The DREAM Project: Diversity, Research, and Engagement for Adolescent Mental Health

Lead Research Organisation: University of Nottingham
Department Name: School of Medicine

Abstract

The number of children and adolescents from migrant backgrounds is increasing in the UK. These individuals may be at increased risk of poor mental health outcomes such as depression, anxiety, and post-traumatic stress disorder (PTSD). This may be because they have experienced stressful or traumatic events before, during, and following migration. For example, children may have experienced violence, conflict, or natural disasters in their countries of origin. They may have had long journeys to the UK, or experienced stressful situations such as refugee camps or detention centres, dangerous transit routes, or poor living conditions before arriving in the UK. Children and adolescents from migrant backgrounds in the UK may also experience stressors here such as poverty, violence, stigma or discrimination, violence, or social isolation.

There has been limited research on ways to protect the mental health of these children and adolescents, or how to prevent poor mental health outcomes. There is also little understanding of how to best connect with these groups to support their engagement in research or health services, or to ensure that interventions are appropriate, effective, and sustainable. Creative and arts-based approaches such as drawing, painting, theatre, music, and dance have been used to both connect and engage with youth from diverse backgrounds in a meaningful way, and to promote mental health and resilience.

The aim of this project is to collaborate with children and adolescence from migrant backgrounds to strengthen what we know about the mental health needs of these youth, and how to promote and protect their mental health. The project will have three interlinked parts in which we will: 1) Develop a research group with collaborators from a range of disciplines and sectors such as research, health services, and community organisations, and the creation of a youth group through which we will collaborate with children and adolescents to develop an art-based intervention; 2) Gather evidence on the mental health needs of children and adolescents from migrant backgrounds and their conceptualisations of stressors, resilience, and barriers to engagement with research and health services through a survey, and a photovoice project using photography to explore their experiences; and 3) Develop, test, and evaluate an art-based intervention in collaboration with the youth group. The findings will be shared with researchers, and the wider community, and will strengthen our understandings of the mental health needs of children and adolescents from diverse backgrounds, and inform future research and interventions.

Technical Summary

The number of children and adolescents from migrant backgrounds is increasing in the UK, with evidence that they may be at increased risk of poor mental health outcomes due to exposure to psychosocial stressors before, during, and following migration. There is limited evidence on protective or preventive interventions to promote mental health and well-being in migrant children and adolescents, and a lack of community engagement or participatory research to support effective implementation. However, creative and arts-based approaches have been used to both facilitate meaningful engagement and to promote mental health and resilience. The aim of this project is to utilise participatory research and engagement to strengthen evidence on the mental health needs of children and adolescents from migrant backgrounds, and approaches to promoting their mental health and well-being. The specific objectives across three interlinked work packages are to: 1) Establish a sustainable foundation for community engagement and participatory research through a multidisciplinary research network, and youth consortium; 2) Investigate mental health needs, and conceptualisations of risk factors, resilience, and barriers to engagement among children and adolescents with migrant backgrounds through a mixed-methods survey and photovoice project; and 3) Develop, pilot, and evaluate a co-produced arts-based mental health promotion intervention through collaboration with the youth consortium and research network.

Planned Impact

Children and adolescents from migrant backgrounds have been shown to experience significant barriers to accessing health and social services and engaging in research, which may be exacerbated by increasingly restrictive immigration and healthcare policies. As a result, these communities are consistently underrepresented and excluded from both health research and health services.

The research will have important benefits both for children and adolescents from migrant backgrounds, and the organisations and services working with them. The participatory emphasis of the research will support engagement, knowledge exchange, awareness raising, inclusion, and capacity building among children and adolescents. The youth consortium who will be engaged in co-producing the interventions, will receive training on research methods, mental health promotion, and arts-based approaches, contributing to capacity building in these areas, in addition to promoting inclusion and the development of social networks.

The research participants will also directly benefit from the research through participation in the arts-based intervention, which will be focused on promoting mental health among children and adolescents, directly benefitting the participants and informing strategies to improve mental health and prevent poor psychological outcomes in wider communities of children and adolescents from diverse backgrounds. The participants may also benefit from the opportunity to engage with other youth, as well as local support organisations through the intervention, strengthening their social networks and resources.

Finally, the project will have important benefits for other sectors, as it will strengthen multidisciplinary and cross-sectoral links through the research network, and inform changes in policy and practice, supporting these organisations to address the social and mental health needs of the communities with whom they work.

Publications

10 25 50
 
Description Influence on training and development for postgraduates and researchers
Geographic Reach Local/Municipal/Regional 
Policy Influence Type Influenced training of practitioners or researchers
Impact In my teaching for the Master's in Public Health, I have discussed the theoretical underpinnings of the research, including my previous work using creative-based approaches to engage with communities from diverse migrant and ethnic minority backgrounds, and previous evidence of the effectiveness of using creative-based approaches to both facilitate involvement and engagement of children and adolescents from diverse migrant and ethnic minority backgrounds, and for mental health promotion. This has formed a part of the training of a cohort of students from diverse national and cultural backgrounds as well as cross-sectoral backgrounds including healthcare, public health, social work, policy, and journalsm. By discussing this project and approaches used, their has been a bidirectional transfer of knowledge, both informing the project through the input based on personal and professional the experience of the students, and also strengthening their training and skill level, which will facilitate their inclusion of diverse groups in future research, policy, and practice, and promote the use of interdisciplinary approaches within their future work.
 
Title DREAM community network 
Description One of the core aims of the project is to develop a multidisciplinary and cross-sectoral research network to support involvement and engagement of diverse migrant and ethnic minority communities in this and future research. In the first phase of the project, we have focused on creating this community network, comprised of researchers, community organisations, and cross-sectoral stakeholders. We have created an initial database for this network, which we will continue to build during the project, and which will serve as a sustainable platform going forward to support involvement and engagement activities. 
Type Of Material Database/Collection of data 
Year Produced 2020 
Provided To Others? No  
Impact This network database will strengthen multidisciplinary and cross-sectoral collaborations in this project and future research, providing a long-term sustainable resource, which can be continously added to, to support involvement and engagement activities locally as well as nationally. 
 
Description Nottingham Together Board and Minoritised Communities Advisory Group 
Organisation Nottingham City Council
Country United Kingdom 
Sector Public 
PI Contribution My core contribution to this partnership has been my research experience and expertise in co-production, involvement, and engagement approaches with the community. In our meetings, I have contributed to discussions around priority areas to facilitate more meaningful involvement and engagement of minoritised communities in Nottingham and the East Midlands more broadly.
Collaborator Contribution I have partnered both with colleagues in the Division of Primary Care (University of Nottingham), and members of the Nottingham City Council Nottingham Together Board, which is comprised of individuals from diverse ethnic backgrounds who work together to strengthen equality, diversity, and inclusion of minoritised communities in Nottingham City Council's work, and in the region more broadly. The Division of Primary Care has contributed to this collaboration by drawing on their extensive expertise in patient and public involvement with diverse groups in health research. They have also drawn on their wider community networks to inform priorities for our collaborations in this partnership. The members of the Nottingham Together Board have made critical contributions to discussions about priorities for research, and how to meaningfully include diverse and minoritised communities in health research. This has strengthened my understanding of priority areas in my own research, key communities who should be better represented and are currently underheard, and how to facilitate inclusion through meaningful partnerships.
Impact This collaboration informed a commentary on how to strengthen the inclusion of underheard communities from migrant and ethnic minority communities, and strategies to facilitate meaningful involvement and engagement of these groups (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7547632/). This collaboration has also contributed to the development of the Minoritised Communities Advisory Group. This advisory group is a multidisciplinary and cross-sectoral collaboration comprised of members from the wider Nottingham community, including individuals from diverse migrant and ethnic backgrounds and working in research, health and social care, education, and policy. The objectives of this group are to discuss priority areas for research to address disparities in health and wider social outcomes experienced by minoritised communities, and to identify opportunities to strengthen involvement and engagement of these groups. This has included working collabotively to identify appropriate and acceptable terminology to describe minoritised communities, and working with organisations engaging with our wider community to support events to engage local communities in research activity. This collaboration will support my ongoing research activities as well as future research, supporting involvement and egnagement of minoritised groups in research activities, co-designing and co-producing research, giving voice to underheard groups, and increasing the diversity of PPI activities.
Start Year 2020
 
Description Nottingham Together Board and Minoritised Communities Advisory Group 
Organisation University of Nottingham
Department Division of Primary Care
Country United Kingdom 
Sector Hospitals 
PI Contribution My core contribution to this partnership has been my research experience and expertise in co-production, involvement, and engagement approaches with the community. In our meetings, I have contributed to discussions around priority areas to facilitate more meaningful involvement and engagement of minoritised communities in Nottingham and the East Midlands more broadly.
Collaborator Contribution I have partnered both with colleagues in the Division of Primary Care (University of Nottingham), and members of the Nottingham City Council Nottingham Together Board, which is comprised of individuals from diverse ethnic backgrounds who work together to strengthen equality, diversity, and inclusion of minoritised communities in Nottingham City Council's work, and in the region more broadly. The Division of Primary Care has contributed to this collaboration by drawing on their extensive expertise in patient and public involvement with diverse groups in health research. They have also drawn on their wider community networks to inform priorities for our collaborations in this partnership. The members of the Nottingham Together Board have made critical contributions to discussions about priorities for research, and how to meaningfully include diverse and minoritised communities in health research. This has strengthened my understanding of priority areas in my own research, key communities who should be better represented and are currently underheard, and how to facilitate inclusion through meaningful partnerships.
Impact This collaboration informed a commentary on how to strengthen the inclusion of underheard communities from migrant and ethnic minority communities, and strategies to facilitate meaningful involvement and engagement of these groups (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7547632/). This collaboration has also contributed to the development of the Minoritised Communities Advisory Group. This advisory group is a multidisciplinary and cross-sectoral collaboration comprised of members from the wider Nottingham community, including individuals from diverse migrant and ethnic backgrounds and working in research, health and social care, education, and policy. The objectives of this group are to discuss priority areas for research to address disparities in health and wider social outcomes experienced by minoritised communities, and to identify opportunities to strengthen involvement and engagement of these groups. This has included working collabotively to identify appropriate and acceptable terminology to describe minoritised communities, and working with organisations engaging with our wider community to support events to engage local communities in research activity. This collaboration will support my ongoing research activities as well as future research, supporting involvement and egnagement of minoritised groups in research activities, co-designing and co-producing research, giving voice to underheard groups, and increasing the diversity of PPI activities.
Start Year 2020
 
Description Student forum 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Postgraduate students
Results and Impact The purpose of this activity was to share information and facilitate knowledge transfer with postgraduate students, as well as wider members of the academic and clinical community, about patient and public involvement, and more broadly, to explore the diversity of approaches to involvement and engagement that exist for promoting meaningful inclusion of the wider community in research. I spoke with a cohort of around 40 students about patient and public involvement, and shared this specific project as an example of a unique approach. I discussed how I was exploring approaches to using creative and art based methods to involve and engage with diverse groups in research, and in particular, how such approaches may be effective in increasing the inclusivity of research, and for facilitating opportunities to explore the experiences of groups who have have been excluded or marginalised. The session included an opportunity for students to share their experiences, and for discussion around key issues in this area. This has fed into some of the research students have gone on to conduct, both within their courses (e.g. dissertations), as well as research assistant posts etc.
Year(s) Of Engagement Activity 2020