To reduce the burden of depression, it is important to ensure that adolescents have access to effective, early interventions. Limited research has explored psychological practitioners’ views during the development of such interventions, despite the potential for this to improve implementation. A brief, imagery-based intervention (IMAGINE) has been co-developed to address issues in treatment provision for symptoms of depression in adolescents. Here, we investigate psychological practitioners’ and supervisors’ views about factors that may act as barriers and enablers to implementing IMAGINE. We used a qualitative interview study with (1) qualified low-intensity practitioners with experience of working in schools, and (2) clinical supervisors to these practitioners, working in England. Reflexive thematic analysis was initially inductive followed by a deductive mapping to normalisation process theory, a theory of how interventions become implemented and embedded in practice. Twenty-four participants (14 low-intensity practitioners and 10 supervisors) were interviewed. Six themes were identified: (1) ‘We could be doing more for young people with low mood’, (2) ‘IMAGINE stands out while feeling familiar’, (3) ‘Which young people is IMAGINE for?’, (4) ‘Pushing the depth of low-intensity practice’, (5) ‘Getting everyone on board’, and (6) ‘A good fit for services, more or less’. The findings show enthusiasm for new interventions to address adolescent depression, with low-intensity practitioners eager to enhance their clinical skills. This was balanced with concerns about the demand for low mood interventions and whether some components of IMAGINE fit within low-intensity practice. These insights suggest barriers and enablers for developing psychological interventions.

Key learning aims

1. (1) To identify implementation and contextual factors that may act as barriers and enablers to implementing imagery-based depression interventions in schools.

2. (2) To explore how an imagery-based psychological intervention for depression in adolescence is perceived from the perspective of psychological practitioners working in schools and their supervisors.

3. (3) To inform future research in the development of imagery- and school-based interventions for adolescent depression.

NHS Talking Therapies for anxiety and depression (NHS TTad) were established in 2008 to increase and improve treatment for anxiety and depression, with the intention of reducing inequalities through being particularly responsive to individuals from marginalised groups. However, racially minoritised clients are under-represented within NHS TTad services, and are more likely to drop out of treatment. A service evaluation was carried out at a central London NHS TTad service to explore the experiences of clients from the ethnic group that was most likely to disengage. The aim was to find ways in which the service could be improved to enhance the experiences of this group and increase the rate of treatment completion. A service audit revealed that clients with a Black background, regardless of their specific ethnicity, had the highest drop-out rate and were significantly more likely to disengage than the White British group. The service evaluation involved interviewing six clients from this group who had recently dropped out of or declined treatment. Interviews were structured and analysed using narrative inquiry, and pattern coding was used to reduce large amounts of data into four main themes. Overall, participants found accessing support relatively easy but had limited knowledge on the service. A lack of choice and flexibility around appointments were highlighted as key factors in not completing therapy. Based on their experiences, participants recommended incorporating community and cultural learning into therapists’ training, and giving clients the option to request a therapist from a similar background. Recommendations are provided for service delivery.

Key learning aims

1. (1) To identify which clients, based on ethnicity, are most likely to decline or discontinue treatment within an NHS TTad service in Central London.

2. (2) To increase understanding of the treatment experiences of clients from the ethnic group with the highest drop-out rates.

3. (3) To provide recommendations offered by these clients for service providers, aimed at improving engagement and treatment completion.

Multilingual experience is seen as a cognitive reserve factor that may protect against neurodegeneration. Accurate language use measurement is essential to understand its cognitive and neural effects. Traditional assessments often rely on a single retrospective questionnaire, which may not reflect the dynamic, context-dependent nature of multilingualism. This study introduces complementary tools – Language History Questionnaire (LHQ), Daily Report Form (DR), Online Messages (OM) and In-lab Language Tasks (EXP) – to assess language use across social contexts in native and non-native languages. Correlational, ANOVA and network analyses showed that self-report tools had high internal consistency, while objective and experimental methods varied in sensitivity to context and modality. Consistency across tools was higher for native language use, especially when aggregating data across contexts. In contrast, non-native English assessments were more affected by contextual variability and tool-specific biases. Findings highlight the need for multimodal, context-rich assessments to improve validity and comparability in real-world multilingual research.