An investigation into the impact of deprivation and ethnicity on treatment engagement within the Sheffield Lucy Project – a low-intensity cognitive-behavioural self-referral service in a paediatric setting

Abstract

Demand for child and adolescent mental health support is rising, with long waits risking deterioration. The Lucy Project provides rapid, self–referral, low–intensity CBT (LICBT) within paediatric settings, with interventions taking place via video call. While previous work suggests good reach and outcomes, equity of access and acceptability across demographic groups requires evaluation. This paper examines whether socioeconomic status (SES) and ethnicity are associated with engagement with the service. Service records for 149 patients referred to The Lucy Project in Sheffield Children’s Hospital between December 2022 and December 2024 were analysed. Engagement (engaged vs not–engaged) was recorded, and this was analysed in the context of ethnicity (White British; other; unknown) and indices of multiple deprivation (IMD) decile. Binary logistic regression tested associations. The sample’s ethnicity was broadly similar to that of the general population where the service is based; 27.5% lived in the two most deprived IMD deciles ( vs 34.2% citywide). Ethnicity did not predict engagement, whereas IMD decile was shown to be associated with engagement. Results suggested that the more affluent a patient, the more likely they were to drop out. In this video-based, self–referral LICBT service, engagement did not differ by ethnicity but was higher among children and young people from more deprived areas. Findings support the model’s potential to mitigate socioeconomic barriers post–referral, while highlighting the need to optimise engagement for more affluent families and to continue addressing pre–referral inequities and digital exclusion.

Key learning aims