Description of superordinate and subordinate themes encapsulating adolescents’ experience of STPP.

Description of superordinate and subordinate themes encapsulating adolescents’ experience of STPP.</p

Participant demographics: Age, number of sessions offered & attended, Mood and Feelings Questionnaire [MFQ] scores at T1 and T2.

Participant demographics: Age, number of sessions offered & attended, Mood and Feelings Questionnaire [MFQ] scores at T1 and T2.</p

Data analysis steps.

Data analysis steps.</p

The experience of sleep problems for adolescents with depression in short-term psychological therapy

A growing body of literature demonstrates a strong relationship between sleep disturbances and depression in adolescence. In spite of this, few studies have explored how adolescents with depression experience sleep problems. The present study aimed to qualitatively explore the experience of sleep problems in adolescents with depression, including their understanding of how a psychological therapy impacted on these sleep difficulties. The sample included 12 adolescents with sleep disturbances who had been offered treatment for depression through a large, multi-centre, randomised controlled trial. Semi-structured interviews conducted after treatment and 1-year post treatment were analysed using thematic analysis. Two main themes were identified. Both themes demonstrated how an overarching desire to escape impacted the adolescents’ sleep in distinct ways; ‘thinking about the ‘bad stuff’’ was characterised by ruminative thinking, which prevented sleep, whereas ‘sleep as an escape’ indicated a desire to sleep excessively due to feelings of helplessness. Overall, the findings demonstrate a nuanced relationship between sleep and depression in adolescence, and imply that the underlying meaning of the sleep difficulties for each young person should be considered in the delivery of therapy for adolescent depression

Table_1_“You can’t really have a relationship with them because they just ask you questions”: understanding adolescent dropout – an empirical single case study.DOCX

IntroductionHigh dropout rates are common in youth psychotherapy, including psychoanalytic psychotherapy, yet the reasons behind this trend remain obscure. A critical focus to enhance adolescent engagement could be the therapeutic alliance, particularly in resolving alliance ruptures. This study sought to clarify the complex relationships between the therapeutic alliance, encompassing alliance ruptures and resolutions, and dropout within the context of poor outcome. It investigated a single case of an adolescent with depression who dropped-out of Short-Term Psychoanalytic Psychotherapy, without showing clinical improvement.MethodData was garnered from diverse sources, including questionnaires, interviews, and session recordings, and analyzed through a mixed-method longitudinal framework. This encompassed views from the adolescent, therapist, parents, and external evaluators.ResultsThe study identifies several factors impacting the decision to drop out, including initial profound distrust toward the therapist, a complex and difficult therapeutic relationship characterized by unresolved alliance ruptures, and sporadic attendance. External factors including minimal parental engagement with therapy were also seen as detrimental to the adolescent’s involvement and progress.DiscussionThe research underscores the challenges in engaging adolescents, especially when there may be distrust of professionals, and in the absence of parental involvement with treatment.</p

Additional file 1: of The Herts and Minds study: feasibility of a randomised controlled trial of Mentalization-Based Treatment versus usual care to support the wellbeing of children in foster care

Results of additional measures. (ODT 12 kb

Well-being package for foster carers and teachers of looked-after children aged 8 to 11 years: the STrAWB feasibility RCT

BACKGROUND: Children in care are at elevated risk of mental health issues and poorer well-being, and social care and health services are under pressure to meet their needs. The Shared Training and Assessment for Well-Being programme is a recent approach to training and assessment designed to bring together foster carers and designated teachers to identify and meet the well-being needs of primary school-aged children in care, across the home and school contexts. OBJECTIVES: This feasibility randomised controlled trial addressed key questions concerning the acceptability of the Shared Training and Assessment for Well-Being intervention (including training, assessments, clinical review and feedback) and the feasibility of the research design for a larger randomised controlled trial (including recruitment, randomisation and outcome measures). DESIGN: This was a two-arm randomised controlled trial (Shared Training and Assessment for Well-Being intervention vs. control group), with two points of data collection (baseline and 12-month follow-up) for our primary and secondary outcomes. SETTING: The study focused on looked-after children from four local authorities in southern England. In the context of the COVID-19 pandemic, both the research and intervention activities were undertaken online with participants. PARTICIPANTS: Looked-after children aged 8-11 years were recruited from the participating local authorities, along with their foster/kinship carers and designated teachers. Carers for all children in the authorities meeting inclusion criteria were initially invited to participate. The original target sample size was 70 children, with 35 receiving the Shared Training and Assessment for Well-Being intervention and 35 in the control group. However, only 21 looked-after children were successfully recruited and randomised. INTERVENTIONS: Shared Training and Assessment for Well-Being is an integrated approach that combines training on mental health, well-being and resilience for foster carers and designated teachers; a multi-informant assessment package; review of assessments by mental health experts; and feedback to enable key adults to respond to identified needs and strengths. COVID-19 adaptations enabled all key elements to be delivered remotely. MAIN OUTCOME MEASURES: Two multi-informant primary outcome measures were included as possible candidates for a larger randomised controlled trial: the Strengths and Difficulties Questionnaire and the Paediatric Quality of Life Scale. A further multi-informant secondary outcome measure was also included: the Behavioural and Emotional Rating Scale. RESULTS: Feasibility was not demonstrated, as recruitment was heavily impacted by the COVID-19 pandemic and further attrition occurred over the extended project duration. For the small number who completed the Shared Training and Assessment for Well-Being package, key elements of the intervention were acceptable to participants. In addition, beyond issues with recruitment and retention, key aspects of the randomised controlled trial design, including randomisation, were acceptable. LIMITATIONS: It is impossible to distinguish precisely between impacts of COVID-19 and broader challenges with securing the capacity and stability needed to deliver and evaluate the Shared Training and Assessment for Well-Being intervention. CONCLUSIONS: Key elements of the Shared Training and Assessment for Well-Being intervention and randomised controlled trial process were acceptable, but the overall randomised controlled trial research design was not feasible in this study. The project was heavily compromised by the impact of the COVID-19 pandemic on foster carers, schools, local services and children. FUTURE WORK: Potential strategies are suggested to address challenges with evaluating integrated training and assessment approaches aimed at key adults supporting looked-after children. FUNDING: This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR127799.</p

S2 File -

BackgroundThe majority of children referred to Child and Adolescent Mental Health Services (CAMHS) in the UK will present with mixed emotional and behavioural difficulties, but most mental health treatments are developed for single disorders. There is a need for research on treatments that are helpful for these mixed difficulties, especially for school-age children. Emotion Regulation (ER) difficulties present across a wide range of mental health disorders and mentalizing may help with regulation. The ability to mentalize one’s own experiences and those of others plays a key role in coping with stress, regulation of emotions, and the formation of stable relationships. Mentalization Based Therapy (MBT) is a well-evidenced therapy that aims to promote mentalization, which in turn increases ER capacities, leading to decreased emotional and behavioural difficulties. The aim of this study is to test the clinical- and cost-effectiveness of MBT compared to treatment as usual for school age children with emotional and behavioural difficulties. If effective, we hope this approach can become available to the growing number of children presenting to mental health services with a mix of emotional and behavioural difficulties.Materials and methodsChildren referred to CAMHS aged 6–12 with mixed mental health problems (emotional and behavioural) as primary problem can take part with their parent/carers. Children will be randomly allocated to receive either MBT or treatment as usual (TAU) within the CAMHS clinic they have been referred to. MBT will be 6–8 sessions offered fortnightly and can flexibly include different family members. TAU is likely to include CBT, parenting groups, and/or children’s social skills groups. Parent/carers and children will be asked to complete outcome assessments (questionnaires and tasks) online at the start of treatment, mid treatment (8 weeks), end of treatment (16 weeks) and at follow up (40 weeks).Trial registrationClinical trial registration:ISRCTN 11620914.</div

SPIRIT schedule of enrolment, interventions, and assessments.

SPIRIT schedule of enrolment, interventions, and assessments.</p

S1 File -

BackgroundThe majority of children referred to Child and Adolescent Mental Health Services (CAMHS) in the UK will present with mixed emotional and behavioural difficulties, but most mental health treatments are developed for single disorders. There is a need for research on treatments that are helpful for these mixed difficulties, especially for school-age children. Emotion Regulation (ER) difficulties present across a wide range of mental health disorders and mentalizing may help with regulation. The ability to mentalize one’s own experiences and those of others plays a key role in coping with stress, regulation of emotions, and the formation of stable relationships. Mentalization Based Therapy (MBT) is a well-evidenced therapy that aims to promote mentalization, which in turn increases ER capacities, leading to decreased emotional and behavioural difficulties. The aim of this study is to test the clinical- and cost-effectiveness of MBT compared to treatment as usual for school age children with emotional and behavioural difficulties. If effective, we hope this approach can become available to the growing number of children presenting to mental health services with a mix of emotional and behavioural difficulties.Materials and methodsChildren referred to CAMHS aged 6–12 with mixed mental health problems (emotional and behavioural) as primary problem can take part with their parent/carers. Children will be randomly allocated to receive either MBT or treatment as usual (TAU) within the CAMHS clinic they have been referred to. MBT will be 6–8 sessions offered fortnightly and can flexibly include different family members. TAU is likely to include CBT, parenting groups, and/or children’s social skills groups. Parent/carers and children will be asked to complete outcome assessments (questionnaires and tasks) online at the start of treatment, mid treatment (8 weeks), end of treatment (16 weeks) and at follow up (40 weeks).Trial registrationClinical trial registration:ISRCTN 11620914.</div