Access to best-evidenced mental health support for care-experienced young people: Learnings from the implementation of cognitive therapy for PTSD

Abstract

Objectives: Rates of PTSD are up to 12 times higher in care-experienced young people (CEYP) compared to their peers. Trauma-focused CBTs are the best-evidenced treatment for youth with PTSD, yet, in practice CEYP often struggle to access this treatment. We worked alongside services to understand barriers and facilitators of the implementation of cognitive therapy for PTSD (a type of tf-CBT) to CEYP. Design: This was an active open implementation trial. Methods: We recruited 28 mental health teams across England, including general CAMHS, targeted-CAMHS for CEYP, and social care based teams. From these teams, participants were 243 mental health professionals, from a wide variety of professional backgrounds. Following recruitment/intervention training, teams participated in rolling 3-monthly focus groups and individual interviews, to understand what helped and hindered implementation. Data were analysed using a framework analysis conducted using the CFIR 2.0. Results: Almost half of the teams were able to implement, but only approximately one quarter with CEYP, specifically. Universal barriers that were discussed by almost all teams, particularly highlighted service-structures and commissioning as a major barrier delivery to CEYP, as well as the complexities of the young person and their network. Unique factors that differentiated teams who did and did not implement included the culture of the team, leadership engagement and style, and the development of in-house supervision structures. Conclusions: Findings offer key considerations for mental health teams, service leads, commissioners and policy-makers, to enhance delivery of best-evidenced mental health treatments like CT-PTSD, for CEYP.