key: cord-0270044-qfp1gjxc
authors: Moore, A.; Baron-Cohen, K. L.; Simes, E.; Chen, S.; Fonagy, P.
title: Protocol for a multi-site case control study evaluating child and adolescent mental health service transformation in England using the i-THRIVE model
date: 2022-03-10
journal: nan
DOI: 10.1101/2022.03.09.22272128
sha: 2d8a0015d0b9695f7149d7c69896eaf4115f6f86
doc_id: 270044
cord_uid: qfp1gjxc

The National i-THRIVE Programme seeks to evaluate the impact of the NHS England-funded whole system transformation on child and adolescent mental health services (CAMHS). This article reports on the design for a model of implementation that has been applied in CAMHS across over 70 areas in England using the THRIVE needs-based principles of care. The implementation protocol in which this model, i-THRIVE (implementing-THRIVE), will be used to evaluate the effectiveness of the THRIVE intervention is reported, together with the evaluation protocol for the process of implementation. To evaluate the effectiveness of i-THRIVE to improve care for children and young peoples mental health, a case-control design will be conducted. N = 10 CAMHS sites that adopt the i-THRIVE model from the start of the NHS England-funded CAMHS transformation will be compared to N = 10 comparator sites that choose to use different transformation approaches within the same timeframe. Sites will be matched on population size, urbanicity, funding, level of deprivation and expected prevalence of mental health care needs. To evaluate the process of implementation, a mixed-methods approach will be conducted to explore the moderating effects of context, fidelity, dose, pathway structure and reach on clinical and service level outcomes. This study addresses a unique opportunity to inform the ongoing national transformation of CAMHS with evidence about a popular new model for delivering children and young peoples mental health care, as well as a new implementation approach to support whole system transformation. If the outcomes reflect benefit from i-THRIVE, this study has the potential to guide significant improvements in CAMHS by providing a more integrated, needs-led service model that increases access and involvement of patients with services and in the care they receive.

5 82 mental health that delivers care according to the individuals' needs, rather than by severity or 83 diagnosis (see S1 and S2 Figs) (4-6). 84 85 i-THRIVE, which stands for implementing-THRIVE, has been developed alongside THRIVE 86 to support sites implementing this approach in CAMHS, drawing on implementation science 87 principles (7). Over 60% of CYP in England currently live in a region who are adopting 88 THRIVE using this approach (8). This paper reports on the design and protocol of the i-89 THRIVE approach to implementation, its planned evaluation and the evidence-base it draws 90 from. 92 The predominant NHS England-led improvement programme between 2015 and 2018 93 focused on developing and evaluating a series of new 'whole system' integrated models of 94 care through pilot sites, known as 'Vanguards' (9). These were created as locally-driven 95 prototypes for integrating health and social care services within a geographically bound 96 region, aiming to transition the NHS to functioning on a 'place-based' framework. In this 97 model organisations within a region have joint responsibility for improving the outcomes of 98 the population within the region, rather than for the care delivered to individual patients 99 within their respective organisations. It was anticipated that approaches developed by 100 successful Vanguards would be disseminated across the NHS in England (1, 3, 10).

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The copyright holder for this this version posted March 10, 2022. ; https://doi.org/10.1101/2022.03.09.22272128 doi: medRxiv preprint 7 126 127 Service transformation within CAMHS 128 During this period of NHS transformation, focus has been placed on improving CAMHS 129 services, supported by the largest injection of spending in its history. Identifying optimal care 130 models and addressing the implementation issues related to whole system transformation for 131 CAMHS has never been more important. Long waiting times have been a major barrier to 132 CYP accessing mental health care in the UK. In 2017 it was estimated that more than 12.5% 133 of CYP in England experience a mental health problem (20) . Prior to the start of national 134 CAMHS transformation, in 2013 the average waiting time to access a routine care 135 appointment in CAMHS was as high as 15 weeks, with only 31% of CYP who required 136 intervention accessing services (21). For those CYP that were offered support, a lack of 137 flexibility in service models to provide care in line with patient needs and preferences 138 resulted in dissatisfaction in the care received, leading to poor patient engagement, and poor 139 clinical outcomes (6). Difficulty accessing care was made worse by patients 'falling through 140 the cracks' when transferring between services, as a result of poor staff coordination and 141 organisations not being incentivised to provide care along whole pathways.

142 A growing body of evidence incorporated into the THRIVE framework indicates that these 143 problems within CAMHS could be improved by actively involving CYP in their own mental 144 health care as collaborative participants and decision-makers, rather than passive consumers 145 of treatment. Enhancing these opportunities through shared decision-making (SDM) is 146 associated with better clinical outcomes as well as greater patient satisfaction (22-24).

147 Reports from CYP, professionals and carers indicate that multi-agency working improves 148 treatment experience, and promotes a more comprehensive delivery of care (25, 26). is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint 159 However, while elements are evidence informed, there remains no large-scale evaluation of 160 the effectiveness of the approach in terms of the outcomes achieved, the key components of a 161 service that has adopted the THRIVE principles, nor the optimal approach to its 162 implementation. The national CAMHS transformation, which includes all CCGs from 2016 -163 2022, has over seventy sites that chose to use i-THRIVE as the basis of their transformation 164 efforts. This provides a unique opportunity to undertake a national evaluation of i-THRIVE, 165 and if adequate quality data are obtained, a study of the implementation has the potential to 166 extend knowledge of what works in the development of whole system, place-based 167 approaches to delivering care in CAMHS and for the NHS more widely.

168 169 Developing the model of implementation 170 The i-THRIVE model of implementation takes an evidenced-informed approach to whole 171 system service transformation and has been designed to implement THRIVE's framework of . CC-BY 4.0 International license It is made available under a perpetuity.

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The copyright holder for this this version posted March 10, 2022. Table) . A local i-THRIVE Community of Practice is also created to provide a mechanism for 230 shared learning across implementation teams. To ensure that the data required to support 231 improvement will be available and used within the teams, data collection mechanisms are 232 established during this phase. Phase Three focuses on implementation of the new system 233 using a variety of change management and quality improvement methods (e.g. 'Plan, Do, 234 Study, Act' cycles), as well as establishing information and quality infrastructures within 235 providers and commissioners. Measurement systems enabling collaborative assessment of 236 progress are set up during this phase to identify potential issues so that these can be tackled 237 across the locality. Phase Four focuses on learning, embedding and sustaining changes to 238 ensure these become 'business as usual' once the transformation programme is complete. is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint

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The copyright holder for this this version posted March 10, 2022. Hypotheses 274 We predict that using an evidenced-informed approach to implementation, i-THRIVE, will 275 lead to improved fidelity to the THRIVE model across macro, meso and micro systems. This 276 will lead to more integrated services and the barriers to implementation will be more easily 277 overcome. Collectively, we hypothesise, this will lead to improved service and patient 278 outcomes, in particular improved access to services, shorter waiting times and shorter length 279 of stay. By providing needs-based care and access to services according to patients' 280 preferences, we expect better engagement with services, improved experience of care, fewer 281 dropouts and better clinical outcomes. Shared decision making and improved signposting will 282 support broader access, positively impacting on diversity and inclusion in services.

285 Study setting and design 286 We plan to use a matched case-control design. Twenty CAMHS sites across England are to 287 be included in the study, comprising: ten 'accelerator sites' that adopted the i-THRIVE model 288 from the start of the NHS England-funded CAMHS transformation, and ten 'comparator 289 sites' that chose to use different transformation approaches within the same timeframe. All is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint

The copyright holder for this this version posted March 10, 2022. 324 face-to-face appointments, non-face-to-face appointments, discharges, and re-referrals. Sub-325 analyses will be conducted to assess ethnicity, age and diagnoses to assess the impact of on 326 equity and diversity. Table 2 show the type of data to be collected, define the measures to be used, and 329 how these measures relate to the CAMHS care pathway. is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint

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The copyright holder for this this version posted March 10, 2022. 366 367 Fidelity will be assessed by the alignment of services to the THRIVE principles across the 368 macro (senior system leadership and commissioning), meso (service management) and micro 369 (front-line professionals working with CYP) levels of the system. Data will be collected 370 through semi-structured interviews using the i-THRIVE Assessment Tool, a measure that has 371 been developed for this specific purpose, and which will be validated during the course of the 372 i-THRIVE programme. Purposive sampling will be used to recruit three interviewees per 373 system level at each site, to collect a multi-agency perspective across CAMHS, third sector, 374 clinical commissioning groups, education and local authority services. Interviews will be . CC-BY 4.0 International license It is made available under a perpetuity.

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The copyright holder for this this version posted March 10, 2022. ; https://doi.org/10.1101/2022.03.09.22272128 doi: medRxiv preprint 23 375 conducted at two time-points: baseline and follow-up (up to four years after service 376 implementation), and will be digitally recorded and transcribed verbatim. The interview 377 transcripts will be scored by researchers who are blind to data collection in relation to how 378 'THRIVE-like' the service described in the transcript is performing. 379 380 Dose and reach will be assessed using a nine-item 'adoption' survey that has been developed 381 based on the RE-AIM framework (53) which is to be sent via email to all front-line staff 382 working within the accelerator sites, to measure their understanding of i-THRIVE and the 383 THRIVE principles. The survey is to be sent at two time-points: baseline and follow-up (four 384 years after service implementation). In addition, mechanisms of impact of service 385 transformation will be explored through semi-structured interviews with both accelerator and 386 comparator sites through questions related to barriers and facilitators of the service 387 implementation.

389 Pathway mapping will be undertaken to compare the structure of CAMHS pathways at 390 baseline and after CAMHS transformation to explore whether transformation led to pathways 391 becoming more consistent with NHS England guidelines and the extent to which services and 392 pathways are integrated. We will record the services provided in a region, including NHS, 393 local authority, third sector and school based mental health interventions. We will record who 394 provides the service, its modality and its relationship to other services in the pathway. WE 395 will record the number of access and assessment points in each system. Data will be collected 396 by reviewing documents of local transformation plans at baseline and after implementation. 397 These will then be supplemented by semi-structured interviews with the site leads to confirm 398 key details and the accuracy of the maps.

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The copyright holder for this this version posted March 10, 2022. 416 The qualitative data will be coded, sorted and classified following the 'framework approach' 417 based on the CFIR framework. General statistical test such as t-tests, ANOVA tests, and chi-418 square tests will be used to evaluate group differences between accelerator and comparator 419 sites, or between the baseline and follow up data collection time points. Difference-in-420 difference (DID) and Interrupted Time Series (ITS) models will be adopted to test the causal 421 relationship between the i-THRIVE intervention, and service and patient outcomes. is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint

The copyright holder for this this version posted March 10, 2022. ; https://doi.org/10.1101/2022.03.09.22272128 doi: medRxiv preprint 25 422 Structural equational modelling will be conducted to test the causal relationship of potential 423 variables to determine which elements of the service lead to improvements in outcomes. All 424 qualitative data will be analysed using NVivo (version 12) and all quantitative data will be 425 analysed using R (version 4.0.0).

428 Data collected will be qualitative and quantitative in nature. Anonymised interviews and 429 service performance data will be stored securely on password protected UCL servers for the 430 duration of the study and then for a further ten years. Anonymised data sets may be 431 transferred to University of Cambridge for analysis. Transfer will be via secure file transfer 432 using the encrypted UCL dropbox account and will be stored on password protected 433 Department of Psychiatry, University of Cambridge servers. Only members of the research 434 team will have access to the data. In line with UCL data management policy, following 435 publication all data will be archived at the university and then destroyed after ten years. 436 437 Data availability 438 The data collection for the study has not yet been completed as this is a protocol paper, and 439 so it is not currently available. The data will be made available by request to the 440 corresponding author as anonymous data, removing information about specific sites' names, 441 as this was the agreed condition for obtaining the data. is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint

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The copyright holder for this this version posted March 10, 2022. ; https://doi.org/10.1101/2022.03.09.22272128 doi: medRxiv preprint 28 492 There were also limited mechanisms in place for the transformation and evaluation teams to 493 meet to coordinate data collection, or to share local knowledge that could be relevant to the 494 analysis and reporting of service outcomes (12). This meant that implementation efforts could 495 not benefit from the learning generated, and obstructed the development of relationships and 496 the trust required to enable partners to 'let go of control' of service operations, which were 497 essential for effective cross-boundary working at both individual and organisational levels 498 (12, 61). Together, these challenges led to significant delays for service transformation to 499 operationalise (62), and it has been almost impossible to establish which service components 500 led to improvement, how these affected each organisation, and the subsequent impact on 501 outcomes (12). Consequently, we have still not been able to draw conclusions about the 502 impact of these whole system transformations in the New Care Programme, nor about the 503 best way to implement them. 504 505 Mental healthcare in general, including CYP MH, is arguably best understood as a complex, 506 adaptive system of interrelated services, organisations, and actors (63). Outcomes are 507 dependent on relationships between these entities; studying facets in isolation can be 508 misleading (64, 65). Complexity in the system also requires contending with 'radical 509 uncertainty' -appreciating that not everything can be predicted (66). Local health systems 510 have begun using routine data for population health management (67), but a missing element 511 has been the involvement of service users and staff to agree local healthcare goals, identify 512 and prioritise metrics, and interpret data (68). The i-THRIVE Approach to Implementation, 513 that addresses each of these practical and operational issues to whole system transformation 514 may be of value for future service implementation teams to consider adopting (69, 70). 515 However, until there is more evidence for implementing whole system approaches to 516 delivering care, and between services in the NHS specifically, it may be prudent for policy-. CC-BY 4.0 International license It is made available under a perpetuity.

is the author/funder, who has granted medRxiv a license to display the preprint in (which was not certified by peer review) preprint should improve the quality of care provided (2, 71). However, for implementation of such 528 approaches to be successful, integration needs to be carefully defined from the start, to ensure 529 the management of implementation, as well as the outcomes intended, are properly planned 530 and can translate into viable governance forms. Too often, terms such as 'whole system' and 531 'integrated care' have been used in a general sense, and described through principally 532 conceptual models that lack clarity surrounding the specific integration intended and how it 533 will be organised (43). This is particularly important in relation to organising accountability 534 across the system-wide framework (2), and to ensure policy-makers can make use of 535 available data determining the level and scope of integration, for any hope of translating 536 successful implementation from one context to another (44, 46, 72). The recent Health Select 537 Committee Report on CYP MH (73) recommends that Government departments, local 538 government and the health system act together to promote CYP MH to prevent new crises 539 emerging and proposes a Cabinet sub-committee to bring together different departments to 540 make sure system wide coordination happens. The i-THRIVE approach we have outlined 541 presents the best available framework yet for implementing the intended transformation and . CC-BY 4.0 International license It is made available under a perpetuity.

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The copyright holder for this this version posted March 10, 2022. ; https://doi.org/10.1101/2022.03.09.22272128 doi: medRxiv preprint 30 542 should ensure that the impact of transformation across each of the key domains, at the macro, 543 meso and micro levels of the system, envisioned by the Select Committee's sub-committee, 544 are kept in focus and offer a broad perspective of the impact of an evaluation for improving 545 CYP's mental health care, which has so far been limited in previous evaluations.

546 547 In addition, to successfully integrate services that may differ considerably at the start of 548 transformation in terms of organisational culture and structure, expertise is required (74, 75). 549 This comes from providing strong leadership at both the clinical and system-wide level, as 550 well as appropriate timeframes for all involved to build new relationships, and learn (as well 551 as un-learn) routines (71). Each of these components benefit implementation and facilitate a 552 positive culture for change. Given the complexities of service transformation, it is essential 553 that each of these resources are invested before any improvements in organisational 554 efficiency may be visible (43). The implementation efforts described in this paper are 555 intended to establish the foundations for a learning health care system (76, 77), both at 556 system level guided by patient data and organizational level showing structures, processes, 557 and culture that promote the potential for continuous improvement based on internal learning. 558 i-THRIVE is designed to establish a culture open as much to learning from the monitoring of 559 internal experience as from external published research. The present evaluation is intended to 560 create a model for integrating qualitative and quantitative data from multiple sources to solve 561 problems in design and execution in the future and test and modify new approaches rapidly in 562 order to put insight into action (78). The i-THRIVE model that incorporates each of these 563 components required to support the whole system, at local levels and across multiple 564 organisational boundaries, may therefore potentially provide an effective protocol for future 565 service transformation teams to adopt to establish systemic change. The spirit of the initiative 566 is for the ability to learn is embedded in the structure of CYP community mental health . CC-BY 4.0 International license It is made available under a perpetuity.

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SDM is a core THRIVE principle. i-THRIVE does not prescribe how shared 201 decision making should be implemented, but provides a range of options and tools. i-202 THRIVE Option Grids© have been developed by the implementation team (49), however, the 203 i-THRIVE implementation programme has also collated a range of other approaches to SDM 204 that have been successfully used by i-THRIVE sites. Core to i-THRIVE is to make such 205 support resources readily accessible and the i-THRIVE Community of Practice website 206 signposts to all of these along with a slew of relevant resources

The 'i-THRIVE Approach to Implementation' is manualized and is structured to be a four-214 phase process, drawing on the Quality Implementation Framework [41] (see S2 Fig) and

33), for implementing complex interventions. Each phase 216 is supported by a range of tools

We would also like to thank IIse Lee

Five year forward view

The future of child health services

New Care Model: Vanguards -developing a blueprint for the future of 601 NHS and care services

Model for CAMHS. London

Can i-THRIVE provide a 609 solution to the CAMHS crisis? British Association of Cousellors and Psychotherapists 610 Journal. 2016. 611 8. i-THRIVE National Implementation program

Developing new care models through NHS vanguards

National evaluation of the Vanguard new care models programme: Interim report: 619 understanding the national support programme

Complex programme evaluation of a 'new care 621 model' vanguard: a shared commitment to quality improvement in an integrated health and 622 care context

The challenges of 624 evaluating integrated care: why are avaluationg not producing the results we expect?

Does integrated care reduce hospital activity for 626 patients with chronic diseases? An umbrella review of systematic reviews

New 629 integrated care models in England associated with small reduction in hospital admissions in 630 longer-term: A difference-in-differences analysis

The effects of 632 integrated care: A systematic review of UK and international evidence

National 635 evaluaiton of the Vanguard new care models programme: Interim report: understanding the 636 national support 637 programme

Developing and 639 evaluating complex interventions: the new Medical Research Council guidance

Process 642 evaluation of complex interventions: Medical Research Council guidance

Getting it right for children and young people: Overcoming cultural

A scoping literature 648 review of service-level barriers for access and engagement with mental health services for 649 children and young people

Adolescents' 651 and parents' views of Child and Adolescent Mental Health Services (CAMHS) in Ireland. 652

Interagency collaborative care for young 654 people with complex needs: Front-line staff perspectives. Health and Social Care in the 655 Community

Service user 657 perspectives of multiagency working: A qualitative study with children with educational and 658 mental health difficulties and their parents

Shrinking the gap 661 between research and practice: tailoring and testing youth psychotherapies in clinical care 662 contexts

Testing standard and modular designs for psychotherapy treating depression, anxiety, and 665 conduct problems in youth: A randomized effectiveness trial

Structuring the Collaboration of Science and Service in 668 Pursuit of a Shared Vision

Improving 671 access to child and adolescent mental health care: The choice and partnership approach

Integrated Youth Care: A Systematic Review of Facilitators and Barriers for Professionals

Administration and Policy in Mental Health and Mental Health Services Research

A rational model for assessing and evaluating complex interventions in health 678 care

Implementing, Embedding, and Integrating Practices: An Outline of

Literature on integrated HIV care: A review. AIDS Care: 682 Psychological and Socio-Medical Aspects of AIDS/HIV

A systematic review of collaborative models for 684 health and education professionals working in school settings and implications for training

Interprofessional collaboration in mental health 687 crisis response systems: A scoping review

What is needed to deliver collaborative 690 care to address comorbidity more effectively for adults with a severe mental illness? 691 Australian and New Zealand Journal of Psychiatry

Integrated service networks: The Quebec case

Education needs for integrated care: a literature 695 review

Facilitators and barriers for co-ordinated multi-agency services. Child: Care, 697 Health and Development

A systematic 699 review of integrated working between care homes and health care services. BMC Health 700 Services Research

Health and Social Services Integration: A Review of Concepts 702 and Models. Social Work in Public Health

Challenges in turning a great idea into great health 704 policy: The case of integrated care

Clinical networks: Advantages include flexibility, strength, speed, and 706 focus on clinical issues

Service Integration

Human Services Integration: Past and Present Challenges in Public

Administration

Effective coordination of medical and supportive services

What Should Guide Health Policy? A Perspective beyond Politics

A scoping review 715 and assessment of essential elements of shared decision-making of parent-involved 716 interventions in child and adolescent mental health. European child & adolescent psychiatry

51. i-THRIVE National Implementation program. i-THRIVE Implementation Framework

Fostering 725 implementation of health services research findings into practice: a consolidated framework 726 for advancing implementation science

CAMHS: Can i

NHS Digital. Mental Health of Children and Young People in England, 2020: Wave 1 734 follow up to the 2017 survey

information/publications/statistical/mental-health-of-children-and-young-people-in-736 england/2020-wave-1-follow-up: NHS

Mental health of children and young people during 738 pandemic

Enduring Mental Health in Childhood and 740 Adolescence: Learning From the Millennium Cohort Study

The Community Mental Health Framework for

/09/community-mental-health-framework-for-adults-and-olderadults

Outer 749 context determinants in the sustainment phase of a reimbursement-driven implementation of 750 evidence-based practices in children's mental health services

Trust and control in evolving inter-organisational 752 relationships: Evidence from the aerospace industry. Accounting, Auditing and 753

Lessons from integrated care pilots in England

Implications of complex adaptive systems 757 theory for the design of research on health care organizations. Health Care Management 758 Review

Complex adaptive systems for management of integrated care

Application of simplified

Complexity Theory concepts for healthcare social systems to explain the implementation of 763 evidence into practice

Radical uncertainty: Decision-making beyond the numbers

Accounting for accountable care: Value-based population health 767 management

Combining patient, clinical and system perspectives in 769 assessing performance in healthcare: an integrated measurement framework. BMC health 770 services research

The impact of a needs-based 772 model of care on accessibility and quality of care within children's mental health services: A 773 qualitative investigation of the UK i-THRIVE Programme. Child: Care, Health and 774 Development

Health and Social Care Committee. The Health and Social Care Committee's Expert 779 Panel: Evaluation of the Government's progress against its policy commitments in the area of 780 mental health services

The Science of "Muddling Through

CC-BY 4.0 International license 40 784 73. Health and Social Care Committee. Eigth report -Children and young people's

Neither market nor hierarchy: Network forms of organization

Interorganizational networks at the network nevel: A 789 review of the empirical literature on whole networks

The fifth discipline: The art and practice of the learning organization: 792 Currency

Can learning health systems help 794 organisations deliver personalised care? BMC medicine

Learning systems: managing 796 uncertainty in the new normal of Covid-19. NEJM Catalyst Innovations in Care delivery

The THRIVE Framework needs-based categories and corresponding inputs 802 (figure from Wolpert et al 2019). A figure and accompanying text providing a description

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