I am a senior Child and Adolescent Psychiatrist working as Research Officer for the VB CAMHS Commission. Our aim is to build an understanding of what really matters to children and young people in the services they are offered as a basis for commissioning and implementing appropriate services. One strand of this work is to develop ways of coming to an understanding of the implicit as well as explicit concerns, hopes and fears of children and young people and how these may act as barriers to effective engagement.