Care-experienced young people—those who have spent time in foster care, children's homes, or other state care—are more likely to develop mental health problems than their peers, yet the treatments offered to them often fail to work or stop working within six months. This project addresses a specific gap: existing interventions are not designed for the complex, overlapping conditions—such as anxiety alongside ADHD or trauma alongside autism—that are common in this group. The researcher will first analyse a large existing dataset to identify distinct symptom patterns, then adapt a modular intervention that lets clinicians pick and mix evidence-based treatment components to match each young person's needs. If successful, the approach could give social care staff and NHS therapists a practical, flexible toolkit that improves mental health outcomes for a population that currently faces higher mortality rates and significant health and social care costs. The study also aims to inform policy decisions, such as how the Adoption Support Fund is allocated, and to reduce carer dissatisfaction with mental health services.
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Care-experienced young people (CEYP) present with elevated rates of mental health problems and neurodevelopmental conditions, with high levels of heterogeneity and comorbidity(1,2). Mental health problems in this population are associated with excess mortality and significant health and social care costs(3,4). Yet CEYP are frequently unable to access evidence-based interventions(5,6), with carers reporting high levels of dissatisfaction with mental health services(7). Currently, our understanding of CEYPs mental health problems and the barriers and facilitators to them accessing mental healthcare is limited. Existing interventions also only have limited efficacy, with 'small' effect sizes at post-intervention and no significant effects found at 6-month follow-up (8). It is hypothesised that modular interventions may provide an effective framework for improving mental health outcomes for CEYP. Research questions: What are the barriers and facilitators to effective mental healthcare for CEYP? What are the symptom presentations of mental health problems in CEYP? Does a modular intervention show evidence of acceptability and preliminary efficacy for reducing mental health problems in CEYP? Aims, methodology and timelines for delivery: 1. To investigate the perspectives of different stakeholders regarding the barriers and facilitators of effective mental healthcare for CEYP This will be achieved through a critical interpretive synthesis incorporating principles from rapid realist reviews. (Year 1) 2. To investigate the symptom presentations of mental health problems in CEYP This will be achieved through a Latent Class Analysis of a large-scale existing data set, to identify symptom subgroups that could be targeted by existing evidence-based interventions. (Year 1) This will also inform the adaptation of an existing modular intervention as part of the third component of this fellowship. 3. To adapt an existing modular intervention that could feasibly be delivered by staff within services, before evaluating it within a single-case experimental design (SCED). This will be achieved through two stages: A treatment development and feasibility phase underpinned by Normalization Process Theory. (Year 2) A SCED with 6-8 young people to preliminarily evaluate the intervention. (Year 3) Patient, carer and public involvement This research proposal has been informed by consultation with a Patient Public Involvement (PPI) Group and a Practitioner Advisory Group (PAG) who will collaborate on each stage of the project. CEYP are an underserved population, with limited inclusion in healthcare research despite the high healthcare burden they experience, and disproportionate numbers of individuals coming from diverse backgrounds. The PPI group will be developed to reflect this, with sensitivity towards diversity embedded throughout the design. This proposal is supported by several existing research groups, which will facilitate engagement with the research community from the outset. Dissemination and impact The results will be disseminated through peer-reviewed journals, conferences, webinars, vlogs/blogs, newsletters and a study website, to maximise engagement with various stakeholders. This study has significant implications for individual and population health. It could improve health outcomes for CEYP and their families and guide treatment decision-making within services, reducing health and social care costs. It could also impact policy- for example, the allocation of the Adoption Support Fund.
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