Helping care-experienced young people get access to best-evidenced treatments for PTSD

The barriers and enablers to offering care-experienced young people the best-evidenced treatments for post-traumatic stress disorder (PTSD) have been explored in a newly published study in the British Journal of Clinical Psychology.

Young people who have been in care are 12 times more likely to have PTSD compared to their peers. There are well-established treatments for PTSD, particularly forms of trauma-focused cognitive behavioural therapy (tf-CBT), which are recommended in guidelines. But care-experienced young people aren’t usually offered such treatment.

The National Institute for Health and Care Research (NIHR) funded ADaPT (Assessment and Delivery of PTSD Treatments) study was led by researchers from University College London, the Universities of East Anglia, Exeter, Bristol and Bath and King’s College London.

The team recruited 28 mental health teams across England. This included professionals from general Child and Adolescent Mental Health Services (CAMHS), targeted-CAMHS for care-experienced young people, and social care-based teams. The teams included 243 mental health professionals, from a wide variety of professional backgrounds.

The recruited teams were given training on the tf-CBT intervention. They then participated in rolling 3-monthly focus groups and individual interviews, to understand what helped and hindered implementation.

Almost half of the teams were able to implement, but only around a quarter specifically with care-experienced young people. Almost all teams highlighted the same barriers, including service structures and confusing pathways between social care and CAMHS, as well as the complexity of the young people’s lives and networks.

Differences between the teams who did and didn’t implement tf-CBT included:

• Commissioning and prioritisation decisions
• The culture of the team and buy-in to evidence-based practice
• Leadership engagement and strong supervision structures

Rachel Hiller, Professor of Child and Adolescent Mental Health at University College London and lead researcher on the study, said:

“We know that children and young people who’ve been in care are far more likely to have PTSD than other young people. But we also know that PTSD is under-diagnosed in this group, for a number of reasons. We have very good evidence-based treatments for PTSD. If we can identify young people who might be struggling with PTSD, we know how to help.

“We also know social care and mental health services are facing many challenges. With the ADaPT study, we wanted to work alongside services to understand what might help or hinder their ability to screen for PTSD and offer best-evidenced care. The findings have helped us develop a national picture of the challenges services face, but also the opportunities to provide best-evidenced care, for PTSD and other mental health difficulties that we know are common in young people in care.

“Taken together, our findings provide insight into what mental health teams, service leads, commissioners, and policy-makers need to consider if services are to deliver best-evidenced practice to care-experienced young people. Certainly, young people in care and care-experienced young people more broadly, have a right to have access to our best-evidenced mental health care.”

This project was led by the NIHR Applied Research Collaboration (ARC) West and ARC North Thames. It was funded through the NIHR ARCs Consortia for Health and Care Inequalities hosted by the ARC North East and North Cumbria and Child Health and Maternity hosted by PenARC.