Learning from lived experience is central to NCB’s work. Children and young people, parents, carers, care-experienced young people, disabled children and families contribute their expertise to shape and improve research, policy and practice. Keith Clements, Senior Researcher at NCB, and Adele and Emma from our parents group, reflect here on a collaborative study, the findings of which were published this week.
Read more about the COACHES self-harm study
At several stages during the study, researchers engaged with experts-by-experience convened and facilitated by NCB. This included working with our parents group, which has experience of interacting with children’s social care, and navigating many other services with their children, including mental health services.
Having already built a relationship collaborating on a previous project, we held two consultation sessions with the researchers to inform analysis, help interpret the emerging findings and, based on that analysis, decide what changes in policy and practice were needed.
We believe responsiveness and flexibility are not "nice to have" additions to services. In the case of therapies being offered to all children and young people in need, they are fundamental to making support accessible and effective.
One potential barrier is the way services respond when families miss appointments or disengage. Families supporting a loved one with poor mental health are often under immense pressure. A young person who cannot attend an appointment may feel overwhelmed, anxious or exhausted, or may be unable to engage safely at that moment.
The research led by Cambridge - the findings of which were presented at a roundtable parliamentary event attended by representatives across the children and young people's sector, including the Minister for Children and Families - highlights that non-attendance should not automatically be interpreted as a lack of motivation or readiness for support, but may indicate that further understanding, flexibility and help are needed.
If a child or young person finds it difficult to engage with the treatment offered, practitioners and services should reflect on how this can be addressed. Sometimes this can be as simple as considering the physical environment in which therapy is delivered.
For example, if cognitive behaviour therapy, or CBT, is delivered in a dark, enclosed space, with harsh lighting, this may make it harder for children to relax sufficiently to benefit from the treatment, particularly if the children in question are neurodivergent. In some cases, this can be traumatic for children and can even make their mental health challenges greater.
Children may also benefit from flexibility in how support is offered. Some may experience a limited number of one-to-one sessions with a stranger as interrogatory or pressuring. For these children, learning in a group about how the brain works may offer another way to develop skills and resilience associated with individual CBT. Alternatives to standard CBT should be readily available, particularly where children are neurodivergent or have experienced trauma.
Some children may need more time to build trust and rapport with those delivering treatment. Others may find it easier to engage at particular times of the day - for example, avoiding evening sessions if overstimulation could disrupt their sleep.
Parents knew from their experience of different services that these adaptations were possible, and they praised the professionals and services that had made them happen. Their message was clear: more children should have access to this flexibility so they can benefit from the treatment available.
People who use services every day bring valuable expertise that cannot be gained from policies, data or professional training alone. When services work alongside young people and families, they are more likely to understand barriers to access, identify what is helping, and develop approaches that genuinely meet people's needs.
We hope the University of Cambridge-led COACHES study strengthens understanding that self-harm does not happen in isolation. There is no one-size-fits-all solution: effective support must respond to the circumstances, needs and preferences of each young person and family.
Young people deserve support that is compassionate, flexible and responsive to their individual circumstances.
Most importantly, they deserve to be heard.
Listening is only the first step. By acting on what young people and families tell us, we can create services that are more accessible, supportive and effective for those who need them most.