Social prescribing for children and young people in the UK: characterising access and care pathways using electronic health records

This study analyzes UK electronic health records from 2017 to 2025 to characterize social prescribing pathways for children and young people, revealing that while referrals predominantly target those in deprived urban areas for mental health reasons, the service currently has limited reach for those under 18, a disparity that appears to be widening over time.

The Gist

Imagine the UK's healthcare system as a giant, bustling hospital. For years, this hospital has been overwhelmed, especially with young people struggling with their mental and physical health. To help, they built a "Community Bridge" called Social Prescribing. Instead of just giving a pill, doctors and nurses act as tour guides, sending people to local community activities like sports clubs, art classes, or job training to help them feel better.

This paper is like a massive report card written by researchers who looked at the digital logs of one of the main "tour guide" systems used across the UK. They wanted to see who is actually crossing this bridge and what happens once they get there.

Here is what they found, explained simply:

1. The Crowd on the Bridge

The researchers looked at over 52,000 young people (aged 4 to 25) who were sent on this journey between 2017 and 2025.

• Who is walking? Most of the people on this bridge are actually young adults (18 and older), not little kids or teenagers. It's like a bridge built for everyone, but mostly used by people in their early 20s.
• Who is missing? Children under 18 are rare visitors. The researchers worry that the bridge isn't reaching the younger crowd it was supposed to help.
• Where are they from? Interestingly, the bridge is doing a great job of reaching people from poorer neighborhoods. About 6 out of 10 young people on this bridge live in the most deprived areas of the UK. This is a good sign, as it means the service is reaching those who need it most.
• How did they get there? Almost 8 out of 10 were sent by a doctor or a medical professional (like a therapist). Very few walked up to the bridge on their own or were sent by schools or community groups.

2. The Tour Guide Experience

Once a young person is sent to the "Community Bridge," they meet a Link Worker (the tour guide).

• The Trip Length: On average, the tour is quite short. A young person meets their guide about 4 to 5 times, and the total time spent talking is just over one hour.
• The Conversation: Most of these chats happen over the phone or via text message, not face-to-face.
• The Destination: The goal is to send the person to a local activity (like a gym class or a support group). However, only about 1 in 3 young people actually get a "ticket" (a referral) to a specific activity. For the other 2 out of 3, the tour seems to end without a clear next step.

3. The Changing Landscape

The researchers looked at how things changed from 2017 to 2025.

• Getting Older: The average age of people using this service has been creeping up. It seems the service is becoming more focused on older young adults and less focused on children and teenagers over time.
• The Reasons: The main reason people are sent here is mental health (feeling anxious, depressed, or stressed). As people get older, they are also sent for help with jobs, education, and practical life skills (like housing or money).

4. The Big Picture: Is the Bridge Working?

The paper paints a mixed picture:

• The Good News: The service is successfully finding people in the poorest areas who need help, which suggests it might be helping to fix some unfairness in the healthcare system.
• The Bad News: It is largely missing the younger children and teenagers. Also, even when young people get on the bridge, they often don't get a clear path to a community activity to help them. It's like being sent on a tour where the guide talks to you for an hour but doesn't actually show you the sights.

In summary: The "Community Bridge" is a promising idea that is reaching the right neighborhoods, but it is currently acting more like a "Young Adult Bridge" than a "Children and Youth Bridge." Furthermore, many young people are sent on the trip but don't get a clear map to their final destination. The researchers suggest we need to build better ramps for younger kids and make sure the tour guides actually get everyone to the activities they need.

Technical Summary

Technical Summary: Social Prescribing for Children and Young People in the UK

Problem Statement
Despite the UK's "10 Year Health Plan" positioning social prescribing (SP) as a central mechanism for addressing health inequalities and shifting care into the community, there is a significant evidence gap regarding its application to children and young people (CYP). While SP is funded as an "all-age" approach, existing research, policy, and practice have predominantly focused on adults. This is problematic because CYP face distinct developmental challenges and social contexts, particularly given that 75% of mental health problems emerge during adolescence. Furthermore, the typical adult SP delivery model (GP referral to a primary care-based link worker) may not align with CYP help-seeking behaviors, which often favor self-referral or access through educational and social care institutions. There is a critical need to determine whether SP is effectively reaching CYP, whether it exacerbates or mitigates health inequalities, and how access and care pathways have evolved over time.

Methodology
This study conducted a retrospective analysis of routine administrative data from Access Elemental, a cloud-based social prescribing platform widely used across the UK.

• Data Source: The dataset included 649,386 SP cases recorded between January 2017 and August 2025.
• Sample Selection: The analysis was restricted to individuals residing in the UK aged 4–25 years. Cases were filtered to include only the first SP record per individual to avoid duplication. The final analytical sample comprised 52,585 CYP from over 700 SP sites across all UK regions.
• Variables:
  • Demographics: Age, gender, country of residence, urbanicity, and Index of Multiple Deprivation (IMD) deciles.
  • Referral Data: Source (medical vs. non-medical) and reason for referral (categorized into seven domains: mental health, physical health, social relationships, lifestyle, employment/education, practical support, and other).
  • Care Pathway: Number of link worker contacts, contact types (face-to-face, phone, text, etc.), duration of contacts, case status, and outcomes (signposting vs. onward referrals/interventions).
• Statistical Analysis: The authors utilized regression models (logistic, multinomial logistic, and negative binomial) to test associations between age and various characteristics, as well as temporal trends from 2017 to 2025. Cluster-robust standard errors were applied to account for individual clustering within SP sites. Ethnicity was excluded from analysis due to 83% missingness.

Key Contributions

• First Large-Scale UK Analysis: This is the first study to characterize access to and delivery of SP for CYP across the entire UK using a large, diverse administrative dataset.
• Pathway Characterization: It provides a detailed empirical description of the SP care pathway for CYP, including the volume of contact, types of interventions prescribed, and the alignment between referral reasons and prescribed interventions.
• Inequality Assessment: The study evaluates whether SP reaches marginalized populations (e.g., those in deprived areas) and identifies disparities in access based on age and gender.
• Temporal Trends: It tracks changes in the demographic profile of CYP accessing SP over an eight-year period (2017–2025).

Results

• Demographics: The average age of referred CYP was 20.04 years (SD=4.71), with the majority being 18 or older. The cohort was predominantly female (57%), lived in urban areas (91%), and resided in highly deprived areas (58% lived in the top three most deprived deciles).
• Referral Patterns: 79% of referrals were medical (primarily from GPs or allied health workers), while 21% were non-medical. The leading reason for referral was mental health/psychological/behavioral needs (44%), followed by practical support (27%).
• Care Pathway: The typical pathway involved a mean of 4.64 contacts (SD=7.70) with a link worker, totaling approximately 66 minutes of interaction. Phone calls were the most common contact type (44%).
• Interventions: Only 34% of CYP received a recorded onward referral (intervention), while 13% received signposting. Among those receiving interventions, mental health was the most common domain (36%). Notably, CYP referred for mental health needs were the least likely to receive a matched intervention (17%).
• Age and Time Trends:
  • Older individuals were more likely to be referred for mental health, social relationships, and practical support, and were more likely to receive interventions for employment/education and practical support.
  • Crucially, the average age of CYP referred to SP increased significantly from 2017 to 2025, indicating a widening disparity where younger children (under 18) are increasingly underrepresented in SP services.
  • There was no significant evidence of a change in the proportion of medical vs. non-medical referrals over time, though data on referral sources was sparse prior to 2021.

Significance and Claims
The paper claims that while SP shows promise in reaching CYP in the most deprived areas—suggesting a potential to reduce health inequalities—its current reach for those under 18 is limited and this disparity appears to be increasing. The authors highlight that the typical SP pathway for CYP involves fewer contacts and shorter durations than recommended best practice guidelines (6–12 contacts over three months), and a significant portion of referrals do not result in recorded onward interventions.

The study concludes that SP is not yet fully realizing its potential for CYP, particularly regarding non-medical referral routes and engagement with younger adolescents. The authors caution that any reduction in link worker capacity could disproportionately harm the most deprived CYP who currently rely on these services. They emphasize the need for improved data recording, further research into non-medical referral pathways, and targeted efforts to ensure SP services are accessible to the full age range of children and young people, rather than skewing toward young adults.