# Exploring and Modifying BarrieRs to enhance ACcess to mental health support for Ethnic minority Children and Young People (CYP) in acute paediatric settings (EMBRACE) in England: a realist review protocol

## TL;DR

This study aims to understand how to improve mental health support for ethnic minority children in UK hospitals.

## Contribution

The study introduces a realist review protocol to explore barriers and solutions for mental health support in acute pediatric settings for ethnic minority children.

## Key findings

- Mental health support in acute pediatric settings is insufficient and unsafe for ethnic minority children.
- Racial disparities exist in the accessibility and outcomes of mental health services for children.
- A refined programme theory will be developed to guide improved mental health support for ethnic minority children.

## Abstract

Globally, up to 15% of children and adolescents experience a mental health (MH) condition. In the UK, an increasing number of children and young people (CYP) are presenting to acute paediatric settings (paediatric emergency departments and paediatric medical wards) with MH issues. However, the literature suggests that the MH support available in acute paediatric settings is insufficient and unsafe in England. A key principle in NHS England’s plan for joint working to support CYP with MH needs in acute paediatric settings is for care to be personalised to the needs of CYP. However, there is a paucity of research that explores the needs of ethnic minority CYP with MH issues in acute paediatric settings, and recent research has highlighted racial disparities in the accessibility and outcomes of MH services for CYP. This is significant as MH issues in childhood are associated with lifelong inequalities in health, employment, education and mortality outcomes in later life. We aim to explore how, why and under what circumstances acute paediatric settings support (or do not support) ethnic minority CYP to access appropriate MH support, and to develop a refined programme theory for the important contextual factors and mechanisms that can influence whether acute paediatric settings support ethnic minority CYP in accessing appropriate MH support.

This review will use the realist approach developed by Pawson and Tilly which involves six steps: (1) Clarifying the scope of the review, (2) Searching for evidence, (3) Selecting and appraising the primary studies, (4) Extracting and organising the data, (5) Analysing and synthesising the findings and (6) Disseminating the findings. We will search OVID Medline, PsycINFO, CINAHL and SCOPUS. Relevant data will also be sought through snowballing and backward citation searching on included studies, seeking document recommendations from relevant professionals, and grey literature searches on Grey Matters, Health Management Information Centre and Google Scholar. The search will cover documents published from database inception. Documents featuring Black and/or Mixed-Black CYP with MH issues in acute paediatric settings will be included. Documents that do not separately report the results of CYP (<18 years old) from Black ethnic groups, or are unavailable in English will be excluded. An advisory group of key stakeholders will be recruited and involved throughout all stages of the review to promote the design and outputs of the realist review reflecting the experiences of (a) Ethnic minority CYP with MH issues and (b) The professionals involved in their care and the acute paediatric setting. The output of this process will be a refined middle-range theory that will provide a detailed understanding and explanation of the key contextual factors and mechanisms involved in ethnic minority CYP accessing MH support.

This realist review will only involve secondary data, so ethical approval will not be required. The developed programme theory will be disseminated through the advisory group, peer-reviewed publications, discussions with relevant stakeholders and presentations at relevant research conferences and community events. Additionally, the theory will inform a primary realist evaluation study where the theory will be tested and refined further.

PROSPERO, CRD420251009912.