Introduction and aims
The social determinants of health are the non-medical factors that influence health outcomes and include aspects such as education, housing, the environment, as well as social inclusion. Increasingly, their role in pre-disposing, precipitating and perpetuating mental health difficulties is becoming understood. However, such factors are not routinely included or tackled as part of treatment in Child and Adolescent Mental Health Services (CAMHS). This may be contributing to why only half of young people reliably recover after treatment, as well as the high rates of relapse being observed.
Social Prescribing is a care pathway linking patients with non-medical forms of support within the community via a link worker or social prescriber. It addresses a patient’s needs holistically by addressing a range of social, economic and environmental factors that determine health and has been found to improve mental health difficulties.
The aim of CASPA is to develop and test a novel social prescribing pathway as part of the offer once young people have started psychological treatment. This will help increase our understanding of the role the social determinants of health play in CAMHS treatment outcomes and provide initial evidence into social prescribing integration for mental health treatment and subsequent recovery.
Research methods
A social prescribing pathway will be developed with four CAMHS sites. This will then be piloted using a two-group (intervention vs. active control) parallel randomised design, with young people as the unit of randomisation. Social prescribing will be the active intervention and compared to signposting, where patients will be provided with lists of the same community resources, but without a link worker/social prescriber. Both social prescribing and signposting will run alongside existing CAMHS treatment.
Mental health and other secondary outcomes will be assessed at baseline and then at 3 and 6 month follow up. An implementation strand using questionnaires and interviews will explore the acceptability, feasibility, and appropriateness of the pathway, potential mechanisms of action and their moderating effects on the outcomes of interest, as well as the perceived impact of social prescribing. Descriptive statistics and interview data will be used to explore the feasibility, appropriateness and acceptability of the pathway and evaluation framework, whilst potential impact will be explored by comparing mean differences between the intervention and control group, and via interviews data using reflexive thematic analysis. Potential mechanisms of action will be explored qualitatively using thematic analysis. Pre-established stop-go criteria will be used to determine whether CASPA is ready to proceed to full trial.
Outcomes
Outcomes for the project will include a social prescribing pathway which is situated within CAMHS and a journal article looking at whether stakeholders find it feasible, acceptable and suitable as well as any evidence of impact. If findings are positive, we will then apply for funding to conduct a full clinical and cost effectiveness trial.