Timetable and Budget
| Description | Deadline/Limit |
|---|---|
| Deadline for Stage 1 Applications | 11 July 2023, 1 PM |
| Notification of outcome of Stage 1 Application | October 2023 |
| Deadline for Stage 2 application | 28 November 2023, 1 PM |
| Notification of outcome of Stage 2 Application | April-May 2024 |
| Project Start | July 2024 |
| Project Duration | 24-36 months |
| Budget | £600,000 |
Introduction
The National Institute for Health and Care Research (NIHR) Policy Research Programme (PRP) invites applications for a single research project to understand whether the “Early Support Hub” model can effectively support children and young people with their mental health and wellbeing.
Background
There has been a steady increase in the prevalence of mental health conditions and evidence indicates this trend has been exacerbated by the pandemic. [1] In 2021, it is estimated that 17% of children and young people aged 6 to 19 have a probable mental health disorder. This has increased from one in six (16.0%) children aged 5 to 16 years in 2020 and one in nine (10.8%) in 2017. [2] For 17- to 19-year-olds and 20- to 22-year-olds, two groups which cannot necessarily access support in an education setting and are therefore more likely to use an open access ‘hub’ model, the rates of probable mental health disorder were 17% and 19%, respectively. [3]
The third follow-up survey to the 2017 Mental Health of Children and Young People in England Survey (MHCYP) showed that the proportion of 17- to 19-year-olds with a probable mental disorder had increased from just over one in six (17.4%) in 2021 to just over one in four (25.7%) in 2022. [4]
Statistics from NHS digital also show there has been an increase in children and young people’s mental health (CYPMH) presentations at A&E, which implies that children and young people are unable to access support before reaching a crisis point. [5] The evidence also suggests that, at least in part, the rising demand for CYP services is because there is inadequate early intervention and prevention support for CYPMH.
“Early Support Hubs” could address some of the increasing need, particularly as hubs are predicated on a YIAC model (Youth Information Advice Counselling) of support, designed to provide young people with a range of wellbeing support — e.g., counselling, group therapy, peer support, careers advice, and access to digital support. This is often delivered alongside support for physical and sexual health, as well as education around alcohol or the use of illegal drugs. One of the crucial features of hubs is that they do not require a referral and are generally aimed at 11–25-year-olds. The package offered is designed to promote mental wellbeing and takes a whole person approach focused on intervening before a given issue can escalate.
There are an estimated 65 Early Support Hubs currently operational in England, though each hub has been locally commissioned. As such, there is no consistent YIAC model being delivered meaning that the provision of early intervention and prevention support differs by local authority or clinical commissioning group, and the extent to which these meet the needs of CYP are not clear. Whilst there is an abundance of support for the hub model across the sector and a limited number of evaluations that focus on an individual service, there are no large-scale quantitative studies designed to determine whether the model can effectively support children and young people with their wellbeing and/or improve their subsequent life outcomes. The Department of Health and Social Care have therefore been engaging the “Fund the Hubs” campaign to ascertain the feasibility of a larger scale rollout of Early Support Hubs. [6]
This call seeks to determine whether or not Early Support Hubs can effectively support CYP with their wellbeing and/or improve their subsequent life outcomes. The research would directly impact the Government’s approach to supporting or implementing the Early Support Hub model, and improving the current range of early intervention and prevention support available for CYPMH and wellbeing.
Research priorities
As the delivery of Early Support Hubs can be variable, a preliminary stage of this research may seek to identify how many Hubs are currently operational and define the differences between the service offerings of these. Applicants are welcome but would not be expected to include every Early Support Hub. It would be acceptable to instead propose plans to engage with a representative number of these services.
The research should explore whether the “Early Support Hub” model can effectively improve children and young people’s mental health and wellbeing. This may also include looking at improvements in:
- Career goals or outcomes
- Sense of wellbeing
- Educational outcomes
- Physical health
We would like to understand which elements, or combination of elements, within the various provisions of Early Support Hubs are most effective and should therefore be accounted for when considering larger scale rollout; for example, in developing a standardised service specification.
A significant element of the research could also determine:
- How CYP access these services
- Whether certain groups of CYP are more likely to access these services than another
- Whether Early Support Hubs are better suited to supporting certain outcomes over others
- If certain groups of CYP experience better outcomes, and if so, why.
This research should recognise the demographic diversity within the broad CYP group. Consideration should be given to how any outcome measures might differ in relation to gender and other demographic factors such as ethnicity and socioeconomic background, and the intersectionality between these factors.
New Guidance on Health Inequalities data collection within NIHR PRP Research
Inequities and inequalities in the provision, access to and experience of health and care services is a high priority area within the Department of Health and Social Care and the NIHR and is present in the majority of funded projects. We are now assessing all NIHR research proposals in relation to health and care inequalities. NIHR asks researchers to explore issues of inequality and inequity in the research being proposed.
Our goal is also to facilitate more widespread and consistent reporting of data on health and care inequalities relating to the primary outcomes of NIHR funded research. Applicants should, if feasible, collect or analyse data related to health and/or care inequalities, we request that this stated in the proposal. This is a new request from the NIHR PRP and we will be continuing to monitor queries and make any necessary clarifications, as needed.
We understand that research projects may employ different methodologies, and focus on different populations. We ask that you please clearly identify in the research plan section of the application whether your application has a health and care inequalities component. If the project uses quantitative methods, please include detail of the core set of data that will be collected or analysed. Submission of the data collection will be a condition of final reporting that will need to be submitted to NIHR PRP when the grant has finished. If a health and/or care inequalities component is not included, please explain clearly why this does not fit within your research.
Specifically for this project, it may be useful to consider whether any particular groups are particularly impacted by discharge delays, and whether interventions have any differential impact for different groups. This may include consideration of local / regional variation, deprivation or characteristics covered by the Equality Act.
A recording of the Health Inequalities in NIHR PRP Research Q&A Event which was held on 19 September 2022 is available online, this may be useful to refer to as it provides additional information.
Further details about this new request can be found in Appendix A.
Areas out of scope for this programme of work
Areas out of scope for this programme of work are:
- Early intervention or prevention support programmes for children beneath the age of 11 (or including family support)
- Early Support Hubs or programmes that require a clinical referral or provide clinical level interventions
- Any programme or support that is located or jointly delivered in an education setting.
Eligibility
Eligibility for the NIHR PRP is laid out in our Standard Information for Applicants and applies to all calls unless otherwise stated in the individual research specification.
Technical requirements / Expertise required
This programme of work would benefit from expertise in:
- CYP Mental Health Service Provision and Evaluation
- CYP Mental Health and Wellbeing
- CYP prevention
- CYP early intervention support for mental health
- Community mental health
- Expertise relevant to the specific outcome measures selected from the list provided in the Research Priorities section (if not already covered in the above bullet point)
Outputs
Applicants are asked to consider the timing and nature of deliverables in their proposals. Policymakers will need research evidence to meet key policy decisions and timescales, so resource needs to be flexible to meet these needs. A meeting to discuss policy needs with DHSC officials will be convened as a matter of priority following contracting, including to discuss the draft project plan.
Ongoing dissemination of findings throughout the life cycle of the project will be required to support ongoing policy development. This includes timely reports for the advisory group as well as a final report and/or slide deck at the end of the project outlining key findings and recommended policy actions. A strategic dissemination plan following the final report would also be desirable.
Budget and duration
Applications will be assessed on value for money, we would not expect them to cost more than £600K.
The duration of the project should be as short as is consistent with delivering a high-quality study.
Costings can include up to 100% full economic costing (FEC) but should exclude output VAT. Applicants are advised that value for money is one of the key criteria that peer reviewers and commissioning panel members will assess applications against.
Management arrangements
A research advisory group including, but not limited to, representatives of DHSC, other stakeholders (such as Youth Access, CYPMH Coalition and Young Minds) and the successful applicants for the research should be established. The advisory group will provide guidance, meeting regularly over the lifetime of the research. The successful applicants should be prepared to review research objectives with the advisory group, and to share emerging findings on an ongoing basis. They will be expected to:
-
Provide regular feedback on progress
-
Produce timely reports to the advisory group
-
Produce a final report for sign off
Research contractors will be expected to work with nominated officials in DHSC, its partners and the NIHR. Key documents including, for example, research protocols, research instruments, reports and publications must be provided to DHSC in draft form allowing sufficient time for review.
It should be noted that this research call relates to another research call ‘Improving access to mental health support and services for ethnic minority children and young people’. We would therefore expect the successful applicants for both of these calls to communicate between teams, as there are areas of overlap that would benefit from shared knowledge and learnings.
References and key documents
- Young Minds. Coronavirus: Impact on young people with mental health needs. Survey 4 [online]. 2021.
- NHS Digital. Mental Health of Children and Young People Surveys. [online]. 2017-2022.
- Ibid.
- Ibid.
- NHS Digital. Mental Health Services Monthly Statistics, Performance May, Provisional June 2022. [online]. 2022.
- Young Minds. Fund the Hubs Campaign. [online] 2021.
Appendix A: Further Detail on the New Guidance on Health Inequalities data collection within NIHR PRP Research
Health Inequalities is a high priority area within the Department of Health and Social Care and the NIHR and is often present in a majority of funded projects. We are now assessing all NIHR research proposals in relation to health inequalities. We are asking applicants to identify in their application whether or not there is a health inequalities component or theme and how this research hopes to impact health inequalities. We are also asking researchers to collect relevant data related to health inequalities, if appropriate for the research. Collecting specific information about health inequalities in research submitted to the programme will allow for categorisation of health inequalities research, curation of data to aid future health inequalities research and enable policymakers to better understand the implications of health inequalities within their policy areas. This is a new request from the NIHR PRP and we will be continuing to monitor queries and adapt the process as needed. If you have any feedback on this new request, please contact us at prp@nihr.ac.uk.
Our goal is to facilitate more widespread and consistent reporting of health inequality breakdown data relating to the primary outcomes of NIHR funded research. We would ideally like researchers to focus on the following equity-relevant variables: age, sex, gender, disability, region*, 5 ONS Ethnic groups**, and the 5 IMD quintile groups. These variables are considered an ideal, but we understand that these are subject to change depending on the sample population and specific research question.
For qualitative research projects, this can be purely baseline characteristics of the participants, for example, the number of participants in each ethnic group.
For quantitative research projects, if there are multiple outcomes/effects with your stakeholders, select a small number of main outcomes as appropriate to report equity breakdowns. We will not be prescriptive about the number of the outcomes, as it will depend on the number of study design types and the nature of the project aims. We are asking for one way cross tabulations of each primary outcome by these equity-relevant variables, if appropriate for your research, together with the number of observations in each cell. If more detailed cross tabulations are appropriate for your proposed research, please include these as well. This request applies to both primary data collection studies and secondary analysis of routine data, and to causal inference studies as well as descriptive studies; however, if this is not possible due to data limitations then please explain. Due to sample size and other data limitations there may be difficult scientific and/or data security*** judgement calls to make about which breakdowns to report and whether to merge categories to increase counts in particular cells; we ask you to make these judgments yourself, bearing in mind our data curation aim of enabling future evidence synthesis work in pooling results from different studies. We also ask that researchers report breakdowns for the unadjusted as well as adjusted outcomes/effects, as appropriate.
We understand that research projects may employ different methodologies, and focus on different populations. Please explain how the variables and data collection methods chosen are appropriate to the methodologies used.
We ask that you please clearly identify in the research plan section of the application whether your application has a health inequalities component or not and detail the core set of health inequality breakdown data that will be collected, if applicable. Submission of the data collection will be a condition of the final report for all research with relevant methodologies regardless of whether the research has a health inequalities component that will need to be submitted to NIHR PRP when the grant has finished. This should only take a few sentences within the research plan section.
* Table below uses the nine regions in England, further regions can be used if using the UK as the study population. Please report region breakdown for large samples in nationally representative descriptive studies. There is no need to report this for small sample studies, for sub-national studies, or for quasi-experimental studies where it would require time-consuming re-estimation.
** White, Mixed/ Multiple ethnic groups, Asian/ Asian British, Black/ African/ Caribbean/ Black British, Other ethnic group. If the sample size is small then it is fine to report only some of the requested equity breakdowns and to merge some of the sub-groups as appropriate.
*** For guidance on how to handle data security concerns in reporting of sensitive data please see ONS guidance.
Example data table for submission at the end of the funded research project
(N.B. If there is more than one main outcome then you will require more tables and if you adjust your outcome then you will need two tables for the adjusted outcome and unadjusted outcome. For other methodologies, variable vs number of observations may be more appropriate to record participant data). This table is for an example only. It does not contain sub variables and does not illustrate any preference for certain variables, as these will be dependent on the proposed research.
| Variable | Outcome (an appropriate average for this subgroup, usually the mean) | Number of observations | Additional information about variation if appropriate, e.g. range, standard deviation |
|---|---|---|---|
| Age | 0 | 0 | Additional information |
| Sex | 0 | 0 | Additional information |
| Gender | 0 | 0 | Additional information |
| Disability | 0 | 0 | Additional information |
| Ethnic Group | 0 | 0 | Additional information |
| IMD Group | 0 | 0 | Additional information |
| Region | 0 | 0 | Additional information |