Introduction to i-THRIVE If we keep on doing what we have been doing, we are going to keep on getting what we have been getting 1 Alignment of i-THRIVE to national strategies 2 CAMHS transformation/ Future in Mind NHS five year forward view Sustainability and Transformation plans Future in Mind* identifies specific challenges with our current Child & Adolescent Mental Health Services Treatment gap: only 25% - 35% young people who need support access services, with increasing levels of need in some groups e.g. eating disorders
Difficulty with access: benchmarking shows an increase in the number of referrals and length of waiting times. Waiting times are around 3 weeks for crises and 18 weeks for routine; out of hour liaison very variable Complex commissioning arrangements: lack of clear accountability between providers, especially between CCGs and Local Authority Worse care for vulnerable groups: they find it hard to access services Gaps in data collection: lack of useful data and information, and there have been delays in developing payment and other incentive systems * Future In Mind: Department of Health & NHS England Joint Taskforce Report on CAMHS, 2015. 3 3 How THRIVE Addresses the Problem
Whole system approach focusing on needs and preferences Builds on & draws from community resources, and individuals resources to create a diverse range of options for care Shared decision making and preference sensitive are core principles Identifies resource-homogenous groups of young people with common needs and preferences, rather than an escalator/severity approach Focus on early intervention & building resilience in young people & families THRIVE advocates the effective use of data to inform service delivery and meet needs
4 The THRIVE Conceptual Framework Input offered Description of the THRIVE-Groups Five Needs Based Groups are distinct in terms of the: needs and/or choices of the individuals within each group skill mix of professionals required to meet these needs resources required to meet the needs and/or choices of people in that group Starting point is always shared decision making 5 i-THRIVE (Implementing-THRIVE) Implementing-THRIVE i-THRIVE is the translation of THRIVE into a model that can be implemented i-THRIVE was selected to be a national NHS Innovation Accelerator, led by Anna Moore. The i-THRIVE partnership has been created between the Anna Freud Centre, Tavistock & Portman NHS Foundation Trust, Dartmouth Centre for Healthcare Delivery Science and UCLPartners. 6
Implementing THRIVE at the different system levels Whole-system (Macro) Considering Population Health Improvement Agencies working together Group (MESO) commissioning services Needs-based groups The services/ teams that enable deliveryIndividual of care according (MICRO)to those needs Working with young people and their families Professionals working together collaboratively 7 Characteristics of a THRIVE-like service: Macro level All agencies are involved (education, health, social care, third sector) Mental health policy is interagency
CYP mental health forms part of the JSNA Data about patient preferences are used to inform resource allocation and commissioning decisions Quality Improvement (QI) approaches are used to inform commissioning and contracts 8 Characteristics of a THRIVE-like service: Meso-level Help is delivered using a conceptual framework of 5 needs 9 based groups Evidence based practice is available and aligned to need There is a comprehensive network of community providers There is a focus on strengths and family resources wherever possible Data is used to inform decisions (meeting using MINDFUL approach and involving multiagency review and individual
practice work) QI is used to inform service or team development Characteristics of a THRIVE-like service: Micro-level Shared decision making is at the heart of all decisions People (staff, CYP and families) are clear which needs-based group they 10 are working within for any one person at any one time and this explicit to all Any treatment involves explicit agreement from the beginning about the outcome being worked towards and the likely timeframe. There would be a plan for what happens if it is not achieved People (staff, CYP and families) are clear about parameters for help and reasons for ending The most experienced practitioners inform advice and signposting THRIVE plans are used to help those managing risk QI is used to inform individual practice
The needs group: Getting Advice & Signposting Simplified, holistic assessment and formulation process considers the problems that the young person considers to be their biggest concerns Considers if the young person prefers active treatment, or if advice and signposting is their preferred option Includes consideration of services/resources in the community, LA, 3rd sector, within the YPs personal networks as well as medical options Considers the young persons preferred way of accessing help digital, peer support, self help A directory or app of local and digital options offered including peer support and self help Co-ordinated network of providers relationships and processes Programmes which engage and target hard to reach groups easily accessible. Multi-agency Highly skilled staff 11 The needs group: Getting Help & Getting More Help Treatment under pinned by Best Practice e.g. NICE Guidelines, CYP IYAPT.
Electronic patient record in place. Rigorous outcome monitoring to inform practice. Care delivered by a range of practitioners. Care not necessarily delivered by health provider Range of ways to access care digital, groups, face to face Shared decision making embedded. Clear treatment outcomes/goals and timescales defined at the beginning of the intervention and used to inform practice
12 The needs groups: Getting Risk Support Integrated Multi-agency approach with joint outcomes and joint accountability for these Documented thrive plans developed in partnership with children young people and their families. Two coordinators, one chosen by YP/family Developing a personal support network and outcomes which are realistic/appropriate Aims to have fewer professionals to relate to AMBIT: Adolescent mentalisation based integrative treatment
Measure how well Integrated services are (IntegRATE measure) 13 Components of the i-THRIVE Model of Care Getting Advice & Signposting Core THRIVE principles delivered using evidence based approaches to delivery that fit local context Needs based care (not severity or diagnosis led) Shared decision making at
each point in pathway Integration: multiagency teams that are trained and located together, with common processes and outcome frameworks Training clinicians in clarity about when treatment is being provided vs. support, promoting & supporting self help, shared decision making Community of Practice building on existing funded work with 10 sites natural route for dissemination Getting Help
Digital front end Single point of access with multi-agency assessment & effective signposting Creating a comprehensive network of community providers: Youth Wellbeing Directory Outreach to Hard-to-reach groups Short, evidence based interventions aligned with NICE Guidance CYP IAPT Wide variety of choice of modality and location, provided by health or alternatives (3rd sector, community providers) Schools and primary care in-reach Self-help and peer-support AMBiT: Integrated multi-agency approach with joint accountability for outcomes Safety plans co-produced
between agencies & young people Outcomes plus goal based measures Longer, evidence based interventions CYP IAPT Provided by health primarily Emphasis on developing Personal support network Self-help and peer-support Risk Support 14 Outcomes plus goal based measures Getting More Help (with thanks to Anna Moore) i-THRIVE approach to implementation Creating change is challenging, no matter how good the
innovation i-THRIVE as an aggregator We encourage an evidence-based approach to implementation informed by implementation science 15 Taking an evidenced based approach to implementation with the Quality Implementation Framework Self Assessment Needs Assessment Fit Assessment Capacity/Readiness Assessment Decisions about adaptation to fit Context Phase 1 Initial considerations Prioritisation
16 Learning from Experience Sustainability Normalisation Process Theory Phase 4 Improving future applications Phase 2 Creating Structure for Implementation Phase 3 Ongoing Structure Supporting Implementation Structural features of Implementation
Finalising Implementation Plan Developing Implementation Teams Community of Practice Training Clinical & Professional Teams Measurement in place Ongoing Implementation Support Strategies Technical Assistance/Coaching/ Supervision Ongoing Training Process Evaluation Supportive Feedback Mechanisms i-THRIVE Community of Practice The i-THRIVE Community of Practice is a group of organisations sharing learning about the implementation of i-THRIVE. They are supported by the i-THRIVE
Partnership, which provides support through the key workstreams below. i-THRIVE Illustrated Sharing examples of THRIVE-like practice, drawing on good practice from members of the iTHRIVE Community of Practice currently implementing the model. 17 i-THRIVE Academy Education and training programmes to build capacity & competency supporting delivery of transformation. Shared learning events, Action Learning Sets and webinars. Includes training practitioners, leaders & commissioners.
i-THRIVE Implemented Providing an evidence based approach to transformation, implementation & dissemination of best practice, supported by the i-THRIVE Toolkit. The i-THRIVE Community of Practice ~20% of CYP Population COP only Accelerators 18 The i-THRIVE Partnership The Anna Freud National Centre for Children and Families http://www.annafreud.org/
The Tavistock and Portman NHS Foundation Trust https://tavistockandportman.nhs.uk/ The Dartmouth Centre for Health Care Delivery Science http://tdchcds.dartmouth.edu/ UCLPartners http://www.uclpartners.com/ 19 Why it matters? If Id only had in my teens what Ive had in my thirties, perhaps I wouldnt have lost my twenties. Mental health service user
20 For more information Dr. Anna Moore: i-THRIVE Implementation Lead & National NHS Innovation Accelerator Fellow [email protected] Dr. Miranda Wolpert: First author of the THRIVE Conceptual Framework [email protected] 21
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