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.

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.

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.

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.

This study explored junior mental health workers’ experiences of conducting assessments involving traumatic events. Semi-structured interviews with 11 junior mental health workers from a UK primary care mental health service were analysed using reflexive thematic analysis. Participants discussed themes of ambiguity in distinguishing trauma and PTSD, high levels of pressure, management of personal distress, appropriate training, and personal support in-service. Findings corroborate previous research regarding challenges experienced by junior mental health workers and offer novel insight into the challenges faced when assessing service-users’ experiences of traumatic events. Recommendations regarding future training, service design and emotional outlets for junior mental health workers are offered.

The Senior Wellbeing Practitioner (SWP) postgraduate certificate is a new low-intensity psychological training intended to expand the Children and Young People’s mental health workforce. It builds on the skillset of qualified Child Wellbeing Practitioners (CWPs) and Educational Mental Health Practitioners (EMHPs), by providing training to work with a broader range of presentations including neurodivergence. The SWP Skills and Competency Framework (SWP-SCF) is a new tool developed in response to the need to operationalise and assess the skills necessary to work with the range of presentations SWPs are required to treat, whilst retaining fidelity to the low-intensity intervention approach. As training providers we have used the SWP-SCF with our first cohorts of SWPs as an aid for skill development and reflective practice, as well as for assessment of clinical competency within assignments. Students and tutors have reported good face validity and utility, and further assessment of the validity of this framework appears warranted.

Key learning aims

1. (1) To understand the role of the SWP and how this fits into the wider child and adolescent mental health workforce.

2. (2) To outline the key skills and competencies necessary for SWPs to deliver effective interventions at the low-intensity level.

3. (3) To present how the SWP Skills and Competency Framework was developed and how this can be used as a tool within training and supervision.

Despite the ubiquity of guided self-help (GSH) interventions in Primary Care psychological services, there have been no previous studies of the relationship between the competence of qualified practitioners and treatment outcomes. This study compared competence-outcome associations in two types of GSH. Competence and clinical outcome measures were drawn from a clinical trial comparing the efficacy of two types of GSH for anxiety disorders, based on cognitive behaviour therapy (CBT-GSH) or cognitive analytic therapy (CAT-GSH). These interventions were delivered over the telephone by qualified and supervised practitioners. Audio-recordings of GSH sessions (n=94) were rated using a validated competence measure. Clinical outcomes were anxiety, depression and functioning. Secondary outcomes were attendance and need for further intervention after GSH. Competence ratings were highly reliable. No significant associations were found between competence and clinical outcomes, treatment engagement or need for further intervention. In this clinical trial, GSH competence ratings were not associated with clinical outcomes. Directions for future competence-outcome research are provided for GSH interventions.

Key learning aims

1. (1) Become familiar with the current empirical literature on therapist competence and associations with clinical outcome.

2. (2) Raise awareness of a recently developed alternative form of guided self-help based on the theory and principles of cognitive analytic therapy.

3. (3) Enhance understanding of the relationship between practitioner competence and clinical outcome in guided self-help for anxiety disorders.

Children with genetic conditions may experience significant mental health difficulties such as anxiety and challenging behaviour. However, understanding of the feasibility and effectiveness of psychological interventions for emotional and behavioural problems in the context of genetic conditions is limited. Low-intensity psychological interventions have demonstrated promise in paediatric populations and may be able to address their mental health difficulties. A case series design was used to assess the feasibility of low-intensity interventions for emotional and behavioural difficulties in children and young people with genetic conditions recruited from a mental health drop-in centre at a tertiary hospital. Participants received seven weekly sessions with a trained practitioner. The intervention was based on existing modular treatments and evidence-based self-help materials. Feasibility and treatment satisfaction were assessed, as well as measures of symptoms of anxiety and challenging behaviour, treatment goals and quality of life, at baseline, during treatment and 6-month follow-up. Five participants received treatment for challenging behaviour, one for anxiety, and one for obsessive compulsive disorder. All participants completed treatment. Clinically significant change in the SDQ Total score was found in three participants. All participants demonstrated progress in goals and symptoms of emotional and behavioural difficulties over the course of treatment. Low-intensity psychological interventions for emotional and behavioural difficulties in children and young people with genetic conditions is feasible, acceptable and potentially beneficial. Further research is warranted to examine the effectiveness of the intervention and its use in clinical paediatric settings.

In this study, a convergent parallel mixed-methods design was used to explore stress, resilience and coping in psychological wellbeing practitioner (PWP) trainees (n = 90) at the beginning of their training. Psychometric tests were used to measure levels of self-reported stress, resilience and dispositional coping styles. Open-text survey data regarding the perceived sources of stress at the beginning of training were also qualitatively analysed using thematic analysis (TA). Results indicated that in the early weeks of their training, trainees reported lower levels of resilience and higher levels of stress than those found in the general population. Statistically significant negative correlations were found between stress and resilience, and between stress and the coping styles ‘Planning’, and ‘Active Coping’. Statistically significant positive correlations were found between stress and the coping styles of ‘Denial’ and ‘Focus on and Venting of Emotions’. The qualitative findings provided a context within which to understand these quantitative results. The three themes ‘I can find the unknown quite unsettling’, ‘I question my competences’ and ‘Learning, consolidating and putting it all into practice’ were generated through the qualitative analysis. These themes were connected by an over-arching theme which suggests that the perceived responsibility of the role is an important source of stress for PWP trainees. Implications for future research and the training of PWPs are discussed.

Guided CBT self-help represents a low-intensity intervention to deliver evidence-based psychological therapy within the Improving Access to Psychological Therapies (IAPT) programme. Best practice guidance highlighting characteristics associated with CBT self-help is available to help services reach decisions regarding which interventions to adopt. However, at present a single process to evaluate written CBT self-help interventions informed by guidance is lacking. This study reports on the development of a standardised criteria-driven process that can be used to determine the extent written CBT self-help interventions are consistent with guidance regarding the fundamental characteristics of low-intensity CBT and high-quality written patient information. Following development, the process was piloted on 51 IAPT services, with 23 interventions identified as representing free-to-use written CBT self-help interventions. Overall, inter-rater reliability was acceptable. Following application of the criteria framework, 14 (61%) were considered suitable to be recommended for use within the IAPT programme. This pilot supports the development and potential utility of an independent criteria-driven process to appraise the suitability of written workbook-based CBT self-help interventions for use within the IAPT programme.

The COVID-19 pandemic increased population levels of depression and anxiety, and infection control measures obliged services to provide psychological therapies remotely. Evidence for the routine provision of psychological therapy via telephone and video-conferencing is limited. This study compared therapy outcomes for 5360 clients in two London Improving Access to Psychological Therapy (IAPT) services before and after homeworking produced a compete shift to remotely delivered therapy. Despite the psychological impacts of pandemic restrictions, and the use of a novel therapy modality in video-conferencing, recovery rates and net score change improved in both services, significantly in one. There was no significant worsening of outcomes for any demographic group or presenting disorder. The findings suggest that for those able to access it, therapy provided by telephone and video is a clinically effective option for IAPT services.

Anxiety and depression affect a significant number of children and young people (CYP) and can have a far reaching and long-lasting impact. Cognitive behavioural (CB) interventions can be effective for treating anxiety and depression in CYP but are difficult to access. Recent government policy in England seeks to train a non-traditional graduate workforce to deliver a range of CB interventions for mild to moderate anxiety and depression to CYP, in community settings. This practice-based evaluation aimed to estimate the effectiveness of CB interventions delivered by postgraduate trainees undertaking training in a range of CB interventions for mild to moderate anxiety and depression whilst on placement in schools or community Child and Adolescent Mental Health Services (CAMHS). Self- and parent-reported routine outcome measures (ROMS) were completed pre- and post-intervention, including measures of symptom severity, symptom impact and goal achievement. Significant improvements were demonstrated across all self and parent-reported measures post-intervention, with mean scores falling firmly in the non-clinical range, a significant reduction in the proportion of CYP in the clinical range on measures, and predominantly medium to large effect sizes. Results are promising in terms of the capacity to train a graduate workforce to deliver a range of low-intensity CB interventions to CYP experiencing mild to moderate depression or anxiety-based difficulties in either CAMHS or school settings, increasing capacity across the system. The current practice-based evaluation also supports the potential effectiveness of current training models/programmes. Further research is needed in terms of long-term outcomes and to compare outcomes between settings, interventions, and demographic groups.

Computerised cognitive behavioural therapy (CCBT) has been made available within the National Health Service (NHS) across Scotland as an alternative treatment for mild to moderate anxiety and depression. However, the provision of CCBT services is still limited in the NHS, possibly affecting delivery of this computer-aided therapy to patients and inhibiting acceptance and uptake of this intervention. This paper reports on the qualitative exploration of patients’ experiences and acceptance of one CCBT programme delivering computer-assisted therapy (Beating the Blues: BTB), examining particularly the point of referral, access to treatment, and support. Thematic analysis was conducted on semi-structured face-to-face and email interviews with 33 patients at different NHS organisations across Scotland. Data analysis generated six key themes which illustrated patients’ experiences relating to referral and access to the treatment, and the challenges they faced: (1) information dissemination; (2) expectations and the impact of waiting for BTB; (3) impact of locations on experience of BTB; (4) preference for home access; (5) desire for better human support; and (6) desire for additional application support features. The findings highlighted that better methods of implementing and delivering such CCBT services together with the design of the technological interventions are vital to the success of these services.

For more than a decade, Improving Access to Psychological Therapies (IAPT) has been training a new workforce of psychological therapists. Despite evidence of stress and burnout both in trainee mental health professionals, and qualified IAPT clinicians, little is known about these topics in IAPT trainees. Consequently, this systematic review sought to establish the current state of the literature regarding stress and burnout in IAPT trainees. Electronic databases were searched to identify all published and available unpublished work relating to the topic. On the basis of pre-established eligibility criteria, eight studies (including six unpublished doctoral theses) were identified and assessed for quality. This review identifies that research into the experience of IAPT trainees is under-developed. Existing evidence tentatively suggests that IAPT trainees may experience levels of stress and burnout that are higher than their qualified peers and among the higher end of healthcare professionals more generally. The experience of fulfilling dual roles as mental health professionals and university students concurrently appears to be a significant source of stress for IAPT trainees. More research regarding the levels and sources of stress and burnout in IAPT trainees is urgently needed to confirm and extend these findings. Recommendations for future research in the area are given.

Mental health problems have a significant impact globally in terms of social and economic costs. Increasing access to and uptake of mental health interventions (particularly by men) remains a challenge for service providers. The current study sought to examine the efficacy of a delivering a Stress Control intervention in partnership with a community sporting organisation (the Gaelic Athletic Assocaition, GAA) in ameliorating mental health difficulties in a general population. Measures of anxiety, depression and quality of life were administered before and after the delivery of the 6-week programme. A focus group was conducted afterwards to gather qualitative data on participants’ experiences of the intervention. Statistically significant decreases in depression scores were found following attendance at the course: t (94) = 3.14, p = .002, with a large effect size (0.5) (n = 95). There was an increase in the number of male attendees compared with clinic-based courses. Thematic analysis of the focus group data revealed a number of key themes including increased accessibility in terms of the scale and context of the delivery of the course. Delivering large-scale psychoeducational courses like Stress Control in partnership with the GAA represents a promising avenue for increasing access (for males in particular) to an effective intervention for improving mental health outcomes

The present study aimed to explore patients’ experience with an Improving Access to Psychological Therapies (IAPT) service, and to investigate the reasons for discontinuing their treatment. A qualitative approach was adopted using thematic analysis of semi-structured interviews carried out with 818 patients attending for treatment in Talking Change from November 2015 to January 2019, retrospectively. The five main themes that emerged from the study were: ‘Felt better’, ‘Issues with group settings’, ‘Therapeutic alliance breakdown’, ‘Miscommunication’ and ‘Impracticalities’. The qualitative study uncovered a wide range of reasons for people who had dropped out from their treatment. The findings mainly emphasised general dissatisfaction and inconvenient appointments. However, improvement in symptoms of depression and anxiety was also identified as a key factor among patients who discontinued their treatment. This recovery is known as ‘progress withdrawal’ in which patients withdraw from treatment early due to good therapeutic progress. We present clinical and procedural implications arising from these themes.