Enhancing Child and Adolescent Mental Health Service Referrals 2
EN-CAMHS 2
EN-CAMHS 2: Enhancing CAMHS Referrals
2 other identifiers
observational
235
1 country
1
Brief Summary
Background Increasing numbers of children and young people are being referred to Child and Adolescent Mental Health Services (CAMHS). However, a quarter are 'rejected' for treatment. This can happen for simple reasons like:
- work with all relevant groups including children and young people and families to build a better referral process
- make an easy-to-use digital referral process for CAMHS
- make everything built useful and easy to use for as many people as possible
- provide GPs, school staff and parents with information about non-CAMHS support
- learn how to embed the new referral system across NHS systems (e.g. NHS app)
- test the new process across 5-8 different CAMHS e.g. in and outside cities
- ask people who tested the new process if they liked it and found it useful
- analyse information collected to see how people used it
- work with the charity MQ to make sure what is built is used widely The project team shall talk to children and young people, families, GPs, school staff, CAMHS staff and policymakers and build the new referral process with the project team. The project team shall hold several workshops which will shape the new digital tools, and ensure the project team considers how to include the right non-digital supports. The project team shall test the new process across 5-8 CAMHS and use a mix of statistical and interview data to understand if the new referral process is valued, useful and easy to use. The project team's partner, MQ, will develop a plan to roll out the tool nationally and to support its use in the long term. Patient \& Public Involvement The project team shall build on established collaborations with young people, their parents/carers/families. The project teamwon a national award for public involvement in the ENCAMHS 1 project. The project team shall be advised throughout by the Young People's Advisory Group (YPAG) and by the Parents and Professionals Advisory group (PPAG). The YPAG and PPAG from the ENCAMHS 1 project have told the project team they would like to work with the project team again on this project. The project team shall also recruit new members. Dissemination The project team want this project to transform how children and young people get access to appropriate mental health support and to reduce some of the pressures on CAMHS. The project team shall share learning with national NHS bodies. The project team shall make the digital tools the project team builds widely available through the networks. The project team shall publish the academic findings and share widely through social media and mental health partner networks.
Trial Health
Trial Health Score
Automated assessment based on enrollment pace, timeline, and geographic reach
participants targeted
Target at P75+ for all trials
Started Feb 2026
Shorter than P25 for all trials
1 active site
Health score is calculated from publicly available data and should be used for screening purposes only.
Trial Relationships
Click on a node to explore related trials.
Study Timeline
Key milestones and dates
First Submitted
Initial submission to the registry
August 28, 2025
CompletedStudy Start
First participant enrolled
February 1, 2026
CompletedFirst Posted
Study publicly available on registry
February 10, 2026
CompletedPrimary Completion
Last participant's last visit for primary outcome
November 30, 2026
ExpectedStudy Completion
Last participant's last visit for all outcomes
November 30, 2026
February 11, 2026
February 1, 2026
10 months
August 28, 2025
February 9, 2026
Conditions
Keywords
Outcome Measures
Primary Outcomes (1)
Primary Outcome Measure
If the referral tool improves the experience of referral process, using data collected during focus groups
2 months
Interventions
Requirements Prioritisation We shall hold 2 x roundtable events (Manchester and London) to gather feedback and input from senior stakeholders (e.g. NHS England senior leaders; commissioners, CAMHS leaders). With our partner MQ, we shall conduct 6 stakeholder focus groups with CYP, families/carers and professionals including GPs, to collaboratively prioritise requirements (identified in EN-CAMHS 1) for the revised digital tool. We aim to recruit up to 10 stakeholders per group, therefore 60 participants in total. We shall use the MoSCoW prioritisation method \[29\] collaboratively as we have done in a number of other NIHR funded digital health projects. As part of this prioritisation process, each of the existing 11 interactive CAMHS referral forms created by individual CAMHS in England will be rated using the System Usability Scale \[30\] and using criteria from the EN-CAMHS 1 focus groups e.g. navigability, clarity of language, accessibility.
Co-Design and Tool Implementation Onboard 5-8 CAMHS providers (with different characteristics and served populations) who are willing and can support an evaluation of the digitally-enhanced CAMHS tool in collaboration with our partners, NHS England. Workshops with 5-8 Trust staff from each provider. Co-design the tool with CAMHS stakeholders (2 x 1-hour workshops with 25 referrers). Ensure accessibility support (WCAG2.2 and assistive technology, translations of the tools etc) is extensive and supports needs identified by stakeholder consultation (Digital Accessibility Working Group n=10) and in collaboration with PPIE, YPAG and PPAG. This group will be formed from the project with characteristics derived from accessibility needs identified in the stakeholder codesign groups and from ENCAMHS 1. This group shall meet twice during the co-design process to review the tool and suggest accessibility enhancements. Every effort will be made to incorporate suggestions made by this group.
Evaluation of Implementation Evaluate implementation of the new digitally-enhanced referral process with 60 key referrers. Explore the potential, enablers and barriers of embedding a new CAMHS referral mechanism via semi-structured qualitative interviews with 25 referrers. Develop a blueprint and toolkit for CAMHS to implement the referral tool. Understand if and how the tool enhances the CAMHS referral process.
The charity MQ Mental Health Research was a key partner to EN-CAMHS 1. We plan to continue this successful partnership in EN-CAMHS 2. In this WP4, MQ will drive the sustainability of the EN-CAMHS tools. MQ are actively engaged in discussions with the Prudence Trust about longer-term sustainability support for the platform. MQ aim to collaborate to drive and support the tools' implementation, nationally if possible. This will require lobbying key national stakeholders (including senior policymakers, regional ICB leads, mental health professional bodies) to support implementation of the platform for the medium and longer terms, beyond the lifetime of this grant. MQ have secured funding from the Prudence Trust to support longer term sustainability for the referral tool and enhanced referral processes developed through this project.
Eligibility Criteria
Professionals, young people and parents/carers who have experience of the CAMHS referral process.
You may qualify if:
- Participants recruited will:
- Have capacity to consent.
- Be 16 years or over.
- Be a CAMHS stakeholder who has had experience with the CAMHS referral process:
- CAMHS Staff: we will include any staff who currently work in CAMHS services Collaborators: We will include collaborators who have direct experience of the current referral process for CAMHS Children and Young People (CYP): We will be recruiting CYP who have been referred to CAMHS regardless of whether they were accepted into the service or not. CYP will be aged 16-30, and will have experience of the CAMHS referral process in the past 5 years.
- Key referrers: We would ask that these individuals have had experience referring CYP to CAMHS, regardless of how many times.
- Parents/carers: we will ask parents/carers who have experience of their child or a child in their care having been referred to CAMHS, regardless of the outcome of the referral. CAMHS Commissioners: We will ask Commissioners who understand the current CAMHS referral processes locally or nationally, and who are involved in the funding process Mental Health Leads: We will invite people with a strategic overview of the CAMHS referral process locally or nationally to share their experiences of the referral process.
- Be proficient in English (or a supported language of the translated referral process).
You may not qualify if:
- People unable to speak and understand written English at a relatively high level.
- People without good internet access to take part in the online focus groups.
- People who have not had experience with the CAMHS referral process.
- People who lack the capacity to consent.
- Young people who are currently accessing CAMHS for support.
- Regarding any level of illness/disability:
- We feel it is up to the young person to make this decision during the consent process, and we could not make that decision for them. We will inform participants during the consent process (i.e. in the PIS and subsequent discussions) that there may be discussion which they could find upsetting, and we have a distress protocol in place for if anyone needs additional support, but that this should be considered when agreeing to take part in the study.
Contact the study team to confirm eligibility.
Sponsors & Collaborators
Study Sites (1)
University of Manchester
Manchester, United Kingdom
Related Publications (45)
1. Department of Health and Social Care (2023). URL: https://healthmedia.blog.gov.uk/2023/06/09/how-we-are-supporting-mental-health-services-in-england/ (accessed 25 July 2023)
BACKGROUND2. Children's Mental Health Services 2021/22 (2023). Children's Commissioner. URL: https://assets.childrenscommissioner.gov.uk/wpuploads/2023/03/Childrens-Mental-Health-Services-2021-2022-2.pdf (accessed 25 July 2023)
BACKGROUND3. Korkodilos M. The mental health of children and young people in England. London: Public Health England. 2016. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_d ata/file/575632/Mental_health_of_children_in_England.pdf (accessed 25 July 2023)
BACKGROUND4. Newlove-Delgado, T., Williams, T., Robertson, K., McManus, S., Sadler, K., Vizard, T., Cartwright, C., Mathews, F., Norman, S., Marcheselli, F. and Ford, T., 2021. Mental Health of Children and Young People in England 2021-wave 2 follow up to the 2017 survey. https://openaccess.city.ac.uk/id/eprint/28718/1/
BACKGROUND5. McNicholas, F., Kelleher, I., Hedderman, E., Lynch, F., Healy, E., Thornton, T., Barry, E., Kelly, L., McDonald, J., Holmes, K. and Kavanagh, G., 2021. Referral patterns for specialist child and adolescent mental health services in the Republic of Ireland during the COVID-19 pandemic compared with 2019 and 2018. BJPsych open, 7(3), p.e91. https://doi.org/10.1192/bjo.2021.48
BACKGROUND6. Grant, C., Blackburn, R., Harding, D., Golden, S., Toth, K., Scott, S., Ford, T. and Downs, J., 2023. Impact of counselling provision in primary schools on child and adolescent mental health service referral rates: a longitudinal observational cohort study. Child and Adolescent Mental Health, 28(2), pp.212-220. https://doi.org/10.1111/camh.12519
BACKGROUND7. YoungMinds (2022). URL: https://www.youngminds.org.uk/about-us/media-centre/press-releases/mental-health-waiting-times-harming-young-people/ (accessed 25 June 2023)
BACKGROUND8. Iskra, W., Deane, F.P., Wahlin, T. and Davis, E.L., 2018. Parental perceptions of barriers to mental health services for young people. Early intervention in psychiatry, 12(2), pp.125-134. https://doi.org/10.1111/eip.12281
BACKGROUND9. Hansen, A.S., Telléus, G.K., Mohr-Jensen, C. and Lauritsen, M.B., 2021. Parent-perceived barriers to accessing services for their child's mental health problems. Child and Adolescent Psychiatry and Mental Health, 15, pp.1-11. https://doi.org/10.1186/s13034-021-00357-7
BACKGROUND10. Scottish Government (2018). URL: https://www.gov.scot/binaries/content/documents/govscot/publications/research-and-analysis/2018/06/rejected-referrals-child-adolescent-mental-health-services-camhs-qualitative-quantitative/documents/00537523-pdf/00537523-pdf/govscot%3Adocument/00537523.pdf (accesses 26 July 2023)
BACKGROUND11. Crouch, L., Reardon, T., Farrington, A., Glover, F. and Creswell, C., 2019. "Just keep pushing": Parents' experiences of accessing child and adolescent mental health services for child anxiety problems. Child: Care, Health and Development, 45(4), pp.491-499. https://doi.org/10.1111/cch.12672
BACKGROUND12. Smith, J., Kyle, R.G., Daniel, B. and Hubbard, G., 2018. Patterns of referral and waiting times for specialist Child and Adolescent Mental Health Services. Child and Adolescent Mental Health, 23(1), pp.41-49. https://doi.org/10.1111/camh.12207
BACKGROUND13. Royal College of Paediatrics and Child Health. URL: https://www.rcpch.ac.uk/news-events/news/school-referrals-mental-health-treatment-rise-third#:~:text=RCPCH's%20Dr%20Max%20Davie%20responds,in%20the%20last%20three%20years (accessed 26 July 2023)
BACKGROUND14. Education and Health Select Committees. URL: https://publications.parliament.uk/pa/cm201617/cmselect/cmhealth/849/849.pdf (accessed 26 July 2023)
BACKGROUND15. Lambert, A.K., Doherty, A.J., Wilson, N., Chauhan, U. and Mahadevan, D., 2020. GP perceptions of community-based children's mental health services in Pennine Lancashire: a qualitative study. BJGP open, 4(4). https://doi.org/10.3399/bjgpopen20X101075
BACKGROUND16. Hinrichs, S., Owens, M., Dunn, V. and Goodyer, I., 2012. General practitioner experience and perception of Child and Adolescent Mental Health Services (CAMHS) care pathways: a multimethod research study. BMJ open, 2(6), p.e001573. http://dx.doi.org/10.1136/bmjopen-2012-001573
BACKGROUND17. Evans, N. and Huws-Thomas, M., 2020. Case note review of community mental health services for children and young people in a UK rural location. The Journal of Mental Health Training, Education and Practice, 15(3), pp.171-179. https://doi.org/10.1108/JMHTEP-10-2019-0055
BACKGROUND18. Abel, K.M., Whelan, P., Carter, L., Elvins, R., Edbrooke-Childs, J., Bunting, S., Stockton-Powdrell, C., Tranter, H., Gutridge, K., Hassan, L. (2022). Enhancing CAMHS Referrals ("ENCAMHS 1"). NIHR131379.
BACKGROUND19. NHS Benchmarking Network (2019). URL: https://www.nhsbenchmarking.nhs.uk/news/2019-child-and-adolescent-mental-health-services-project-results-published (accessed 25 July 2023)
BACKGROUND20. Hansen, A.S., Christoffersen, C.H., Telléus, G.K. and Lauritsen, M.B., 2021. Referral patterns to outpatient child and adolescent mental health services and factors associated with referrals being rejected. A cross-sectional observational study. BMC Health Services Research, 21, pp.1- 12. https://doi.org/10.1186/s12913-021-07114-8
BACKGROUND21. Patalay, P. and Fitzsimons, E., 2017. Mental ill-health among children of the new century: trends across childhood with a focus on age 14. London: Centre for Longitudinal Studies, pp.1-6. URL: http://www.cls.ioe.ac.uk/shared/get-file.ashx?itemtype=document&id=3338 (accessed 25 July 2023)
BACKGROUND22. Frith E. Access and waiting times in children and young people's mental health services. (2017). URL: https://epi.org.uk/wp- content/uploads/2018/01/EPI_Access-and-waiting-times_.pdf (accessed 25 July 2023)
BACKGROUND23. Frith, E., 2016. Progress and challenges in the transformation of children and young people's mental health care. Education Policy Institute, London. URL:https://epi.org.uk/wp- content/uploads/2018/01/progress-and-challenges.pdf (accessed 25 July 2023)
BACKGROUND24. Scottish Government (2018). URL: https://www.gov.scot/publications/rejected-referrals-child- adolescent-mental-health-services-camhs-qualitative-quantitative/pages/3/ (accessed 25 July 2023)
BACKGROUND25. Care Quality Commission (CQC) (2018). URL: https://www.cqc.org.uk/publications/themed-work/are-we-listening-review-children-young-peoples-mental-health-services (accessed 25 July 2023)
BACKGROUND26. Fazel, M., Rocks, S., Glogowska, M., Stepney, M. and Tsiachristas, A., 2021. How does reorganisation in child and adolescent mental health services affect access to services? An observational study of two services in England. PloS one, 16(5), p.e0250691. https://doi.org/10.1371/journal.pone.0250691
BACKGROUND27. Rocks, S., Glogowska, M., Stepney, M., Tsiachristas, A. and Fazel, M., 2020. Introducing a single point of access (SPA) to child and adolescent mental health services in England: a mixed-methods observational study. BMC health services research, 20, pp.1-11. https://doi.org/10.1186/s12913-020-05463-4
BACKGROUND28. The Children and Young People's Mental Health Taskforce. (2015). URL: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/414024/Childrens_Mental_Health.pdf (accessed 25 July 2023)
BACKGROUND29. The MoSCow Method (2023). URL: https://www.mindtools.com/a4xmovt/the-moscow-method (accessed 25 June 2023)
BACKGROUND30. System usability scale. URL: https://www.usability.gov/how-to-and-tools/methods/system- usability-scale.html (accessed 14 March 2023)
BACKGROUND31. Web Content Accessibility Guidelines (WCAG) 2.2. URL: https://www.w3.org/TR/WCAG22/ (accessed 20 May 2024)
BACKGROUND32. Greenhalgh, T., Maylor, H., Shaw, S., Wherton, J., Papoutsi, C., Betton, V., Nelissen, N., Gremyr, A., Rushforth, A., Koshkouei, M. and Taylor, J., 2020. The NASSS-CAT tools for understanding, guiding, monitoring, and researching technology implementation projects in health and social care: protocol for an evaluation study in real-world settings. JMIR research protocols, 9(5), p.e16861. https://doi.org/10.2196/16861
BACKGROUND33. Murray, E., Treweek, S., Pope, C., MacFarlane, A., Ballini, L., Dowrick, C., Finch, T., Kennedy, A., Mair, F., O'Donnell, C. and Ong, B.N., 2010. Normalisation process theory: a framework for developing, evaluating and implementing complex interventions. BMC medicine, 8, pp.1-11. https://doi.org/10.1186/1741-7015-8-63
BACKGROUND34. NHS BaRS standard (2023). URL: https://digital.nhs.uk/services/booking-and-referral-standard (accessed 25 June 2023)
BACKGROUND35. NHS App (2023. URL: https://www.nhs.uk/nhs-app/about-the-nhs-app/ (accessed 25 June 2023)
BACKGROUND36. Greenhalgh, T., Wherton, J., Papoutsi, C., Lynch, J., Hughes, G., Hinder, S., Fahy, N., Procter, R. and Shaw, S., 2017. Beyond adoption: a new framework for theorizing and evaluating nonadoption, abandonment, and challenges to the scale-up, spread, and sustainability of health and care technologies. Journal of medical Internet research, 19(11), p.e8775. https://doi.org/10.2196/jmir.8775
BACKGROUND37. Agile delivery (2023). URL: https://www.gov.uk/service-manual/agile-delivery (accessed 25 June 2023)
BACKGROUND38. How the discovery phase works (2021). URL: https://www.gov.uk/service-manual/agile-delivery/how-the-discovery-phase-works (accessed 25 June 2023)
BACKGROUND39. How the alpha phase works (2019). URL: https://www.gov.uk/service-manual/agile-delivery/how-the-alpha-phase-works (accessed 25 June 2023)
BACKGROUND40. How the beta phase works (2021). URL: https://www.gov.uk/service-manual/agile-delivery/how-the-beta-phase-works (accessed 25 June 2023)
BACKGROUND41. How the live phase works (2019). URL: https://www.gov.uk/service-manual/agile-delivery/how-the-live-phase-works (accessed 25 June 2023)
BACKGROUND42. Amused Framework : Miller S, Ainsworth B, Yardley L, Milton A, Weal M, Smith P, Morrison L A Framework for Analyzing and Measuring Usage and Engagement Data (AMUsED) in Digital Interventions: Viewpoint J Med Internet Res 2019;21(2):e10966. https://doi.org/10.2196/10966
BACKGROUND43. Ritchie, J. and Spencer, L., 2002. Qualitative data analysis for applied policy research. In Analyzing qualitative data (pp. 173-194). Routledge.
BACKGROUND44. Ritchie, J., Lewis, J., Nicholls, C.M. and Ormston, R. eds., 2013. Qualitative research practice: A guide for social science students and researchers. sage.
BACKGROUND45. Nvivo 11 (n.d.). URL: https://help - nv11.qsrinternational.com/desktop/concepts/about_framework_matrices.htm (accessed 25 June 2023).
BACKGROUND
Related Links
MeSH Terms
Conditions
Condition Hierarchy (Ancestors)
Central Study Contacts
Study Design
- Study Type
- observational
- Observational Model
- OTHER
- Time Perspective
- OTHER
- Sponsor Type
- OTHER
- Responsible Party
- PRINCIPAL INVESTIGATOR
- PI Title
- Professor Kathryn M Abel
Study Record Dates
First Submitted
August 28, 2025
First Posted
February 10, 2026
Study Start
February 1, 2026
Primary Completion (Estimated)
November 30, 2026
Study Completion (Estimated)
November 30, 2026
Last Updated
February 11, 2026
Record last verified: 2026-02
Data Sharing
- IPD Sharing
- Will not share
It is not required for IPD to be shared as part of this study.