Second Edition Miranda Wolpert, Rita Harris, Sally Hodges, Peter Fuggle
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- THRIVE and CAPA
8 THRIVE FRAMEWORK FOR CHILDREN AND YOUNG PEOPLE MENTAL HEALTH SERVICES: A NECESSARY PARADIGM SHIFT? We are proposing to replace the tiered model with a conceptualisation of a whole system approach that addresses the key issues outlined above and is aligned to emerging thinking on payment systems, quality improvement and performance management. The framework outlines groups of children and young people, and the sort of support they may need, and tries to draw a clearer distinction between treatment on the one hand and support on the other. It focuses on a wish to build on individual and community strengths wherever possible, and to ensure children, young people and families are active decision makers in the process of choosing the right approach. Rather than an escalator model of increasing severity or complexity, we suggest a framework that seeks to identify somewhat resource-homogenous groups (it is appreciated that there will be large variations in need within each group) who share a conceptual framework as to their current needs and choices. The THRIVE framework below conceptualises five needs-based groupings for young people with mental health issues and their families. The image on the left describes the input that is offered for each group; that on the right describes the state of being of people in that group – using language informed by consultation with young people and parents with experience of service use. Each of the five groupings is distinct in terms of the: • needs and/or choices of the individuals within each group 6 • skill mix required to meet these needs • dominant metaphor used to describe needs (wellbeing, ill health, support) • resources required to meet the needs and/or choices of people in that group. 6 Need is taken to refer to “the minimum resource required to exhaust capacity to benefit”. Choice is taken to refer to the shared decision making between a young person or family member and those providing help and support. Getting Advice Getting Help Getting
More Help Getting
Risk Support THRIVING
Figure 2: THRIVE framework 9 The groups are not distinguished by severity of need or type of problem. Although it is likely that certain problems or severities may be more common in some groups, there is no one-to-one relation between severity or type of problem and grouping. Rather, groupings are primarily organised around different supportive activities provided by children and young people mental health services in response to mental health needs and strongly influenced by client choice. THRIVE focuses on clarity around need rather than prescription as to exact structures or interventions to meet those needs. The THRIVE categories are “needs-based groupings”. “Need is defined as the identified approach … collaboratively agreed via a process of shared decision making between service provider and service user. It includes both judgement of the appropriateness of interventions offered and the informed choices of children, young people and their carers regarding the approach ... that is best for them, within the parameters and scope of the commissioned service,” (Wolpert et al., 2015, p.7). Thus each person or family accessing services is entitled to the following respect agenda: As someone seeking help from a professional, I have a right to RESPECT
• Know what options are available • Know the pros and cons of the different options
• Know the evidence for the help and support being suggested • Know If there are different types of help that may be effective • Know what is expected from me or others for the treatment S elect • Make choices about what help I get when different evidence-based approaches exist • Be involved in setting and reviewing goals • Know how soon and to what extent things are likely to improve • Agree what will happen if things don’t get better P rogress • Be listened to and have my views taken into account E xpression • Know how those supporting me understand the difficulties C larity • Know what is happening to information about me T ransition Support • Be supported to find further help if needed Figure 3: Respect agenda 10 THRIVE AND IMPLEMENTATION THRIVE is a framework that brings to bear some of the ideas that a number of us have had over many years based on our experience in providing, researching, using and change-managing systems related to supporting child and adolescent mental health, including our experience of what those accessing services tell us they want and need from services. THRIVE offers a set of principles and values to guide implementation but it is not itself a how-to guide nor does it provide a blueprint for implementation. We want neither to prescribe nor proscribe what implementation might look like locally – rather we are interested to learn from local models of implementation. In the light of this we have started to refer to THRIVE as a framework to try to emphasise this. We reiterate our wish, laid out in the November 2014 document, that we genuinely want to learn from local implementation and how the model has been applied across sectors. The author group see themselves as akin a to think tank organised around trying to address key aspects of service delivery using a number of key principles tested against what is known about service delivery and service use. There are a number of initiatives and approaches that are aligned with THRIVE principles and which might support implementation of THRIVE: • The Choice and Partnership Approach (CAPA) is a well-developed approach that many areas have found can aid implementation of the key principles of shared decision making and clarity of choice. The alignment of CAPA to THRIVE is discussed in more detail below. www.capa.co.uk • Children and Young People Improving Access to Psychological Therapy (CYP IAPT) is being rolled out across the country and seeks to combine evidence-based practice with user involvement and rigorous outcome evaluation to embed best practice in child mental health. www.cypiapt.org • The Child Outcomes Research Consortium (CORC) learning collaboration can aid alignment and integration of data and outcomes across agencies and organisations, and is seeking to support areas to develop and embed cross-sector outcomes. www.corc.uk.net • Peer-review networks such as the Quality Network for Community CAMHS can aid embedding and consideration of key elements of practice. www.rcpsych.ac.uk/quality/quality,accreditationaudit/communitycamhs.aspx An implementation group, i-THRIVE, has formed consisting of an initial partnership between AFC, Tavistock and Portman NHS Foundation Trust, UCLPartners and Dartmouth Center for Healthcare Delivery Science (US), drawing on support from a range of partners, including YoungMinds, CAPA and CORC. The purpose of i-THRIVE is to translate the THRIVE framework into a model of care, and to support sites implementing this model locally. In order to support shared decision making, which is core to THRIVE but which continues to present an implementation challenge, the group is seeking to combine THRIVE with specific tools developed in the US, in particular Options Grids™, and tools to assess extent of both collaboration and integration of services (CollaboRATE® and IntegRATE®). i-THRIVE has recently been awarded NHS Innovation Accelerator status, led by Dr Anna Moore, and has launched the i-THRIVE Community of Interest. The programme is currently developing a range of tools to support local sites interested in adopting the model.
A key question we are often asked is “How does THRIVE relate to a Choice and Partnership Approach (CAPA)?” The THRIVE framework is consistent with a CAPA approach and draws on the rich learning from CAPA. CAPA also provides an important potential model of implementation of the principles within THRIVE. CAPA is used in children and young people mental health services and increasingly in adult mental health all over the world and includes a “how to” system in place that consists of 11 key components. The ways in which CAPA and THIRVE align include: • The THRIVE groupings align with those used in CAPA of choice (getting advice) and partnership (core partnership is equivalent to getting help, Specific partnership with getting more help and getting risk support). CAPA, like THRIVE, defines the groupings in terms of needs/choices of individuals, description of needs, skill mix and resources needed to support those choices.
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