Emotional dysregulation (DE) and self-harming behaviours (SH) (DE-SH) occur in approximately 20-30% of young people receiving psychiatric care. Care for these populations is typically disrupted, with young people commonly moving from one agency to another without being able to make use of the treatment or support offered. Low adherence to treatments, especially demanding treatments, is a well documented challenge.

What is offered currently

Many NHS services in the UK have established dedicated treatment teams to support the needs of young people experiencing DE-SH. The primary treatment model to date relies on Dialectical Behaviour Therapy for Adolescents (DBT-A).

DBT-A is an evidenced-based treatment for adolescents experiencing DE-SH. Within this model, young people attend weekly sessions with a therapist, and weekly group meetings with other young people over a 24 week period. In the UK, service’s involvement of parents varies considerably with some services following the manual and others running separate groups for parents.

However, DBT-A requires motivation to change and commitment to treatment over at least 6 months. It is undoubtedly effective when the young people are motivated and committed, but it is clear from published data and from data collected by the DBT-A teams participating in our project, that at least 50% of those referred to the teams do not receive the treatment or are not significantly helped by it.

Developing an intervention from a more inclusive alternative model

The Family Domains framework (e.g. see Hill et al., 2014) has a strong research background, and is being used by a wide range of NHS clinicians in child and adolescent services, but it has not yet been used to generate a manualised intervention based on the needs and contributions of service users. It is particularly relevant to the problem to be addressed because it draws on a large body of research into the different ways in which parents provide resources for their children, and the different facets of children’s development which each supports. Each ‘domain’ is a different type of parent-child interaction, making a distinctive contribution. A psychoeducation intervention addressed to parents, based on this framework, may help parents to feel more able to support young people, and thus provide a general alternative which can be provided to families who are not able to access, complete or benefit from DBT-A.

To address gaps in the existing literature, this project aims to co-design a family domains intervention to support the needs of young people with ED-SH. Specifically this project will:

a) Conduct and analyse qualitative interviews with parents, young people, and professionals (primarily in the UK, but with some triangulation re: Australia);

b) Engage parents, young people, and professionals in co-design discussions;

c) Co-produce a first draft manual with training materials to be used with parents; and,

d) To use feedback from qualitative interviews, and perhaps other sources, to modify and finalise the manual and materials, and suggest adherence criteria.