Wait Less: Co-designing and Evaluating An Online Self-Help Brief Psychosocial Intervention (eBPI) For Young People With Mood Related Mental Health Problems To Reduce Waiting Lists in Specialist CYPMHS.

Research question: Could a newly developed digital version of an established NICE recommended psychological therapy (digital Brief Psychosocial intervention – eBPI) alleviate symptoms and impairments such that a young person may not need subsequent face to face treatment or require fewer face to face sessions? Background: The increasing waiting lists for Children and Young People’s Mental Health Services (CYPMHS) are a major barrier for young people trying to access mental health care. The average wait until the first assessment is 9 weeks, often followed by a further 20 weeks wait for treatment, with huge variation between- and- rapid-variation within clinics. Access to digital support earlier is highly desirable and might free up CYPMHS capacity for those who need more treatment. There is no adequately tested digital tool that can achieve these aims. Aims and objectives: We aim to test the feasibility, acceptability, and potential utility of eBPI to reduce wait list suffering among young people on CYPMHS waitlists. Our objectives are to: i) understand young people’s, parents' and clinicians' waitlist experiences ii) co-produce eBPI iii) determine if eBPI warrants a fully powered RCT to robustly establish clinical and cost effectiveness. Methods: Four linked work packages (WPs) using a mixed methods design as follows: WP1 will focus on discovery of patient waitlist experiences and clinical governance for eBPI; WP2 will engage with young people and carers using existing BPI manuals and early data from WP1 to provide the initial stimulus for discussions and development. They will contribute to the selection and presentation of eBPI materials as well as the content and design to ensure eBPI is accessible, intuitive, engaging, and user friendly. WP3 will deliver prototype eBPI with five young people from participating CYPMHS to check implementation efficiency, finalise standard operating procedures and determine a protocol for clinician support. Feedback from young people, parents and clinicians will feed into refining eBPI. WP4 will comprise a pilot trial of eBPI versus waiting list as usual with embedded process and economic evaluations. We will randomly allocate 80 young people aged 12 to 17 years to eBPI or waiting as usual with duty clinician support as provided by local CYPMHS across both arms. The participating CYPMHS are all currently using the established, NICE approved, face-to-face BPI in their clinics so have trained and experienced clinical staff to support the use of eBPI implementation. Young people trialling eBPI will keep their ‘slot’ on the waiting list unless a shared clinical decision is reached to discharge them. Timelines for delivery: WP1, Discovery of patient experiences and clinical governance for digital health intervention eBPI, months 0 to 12 ; WP2, co-design of eBPI, months 12 to 22; WP3, acceptability and feasibility, months 16 to 22; WP4, pilot trial of eBPI versus waiting list as usual with embedded economic and process evaluation, months 23 to 34, with two months for syntehsis and reporting. Anticipated impact and dissemination: We will establish whether eBP is a potentially useful treatment, for CYPMHS and other settings, such as primary care and schools. Regardless of whether eBPI looks clinically promising each WP will generate useful findings, which we will publish through a variety of media. If appropriate, we would conduct a definitive randomised controlled trial in a subsequent study.