non-randomised multi-site study for children and young people and their families – study protocol

“…That said, there are several barriers that limit access to evidence-based mental health care for CYP with LTCs. These include a lack of trained therapists, work demands, time, transport and costs alongside a lack of understanding that CYP with LTCs respond to existing evidence-based treatments [ 16 – 18 ]. There are also structural barriers in terms of service support for example, who is permitted as a referrer, and increasingly stringent referral criteria for services with referral outcomes for CYP with LTCs often unknown [ 19 ].…”