Scaling Up Improvement Round 2. Helping Young People THRIVE: implementing a person-centered model of care for Young People’s MH – The Anna Freud National Centre for Children & Families. (ARCHIVED)
The THRIVE framework is a way of conceptualising need amongst a community of children, young people and families. The implementation of THRIVE (i-THRIVE) results in a needs led approach to delivering young people’s mental health services. Need is measured under five categories: thriving, getting advice, getting help, getting more help, getting risk support.
The ‘Implementing THRIVE in North East London Foundation Trust (NELFT)’ project is part of the Health Foundation’s Scaling Up Improvement Programme. This project began in April 2016 and will run until September 2018.
The THRIVE framework is a way of conceptualising need amongst a community of children, young people and families. The implementation of THRIVE (i-THRIVE) results in a needs led approach to delivering young people’s mental health services. Need is measured under five categories: thriving, getting advice, getting help, getting more help, getting risk support.
The i-THRIVE in NELFT project supports sites to translate the principles of THRIVE into a model of care that fits local context, tackling some of the barriers to implementation while building on a localities strengths. We are working across four NELFT CAMHS teams; Barking and Dagenham, Waltham Forest, Redbridge and Havering.
Expected improvements as a result of delivering i-THRIVE in NELFT include better access to care and reduced waiting times. It is expected that effectively identifying the preferences of children and young people will lead to more effective signposting, adherence to treatment and better patient experience. Engagement with services will also improve as children and young people will be involved in co-designing their services and care, and participate in peer-support networks.
This project has begun to test out what works well with regards to scaling up i-THRIVE into different localities, what the barriers to implementation of the model are, and whether the expected benefits can be translated across different services.
To do this the implementation team has focused on:
Facilitating four workshops in each site covering:
Understanding the system,
Self-assessment against THRIVE principles,
Identifying priority areas for further investigation
Driver diagram workshops to identify core components and associated work packages to design local, needs led whole system approach to mental health care.
Delivery of training in line with four THRIVE core competencies:
Delivering risk support
Deliver advice and sign posting
Ending treatment
Shared decision making
Intelligence gathering via a series of qualitative interviews with CAMHS, local schools, local authorities, the voluntary sector, and CCGs
Attendance and facilitation at strategic planning groups
Proactively engaging with wider system partners in health, education and social care
Supporting teams deliver co-produced implementation plans to take this work forward over the next year
Wider Support
i-THRIVE is being delivered in partnership with the Anna Freud National Centre for Children and Families, the Tavistock and Portman NHS Foundation Trust and North East London Foundation Trust. The University of Roehampton is undertaking the project evaluation.
i-THRIVE in NELFT is supporting services with a whole-system approach to the delivery of child mental health services, encouraging integration across health, social care, education and the third sector, with a focus on delivering improved outcomes for children and young people.
This collaborative approach has been enabled via:
the provision of co-training opportunities
cross system workshops to identify priorities and work packages to take forward together *
a series of interviews to ensure all parties views were considered when trying to understand what is working and what needs improvement across the whole system
local project governance consisting of a mix of partner organisations
ensuring local commissioners are supportive of a partnership approach to change
*These workshops have enabled sites to translate a high level improvement goal of ‘Implementation of a whole system approach to the delivery of mental health care based on needs and choices of families’ into a logical set of underpinning components and a set of change ideas to take forward over the next year.
Co-Production
i-THRIVE places strong value on the inclusion of the service user voice at all levels of the system – from influencing the commissioning of services, to the design of the offer from different teams and to the interaction between the individual professional and young person. As part of this project we have consulted with participation groups and included their feedback in the recommendations that have been presented to and adopted by services, transformation boards, and commissioners.
Choice and personalisation of care are core values of i-THRIVE and these are delivered in part through the systematic implementation of shared decision making. Professionals from across the system of support for children and young people’s wellbeing have attended an i-THRIVE Academy on ‘Shared Decision Making’ delivered by Common Room. As part of implementation and system redesign, shared decision making will be embedded into each step of the pathway.
An example of young person co-production is the i-THRIVE Grids which young people have been involved in the development, design and testing of since the beginning of this project. Last autumn, several Expert Reference Groups (ERGs) were held involving young people with lived experiences of depression, self-harm and/or ADHD. For the ADHD ERG, parents/carers also attended. During these meetings, young people were shown current mock-ups of the grids and were asked for their feedback. A young person editor was also appointed who continued to help us outside of the meetings to refine the grids.
In coming phases of the i-THRIVE project, youth participation and feedback will continue to be vitally important. In the development of change ideas and action plans for transformation it is paramount to gain insight from those that the changes will impact on Going forward we hope to build on the engagement of young people already undertaken and support the four boroughs to strengthen and formalise their forums for co-production. Children and young people across all four boroughs will have the opportunity to review proposed change projects and take up positions on strategic boards.
Looking Back/Challenges Overcome
Despite each of the four NELFT i-THRIVE sites experiencing significant budget cuts and staff consultations, the project implementation team has supported each site to work towards the design of their implementation plans, and have been successful in fostering a sense of shared purpose across a fragmented system. Bringing stakeholders together to focus on a shared vision for children and young people, and using quality improvement methodology to guide a step by step approach to improvement has enabled this despite the contextual challenges.
Professionals from across the system have had access to free training and development opportunities through the i-THRIVE Academy and access to national shared learning events as part of the i-THRIVE offer. These have enabled the project team to continue to build good relationships despite a tricky local context, and ensured we have been able to maintain engagement in the project.
Sustainability
We have set up lines of accountability into the Operational Lead for Children’s across NELFT, as well as into the NELFT transformation team, and the NELFT CAMHS community of practice – these three directorates report directly into the NELFT executive management team for which we provide updates. This in effect provides a three line whip for the project so that if one senior sponsor moves on we are embedded elsewhere within the service’s governance structures. We also report into local transformation steering groups chaired by CCG and LA commissioners to ensure an additional pressure to maintain momentum.
We have internally seconded an i-THRIVE Champion (a band 8a clinician who has worked in the service for 10 years) to work with sites to build long-lasting collaborative relationships between CAMHS services and their wider system partners. Our champion will be working closely with the NELFT QI team to ensure there are structures in place to continue to i-THRIVE approach is sustained past the end of the project.
Evaluation (Peer or Academic)
The evaluation of i-THRIVE in NELFT is being conducted by the University of Roehampton and will be completed by the end of September 2018.
The aims of the NELFT i-THRIVE evaluations are:
To evaluate whether i-THRIVE implementation can be scaled up in in NELFT, including understanding the barriers and facilitators to implementation
To evaluate whether implementation of i-THRIVE is associated with greater improvements in CAMHS services
The evaluation will collect a mix of quantitative service level and qualitative experience data to assess these questions.
Outcomes
At this moment in time there is insufficient data to show improved outcomes for CYP using the service. However, we expect improved outcomes in the following areas in the coming months:
Access:
Reduction in waiting times
Increase in proportionate number of appropriate referrals to specialist services
Increase in young people appropriately supported in community settings
Service satisfaction, as reported by young people, families, referrers and professionals
Improved adherence to treatment
Young people involved in service design
For those working in the services, we have had qualitative feedback from clinicians that the i-THRIVE approach has provided a coherent strategic direction which they feel engaged with and able to effect, as well as providing a unique opportunity for co-design of the local system with partners.
Sharing
NELFT sites implementing THRIVE are a part of the broader i-THRIVE Community of Practice. Five shared learning events have been held between November 2015 and April 2017. These events are designed to support the sites to deepen their understanding of the THRIVE conceptual framework and the i-THRIVE Approach to Implementation, whilst also giving sites the chance to showcase progress and work through challenges.
Case studies published on the ‘implementing THRIVE’ website also provide examples of how some of the NELFT sites have approached implementing some of the THRIVE principles locally.
In NEFLT we are also sharing learning through regular external communications and events. For example, the ‘i-THRIVE in NELFT’ newsletter is circulated amongst CAMHS and the wider system on a monthly basis. We are also planning a shared learning event for the implementation sites in NEFLT in autumn 2017.
