The DISCOVER implementation study: Investigating the sustainability and scale up of a schools based intervention to improve mental wellbeing of 16-18 years olds across six regions in England.

Research question: What are the factors that help or hinder the implementation of the DISCOVER intervention in a sustainable, cost-effective way outside of a trial environment in the NHS, whilst achieving the clinical outcomes observed within the trial environment? Background: The prevalence of mental health problems among young people has dramatically increased, with a significant proportion of 17- to 19-year-olds in England experiencing mental disorders. Barriers to accessing formal mental health support include stigma, confidentiality concerns, and limited capacity of specialist services. The DISCOVER intervention, a school-based program delivered by NHS staff, aims to address these issues by providing accessible, evidence-based mental health support to adolescents to manage and reduce symptoms of anxiety and depression. Aims 1. To provide a theoretically informed assessment of the factors influencing successful and sustained implementation of DISCOVER in routine practice in secondary schools. 2. To publish evidence-based recommendations, guidance and toolkits to support future implementation of DISCOVER across the secondary education sector. Objectives 1. To develop an Outcomes Measurement Framework to track ongoing effectiveness of the DISCOVER intervention 2. To support 3 regions previously involved in the BESST trial to run further cohorts of DISCOVER workshops, alongside mobilising and training 3 new regions in England to implement the DISCOVER intervention in a diverse sample of schools 3. To use the Consolidated Framework for Implementation Research (CFIR) to investigate factors that positively or negatively influence implementation of the DISCOVER intervention and to assess the effectiveness of implementation in terms of reach, consistency of adoption, equity and sustainability. 4. To evaluate the cost implications of implementing the DISCOVER intervention. 5. To consolidate findings into a DISCOVER implementation guide and toolkit for NHS providers and education settings for 16-18 year olds. Methods: A three-year mixed-methods study employing the Consolidated Framework for Implementation Research (CFIR) to investigate the implementation process. Outcomes data from students will be collected using an established electronic tool, POD, with a pre-post design to assess clinical outcomes. Interviews, focus groups and a live implementation journal will provide qualitative data on the process of implementation, and quantitative data will provide understanding of the scale of uptake and potential inequalities. A cost-consequence analysis will report the implementation costs and implementation outcomes. We will work closely with young people and other PPI groups. Timelines for delivery: 1st April 2025 to 31st March 2028 (3 years) Impact and Dissemination: This study will provide robust evidence on the implementation of DISCOVER, offering practical recommendations for scaling up the intervention within the NHS and educational settings. The findings will be shared through high-impact journals, conferences, policy briefings, and an accessible online implementation guide. By addressing critical gaps in adolescent mental health support, this research aims to improve mental wellbeing outcomes and reduce the burden on specialist services.