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So this whole can you just say your name and what your title is?

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Yes. I'm Kathy Creswell. I'm a professor of developmental clinical psychology.

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Lovely. And this will just tell me a little bit about yourself.

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So starting from when you first got interested in the subject to how you got to be where you are now.

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Yeah. So my background is in clinical psychology.

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So I did a psychology degree here in Oxford and then after getting some experience trained as a clinical psychologist and during my training,

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I became really interested in child and adolescent mental health and spent a year of the three year course working with children,

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young people and families. And when I finished that clinical psychology training, qualified as a clinical psychologist,

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I was really keen to work with children, families, but also I was very driven to continue doing research,

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not just clinical work,

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because there are quite large gaps in our understanding about what we need to be doing to get the best outcomes for children and young people.

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So from there I did a page deep after my clinical training which focussed on anxiety problems in children and I very much carried on in that area.

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And that's that continues to be the main focus of most of my work.

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And when did you come here to your present post? So I came here to Oxford three years ago,

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so it feels like yesterday because we've obviously had two years of pandemic and in those three years I still very much feel like a new person.

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But I came here three years ago. So what?

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How much of a problem is anxiety for children?

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Yeah, well, so anxiety problems are probably the most common emotional problems that children well that anyone experiences across the lifespan.

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And, and so actually it's thought that about 25% of people will experience significant problems, anxiety at some point in their life.

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And actually for most of those people, those problems will first emerge sometime during childhood and adolescence.

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And some studies have estimated that the median age of onset of anxiety problems is 11.

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So it's half of everyone who will have an anxiety problem in their life will first have those problems before they leave primary school.

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And international studies of collated data suggest that at any one time,

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probably about six or 7% of children will have a significant problem with anxiety.

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So a level of anxiety that's causing problems in their day to day life.

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I wonder how you define that, because, I mean, we all get anxious. Yes. And anxiousness must be a it's a normal reaction.

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Yeah. To uncertainty. Yeah. So where do you decide that anxiety has actually become a problem?

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Yeah, yeah. No, absolutely. You're absolutely right. Obviously, we all have fears and worries and anxiety about things.

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But when we talk about anxiety problems, it's really where the anxiety persists so longer than you know.

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So it's not specific to one very particular situation and it's out of proportion to the threat that that they're experiencing in their life,

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but also critically, that it is causing interference and impairment on a day to day basis.

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So that might be for children commonly. That might be problems like, for example, attending school or getting school on time,

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being able to participate at school, be able to do sort of age appropriate activities.

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And also there can be huge sort of difficulties that families have to manage often could be enormous problems with eating, with sleeping,

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and also just becoming very distressed on that on a regular basis, which is obviously difficult for for the child and also their family around them.

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So it's usually the family who become concerned and might approach services for help.

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Yes, that's right. So we I mean, we do a lot of work with pre-adolescent children.

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So there it almost always is. The family say seek help.

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And actually, interestingly, with adolescents, we found the same that where young people do manage to reach services often is

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because of members of the family have been able to really help push that forward.

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So what are some of the projects that you've set up since you've been here.

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Yeah, to try and address that. Yes. So to Non-covid projects.

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Yes. Okay. In a lovely sunlit world where COVID.

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All right. Yeah.

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So we've we've got a number of projects going on, focusing on anxiety in children that are focussed on prevention and early intervention particularly.

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So one of the things that we found previously is that it probably isn't a surprise to anyone is that very few children I saw

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problems actually access evidence based psychological therapies and there are lots of barriers that come along at different stages.

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You know,

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in this sort of from realising there's a problem to you to actually being able to get some help that we've tried to address in a number of ways.

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And one of the ways is by developing brief interventions where we can kind of

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empower parents to be able to help their children in their day to day lives.

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And that way you can fit around busy family lives. And also we can deliver treatments quite efficiently from a health service perspective as well,

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bypass child and adolescent mental health service completely, or does it go through that?

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Yeah, because we're reading in the papers every day at the moment about how completely.

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Yeah. Say the interventions that we tend to deliver do come with therapist support.

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Because when you're working with families where children do have having problems and things are interfering,

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you know, studies generally find that having some level of therapy support is really important to get good outcomes.

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So we, we all studies do involve delivering interventions that have therapy support.

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But what we're trying to do more and more is deliver, develop interventions that can be delivered by sort of non not highly specialist practitioners.

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So for example, in recent years there's been an initiative to increase the mental health support provision that's directly accessible through schools.

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And so we're working with lots of those teams to make sure that the practitioners that work in

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those teams are able to deliver interventions that work so that when families are first concerned,

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they get access to to good quality treatment and that can fit around their lives.

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So we've got a few studies. We've got a trial programme of work called I Identifying Child Anxiety through schools,

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which is all about improving our identification of anxiety problems.

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But we've then also developed a kind of pathway from ID.

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Feedback and then offering an online intervention to parents to support them.

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And we're currently doing quite a large randomised controlled trial to look at whether we can reduce

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the number of children who have anxiety problems through that early screening and intervention.

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We have another trial called My Cats, minimising young children's anxiety through schools which are with younger children in key stage one,

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where we identify children who might be at risk of anxiety problems.

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And again, we support parents to try and prevent the development of anxiety disorders.

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But we also have a study which is is more delivered through services again of an online intervention for

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parents where we're doing a randomised controlled trial to see whether this brief online intervention parents,

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whether we can get as good outcomes as would normally be achieved through what child numbers mental health services would usually do,

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which would generally be sort of a more intensive, more potentially more expensive treatment.

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So if we can get good outcomes, but with less, less demands on both parents on services,

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then obviously that means more people can access good treatments. So lots of different trials going on.

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There are lots of other projects going on around the edges, but those are some of the the larger ones that are going on at the moment.

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Tell me a bit more about the intervention. What it's it's evidence basically, like anything and it's philosophical.

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Yeah, yeah, yeah. So the intervention, the online intervention we developed is called OSI stands for online support and Intervention,

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but it very much is based on a non online intervention that we'd previously developed, which is a parent led cognitive behavioural therapy approach.

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So very much using the principles of cognitive behavioural therapy, which are very much about in order to overcome anxiety,

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you need to identify what the thoughts are, what your expectations and your predictions are that are leading to anxiety.

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And then you have to help people to have opportunities to learn new things about, to help them have new ways of thinking.

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And by thinking differently, we obviously then behave differently and we can come to feel differently.

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So what we do in this approach is we support parents to have different sorts of conversations,

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to help parents get a really good understanding of what it is that their child's worried about.

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And then we help parents to create plans that they can do with their children that give their children opportunities to learn new things.

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So setting up different tasks and experiments they can do together,

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as well as sort of just generally building their confidence in sort of solving problems and challenges that might come up along the way.

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If you can just pick up that excellent example of how that Yeah.

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How that might work that, that, that might be. Yeah.

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So a really common, really common thing can be problems at bedtime with sleep and so children feeling very frightened about sleeping on their own.

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And so you might have a child who's now coming to the end of primary school but possibly hasn't slept on their own at all and is very fearful,

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for example, that something bad will happen to them in the night if the parent is not right there with them.

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So they might have got into a pattern of of needing the parent with them to go to sleep,

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wake up in the night, needing the parent there to go back to sleep.

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So sometimes that might mean one parent essentially just has moved in with the child,

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or it might mean parents are getting just interrupted sleep every night, which obviously is very difficult to manage.

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And so in that sort of situation would be helping parents to have conversations where they explore what their child's worried about.

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And it might be that they discover that the child thinks something bad is going to happen.

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They might think something.

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Someone's going to break in in the night, and then we would help them think about, well, how can you how can you put that to the test?

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So there might be things that they can do to to put that to the test.

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So it might be the child thinks someone's breaking the window.

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So there might be experiments they can do to see how really, you know, how much of a threat that is.

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And sometimes children might be worried about things like, you know, they're just worried that they're going to get very upset.

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And so then it could be about that, just giving them the opportunity to have a bit of time on their own,

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but in a way that they do feel safe and comfortable and then gradually kind of increasing that.

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So it's certainly not about sort of throwing children into difficult situations and making them,

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you know, experience the fear and have a terrible time, but deal with it.

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It's much more about just gradually giving children opportunities to learn new things,

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discover things about themselves, discover things about the world around them.

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That's quite a skilled job to ask of parents, in a way.

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I mean, you would of think, well, parents ought to be able to do all these things.

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But actually there is an awful lot of thinking and research that's gone into that.

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And that's why having the therapy support, I think, is so critical.

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So so parents, we now have this online version, so parents can access lots of information.

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But then the therapist is they're generally on the phone for a short amount of time each week.

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He can help parents think, okay, right. Break it down.

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So it's a sort of said it's not too complicated the process and to help parents say okay so what have we learned this week?

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What can we do and how can we make this fit for your child and obviously address any problems that might arise along the way?

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And I guess. So this is such an interesting subject, but presumably the anxiety of the child communicates itself to the parents.

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So presumably these parents are quite anxious. Well, I think may have been beforehand.

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I don't know. But yeah, but you're right, having it as a child is really anxiety provoking.

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I mean, obviously we all worry about our children.

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And so if your child is struggling and and getting distress alert or missing out on things like that is really anxiety provoking.

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And that's you know, there's a certain extent that anxiety does run in families.

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However, you know, many families that we work with, there's no family history of anxiety.

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But of course, there's a lot of stress that comes with the child having having anxiety.

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And so we've really found that parents are often, you know,

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really engaged with this process of, you know, being supported to manage things themselves.

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And actually where in one trial, we specifically worked with parents who told us they did also have difficulty with anxiety,

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and they reported quite marked reductions in their own anxiety as well, even though we didn't direct that directly address it.

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But I guess that experience that well, one your child's this anxious so that removes lots of stress in your life but also that experience

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of being empowered and the confidence you can get and the control you kind of have over your world.

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But also, I mean, potentially parents may also use some of the stresses themselves.

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So there's a number of ways that it may be may be beneficial.

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So you say these trial trials are ongoing, do get some results.

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The ones I've mentioned are all ongoing.

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So we have run previous trials with prior to having the online version where we find that from just about 5 hours of intervention from a therapist,

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about three quarters of the children were free of their exact problems at the end of of the treatment.

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So expected good outcomes. Yes, yes, yes.

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So let's finally get round to talk of it. So first of all, just looking at yourself individually,

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can you remember where you were when you first heard about the pandemic and how long was it

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before you realised that this was something that might actually you might become engaged with?

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Yes. Yeah. I can't remember where I was when I first heard about it.

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However, I did go to France in the February prior to everything kicking off and and came back with a really bad cough.

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And at that point people were just starting to talk about it.

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We've had the first few cases and we'd come back on a ferry full of people coming Italian ski, ski holidays.

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And so and it really sticks in my mind because I remember phoning, you know, helpline and saying, might this be COVID?

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And they said wanted to go to Italy. And I said, no, but they were like, Well, no, it's fine then.

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Which of course, now with everything, everything we know, you sort of think, well, was it so?

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I remember. Yes, so I remember that that obviously towards the end of the February,

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it was definitely on my radar because I had a very bad cough, which may or may not have been okay, but who knows?

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Yeah. And then when did you when did it become apparent that this was going to be contributing to anxiety?

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Yeah, I feel like. Yeah, well, I mean, I think as soon as as soon as we were talking about lockdowns,

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I think that was when it became really clear that that the huge impact this was going to have on children and and families.

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So I guess we weren't thinking necessarily about COVID itself.

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It was it was more at that point thinking about the restrictions, because for the children and and parents, obviously, that was a huge, huge shift.

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And I guess at that point,

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we also didn't we didn't really know what the impact would be in terms of case numbers and the impact on children's lives in those ways.

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But obviously, the impact of the restrictions was felt. The potential impact was very clear.

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Certainly the change to people's lives that was coming. We, of course, had no idea how long it was all going to go on for.

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And so we set up the case based study with my my colleague sat for COVID 19, supporting parents and children in epidemics.

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I think it was still an epidemic at that point.

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And so which I set out with my colleague Polly Waite and many members of our team here, I kind of just got involved very,

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very quickly because it felt really important to understand the experiences of children, young people and families.

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And I think we thought, you know, we set it up as a it's a survey that parents could take part in.

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And the idea was to track children's mental health over time.

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But we thought that would be quite a short period of time.

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But we've just now last week launched a two year, two year survey to follow up those families two years after we started the first survey.

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So we really had no idea how long it was going to go on for at that point.

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And how did you recruit your participants for that? Yeah, so it's a very open study, so it's not a representative population of the UK.

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It was it was all done very rapidly.

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But one of the things that we were really helped by is I lead a Ukraine funded research network called Imagine Mines.

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And Imagine Mines is all about trying to facilitate more research in child and adolescent mental health,

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working across disciplines, working across sectors, and working a lot with families with relevant lived experience.

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And because we had that network, we were able to one, we were able to talk to families very quickly and get lots of input on our plans.

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So a fantastic group of parents came together very quickly and sort of we talked about the questions that we wanted to ask,

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what they felt were important things to address that that was great.

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But also we were able to reach out through all of our voluntary community sector organisations

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that we work with who were really helpful in just sharing information about the survey.

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Because we the way that we said that we weren't going to get a representative population,

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you know, it's an online survey, there's always going to be biases in who takes part.

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However,

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what we did want to do was to try and just get as much diversity in that sample as we could say that ultimately we could look at within our sample,

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you know, what are the different experiences people have and how might you be able to explain them?

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So we were really helped by, you know, a wide network of voluntary community sector organisations,

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sort of spreading the world words and encouraging parents to take part. And with this after schools, it closed.

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So you couldn't go through schools? That's right. Yeah.

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So we did actually, because all three schools were communicating. So we did also contact schools and ask them to send things out.

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But schools obviously were in, you know, obviously such a difficult time for them.

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So yeah, so we did actually reach out through schools as well.

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But I think we got particularly through the voluntary community sector organisations that we work with.

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And so how many families did you have in the study. Yes. Is say, well, the numbers have sort of built up at different times.

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Essentially we have data from about 9000 families, but not not everybody has completed the measures every month.

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And so it's a smaller number, around 3000 where we have good longitudinal data that we can use.

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And it will be interesting to see now with this two year follow up,

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we had them literally launched that last week and on day one we had 100 people fill in the survey and very quickly.

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So that was really fantastic. And obviously more people we hope will continue to fill it out over the coming week or so.

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So, yes, so different numbers at different points of the pandemic,

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but it's it's a within that there is quite a lot of variability in people's experiences.

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So some of the analysis that we've done, we've looked at how did mental health symptoms generally change over the symptom in our population,

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remembering that it's not representative sample what essentially what you say is the pattern of the rest of the pandemic,

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really the restrictions in cases that when things were, you know, the cases were higher, restrictions were higher.

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We see increases in the mental health symptoms we were measuring.

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And then generally they dropped down again and then then they've gone up again.

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We found that in the second national lockdown,

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things seemed to peak at a higher level than they did in the first one, which definitely fits with people's reports.

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Generally, they know more anecdotal reports, but the really is it's not a represents all of yet but the really useful thing has been up to

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say okay over time then how have the trajectories of change differed for different people?

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And actually we find that about globally about two thirds of the children and young people in the surveys have been fine all the way through.

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So low levels of symptoms all the way through.

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However, there are other groups, so there is a smaller group who was struggling at the beginning and have struggled all the way through.

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There's another group who were doing okay at the beginning, but definitely things got worse as time went on.

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And then there were also some who started off with with them more, of course, but actually may have seen a bit of an improvement over time.

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And then we were obviously then able to look at, well, who are those children?

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What, you know, can we tell which of the children are more at risk of a more difficult trajectory over time?

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And then should we be in this one today? Who might need further support now coming out of the pandemic?

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But also, if we're ever in this situation again, we've got a better sense of who we need to be paying particular attention to.

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I mean, I suppose you might find that there are some children who find going to school very anxiety producing.

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And so lockdown was actually a treat. Yeah, absolutely. And it's been really interesting because actually,

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said my colleague Polly Waite led up with other members of the team on some qualitative interviews as well with with them young people and families.

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And after the second lockdown, lots of people referred to the first one as being feeling a bit like a holiday because that was in the summer.

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And, you know, I think at the time, obviously, there were lots of changes people make.

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But but compared to the second one, which was in the winter and if one had been it had been going on so long,

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you know, the first one maybe didn't seem so bad. But also there have been studies.

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Yeah, we definitely. Found some groups who, particularly early on in the pandemic, definitely found life easier,

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and that was children who will probably find school more difficult.

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And other studies have found the same. So our colleagues in psychiatry have been running another study called Coxwell,

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and in that they've recently been particularly focusing on those children who seem to thrive during lockdown,

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which is about a third of their sample, and that's based on Child Report.

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And again, I think it does come down to, you know, maybe often, for example, in our study,

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children with special educational needs that where they may feel less comfortable in the school environment.

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And actually what families have said is then being able to learn at their own pace and in their own ways, having time to engage,

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more time to engage in activities that they enjoy were quite positive for some children, but probably more so the first lockdown and the second one.

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So that study was mostly about measuring the size of the problem.

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Yeah. Have you also gone on to do interventions? Yes. Yes, we have.

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Yes. So it was very clear straight away that from what parents were telling us in response to the survey,

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that they wanted support and were really concerned about their children's emotional and behavioural outcomes.

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And it was interesting because there's been huge educational disruption,

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but pretty consistently concerns about the sort of emotional impacts on children is it's been a real priority for a lot of parents.

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So there are two ways that we've responded to that.

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One is that we one of the things parents were saying in the survey early on was that they wanted kind of, you know, very accessible support.

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They wanted it to be from a credible source with, you know, professional input.

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But they, you know, wanted it to be stuff they could access from home.

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And they were quite interested in digital things. So we worked with a team led by Edmondson Knickerbocker at King's College London,

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who very rapidly worked with parents in a tech company to develop an app for offering parents support in the pandemic context.

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And that was funded that was also funded by equally as a case by study was.

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And essentially we were able to do a really rapid trial where we invited coast based participants to take part

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in this trial where they were randomised either to get the app straightaway or to get the app after a month.

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And the app is called Parent Positive and it's a really nice app that includes lots of information,

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lots sort of advice and guidance and really nice animations that they had

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already produced which have sort of very sort of celebrities talking over them.

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And there's also a parent exchange where parents can share advice,

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which is moderated by sort of expert parents who are trained and supported to do that.

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So yeah, it's a really nice app that was very rapidly developed and we've never recruited to a trial so quickly ever.

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I guess partly we had this case based population and this is what they told us they wanted.

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But I guess it also really reflected the yeah, the need that parents had at the time for full support.

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So that's, that said, we're just sort of like, you know, looking at the analysis now, the trial's finished.

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And so it's now a case of looking at the data itself to watch this space for that one.

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So that's one thing we did.

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The other thing that well, another couple of things actually, another thing we did in terms of interventions was it was clear,

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but we were seeing these these pressures in terms of children and people's mental health and services

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were having to rapidly adapt to be able to deliver interventions online in some form or other.

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And also services were really worried about the increase in referrals as restrictions eased, which is what we've seen.

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And so we also applied for funding,

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which we got from the Department of Health and Social Care through the Nature and the Medical Research

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Council to do a randomised controlled trial of our online parent led intervention for child anxiety.

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So here this is the co cat study and this is where we're comparing the parent led online parent intervention to whatever child loss mental health

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services are delivering in this kind of ongoing pandemic context and that we're sort of approaching the final stages of recruitment to that study now.

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So but it's quite a major trial.

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And we're working with over 60 clinical teams around the country with really good representation, you know, around different parts of the country.

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So those have been our two main intervention projects. But we've also had another project called Cove Ray, which is a knowledge mobilisation project.

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This is funded by the Medical Research Council and is about making evidence,

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getting evidence based messages about mental health to young people in the pandemic context and addressing their priorities.

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So in that project, we we did a lot of the team did a lot of work with young people to identify what were their priorities.

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Teenagers. Teenagers now. Yeah, teenagers to identify what they felt with a.

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The priorities and the things that they identified were early on dealing with boredom and boredom and

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sort of lack of motivation and also sort of social isolation and loneliness and dealing with uncertainty.

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And then also, they they identified that, you know, actually, there are ways to get help that are out there.

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But there is you know, we face barriers ourselves and say, so, you know, we need to help people overcome the barriers to seeking help.

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So those are the four areas they prioritise. And then we worked with lots of research and clinical experts and reviewed the literature and then

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work with some really exciting partner organisations to work with young people to produce resources,

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evidence based resources for young people.

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Say we've been working with a company called Philly Focus where young people make really fantastic drama based films.

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So they've just released a three part drama series all about trying to embed those messages about overcoming loneliness and social isolation.

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I've been working with an organisation called Headline is who support young people in developing that sort of journalism and multimedia skills.

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And they've been creating blogs where they've been interviewing experts about these topics.

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And we've also worked with colleagues at the design school at University of Reading who've been making some fantastic infographics with young people

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and then also with BBC by sides who've made some really nice one film piece and one really nice animation to address barriers to help seeking.

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So, so that's been the other, other strand of what we've been doing,

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individual young people to access that sort of a being provided to schools so they can have some discussion.

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Yeah, really good. Really good question. Because so far it has been kind of up to people said BBC bite size the things on their website.

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So obviously there's a big reach that way.

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Fully focussed have been sharing and getting huge reach from young people through their their social media channels and headline is we're doing the

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same but we're working at the moment on developing a programme that where these will all be provided to schools with materials that accompany them,

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that promote discussion and enable people to draw out the evidence based messages from them.

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So that's that's very much the next stage that we're working on now.

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And we very much hope that, you know, we've we deliberately created those resources in ways that met the needs that young

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people identified during the pandemic that were kind of amplified in the pandemic,

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but creating the resources in ways that live beyond the pandemic and hopefully still feel relevant.

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You know, as we as we move out of this and be a lot of those problems exclusive know exactly.

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Yeah. Oh, very good. Yes.

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I mean, do you think anything that you've been doing has contributed to policy making in education or mental health?

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Yes, that we've had a lot of conversations with policymakers throughout throughout the pandemic.

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And so we particularly, you know, in this sort of between the national lockdowns and just beyond, we're producing regular reports,

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which we shared very widely with policymakers, practitioners, voluntary community sector organisations to help influence their decision making.

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And we contributed to quite a lot of discussions with policymakers through All-Party Parliamentary groups and other sessions that

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were run for for policymakers and had a lot of conversations with Department for Education and contributed for the last two years,

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have contributed to the State of the Nation report, which focuses on children and young people's wellbeing.

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So we've certainly been providing lots of information. I guess it's less easy to say what impact that's had on in terms of policy change.

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But I think what we definitely did see was, you know,

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a gradually increasing awareness of the impact on children and young people and obviously their education, but also their mental health and wellbeing.

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And I think that that sort of conversation definitely grew as the pandemic moved on.

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And I think now, you know, is something that is a lot is written about and it's talked about a lot.

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And obviously we can't evidence anything, but it felt like we were able to contribute to getting getting that clearly

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on the agenda by being able to just having data that we could help provide.

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There obviously is other data as well that can be drawn on. And and, you know, all the studies provide slightly different things.

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I mean, the problem with with the pandemic is you can't ever there's no control group.

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You don't know what how things would have been otherwise. But we can kind of try and triangulate data from different sources.

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And, you know, and I hope that our data has made a contribution to that.

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And I hope that and obviously our intervention studies are ongoing.

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But as we get the results for those, you know, we obviously very much hope that there will be interventions that can be taken forward.

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And not just in pandemic circumstances, but actually if it means that it provides ways to increase access to psychological

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therapies and make them more flexible and easy for families to access,

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then that would be a great thing. Mm hmm. And do you work with teachers at all?

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It just struck me that, yes, although they probably haven't got time to sit down and deliver interventions.

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What what in the way that parents have. Yeah. Simply knowing and understanding how these things work.

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Yeah. Yeah. No, absolutely. I completely agree. And we do so in the Ikettes study, for example,

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which is about identifying child anxiety through schools and improving access to interventions that we we screen for anxiety children.

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And the main intervention is supporting parents. But we actually also go in and do a lesson for the whole class about anxiety,

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which and we provide information to teachers so we provide resources they can use,

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but also information so that they can, you know, respond to children consistent ways with the work that we're doing with parents.

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So we are doing that. But actually one of my team, Helen Manley, is a primary school teacher who's now doing a dphil here.

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And her focus is actually very much about picking up on your point that teachers don't necessarily have the time to deliver an intervention.

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And, you know, and maybe that's not what they're there for.

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However, they are interacting with children all the time. So are there things that teachers could do in just how they manage their classes generally?

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That exactly that might help you know,

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might help minimise the impact of anxiety for children and help children who might be prone to struggling with anxiety.

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Say she's been doing some fantastic, but she's done a systematic review interviewing lots of parents, teachers and children.

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And the next stage is developing a training intervention for teachers.

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All all about that. So address exactly the issue you raised.

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So, yes. And one of the things that a number of the researchers that I've interviewed have said that being thrust into suddenly doing very important

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things very quickly meant that they had to work in a much more collaborative way with colleagues from other teams than they had done previously.

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And in some cases, what revelation that was like compared with the slightly competitive way that.

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Particularly people in mobile sites tend to tend to do where you're, you know, constantly running to get the next paper out.

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Yes. At the nice conference presentation. Is that does that resonate?

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Yeah. I mean, I think I mean, I think we I hope that we will work in quite a collaborative way already.

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So I mentioned the Emerging Minds Network, which is all about, you know, building a network, helping people to work together.

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But we've certainly been we've tried to be really collaborative and mostly by just being very open about what we're doing.

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So with the case based study we made, we, you know, obviously the protocol was available so people could see what we were doing.

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But also we made all of the whole survey available to anyone who wanted it.

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And actually so we ended up sharing the survey and the sort of the script for the,

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the actual, the software that lives are available to collaborate from all around the world.

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So I think there are about 30 different coast based studies going on, which we're not running.

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We just sort of said, well, this is what we're doing, is it, if you like?

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And actually now we're just in a couple of weeks going to be meeting with many of those groups to think, to learn.

361
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No, sadly, no, I have. But but you'll you'll align.

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But to to you know, to share on what we've all learned from collecting that same data.

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And and certainly it was really important to us to, to try to minimise us all doing things a bit differently.

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But actually, if we can do things so that we can then pull our data pool alert and compare findings, then that's definitely preferable.

365
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So, so that was one thing that we did to really try and promote that collaboration and that's ongoing.

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And actually it has led to a recent grant led by my colleague Simona,

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who which is a collaborative grant with Japanese colleagues who have been collecting data during the pandemic.

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And now we've got this grant together where we'll be.

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We're all flip, they and us following everybody up at this two year mark and again over the next year,

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and also bringing young people together for discussions about the different experiences in Japan and the UK and what we can learn from that.

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So that's been a really nice example of a collaboration that's come from it.

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So are you finding that pretty much that the that the increase in anxiety,

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that that increases anxiety that you saw are repeated internationally, you're getting a similar result.

374
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Yeah. Well, so interestingly actually in our study, it's not anxiety specifically where we've tended to see the the main changes in,

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in children and in our study because we have a lot of children primary school age actually it's been more the sort of

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behavioural difficulties that have been more marked which makes sense given children were really cooped up and yes,

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yeah. So those were more marked than the sort of emotional, emotional symptoms amongst our sample.

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And that's something that's varied from study to study.

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So we haven't really been able to pull these different case based studies, but where but,

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but studies generally have varied on that and I think it depends on the specific age of the sample.

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It very much depends on the timing when the data, you know, when data was collected.

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So, you know, at some point in the pandemic, as we talked about for, you know,

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sometimes it might've been slight reductions, but then other times have been increases.

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And also it depends on the the demographic characteristics of the participants because, you know,

385
00:37:29,730 --> 00:37:35,040
we've definitely seen these very clear differences depending on people, circumstances,

386
00:37:35,040 --> 00:37:41,820
say, where children with special educational needs, children with where they're living in low family incomes,

387
00:37:43,230 --> 00:37:48,059
then in those situations, we see much higher levels of problems throughout.

388
00:37:48,060 --> 00:37:53,670
So so get that. So it's quite messy trying to pull the data together across these different places.

389
00:37:54,720 --> 00:37:57,890
But again, in some ways it's a very rational response.

390
00:37:58,620 --> 00:38:02,430
Ration isn't perhaps understandable. Yes, yes, of course.

391
00:38:02,580 --> 00:38:07,920
I mean, it's just it's just a kind of given of parenting that children need to let off staff.

392
00:38:07,920 --> 00:38:15,479
And that's all right. Yeah, that's right. And they couldn't get you know, some children had gardens that all children had gardens in many cases.

393
00:38:15,480 --> 00:38:18,750
Did you collect that? We did, yes. And we haven't done a lot with that yet.

394
00:38:18,750 --> 00:38:20,879
So there's a lot there's so much that.

395
00:38:20,880 --> 00:38:27,030
And we've just made the data available from the first year, the data available, open access on the UK data service.

396
00:38:27,030 --> 00:38:28,319
So because there is so much,

397
00:38:28,320 --> 00:38:35,070
we're just hoping other people will also go in and analyse it and ask interesting questions because there's a huge amount of data there.

398
00:38:36,330 --> 00:38:41,160
But they you also collect histories. I mean, like early, early trauma.

399
00:38:41,430 --> 00:38:48,830
No, not really. I mean, the whole it's always a very pragmatic decision, you know, of what you know, you can't ask too many questions.

400
00:38:48,840 --> 00:38:54,629
They try to narrow it down. So we did ask questions about whether there were pre-existing mental health problems and neurodevelopmental problems,

401
00:38:54,630 --> 00:38:58,380
but not much else in terms of of past histories.

402
00:38:58,650 --> 00:39:01,950
But yeah, a huge amount still to to look at and.

403
00:39:02,080 --> 00:39:06,129
Yes. Certainly those sort of environment, you know, the amount of space, whether that was gardens,

404
00:39:06,130 --> 00:39:10,050
you know, the demands of the demands on parents, all of those things were definitely made.

405
00:39:10,060 --> 00:39:16,480
Huge differences in people's experiences. I'm just going to turn a little bit more to the personal to you.

406
00:39:16,990 --> 00:39:21,140
So how did the lockdown itself impact on what you were able to do?

407
00:39:21,160 --> 00:39:31,149
How did you change how you work? Yes, well, we we were quite lucky because probably about two weeks before the pandemic hit South Korea.

408
00:39:31,150 --> 00:39:39,280
He's a wonderful administrator in our team, did a session for our whole team about Microsoft teams, which none of us had ever used before.

409
00:39:39,610 --> 00:39:43,870
And it was funny because she did the presentation and I thought, Oh, I can't be bothered to learn anything.

410
00:39:44,080 --> 00:39:50,770
And then of course, it got forced on us. So and luckily my team really embraced using technology.

411
00:39:50,770 --> 00:39:54,430
And many of the studies we spoke about, you know, got started during the pandemic.

412
00:39:54,440 --> 00:39:57,840
So we had staff who have never been to the office.

413
00:39:57,850 --> 00:40:07,660
So I think we've worked really well and have definitely moved, you know, moved our ways of working forward a lot by really embracing technology.

414
00:40:08,740 --> 00:40:17,080
And yeah, and so I think we were able to work quite effectively because we could do a lot remotely.

415
00:40:18,410 --> 00:40:23,319
And, you know, luckily having reasonable wi fi at home and personally, my children,

416
00:40:23,320 --> 00:40:27,860
the teenagers say they didn't really want me hanging around all the time anyway so I could.

417
00:40:27,940 --> 00:40:32,650
And so it meant I could actually work a lot, but still be around in a way that,

418
00:40:33,340 --> 00:40:36,910
you know, I wouldn't want to work that much if I was out of the house all the time.

419
00:40:37,900 --> 00:40:41,960
Yeah, but they were being homeschool. Were being homeschool. They were having to study at home.

420
00:40:41,980 --> 00:40:45,400
Yes, yes, yes. In theory being true. What you would study.

421
00:40:45,760 --> 00:40:52,480
Yeah. So yeah. Well, although one of mine was GCSE year, so his GCSE is obviously cancelled and then they had nothing.

422
00:40:52,660 --> 00:40:57,460
Nothing to do what. Schoolwork wise. So yeah we were looking at that as well.

423
00:40:57,610 --> 00:41:00,400
Yeah. Yeah, yes, yes.

424
00:41:01,030 --> 00:41:08,979
And I suppose because you suspected you might have had COVID so very early on, the threat of it, the threat of infection, I don't know.

425
00:41:08,980 --> 00:41:18,639
But did you feel under threat? Yeah, I don't think we did, because none of us in my household, none of us are clinically vulnerable.

426
00:41:18,640 --> 00:41:24,430
And that, you know, the messages about the risk to children were, you know, were quite low.

427
00:41:24,440 --> 00:41:27,820
And, you know, my husband, I didn't have any particular vulnerability.

428
00:41:27,830 --> 00:41:35,050
So I think we didn't really feel that, you know, we didn't feel worried about getting COVID particularly.

429
00:41:35,380 --> 00:41:39,400
The worry was always more about passing on to others for us.

430
00:41:39,400 --> 00:41:41,920
And actually that's what we saw in the case based study as well.

431
00:41:41,920 --> 00:41:49,690
When we asked about what children were worried about, it was it was typically well, it was typically about other people get other people getting it.

432
00:41:49,900 --> 00:41:53,110
Grandparents, yes. Exactly. Yes. Yeah. Mm hmm.

433
00:41:54,700 --> 00:41:57,730
Yes. I'm sorry. I think I missed all that out. Sorry. We need to get back to that.

434
00:41:57,910 --> 00:42:03,370
So what? Yes. Apart from. Yes, you you talked about loneliness and isolation and that kind of thing.

435
00:42:03,370 --> 00:42:07,870
But what were the specifically COVID related things that people were worried?

436
00:42:07,930 --> 00:42:13,870
Yeah. So I mean, definitely there was a worry about catching COVID, but particularly amongst children,

437
00:42:13,870 --> 00:42:18,129
particularly a worried worry about other people in other people catching it.

438
00:42:18,130 --> 00:42:22,960
And, you know, the messaging was quite frightening, wasn't it, about older people and grandparents and so on?

439
00:42:23,680 --> 00:42:30,940
And so that was definitely a worry parents were worried about, yeah, children's the emotional impact it would have on them.

440
00:42:30,940 --> 00:42:34,780
They were worried about their children's education and it was quite it was quite interesting.

441
00:42:34,780 --> 00:42:41,799
And I guess it reflects the population we're working with which are, you know, not generally ages that were particularly vulnerable,

442
00:42:41,800 --> 00:42:47,770
that they were more worried about the impacts of the wider impacts than the threat of keep it to themselves.

443
00:42:50,430 --> 00:42:53,819
And I mean, what about your your wider team?

444
00:42:53,820 --> 00:43:01,350
Did did they did you feel they needed additional support? I mean, was that were the levels of anxiety among your team different?

445
00:43:01,710 --> 00:43:10,130
Well, I mean, I think our team were absolutely amazing at just reacting in a very productive way.

446
00:43:10,140 --> 00:43:13,180
Say, for example, the case based study we launched very quickly.

447
00:43:13,260 --> 00:43:15,270
First of what? We didn't have any funding initially,

448
00:43:15,480 --> 00:43:20,280
but a number of people were just interested and just got involved and just took it on on top of their normal stuff.

449
00:43:20,280 --> 00:43:29,429
So I think a lot of people's response was just get very busy. Obviously we had to suddenly find lots of laptops and things that you know and

450
00:43:29,430 --> 00:43:32,430
buy things that we didn't have so that people were able to work from home.

451
00:43:32,430 --> 00:43:41,130
And I think, you know, initially and probably for too long for some people that were not really ideal situations for working at home,

452
00:43:41,430 --> 00:43:44,700
I mean, I think with, you know, within our team as it would be for anyone,

453
00:43:44,700 --> 00:43:49,620
people circumstances vary so dramatically and that makes such a difference to, you know,

454
00:43:49,680 --> 00:43:57,090
the impact that the pandemic had say, you know, whether people have young children versus teenagers like me with teenagers.

455
00:43:57,420 --> 00:44:04,170
For me personally, it wasn't, you know, that they you know, they're able to be quite independent in lots of ways.

456
00:44:04,170 --> 00:44:10,559
Whereas I think if you've got young children and you're trying to work, it was obviously hugely, hugely stressful and demanding.

457
00:44:10,560 --> 00:44:19,139
I think equally, you know, some people in the team may live on their own and at those early stages of becoming kind of living independently like that.

458
00:44:19,140 --> 00:44:28,800
And that's obviously hugely challenging. So I think people's individual circumstances like like anywhere hugely dictated the experience that they had.

459
00:44:29,700 --> 00:44:34,440
And were they able to talk about those different fears and worries?

460
00:44:34,450 --> 00:44:37,710
I think so. Yes, I think so.

461
00:44:38,340 --> 00:44:43,079
I mean, I'm sure have I'm probably not aware of of everything that that everybody experienced.

462
00:44:43,080 --> 00:44:50,280
But certainly, I mean, I think the university were very I mean, universities allowed people to, you know,

463
00:44:50,280 --> 00:44:55,169
like with people care responsibilities to basically reduce their working hours and things like that,

464
00:44:55,170 --> 00:45:01,530
which were really, really important to reduce relieve some of the pressure from parents, for example.

465
00:45:02,670 --> 00:45:08,819
And I think certainly within our departments, there's a lot of very helpful messaging that was very, you know,

466
00:45:08,820 --> 00:45:16,650
normalising the trickiness of it and trying to encourage people to seek seek help that they might need and to reach out to others.

467
00:45:17,280 --> 00:45:25,499
We also do I mean, I think I'm really lucky to have a very supportive team where people were so people quite rapidly set up, you know,

468
00:45:25,500 --> 00:45:32,280
regular coffee set online coffee sessions so that people would always know there was a point to check in with people,

469
00:45:33,300 --> 00:45:37,830
which I think also, you know, was just helpful, just making sure people were connected as much as possible.

470
00:45:37,830 --> 00:45:44,639
Yes, yes, yes. So so do you think the fact that you had that this you did, as you say, pivot to becoming very busy?

471
00:45:44,640 --> 00:45:52,890
Yeah. Do you think that was you know, again, people have been on a spectrum between, say, I was so busy, I was just exhausted all the time, too,

472
00:45:52,890 --> 00:45:58,920
saying working on something, even though I was working very hard because I knew it was important, it was really supportive of my wellbeing.

473
00:45:58,920 --> 00:46:04,680
Yeah. Where would you put yourself? Okay. Yeah. I mean, I think probably at different places, at different points in the pandemic.

474
00:46:04,680 --> 00:46:14,550
I think that initially definitely it felt, you know, it was it felt good to be able to do something that felt useful.

475
00:46:15,330 --> 00:46:19,350
Definitely. And I'm really glad that we've been able to contribute.

476
00:46:20,400 --> 00:46:24,000
But I think, yes, we definitely didn't realise how long it would go on,

477
00:46:24,000 --> 00:46:29,760
as we would say before and say, and it's just not sustainable to really go at that felt.

478
00:46:30,540 --> 00:46:35,849
But I think what most people are finding is things on the pressures, not necessarily relieving now as we come out of it.

479
00:46:35,850 --> 00:46:41,249
So I think we all do need to think a bit about the habits that we've got into over the last two years

480
00:46:41,250 --> 00:46:50,820
and start to make some adjustments because it is exhausting and you can't sustain that for forever.

481
00:46:51,360 --> 00:46:57,360
Yeah. I mean, do you think the remote working, for instance, has been something that you can learn from as an option?

482
00:46:57,360 --> 00:47:00,419
Definitely flexible way of approach? Yeah, definitely.

483
00:47:00,420 --> 00:47:06,030
And actually, we've been talking about this a lot as a team and most people, if not everybody,

484
00:47:06,030 --> 00:47:14,489
and now we've now sort of organised the arrangements for a lot of flexible work commitments where people will work from home a bit and in the office,

485
00:47:14,490 --> 00:47:20,309
but some people almost entirely from home, but most people a bit in and a bit out.

486
00:47:20,310 --> 00:47:24,000
And I mean personally I think that for me that works really well.

487
00:47:24,010 --> 00:47:30,260
I really like working that way and it's definitely a shift from how we were working before.

488
00:47:30,270 --> 00:47:33,299
No, I mean, I think the whole country has let up and the world probably has learnt.

489
00:47:33,300 --> 00:47:39,610
Yeah, you do. You don't have to. Presenteeism is not you don't have to see the person that know you.

490
00:47:39,720 --> 00:47:41,879
And you know we do have that within our team.

491
00:47:41,880 --> 00:47:49,740
Some of the project teams have never they you know, they started them, they could catch fire, which I mentioned that started quite far into.

492
00:47:49,800 --> 00:47:53,050
The pandemic. We recruited new staff in.

493
00:47:53,520 --> 00:47:55,200
Some of them have never been in a room together,

494
00:47:55,200 --> 00:48:01,080
but they work really well together and feel like they know each other really well because they're communicating all day long.

495
00:48:02,040 --> 00:48:04,490
You're just not physically in the same place. Yeah. Yeah.

496
00:48:05,830 --> 00:48:11,370
Um, so has the work you did specifically on COVID raised new questions that you're interested in exploring?

497
00:48:12,240 --> 00:48:19,150
I mean, I think that the, um, well, say the case study, I mean, there's huge amounts in there still to delve into.

498
00:48:19,170 --> 00:48:20,969
I think the thing that it's really highlighted is,

499
00:48:20,970 --> 00:48:29,250
is the role of inequalities and just that we've seen that there are groups there who have been particularly vulnerable all the way through.

500
00:48:29,460 --> 00:48:33,540
And, you know, for example, families living on very low incomes.

501
00:48:33,750 --> 00:48:37,379
That's a major, you know, such a major risk factor.

502
00:48:37,380 --> 00:48:43,110
And that was known before the pandemic. I think the pandemic is really sort of highlighted some of these things,

503
00:48:43,740 --> 00:48:51,299
and I think that's really made that become a more prominent focus, if not a focus of our work.

504
00:48:51,300 --> 00:48:59,340
But I think it means that in all of our work, we need to make sure that we are including families and you know, from so a broad,

505
00:48:59,730 --> 00:49:03,660
broad spectrum of backgrounds and circumstances so that we know that we're not

506
00:49:03,660 --> 00:49:07,049
excluding any groups who might particularly benefit and might have particular needs.

507
00:49:07,050 --> 00:49:09,070
So that's definitely been highlighted.

508
00:49:09,300 --> 00:49:17,580
I mean, I think one of the things that the digital intervention work that we're doing has definitely accelerated in pace because,

509
00:49:17,820 --> 00:49:20,520
you know, people have just been forced to use technology.

510
00:49:20,520 --> 00:49:24,750
And so whereas it might have been slower, people might've been a bit reluctant, people just had to embrace it.

511
00:49:25,650 --> 00:49:29,820
And so, you know, that's obviously a silver lining from an otherwise very difficult time.

512
00:49:30,360 --> 00:49:36,480
And I really and I think, you know, we want to really keep pushing at that now because for families, yeah.

513
00:49:36,510 --> 00:49:40,440
For parents who are busy and working, have children, etc.,

514
00:49:40,440 --> 00:49:44,819
actually there's huge advantages to be able to work in those kind of ways rather than

515
00:49:44,820 --> 00:49:48,270
have to take the whole day off work to drive your child an hour to an appointment,

516
00:49:48,270 --> 00:49:56,280
sit there for an hour, drive home, etc. So we can do a lot to increase access to interventions through digital means.

517
00:49:56,280 --> 00:50:01,320
And so that's that's definitely one thing that I hope will really keep moving forwards at pace now.

518
00:50:01,490 --> 00:50:06,780
Mm hmm. I mean, it sounds this it sounds like something that really needs to be adopted across the country.

519
00:50:06,780 --> 00:50:09,920
Yes. And so how far do you think you've got to you know,

520
00:50:09,960 --> 00:50:15,960
if you still got to wait for the results to come out before you can start persuading the Department of Health and Social Services.

521
00:50:15,960 --> 00:50:21,210
Yes, that we've got because we've got we got we've got some initial findings that look really, really promising.

522
00:50:21,240 --> 00:50:27,389
But we do need to wait for the results from the trials. But it's a slightly tricky situation because we have to wait for the results from the trials.

523
00:50:27,390 --> 00:50:31,260
But in the meantime, the clinical teams are working with us. I can we keep using this.

524
00:50:31,350 --> 00:50:37,409
Yeah. And because you know they've got on well with it and and it seems to work well from their perspective.

525
00:50:37,410 --> 00:50:42,569
So we do need to find the mechanism to to keep going with it and to keep rolling it out.

526
00:50:42,570 --> 00:50:45,330
So we've got some plans for some interim solutions.

527
00:50:45,330 --> 00:50:51,990
But but yeah, we do need to be pushing forward, really developing our plans for how we roll this out at scale.

528
00:50:53,920 --> 00:51:02,250
This might be slightly repetitious, but that has the experience of the pandemic changed your attitude, your approach to work in any way?

529
00:51:03,750 --> 00:51:09,730
Um. Oh. If I got anything else to say that you know that we haven't spoken about.

530
00:51:12,350 --> 00:51:19,540
The fall. He can't move anything further.

531
00:51:19,810 --> 00:51:24,250
No. Are there any. I should have asked this earlier.

532
00:51:24,250 --> 00:51:25,090
Really? But I don't know.

533
00:51:25,120 --> 00:51:32,080
Are there any comments from parents or children that you've come across in the course of your work that really stick in your mind,

534
00:51:32,380 --> 00:51:40,270
that illustrate the kind of thing you're trying to do? Oh I think now on the spot for.

535
00:51:40,510 --> 00:51:44,049
Yeah. No, I just wondered whether they might be something that you were always, you know,

536
00:51:44,050 --> 00:51:49,840
when you talk to people socially, you know, I've said this think that if they if there wasn't.

537
00:51:50,770 --> 00:51:54,220
Yeah nothing stomach to something will probably come to my mind in 5 minutes.

538
00:51:54,550 --> 00:51:57,640
Yeah. Okay. That's lovely.

539
00:51:57,640 --> 00:51:59,650
Thank you. Yeah. No. Am I talking to you?