Research
Please see below for current and past projects.
Current Projects
Our team run mixed-methods research projects that aim to better understand the mental health needs of young people who have experienced complex trauma and adversity. Below is information on our main projects.
For a list of academic publications click here.
Accessible summaries of published papers are available below:
- What do we know about the mental health and wellbeing of care-experienced young people in the UK?
2. What helps and hinders mental health services in delivering best-evidenced therapies to care-experienced young people?
A ReThink Spotify playlist has been created by young people involved in our research project, including our care-experienced participants (aged between 10-14 and 16-18) and our care-experienced advisors. Young people chose their favourite ‘feel good’ songs or songs that represent something about their experience of living in care.
Click here for a version suitable for all ages
Click here for a version suitable for over 18s
ReThink: A longitudinal investigation of the mental health and wellbeing of care-experienced young people
The Re-Think programme: A longitudinal investigation of the mental health and wellbeing of care-experienced young people
The ReThink programme is funded by the Medical Research Council and is co-led by Prof Rachel Hiller and Prof Lisa Holmes.
Compared to the general population of young people, those with care-experience have far higher rates of mental health difficulties, which can have
lifelong consequences for their wellbeing (e.g., relationships, school, work). But poor outcomes are not inevitable. With the right support care-experienced young people can thrive. However, there remains little research evidence to help us understand what drives mental health and wellbeing in this group, and therefore how we might best provide support or develop interventions.
The aim of the ReThink programme is to learn what drives the mental health and wellbeing of care-experienced young people, including what predicts poor mental health, but also positive outcomes such as liking school or life satisfaction. We are particularly interested in understanding this over two key transition periods: as young people move into secondary school, and then again as they move into early adulthood. These can be times of change and disruption and we want to better understand what good quality support could and should look-like during these periods.
ReThink uses multiple methods to explore drivers of mental health and wellbeing. We are particularly focused on unpacking the role of: i) pre-care experiences, ii) within-service experiences (particularly in care and school), and iii) psychological and social processes (e.g., how they see themselves and others, manage emotions, and their feelings about support from friends and at home). If we can understand what processes are important and what they mean for wellbeing, we can help social workers, teachers, and mental health workers better identify those who might need help, and design better prevention and intervention programmes.
For any questions about ReThink please contact Eva Sprecher on eva.sprecher@ucl.ac.uk
ADaPT: Assessment and Delivery of PTSD Treatments for care-experienced young people
The cross-sector pilot implementation of trauma-focused CBT for care-experienced young people with posttraumatic stress disorder.
The ADaPT project is funded by the NIHR Applied Research Collaboration network.
We know from previous research that there are high rates of posttraumatic stress disorder (PTSD) symptoms in care-experienced young people. This may stem from very difficult early life experiences or could be from experiences within the care system. PTSD is a trauma-specific mental health outcome. While the symptoms of PTSD can be very
difficult for a young person to live with and manage, we do have good treatments available. Trauma-focused cognitive behaviour therapies (tf-CBT) are the best-evidenced approach for supporting children and young people (and adults) to overcome PTSD, including children who have experienced very complex traumas. However, we know that PTSD is often not routinely assessed in this group and that this treatment is often not available, even when these young people do access mental health services.
The ADaPT project seeks to understand what training, support and structures mental health services need to be able to deliver best-evidenced mental health treatments to care-experienced young people, with a specific focus on PTSD and tf-CBT. As part of this project the team have trained over 200 mental health professionals in this treatment. Most of these professionals work within general or targeted CAMHS, while some work in mental health teams based in local authorities. They come from a range of different professional backgrounds. Following the training, the ADaPT team have worked alongside these professionals and their services to understand barriers and facilitators of both screening care-experienced young people for PTSD symptoms, and delivering tf-CBT.
As part of ADaPT we have also created a series of resources for young people and for mental health professionals.
Trial registrations: ISRCTN38238325 https://doi.org/10.1186/ISRCTN38238325, CPMS 52819, IRAS 307056.
For any questions about ADaPT please contact Prof Rachel Hiller on r.hiller@ucl.ac.uk
Past Projects
The ReLATE Trial
A feasibility and pilot randomised controlled trial of a low-intensity group intervention for young people in care with elevated posttraumatic stress symptoms
The RELATE trial is funded by the National Institute for Health and Care Research.
The main aim of the RELATE trial is to test a group-based mental health intervention to support children and teens in care experiencing high PTSD symptoms. It is a feasibility pilot study, meaning we want to understand how we can best test this intervention at a larger scale and whether it is acceptable to young people and mental health professionals. The intervention being tested is called Teaching Recovery Techniques. This was originally designed for children exposed to war and we adapted it for children and teens in care. It involves five sessions with the young person and two with their caregiver. We tested the intervention delivered in-person and as a digital intervention (over Teams and Zoom). The intervention was delivered by mental health professionals within a social-
care based team and a specialist CAMHS team. Young people and caregivers completed assessments before treatment, after treatment, and at a three-month follow-up. We also interviewed young people, caregivers and service-providers about their experiences with the intervention.
Progress: Recruitment for RELATE has now finished and the project is closed. Data analysis is currently underway, and the results from this study will inform the design of a definitive RCT.
Trial registration: ClinicalTrials.gov, NCT04467320 (13/07/2020).
CCATS Project
The C-CATS project was funded by the Economic and Social Research Council (ESRC) and looked at whether our current understanding of posttraumatic stress symptoms (PTSD symptoms) was applicable to children and teens in care. In particular, we explored the relevance of the cognitive model of PTSD, both in terms of PTSD and complex PTSD. This is the model that underlies our main treatment approach (trauma-focused CBT), but clinically and academically there is often debate about whether it applies to children who have experienced more complex trauma or face more ongoing instability. The study recruited 120 young people in care, aged 10-18yrs. They and their caregiver completed questionnaires at two timepoints, one year apart. Some young people and caregivers also participated in qualitative interviews to learn more about their experiences with mental health, coping and support.
We found that our current cognitive models of PTSD were highly applicable to these young people. In particular, maladaptive appraisals (thoughts like ‘I can’t trust anyone’, ‘the world isn’t safe’, ‘It was my fault’) and coping (avoiding thinking or talking about what happened) were strong predictors of higher PTSD symptoms and complex PTSD symptoms. From carer interviews we also learned about the challenges they faced trying to support their young people and get them professional support, where needed. From young people we learned about what they like and don’t like about being in care and about the support they have received for their mental health.
Publications from the CCATS project can be found here.
Related media and engagement activities from CCATS can be found here.
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