Defining research priorities for youth public mental health: reflections on a coproduction approach to transdisciplinary working.

BACKGROUND: With most mental health problems established during childhood/adolescence, young people must be a key focus of public mental health approaches. Despite the range of factors known to influence mental health, evidence for effective interventions is lacking for this age group. This study aimed to define priorities for future public health intervention-focused research to support youth mental health by engaging with transdisciplinary stakeholder groups. METHODS: Our coproduction approach involved priority-setting workshops with young people, researchers, practitioners and policy-makers. Each workshop focused on three thematic areas: social connections and relationships; schools and other education settings; and key groups at greater risk of mental ill-health, specifically LGBTQ+ and care-experienced young people. Workshop outputs were synthesized to define research priorities. RESULTS: This paper presents the research priorities that were defined through the priority-setting workshops, and our reflections on the coproduction approach to guide future similar activities undertaken by others. Ten priorities for youth public mental health research were defined, covering the following areas: building supportive relationships; whole system approaches; social media; support at times of transition; improving links between different services; development and training for those who support young people; staff mental health; engaging with families; awareness of and access to services; and out-of-school and community settings. CONCLUSIONS: These research priorities can inform future intervention development to support youth public mental health. Our transdisciplinary approach means the identified research priorities are likely to be relevant to young people's experiences and needs, and to fit with the needs of those working in practice and policy to support young people.

How do Pregnant Women with Additional Health or Social Care Needs Experience Parenting Groups: Evidence from Delivery of Enhanced Triple P for Baby and Mellow Bumps as Part of the Trial of Healthy Relationships Initiatives in the Very Early Years (THRIVE).

There is still relatively little known about when, why, how and in what circumstances parenting interventions are effective. Support within the group context has been theorised as a key mechanism. This paper explores how pregnant women with additional health or social care needs participating in two group parenting interventions-Mellow Bumps or Enhanced Triple P for Babies-experienced being in a parenting group, and how this shaped how they engaged with the interventions; and it examines how group delivery may have facilitated or inhibited the effectiveness of the interventions, and for whom it did so. Session evaluation forms (n = 708) and a post-intervention questionnaire (n = 117) were completed by participants. In-depth interviews were conducted following the MB/ETPB antenatal sessions (n = 19), and 6-12 months after the birth of their baby (n = 15). Group delivery of these parenting interventions had the potential to support participants, particularly those with multiple additional health and social care needs. There are, however, important caveats including patchy attendance reducing the supportiveness of the groups, and few discernible longer terms changes. More group sessions, less patchy attendance, and more encouragement from facilitators for the women to keep in touch, and to join other community parent-child groups after the birth of their baby are likely to have increased feelings of support and connectedness.

Classification of cochlear implant complications using a modified Clavien-Dindo classification.

OBJECTIVES: Cochlear implantation (CI) surgery is a highly effective procedure for severe to profound hearing loss, with a low complication rate. There are currently multiple grading systems for CI surgery complications, making comparison of outcomes difficult. We propose a modification to the Clavien-Dindo classification of complications, and use this modified classification to analyse our complications. METHODS: Complications were classified as: I - Self-limiting complications requiring no treatment or simple pharmacological therapies; II - Complications requiring pharmacological interventions other than those permitted under the criteria for Grade I, or non-invasive radiological imaging; IIIa - Complications necessitating surgical, radiological or endoscopic intervention, but excluding implant explantation and/or reimplantation. IIIb - Complications necessitating implant explantation and/or reimplantation. RESULTS: 1053 patients were recorded as having had at least one cochlear implant inserted with 114 complications reported in 90 patients. The 114 complications were classified into the proposed classification with 18 (15.7%) as Grade I, 36 (31.5%) as Grade II, 17 (14.9%) as Grade IIIa and 43 (34.2%) as Grade IIIb. DISCUSSION: We found a low complication rate, and were able to use the modified Clavien-Dindo classification system to analyse our data. We would strongly advocate for a uniform reporting system and propose this modification of a widely used system.

Recruiting hard-to-reach pregnant women at high psychosocial risk: strategies and costs from a randomised controlled trial.

BACKGROUND: Recruiting participants to randomised controlled trials (RCTs) is often challenging, particularly when working with socially disadvantaged populations who are often termed 'hard-to-reach' in research. Here we report the recruitment strategies and costs for the Trial for Healthy Relationship Initiatives in the Very Early years (THRIVE), an RCT evaluating two group-based parenting interventions for pregnant women. METHODS: THRIVE aimed to recruit 500 pregnant women with additional health and social care needs in Scotland between 2014 and 2018. Three recruitment strategies were employed: (1) referrals from a health or social care practitioner or voluntary/community organisation (practitioner-led referral), (2) direct engagement with potential participants by research staff (researcher-led recruitment) and (3) self-referral in response to study advertising (self-referral). The number of referrals and recruited participants from each strategy is reported along with the overall cost of recruitment. The impact of recruitment activities and the changes in maternity policy/context on recruitment throughout the study are examined. RESULTS: THRIVE received 973 referrals: 684 (70%) from practitioners (mainly specialist and general midwives), 273 (28%) from research nurses and 16 (2%) self-referrals. The time spent in antenatal clinics by research nurses each month was positively correlated with the number of referrals received (r = 0.57; p < 0.001). Changes in maternity policies and contexts were reflected in the number of referrals received each month, with both positive and negative impacts throughout the trial. Overall, 50% of referred women were recruited to the trial. Women referred via self-referral, THRIVE research nurses and specialist midwives were most likely to go on to be recruited (81%, 58% and 57%, respectively). Key contributors to recruitment included engaging key groups of referrers, establishing a large flexible workforce to enable recruitment activities to adapt to changes in context throughout the study and identifying the most appropriate setting to engage with potential participants. The overall cost of recruitment was £377 per randomised participant. CONCLUSIONS: Recruitment resulted from a combination of all three strategies. Our reflections on the successes and challenges of these strategies highlight the need for recruitment strategies to be flexible to adapt to complex interventions and real-world challenges. These findings will inform future research in similar hard-to-reach populations. TRIAL REGISTRATION: International Standard Randomised Controlled Trials Number Registry ISRCTN21656568 . Retrospectively registered on 28 February 2014.