Children in classrom

Mental health difficulties and academic performance during middle childhood and early adolescence interrelate over time

New research led by the Evidence Based Practice Unit has investigated the link between mental health difficulties and academic performance during middle childhood and early adolescence.

It is widely accepted that different aspects of a child’s development are related over time. Dr Jess Deighton led the study to investigate the link between internalising symptoms (i.e. those that are focused inwards, such as depression and anxiety); externalising problems (i.e. those that are directed outwards, such as aggressive behaviour); and academic attainment during childhood in two age groups: middle childhood (ages 8–9) and early adolescence (ages 11–12). 

Children completed questionnaires at the beginning of the study and again two years later. The analysis of the resulting data built on the principle of development cascades: different aspects of functioning are developmentally related, and these relationships may vary according to the age and stage of development. 

The study’s results highlight that externalising problems can be barriers to academic achievement for primary and secondary school students. Findings suggest that interventions aimed at addressing challenging behaviour could also help to enhance academic achievement.

The results also indicated some difference between the different age groups involved in the study groups: internalising problems predicted later academic attainment, but only for the adolescent age group. Furthermore, low academic attainment was related to later internalising symptoms, but only in the middle childhood age group.

According to Dr Deighton et al., this study draws out interesting similarities and differences between these two age groups, and contributes to the growing research on longitudinal associations between internalising symptoms, externalising problems and academic attainment in childhood and adolescence.

 You can read the full article here.

MW speaking ebpu conf

New mental health research unit launched

November 2017

The NIHR Mental Health Policy Research Unit is launched today. Led by UCL and King’s College London, the new research unit will provide evidence to inform mental health policy.

Professor Miranda Wolpert, Director of the Evidence Based Practice Unit, is a co-investigator in the research unit, which will bring mental health policy makers, researchers, clinicians, service users and carers closer together.

The research unit will help the Department of Health and other policy makers develop plans that are based on sound evidence. The unit will focus on prevention, access and quality of mental health care, by conducting research on the impact of existing policies. With a national focus, it will help to guide future plans, and provide expert advice.

Commissioned by the Department of Health’s Policy Research Programme and funded by the National Institute for Health Research (NIHR), the research unit will be hosted at UCL, jointly led by UCL and King’s, alongside researchers from City, University of London and Middlesex University.

Professor Sonia Johnson (UCL Psychiatry), the Director of the Unit says:

Across the health care system, we know more about what works than what we actually put into practice, as policy makers don’t always have the latest research findings readily available.

We are putting together a responsive core team, and building up a broader network of experts who will ensure that policy makers will have access to the most comprehensive and up-to-date evidence to guide their plans.”

You can read more about the unit and follow the unit on Twitter.

September 2017

Changes in severity of psychosocial difficulties article published

Lead author, Julian Edbrooke-Childs, talks about the findings of this research.

You can also read the article in the Journal of Adolescence.

July 2017

What constitutes a good outcome in mental health? 

In July we hosted a conference around what constitutes a good outcome in child and adolescent mental health, bringing together speakers from a variety of backgrounds. 

You can watch the panel discussion that took place at the conference.   

New article published 

Rosa T

A qualitative investigation of staff's practical, personal and philosophical barriers to the implementation of a web‐based platform in a child mental health setting by Rosa Town, Nick Midgley, Louise Ellis, Rebecca Tempest and Miranda Wolpert was published in Counselling and Psychotherapy Research on 4 July.

Q&A with lead author, Rosa Town

What did this research aim to find out?

The research aimed to help us to understand the factors that discouraged staff from using an interactive, web-based platform called CAMHSweb (now called ‘IncludeMe’) with young people in a child and adolescent mental health service (CAMHS).

CAMHSweb aimed to increase shared decision making (SDM) and collaborative practice in child and adolescent mental healthcare. Although the use of evidence-based technology is becoming more widespread, the barriers to staff using web-based platforms in child mental health services have not been explored in previous research.

How did you investigate this?

We carried out semi-structured interviews with open-ended questions which were used to prompt discussion, and we then explored participants’ responses further in follow-up questions. We interviewed six employees in a child mental health service where the platform was not being successfully used in clinical work. We then analysed the interviews using thematic analysis, which looks at the themes in the data.

What did you find?

There were three themes which covered the practical, personal and philosophical barriers to staff using CAMHSweb. The first theme, a practical barrier, was that it is too challenging to implement new technology in the service. Interviewees described their frustration with using new technology and their lack of “headspace” due to a service restructuring. The second theme, a personal barrier, was that the platform is not an asset to therapists. Clinicians did not believe the portal would be personally useful to them, either because it was unappealing-looking or an unnecessary addition to practice as usual. The third theme, a philosophical barrier, was that the platform interferes with the therapeutic process. Here clinicians described how they believed the portal had the potential to damage the therapeutic relationship or hinder collaboration in therapy.

What does this mean?

Identifying these barriers may be useful in the future design, development and implementation of web-based platforms in child mental health services. However, given the small sample size of the study, further research into the use of web-based platforms in other CAMH services would be necessary to see if these or other barriers are present elsewhere.

June 2017

Congratulations to EBPU staff on their promotions at UCL!


EBPU is proud to announce that two key members of staff, Dr Jessica Deighton and Dr Julian Edbrooke-Childs, are to receive promotions at UCL.

Jess Deighton is to become a Reader in Child Mental Health and Wellbeing and Julian Edbrooke-Childs a Lecturer in Evidence Based Practice.

The promotions are recognition of both Jess and Julian’s hard work and achievements in the field of evidence-based practice in child mental health.

A key strand of Jess’ current work is the HeadStart project, a major seven-year national programme trialling a broad range of initiatives for improving resilience in young people,  aged 10 to 16, funded by the Big Lottery. Jess leads the Learning Team which works alongside the University of Manchester, London School for Economics, the Child Outcomes Research Consortium (CORC), Common Room and the partnership areas to evaluate the impact of the programme. The Wellbeing Measurement Framework, a set of wellbeing measurement tools for schools, helps to do this and  ensures consistent measurement of young people’s resilience and wellbeing across the programme.

Julian is currently working on Power Up, a smartphone app which aims to enable young people, aged 11 to 19, to record and share ideas and decisions in ways that empower them to take a more active role in therapy. Funded by the National Institute for Health Research, the app is undergoing a year-long feasibility trial in three child and youth mental health services in London.

By Charlotte Payne

May 2017

New resources released

Embedding tools leaflet

EBPU and CORC have collaborated with The Health Foundation and Common Room to create a set of guidance for children and young people, commissioners, and practitioners working with children and young people. The following resources about person-centred care in children and young people's mental health services have just been released:

For children and young people

For commissioners

For practitioners

April 2017

'So what are the barriers and facilitators to person-centred care in CAMHS?', delivered by Dawid Gondek

Despite a recent emphasis on providing person-centred care within child and adolescent mental health services (CAMHS), research shows children and young people are rarely actively involved in their treatment. Drawing on a recent systematic review, this seminar on 25 April 2017 asked "So what are the barriers and facilitators to person-centred care in CAMHS?" through a presentation on the paper by its lead author, Dawid Gondek, and an interactive panel discussion.The seminar was attended by practitioners and researchers, and was facilitated by Professor Miranda Wolpert.

For more information, see the presentation.

"So What?" seminar series

The "So What?" seminar series aims to build the bridge between evidence and practice in child mental health by asking 'So what does this mean for policy and practice?' in response to research findings, project outcomes, and the work of our collaborators.

High integrity mental health services for children: focusing on the person, not the problem by Miranda Wolpert, Panos Vostanis, Kate Martin, Simon Munk, Rachael Norman, Peter Fonagy and Amy Feltham, published on 3 April

High integrity healthcare emphasises that more services do not guarantee more health, that clinical evidence alone should not determine treatment, and that healthcare is best delivered by including non-health professionals. The authors consider these three principles and look at the way forward for provision of mental health services for children. 

You can also listen to a related podcast about high integrity healthcare with authors Miranda Wolpert and Amy Feltham, and Clare Rowland, a volunteer from the Pause Centre in Birmingham.

March 2017

At the end of March, the Evidence Based Practice Unit relocated from Rodney Street, London, to Jordan House, near Old Street. This was to allow building work on the Anna Freud National Centre for Children and Families' new Centre of Excellence to commence.

The new Centre will bring under one roof the very best science, education and mental health support for families struggling to cope with profound mental ill health. At the heart of the campus will be the Family School, which is for 48 vulnerable children who have been excluded from mainstream education and face a bleak future without the dedicated support the new Centre will provide.

We are very happy in our new home in Jordan House, but look forward to returning to Rodney Street – and to establishing the Unit in the new Centre of Excellence – in 2018.

February 2017

Rosa Town, a research assistant at EBPU, is running the London Marathon to raise money for the Anna Freud National Centre for Children and Families.

You can read more about why she is running the marathon here.

January 2017

New articles published

Goal formulation and tracking in child mental health settings: when is it more likely and is it associated with satisfaction with care? by Jenna Jacob, Davide De Francesco, Jessica Deighton, Duncan Law, Miranda Wolpert and Julian Edbrooke-Childs, published in January 2017

Q&A with senior authorJulian Edbrooke-Childs


What did this research aim to find out?

Goal formulation has been used in mental health settings in the UK and the US for some time, and is seen as important in evidence-based practice. However, little is known about this approach in children’s therapy.

Specifically, we wanted to find out whether setting goals with patients, and keeping track of the goals, was more likely with certain children and young people – and whether setting goals and keeping track of them meant that patients’ parents were more satisfied with the care their children received.

How did you investigate this?

We looked at 3,757 cases from 32 child mental health services and used the Goal-based Outcomes (GBOs) tool and the Experience of Service Questionnaire (ESQ). The GBO tool measures progress towards goals which have been agreed and set by practitioners, children and parents. The ESQ asks 12 questions about the support received and is completed by parents.

We then used two statistical methods: a multilevel logistic regression to look at the goal setting against children’s characteristics, and a Poisson regression to look at the difference between parents who were completely satisfied with care, and the parents who were not completely satisfied with care.

What did you find?

We found that formulating goals was more likely for pre-schoolers, those with learning difficulties, or those with both hyperactivity disorder and conduct disorder.

With regard to whether parents were more likely to be satisfied with their child’s care if goals were set and tracked, we found that parents of children where this had occurred were more likely to report that they were completely satisfied with the service.

What does this mean?

The findings suggest that goal formulation and tracking might be important in patient satisfaction with care. We would recommend that clinicians consider using goal formulation and track the goals with their patients, as it seems to promote collaboration. We would also highlight the need for better training in goal formulation and setting, in order to make sure that more children and parents can be worked with in this way.

You can read the goal formulation article in full.

Service-level variation, patient-level factors and treatment outcome in those seen by child mental health services by Julian Edbrooke-Childs, Amy Macdougall, Daniel Hayes, Jenna Jacob, Miranda Wolpert and Jessica Deighton, published in January 2017

Q&A with lead author, Julian Edbrooke-Childs

What did this research aim to find out?

The research aimed to find out whether child mental health outcomes varied across different mental health services. Comparing the outcome of treatment across services is a priority in healthcare in order to find out the impact and quality of the service, and because it is important to be able to demonstrate what the service is achieving – to secure future funding, for example.

We also wanted to find out whether there were particular characteristics of patients which were associated with the difference in the services.  

How did you investigate this?

We had a sample of 3,256 young people from 13 child mental health services. Their parents had completed a commonly used questionnaire, the Strength and Difficulties Questionnaire. We applied a statistical method, multilevel regression, to the scores on the questionnaire in order to examine service level variation and whether this was explained by the demographics and characteristics of the patients.

What did you find?

We found that there was a slight variation in outcomes (4–5%) and that children with autism – and less common characteristics (termed ‘infrequent cases characteristics’), such as substance misuse, had a greater risk of poor outcomes.

What does this mean?

Although the findings showed variation between services, it is important to treat these cautiously. This is because there appears to be more variation between patients than between the child mental health services. For this reason, we would recommend using methods which account for differences across services, such as funnel plots.

We should also be particularly careful when looking at services with high proportions of young people with autism, or less common characteristics, who require specialist input. It may appear that these services are performing less well than other services, when the differences may be because of the patients’ characteristics.

You can read the service-level variation article in full