Young people who have experience of the care system are at much higher risk of experiencing mental health difficulties. Rates of post-traumatic stress disorder (PTSD) are around 12 times higher among care-experienced young people than their peers.
There are well-established, evidence-based treatments for PTSD, including trauma-focused cognitive behavioural therapies (tf-CBT), which are recommended by NICE. However, care-experienced young people often struggle to access these treatments. Despite having a greater need for support, they can face barriers within mental health services that mean they are less likely to be assessed for PTSD or offered the treatments that could help them.
The ADaPT (Assessment and Delivery of PTSD Treatments) study set out to understand why this was happening and what could be done to improve access to the best-evidenced mental health care for care-experienced young people.
The research team worked with 28 mental health teams across England, spanning 11 NHS Trusts and three local authorities. This included general Child and Adolescent Mental Health Services (CAMHS), specialist CAMHS teams supporting young people in care, and social care-based mental health teams. More than 240 mental health professionals took part.
Teams were trained to assess care-experienced young people for symptoms of PTSD and to deliver Cognitive Therapy for PTSD (CT-PTSD), a form of trauma-focused CBT. Researchers then worked alongside the teams over 12–18 months, using focus groups, interviews and service data to understand what helped or prevented the approach from being implemented in everyday practice.
The research showed that providing training alone was not enough. Almost half of the teams were able to implement the treatment, but only around a quarter specifically used it with care-experienced young people. Teams highlighted barriers including service structures, unclear pathways between social care and CAMHS, commissioning and prioritisation decisions, team culture and leadership, as well as the complexity of the lives and support networks of care-experienced young people.
This learning has helped the team develop practical resources to support services to overcome these barriers and make evidence-based treatment more accessible. These include freely available animations, training videos and e-learning for professionals, supervisors, commissioners and decision-makers. The resources have been widely used, with the project’s animations and clinical resources reaching a substantial national audience.
The research has also moved beyond individual services and begun to influence policy. Findings from ADaPT have informed national recommendations published in the Education Select Committee’s report on children’s social care, while the team has submitted evidence to the Children’s Wellbeing and Schools Bill. The research has also been cited in Welsh Government National Practice Guidance, demonstrating its influence beyond England.
The work is continuing to support services to improve access to best-evidenced mental health care. The next phase of ADaPT is working with CAMHS and social care teams in four regions to develop and test models of best practice, with the aim of understanding how services can be structured to make evidence-based psychological therapies more accessible to care-experienced young people.
From identifying an inequality in access to mental health treatment, to working directly with services to understand the barriers, develop practical solutions and influence national policy, ADaPT demonstrates how NIHR-supported research can help turn evidence into better mental health support for some of the young people who need it most.