Roach, Anna; (2024) Developing and evaluating the national roll-out of drop-in mental health services at paediatric hospitals. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Children and young people (CYP) with long-term conditions (LTC) have significantly elevated mental health needs. However, many fail to access evidence-based psychological interventions. Access could potentially be improved by providing drop-in services in paediatric hospitals acting as a single point of access offering low intensity cognitive behavioural therapy (CBT), onward referrals and signposting. This was shown to improve quality of life, reduce emotional and behavioural symptoms, and was highly acceptable at a single specialist hospital. The aim of this thesis was to implement drop-in services at other paediatric hospitals and investigate their effectiveness. A rapid realist review was conducted using Normalisation Process Theory (NPT) to identify common barriers and facilitators to implementing low intensity psychological interventions (Chapter 2). Staff capacity, training and intervention characteristics were highlighted as key factors. A national survey (n=102) identified a wide variety of low intensity interventions used in practice, most of which have a limited evidence base; additionally, evidence-based low intensity interventions were often difficult for clinicians to access (Chapter 3). Six paediatric hospitals implemented the drop-in service (Chapter 4) and were offered hybrid training. Results of the training showed significant improvement in understanding of low intensity CBT and feedback demonstrated high levels of satisfaction (Chapter 5). A prospective non-randomised single-arm interventional trial (n=120) across the sites demonstrated that accessing the drop-in service was associated with a significant reduction in emotional and behavioural symptoms and improved quality of life for CYP (p<0.01; Cohen’s d=0.39 and d=0.44 respectively) (Chapter 6). Qualitative interviews explored staff experiences and identified common barriers and facilitators to implementation (Chapter 7). Synthesising the overall findings revealed staffing, leadership, funding and knowledge as key factors for successful implementation. The conclusion of the thesis is that drop-in mental health services can be implemented successfully at paediatric hospitals and are effective (Chapter 8).

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