Beth Cumber Hi, I’m Beth. I’m a PhD  student at the University of Warwick,   and I’m funded by Birmingham Women’s  and Children’s NHS Trust. Today,   I’m going to talk a little bit about the planning  of my PhD project, which involves some qualitative   work and evaluation piece within the field of  child and adolescent mental health services. So, I thought I’d start with a little bit  about me. I started my university journey   by studying psychology, and then I went onto  study mental health nursing and CBT therapy.   I’ve worked in both community and inpatient  child and adolescent mental health services,   which is a bit of a mouthful, so I’ll go on  to refer to that as CAMHS from now on. I’ve   always been really interested in research and  why we do what we do in mental health services,   and I was lucky enough to be linked  in with my now PhD Supervisor,   whilst I was working clinically, and he let  me know when this PhD opportunity came up. I’m really passionate about the  opportunities for Mental Health   Nurses to get involved in research and,  personally, I hope that following my PhD,   I can go on to facilitate that link between  the clinical and research world and, also,   for myself to be working clinically  and academically, as well. So, like I said, I’m funded by an NHS Trust, and  that is based on me undertaking an evaluation   piece of work, up – of a new CAMHS service in the  West Midlands. My project’s also going to include   a piece of qualitative work, and I hope to look  at the experiences of children and young people   who’ve been admitted into CAMHS inpatient units  from residential care placements, and I’ll also   be taking a systematic literature review, looking  at systemic approaches in CAMHS care, as well. So, this PhD project has presented with some  challenges, but also some great opportunities,   in terms of its planning procedures, so I’ll  go on to speak about those today. But, first,   I thought I’d give a little bit of background to  the project. So, think about why I want to look   at this topic, I suppose, most importantly,  it’s been informed by my experiences as a   Mental Health Nurse, working in the field  and, also, the literature that exists. So,   in the UK, there have been calls to reform  CAMHS services, and this is as a result of   high levels of dissatisfaction among young  people and also their family and carers. There have also been long wait times  reported within the field, and also   levels of – lack of integrated care and  co-ordination, as well. And, in England,   between December 2019 and April 2021, there  was a 47% increase in emergency referrals to   CAMHS crisis teams, and it’s unsurprising, as  wait times for mental health support increase,   that more young people are reaching the point of  crisis. And the current demands on our community   mental health services mean that whilst  hospitalisation rates for most paediatric   conditions are decreasing, the rates of admissions  into inpatient CAMHS units are increasing. And mental health inpatient admissions can provide  vital, necessary support for children and young   people when they need it most. But it is generally  recognised that safely avoiding admission into   hospital is favourable, and part of the reasons  of that are – is because concerns have been raised   about the impact of restrictive practices, the use  of the Mental Health Act, reliance on medication,   and witnessing restrictive practice, the effects  that that can have on sustainable wellbeing   and long-term recovery for children and young  people that have been admitted into hospital. As we know, as well, there’s a well-established  link between trauma and poorer physical and   mental health outcomes across the lifespan, and  there’s an increased likelihood for those who’ve   experienced adversity to need mental health  support. We also see higher rates of mental   health difficulties and childhood adversity for  young people in the care system. And despite these   well-established links, mental health intervention  often still focus on changing the young person’s   behaviour, rather than seeing it as a reasonable  response to traumatic life experiences,   and the voice of these vulnerable young people  is often underrepresented in the literature. So, as I mentioned, my PhD also involves  an evaluation piece of a service called   IROC which stands for Intensive Residential  Outreach Care, and this was developed in the   West Midlands to support vulnerable young people  presenting with complex psychological needs. So,   IROC provides a systemic approach, so  they work with the network around the   young person, rather than directly  with the young person themselves. So, the network may include social care  staff, family members, residential care staff,   other agencies, mental health professionals, so  it’s bringing all of those people together. And   they provide a psychologically and trauma-informed  approach, that includes assessment, formulation,   supervision, and psychoeducation, and the  underpinning aims of this service are to secure,   stabilise, support and sustain the  young person and their network.   They hope that this will build the right  clinical treatment pathways for the young person,   reduce staff burnout, reduce anxiety  within the network, and also help to   safely avoid hospital admissions, manage  risk, and to reduce placement breakdowns. So, that brings me onto some of the challenges  associated with planning this type of research   and evaluation. And, I suppose, one of  the main things has been is that IROC   is a time-limited pilot, and so there have  been some time pressures to prove its worth,   which may be slightly different  to the timeline of a PhD. Also,   mental health interventions are dynamic and  they evolve to better address the diverse and   changing needs of the population and the wider  services. And this evolution is really important,   but it can make it difficult to establish  a standardised evaluation framework,   and it can result in challenges maintaining  fidelity to the original intervention model. Mental wellbeing is influenced by complex  interactions between psychological,   social and biological factors, and evaluating an  in – the effectiveness of an intervention in this   field requires capturing the full spectrum  of the impacts for everyone involved. Calls   to reform mental health services also highlight  the need for robust evaluations of new services,   and this is so that we can develop a really great  evidence base for future service developments. Historically, randomised controlled  trials have been seen as the, kind of,   gold standard for evaluation. But randomised  controlled trials might not always be feasible   or appropriate for evaluating complex  interventions in mental health services,   especially when a lot of this service innovation  is happening within small local teams. So, taking   a creative study design might be better suited  to capture the nuances of these intervention,   and providing a holistic understanding of  what’s working for who, and in what context. I’m also currently in the process of applying  for ethical approval for my study, and this has   presented with some challenges and some hurdles.  And I think one of the main things that has stood   out to me during this process is that when we’re  thinking about this NHS process, it’s the same   forms and processes, whether you’re conducting a  medical trial with medications, or conducting a   qualitative piece of work, like I’ve planned. And  so, that’s been quite a lot to get my head around. It has also meant considering all  different elements of the project,   and thinking about NHS, university, or social  care sponsorship, as well. I think, as well,   one of the challenges associated with that is,  as a PhD student, you’re really keen to get out   there, collect data, analyse your findings,  to have something to share with people. But,   having said that, these things have  also provided a lot of opportunities. So, like I said, debi – despite those delays  being frustrating at times, it has allowed me to   get a really good understanding of those research  procedures, which will be – definitely be really,   really helpful if I go on to do more research  in this field in the future. I’ve also had the   opportunity to work with a great youth advisory  group, and their input has been invaluable. And,   likewise, meeting with other people  who are doing research in this field   has really helped to keep me motivated  and see what can be done and achieved. I’m also really grateful to my supportive  supervisory team, and they’ve helped me   to think creatively about how to overcome  these challenges and what methods I can use,   and supported me to develop the skills, as well,  to plan this research. I’d say it’s been a big   jump from the clinical world to the academic  world, but, with that, there’s been loads of   learning opportunities. And I think it’s  also given me the chance to reflect on   clinical practice, taking that step out of  the clinical world has given me a chance to,   kind of, breathe and think about my own  clinical practice, and hopefully to be   a better Clinician and Mental Health Nurse,  when I do go back and work with young people. So, faced with these challenges and opportunities,  me and my supervision team have proposed a case   study approach to evaluating IROC, and I hope that  that will let me look at what’s working for who,   and in what context. So, the plan is to  collect data across three to five cases,   in different contexts. So that might be  a network working with a young person in   residential care, a network working  with a young person in foster care,   and maybe across different geographical  regions of the West Midlands, as well. Because it’s a systemic approach,  I want to primarily look at what’s   working within the network. So, taking  the focus away from the young person’s   behaviour and thinking about how, when  we work with a network in this way,   how does that then impact the care that’s  provided and the outcomes? So, I’ll collect   data by conducting individual interviews,  focus groups, and observing key IROC processes,   so maybe their assessment sessions, their care  planning, and their training sessions, as well. I then plan to analyse the data for each  case, individually, before comparing them,   and I hope that this data can then go on  to contribute to case mechanism outcomes,   that will help provide some  explanations of some of the   experiences and outcomes associated  with this approach to providing care. So, like I said, I hope that this approach  provides a useful answer to some of the   challenges associated with planning an evaluation  of a complex intervention like IROC, and, also,   will provide a useful exploration of how it’s  being received on the ground, and what’s working   for who. I hope that this can then be used to  make sure that services are meeting the needs of   this vulnerable population, and that we can share  learning from other interventions in this field. I’m also looking forward to developing my research  skills in these methods, and hopefully highlight   how something like this can be used for other  evaluations of complex interventions. And,   I think, most importantly, I really hope that  my research in this area will give a voice to   children and young people who have been admitted  to hospital from residential care, and make sure   that their voice is represented in the literature,  and that when we think about future service   developments, their voice and their experiences  that are at the core of those developments. Thank you very much for listening.