A protocol for a multi-site cohort study to evaluate child and adolescent mental health service transformation in England using the i-THRIVE model

Abstract

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 people's mental health, a cohort study 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 people's 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.

Fig 1. i-THRIVE logic model.

The i-THRIVE logic model shows the inputs, processes, outputs and the expected outcomes and impact of implementation.

Fig 2. The conceptual model underpinning the study design (Moore et al., 2015), indicating measurement domains.

Fig 3. Quantitative measures collected per patient, defining ‘access’, ‘diversity’, ‘waiting times’, ‘efficiency’ and ‘clinical outcomes’.

The CAMHS pathway is illustrated by the grey boxes. Our base cohort includes all patients referred to a site within the four-year period of the evaluation. For every patient referred we will collect demographic information (age at referral, ethnicity and presence of learning disability). For each subsequent contact point (triage to discharge) the information shown in the relevant box will be collected. This refers to one episode of care. In the case of a patient being re-referred, each subsequent referral will be identified as a separate episode of care. Episodes of care will be recorded accumulatively and given an ID unique to the patient in question. A range of measures have been constructed for the evaluation using data from different parts of the data model. These are numbered 1–12 above and details are provided in Table 2.