Widening participation in psychological wellbeing practitioner (PWP) training by targeting mature candidates has the potential to bring greater diversity of life experience into the profession, as well as address retention challenges. This paper presents observations on recruitment interest, academic performance, and career aspirations among mature PWP trainees (aged 35 years and older), in comparison with those of traditional PWP trainees (aged under 35 years). Participants were recruited from pre-training events and training cohorts at the University of Surrey. The study utilised a cross-sectional survey to understand the age profiles of trainees recruited into training, an analysis of routinely held participation and academic attainment data, and a longitudinal survey to explore future career aspirations between mature and traditional trainees. The findings showed that mature candidates attended recruitment events in proportionally higher numbers, but this did not necessarily translate to securing places on training. Mature trainees achieved lower class awards and exhibited higher withdrawal and termination rates compared with traditional trainees. Mature trainees reported higher intentions to stay in a PWP-related role than their traditional counterparts; however, both groups expressed concerns about poor progression opportunities and the risks of burnout. The implications of these findings for clinical services and university providers, along with recommendations for future research, are discussed.

Key learning aims

1. (1) To outline the rationale for widening participation in PWP training, specifically focusing on mature candidates.

2. (2) To outline interest for PWP training, academic attainment and career aspirations in mature PWP candidates and trainees.

3. (3) To consider the implications of these findings for Talking Therapies services and university training providers, with regard to recruitment practices, training support and retention.

Children and young people (CYP) living with long-term physical health conditions (LTCs) have a higher prevalence of mental health conditions but report barriers in accessing mental health interventions. One way to increase access to such interventions is through Children and Young Person Wellbeing Practitioners (CWPs) who deliver low-intensity cognitive behavioural therapy (LI CBT). This non-randomised study evaluates the effectiveness of LI CBT delivered by CWPs integrated in a specialist paediatric psychology service. Thirty-six CYP aged 3‒23 years receiving LI CBT interventions were included in the evaluation. Outcome measures included the Revised Children’s Anxiety and Depression Scale (RCADS) and goal based outcomes (GBOs), which were administered at the beginning and end of the intervention. Feedback from participants was also gathered to complement quantitative data. Analysis of pre- and post-intervention data highlighted a reduction in symptoms across all RCADS subscales with notably large effect sizes observed when comparing total RCADS scores (d = 0.86) and low mood scores (d = 0.99). GBO data similarly reflected progress towards personal goals with a large effect size reported (d = 1.44). Participants provided positive feedback, emphasising improvements in symptom control and emotional understanding. The integration of CWPs into paediatric hospitals demonstrated preliminary effectiveness in reducing anxiety and depression symptoms among CYP with LTCs and significant progress towards their personal goals. These findings suggest that LI CBT delivered by CWPs could fill a critical gap within paediatric settings, although further research with a larger sample size is warranted.

Key learning aims

1. (1) To understand the mental health needs of children and young people with long-term physical health conditions.

2. (2) To learn how low-intensity cognitive behavioural therapy (LI CBT) delivered by Children and Young People’s Wellbeing Practitioners (CWPs) can be integrated into paediatric healthcare settings to improve mental health outcomes.

3. (3) To explore the preliminary effectiveness of CWP-delivered interventions through clinical outcome measures and participant feedback, and consider implications for future service development and research.

There is recognition of the need to design wellbeing interventions in contextually sensitive ways, and report systematic, theory-driven approaches to intervention development. However, many intervention studies in the burgeoning literature on psychological professional trainee wellbeing do not include information on processes or theory surrounding the development of interventions tested. This theory- and stakeholder-informed intervention development study was guided by the MRC framework for developing and evaluating complex interventions and underpinned by the COM-B. Evidence and theory were used to support an initial intervention outline. Meetings were subsequently held to gather stakeholder perspectives, to address unknowns of intervention design, and to support development of a theory of change. Stakeholder (trainees and professional training staff) perspectives and relevant theory were used to inform the design of an acceptance and commitment therapy (ACT) based intervention, to address key stressors experienced by trainees. The intervention was delivered in a group setting, over the course of four sessions spaced 1–3 weeks apart. Collaboratively constructed COM-B analyses identified target behaviours and shaped intervention design. A comprehensive theory of change was developed, outlining key assumptions and setting out hypothesised pathways of change. An evidence-informed ACT-based intervention for psychological professional trainee wellbeing has been developed with key stakeholder collaboration. An acceptability and feasibility evaluation of this intervention is underway.

Key learning aims

1. (1) To understand the processes through which a tailored wellbeing intervention for psychological professional trainees was developed in collaboration with key stakeholders.

2. (2) To consider how an acceptance and commitment therapy (ACT) based intervention was adapted to address specific challenges encountered by psychological professional trainees.

3. (3) To understand the pathways through which an adapted ACT intervention is anticipated to support trainee wellbeing.

Psychological Wellbeing Practitioners (PWPs) deliver high-volume, low-intensity psychological interventions for mild to moderate mental health problems within NHS Talking Therapies (formerly IAPT). However, anecdotal reports suggest they are working with clients presenting with more complex needs, including moderate to severe mental health difficulties, severe and enduring mental health problems, high-risk levels, and facing co-occurring social or systemic challenges. This qualitative study examines the experiences and perspectives of PWPs on working with complexity in clinical practice. An online questionnaire was completed by 104 PWPs working within NHS Talking Therapies services. Data analysis utilised qualitative content analysis. Seven themes were identified, highlighting a range of factors contributing to complexity, including psychological, social, physical, and systemic issues. PWPs also described the emotional toll of managing complex cases and emphasised the need for improved supervision, training, and leadership. The findings underscore a growing disconnect between the intended role of PWPs and the realities of clinical practice. PWPs are routinely expected to manage complexity, high level of risk, and co-occurring social problems. While some practitioners find ways to navigate these demands with adequate support, the overall picture points to significant strain on individuals and services alike. Future research should refine the conceptualisation of complexity, evaluate the proposed decision-making tools, and explore the perspectives of PWPs and clients to inform service development.

Key learning aims

1. (1) Gain insight into PWPs’ experiences and perspectives on managing complexity in clinical settings.

2. (2) Examine the impact of working with complex or inappropriate presenting problems or multiple needs on PWPs’ professional wellbeing and clinical efficacy.

3. (3) Contribute to the limited research on PWP and low-intensity psychological interventions by expanding understanding of its use, challenges, and the impact of complexity within TTad.

It has long been recognised that there is a cohort of service users who typically fail to meet criteria for specialist secondary mental health services, yet their needs are considered too complex for Talking Therapies services. As a result, new psychological practitioner roles, including mental health and wellbeing practitioners (MHWP), were introduced to support implementation efforts, including for newly commissioned Psychological Therapies for Severe Mental Health Problems (PT-SMHP) programmes. This study aimed to explore the impact of the newly commissioned MHWP role’s deliverance of low-intensity CBT-informed interventions on service user outcome measures across three time points during psychological intervention within a primary care-based PT-SMHP service in the East of England. Repeated measures-ANOVAs found significant improvement in all outcome measures, and further post-hoc pairwise comparisons generally found significant improvements in measures across each of the three time points. These preliminary findings provide initial evidence that the role of MHWPs are making a difference in community-based primary care services and positively impacting service user outcomes. Further studies are needed to investigate efficacy of the role with a larger sample, including across other mental health settings such as secondary care to ensure external validity.

Key learning aims

1. (1) To introduce the role of a mental health and wellbeing practitioner in a primary care-based psychological therapy service for severe mental health difficulties.

2. (2) To examine preliminary outcomes of mental health and wellbeing practitioners in the treatment of individuals presenting with a personality disorder.

3. (3) To consider what further research may be needed in relation to the mental health and wellbeing practitioner role.

Demand for child and adolescent mental health support is rising, with long waits risking deterioration. The Lucy Project provides rapid, self–referral, low–intensity CBT (LICBT) within paediatric settings, with interventions taking place via video call. While previous work suggests good reach and outcomes, equity of access and acceptability across demographic groups requires evaluation. This paper examines whether socioeconomic status (SES) and ethnicity are associated with engagement with the service. Service records for 149 patients referred to The Lucy Project in Sheffield Children’s Hospital between December 2022 and December 2024 were analysed. Engagement (engaged vs not–engaged) was recorded, and this was analysed in the context of ethnicity (White British; other; unknown) and indices of multiple deprivation (IMD) decile. Binary logistic regression tested associations. The sample’s ethnicity was broadly similar to that of the general population where the service is based; 27.5% lived in the two most deprived IMD deciles (vs 34.2% citywide). Ethnicity did not predict engagement, whereas IMD decile was shown to be associated with engagement. Results suggested that the more affluent a patient, the more likely they were to drop out. In this video-based, self–referral LICBT service, engagement did not differ by ethnicity but was higher among children and young people from more deprived areas. Findings support the model’s potential to mitigate socioeconomic barriers post–referral, while highlighting the need to optimise engagement for more affluent families and to continue addressing pre–referral inequities and digital exclusion.

Key learning aims

1. (1) To Understand the context of the implementation of The Lucy Project, a self-referral low-intensity cognitive behavioural therapy service in a paediatric setting.

2. (2) To explore the relationship between experiences of deprivation and its impact on engagement with The Lucy Project.

3. (3) To explore the relationships between ethnicity and engagement with The Lucy Project.

4. (4) To explore potential pros and cons of a self-referral mental health service in a paediatric setting.