Understanding young people's engagement with psychological therapies through a social inequalities lens

未来奖学金的最终目标是确保心理治疗适当和敏感地适应它所提供的人群;证据表明，这会在个人和社会层面上改善结果。本奖学金将通过以下方式进一步实现这一目标：1。重新考虑已经从不同角度收集的数据心理或谈话疗法越来越多地用于帮助患有抑郁症等常见心理健康问题的人。有必要向更多的人提供治疗;扩大覆盖范围的一个方法是由不太专业的工作人员提供治疗。行为激活（BA）是一种简单，简短的谈话疗法，使用手册来指导从业者。我的博士学位探讨了BA是否有助于参加儿童和青少年心理健康服务（CAMHS）的抑郁症年轻人，以及是否可以由心理治疗经验有限的工作人员提供。在研究BA时，数据中的一个主题显示，一些患者和家属在接受治疗时遇到了意想不到的困难。这些障碍与心理健康问题无关，而似乎植根于社会、环境或经济环境。我的博士学位不是为了进一步研究这个问题。在研究期间，我将重新检查这些数据。通过集中阅读的文献和指导我的导师，我将建立一个分析“框架”的因素，表明不利因素，我将适用于现有的数据从：-在CAMHS集中民族志（文件/访谈/观察）和访谈（与那些提供BA），以了解工作人员的观点，患者经历的不平等如何可能干扰治疗。与接受BA的年轻人（和陪同父母）进行访谈，以评估经验是否因社会经济地位而异。生活在较富裕地区的家庭将被一起分析，并与来自较贫困社区的家庭进行比较（基于部分邮政编码）。作为剥夺的另一种衡量标准，我将探讨不同群体之间不良的童年经历。如果来自弱势社会群体的家庭在治疗过程中确实遇到了更大的挑战，这将特别令人担忧，因为这些群体中心理健康问题的比例过高。发表我的发现在这些社会问题的高级培训之后，我将使用重新分析的结果来设计一个“逻辑”模型，详细说明解决CAMHS治疗弱势青年的障碍的资源，活动，产出，成果和影响。这是一种直观的方式来呈现和分享在政策背景下对这些关系的理解;阐明知识的差距并确定临床服务的应对方式。我会在不同的出版物上写我的工作，并使用社交媒体宣传研究。建立和保持联系除了在我的博士学位期间建立的临床网络，我将识别并与感兴趣的利益相关者沟通，以支持奖学金期间和之后开展的工作。我将通过面对面的研讨会（利用现有的会议和网络，如白色玫瑰博士培训伙伴关系[WRDTP]）和虚拟（通过举办网络研讨会）分享获得的知识和发现。这将增加我的研究的可见度，并促进共同解决问题。开发资金提案回到我的数据将最大限度地提高已经进行的公共资助研究的价值，逻辑模型将决定未来的研究方向。统计培训将扩展我的个人技能，为探索这些研究问题提供更广泛的机会。在确定的利益相关者的支持下，我将向外部资助者提交申请，旨在提供公平的护理和及时的患者福利;将自己定位为未来的领导者。

The ultimate aim of future Fellowships is to ensure psychological treatment is appropriately and sensitively adapted to the population it is being delivered to; evidence suggests that this results in improved outcomes at a personal and societal level. This Fellowship, will further this aim by:1. Reconsidering data already collected from a different perspectivePsychological or talking therapies are increasingly used to help people with common mental health problems, such as depression. There is a need for treatments that can be delivered to greater numbers of people; one way to increase reach, is through delivery by less-specialist staff. Behavioural Activation (BA) is one such simple, brief talking therapy that uses a manual to guide practitioners. My PhD explored whether BA was helpful to young people with depression attending Child and Adolescent Mental Health Services (CAMHS) and whether it could be delivered by staff with limited psychotherapies experience. Whilst researching BA, a theme from the data revealed that some patients' and families' experienced unanticipated difficulties in engaging with therapy. Rather than being related to mental health problems, these barriers seemed instead to be rooted in social, environmental or economic circumstance. My PhD was not designed to investigate this further. During the Fellowship, I will re-examine this data. Through focused reading of the literature and guidance from my mentor, I will build an analysis 'framework' of factors indicating disadvantage that I will apply to existing data from:- A focused ethnography in CAMHS (documents/interviews/observation) and interviews (with those delivering BA) to understand staff perspectives of how inequalities experienced by patients may interfere with treatment.- Interviews with young people receiving BA (and accompanying parents) to assess whether experiences differ based upon socioeconomic position. Families living in more affluent areas will be analysed together, and compared with those from more deprived communities (based upon partial postcodes). As an additional measure of deprivation, I will explore adverse childhood experiences between groups. If families from disadvantaged social groups did encounter greater challenges during treatment, it would be particularly concerning because mental health difficulties are over-represented in these groups.2. Publishing my findingsFollowing advanced training on these social issues, I will use the findings from the re-analysis to design a 'logic' model detailing the resources, activities, outputs, outcomes and impact of addressing barriers to CAMHS treatment for disadvantaged youth. This is a visual way to present and share understanding of these relationships in a policy context; illuminating gaps in knowledge and identifying ways clinical services could respond. I will write about my work in different publications, and publicise the research using social media.3. Making and maintaining connectionsAlongside clinical networks built during my PhD, I will identify and communicate with interested stakeholders, to support the work undertaken during and after the Fellowship. I will share acquired knowledge and findings via in-person workshops (utilising existing conferences and networks such as the White Rose Doctoral Training Partnership [WRDTP]) and virtually (by hosting a webinar). This will increase the visibility of my research and foster shared problem-solving.4. Developing funding proposalsReturning to my data will maximise the value of the publicly-funded research already undertaken and the logic model will determine future research directions. Statistical training will expand my personal skillset, providing greater breadth of opportunities for exploring these research questions. With the support of identified stakeholders, I will submit an application to external funders aimed at providing equitable care and timely patient benefit; positioning myself as a future leader.