Second Edition Miranda Wolpert, Rita Harris, Sally Hodges, Peter Fuggle

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GETTING RISK SUPPORT

Context: This is perhaps the most contentious aspect of the THRIVE model and has certainly been the 

need-choice group we have found it hardest to agree a simple heading for. We posit that even the best 

interventions are limited in effectiveness. As noted above, a substantial minority of children and young people 

do not improve, even with the best practice currently available in the world (Weisz et al., 2013). There has, 

perhaps, in the past been a belief (strongly held by service providers themselves) that everyone must be helped 

by a service and if they are not then that is an unacceptable failure. 

The THRIVE model suggests that there be an explicit recognition of the needs of children, young people and 

families where there is no current health treatment available, but they remain at risk to themselves or others.

Data: On current data sources available it is not possible to disaggregate this group from the other groups 

within the THRIVE model, which are proposed to be used for future payment systems. It is likely that 

many, though not all, of this group will be subsumed within the getting more help group above – and our 

hypothesised estimate is that this group may account for 5% of all young people accessing services currently.

Resource: Practitioner reports suggest this group may require significant input; they certainly take up a lot 

of energy in terms of discussions within and between services. Some services report that they are currently 

distinguishing members of this group as a group of children, young people and families who may be termed 

“not ready” for treatment, or in need of ongoing monitoring. It may be that many are currently being offered 

intensive treatment for which they are failing to attend appointments or making no progress in terms of 

agreed outcomes. It is suggested that over time this group may be disaggregated as a distinct grouping for 

payment systems.

Need: This grouping comprises those children, young people and families who are currently unable to benefit 

from evidence-based treatment but remain a significant concern and risk. This group might include children 

and young people who routinely go into crisis but are not able to make use of help offered, or where help 

offered has not been able to make a difference; who self-harm; or who have emerging personality disorders or 

ongoing issues that have not yet responded to treatment.

Provision: The THRIVE model of provision would suggest that, for this group, there needs to be close 

interagency collaboration (using approaches such as those recommended by AMBIT (Bevington, Fuggle, 

Fonagy, Target, & Asen, 2013) to allow common language and approaches between agencies) and clarity as 

to who is leading. Social care may often be the lead agency and the language of social care (risk and support) 

is likely to be dominant. Health input should be from staff trained to work with this group and skilled in 

shared thinking with colleagues in social care, but with explicit understanding that, although it is not a health 

treatment that is being offered, health staff must play their part in providing input to support and in some cases 

lead on risk support provision.

In terms of the support offered within this grouping, it would focus on supporting children and parents/carers 

during periods when they did not feel safe and were unable to take ameliorative action to regain safety. Service 

users would have access to support from someone whom they know, whom they had helped select and in 

whom they had confidence and trust, and who is responsible for coordination of the support backup-team 

(this could be anyone in the system, not necessarily a social care worker). Children and families would have an 

agreed written safety plan which they participated in drawing up and which explicitly lists agreed actions to be 

taken by everyone concerned (including the backup team). The aim of the support is to develop the children 

and families’ capacities for self-management of the emergent needs and the opportunity to exercise this 

capacity as rapidly as it is feasible to move people either into the getting advice, thriving or getting help/more 

help groupings as relevant.

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24

THRIVE AND OUTCOMES

It is suggested that the approach to outcome measurement for those implementing the framework should 

follow that suggested by Jacob et al (in press) and endorsed by the Payment Systems project team (Wolpert, et 

al., 2015).

This approach suggests that the personalised goal of the young person or family can helpfully point to a 

standardised measure that might also be helpful to track progress. Where possible a service should track a 

personalised goal, alongside a standardised outcome measure, as well as capture the young person or family’s 

experience of the service. 

For example, for a family with the goal of “having better family relationships”, the service may want to track the 

family’s progress using a personalised goal tool and select a standardised measure such as SCORE-15, if this is 

helpful to the family and practitioner.

In the light of analysis of goals brought by family members, the following five possible domains of 

measurement are suggested currently, in addition to measurement of whatever bespoke goal the service 

user identifies: 

• 

symptom change 

• 

greater understanding 

• 

general wellbeing 

• 

relationship enhancement 

• 

impact on life.

The indicators in Table 3 are examples relating to the sort of goals agreed by children, young people and 

families accessing services. Any appropriate indicator can be used that is consistent with your service’s policy. 

To note Goals Based Outcomes (Law & Jacob, 2015) may be useful in relation to the themes above and/or other 

bespoke goals agreed.

Table 3: Goal themes mapped to corresponding suggested outcome indicators

11

Overarching theme

Agreed goal

Some possible outcome indicators that can 

be used

Relationship /interpersonal

Make more friends

Strengths and Difficulties Questionnaire (SDQ); 

Child Outcome Rating Scale (CORS) 

Have better family relationships

SCORE Index of Family Function and Change-15 

(SCORE-15)

Have less fights

Me and My School (M&MS)

Better management of child’s 

behaviour by parent

Brief Parental Self-Efficacy Scale (BPSES)

Coping with specific problems 

and symptoms

Less symptoms PTSD

Impact of Events Scale (IES)

Less low mood

Strengths and Difficulties Questionnaire (SDQ)

Revised Child Anxiety and Depression Scale 

(RCADS)

How are things: Depression/low mood (PHQ-9)

Manage intrusive thoughts and 

compulsive behaviours

OCD subscale of Revised Child Anxiety and 

Depression Scale (RCADS)

Personal functioning

Doing better at school 

Number of days attending school; academic 

achievement

Feeling happier

Short Warwick-Edinburgh Mental Well-being 

Scale (SWEMWBS)

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 Aspects of table derived from Jacob, Edbrooke-Childs, Law, et al. (2015). Goal frameworks taken from Jacob, 

Edbrooke-Childs, Holley, Law, & Wolpert, 2015.

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