UCL Great Ormond Street Institute of Child Health


Great Ormond Street Institute of Child Health


Inequality of access to and outcomes of child mental health interventions: a national linked data st

Supervisors: Dr Sophie Bennett, Dr Linda Wijlaars, Professor Roz Shafran

Inequality of access to and outcomes of child mental health interventions: a national linked data study

Children and young people including care givers, from poor and disadvantaged backgrounds, who have parents with mental health difficulties, from refugee and asylum-seeking families, disabled, LGBTQI+, looked-after children and children with physical health conditions and/or neurodevelopmental disorders, are more vulnerable to mental health problems. The majority get no support and there are often extensive waiting lists for Child and Adolescent Mental Health Services. Access can be particularly difficult for those groups who are already more vulnerable to mental health problems and therefore they are doubly disadvantaged and subject to significant inequities of treatment. One way of increasing access to evidence-based psychological treatments is through brief, ‘low-intensity’ interventions, such as guided self-help, which takes place over multiple sessions with a facilitator. They are recommended by NICE guidance as first line therapies for some mild to moderate problems and are used nationally within a stepped care model. However, there is significant variability in benefit and number of sessions completed. 

The overarching aim of this PhD study is to examine inequalities of access to and outcome of mental health care for children and young people with a view to reducing them. The PhD will uniquely combine qualitative methods with administrative datasets that include key variables associated with inequalities of care such as SES and ethnicity that have only recently become available for analysis. The PhD student will conduct a mixed-methods investigation of the outcomes of stepped care for mental health problems children and young people, and predictors of response. 

The Ph.D. is formed of 3 complementary studies, which will run concurrently. The first is a systematic review and meta-analysis of existing studies of low-intensity and stepped care treatments in children and young people, examining the dose-response and impact of factors associated with inequalities on this.  The second, multicomponent study is a statistical analysis of existing national datasets to examine:
What is the impact of clinical and demographic factors previously demonstrated to be associated with inequalities of care on treatment offered (a. whether referrals are accepted and treatment offered, b. what treatment is offered, particularly considering whether low or high intensity treatment is offered)?
1. To what extent is there a dose-response relationship between and within steps of care (i.e. low and high intensity treatments)
2.To what extent does dropout from low and/or high intensity treatments affect outcome?
3.What is the impact of clinical and demographic factors on this relationship?
The third main study is a qualitative investigation of the barriers to treatment for groups found to have unequal access to, or outcomes, of care in both the meta-analysis and the administrative data analyses.

1.    Delgadillo, J., McMillan, D., Lucock, M., Leach, C., Ali, S., & Gilbody, S. (2014). Early changes, attrition, and dose–response in low intensity psychological interventions. British Journal of Clinical Psychology, 53(1), 114-130.