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

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•  CAPA focuses on helping people make explicit choices about what may most benefit them and links this 

with clear evidence-based packages of care. A focus on being clear what the task is and how it is to be 

delivered and the agreement on the task alliance with the client is embedded in CAPA.

•  One of CAPA’s 11 key components is to change language to that which promotes strengths-based, 

collaborative work towards shared goals with young people and their families, thinking about skills needed, 

rather than access to a particular professional discipline. The THRIVE framework promotes this way of 

thinking by furthering the use of language to one that is helpful to young people and families and services.

CAPA addresses many areas the THRIVE framework does not address (nor necessarily endorse).

•  Workforce and capacity planning. In particular, CAPA segments work so that skills and capacity can be 

properly identified and deployed. In addition CAPA identifies all the other types of work staff do in their job 

to allow capacity to be calculated.

•  Consideration of staff training, for example in relation to language used with clients and with each other. 

THRIVE emphasises aspects that are aligned but not synonymous with CAPA, including a more explicit and 

focused emphasis on: 

•  the difference between risk support and other forms of help. This includes being explicit about the role of 

children and young people mental health services, which is not about treatment, i.e. risk support is seen as 

the business of children and young people mental health services. 

•  the potential for treatment harm as well as the limitations of what can be achieved

•  endings, even when significant change has not been achieved and focus on more explicit discussion of this 

with service users

•  use of tools to support empowerment and shared decision making

•  interagency ownership of the framework including cross-sector outcome measurement.

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THRIVE AND PAYMENT SYSTEM DEVELOPMENT

Payment systems attempts to capture a more complete picture of the work done by clinicians, and therefore its 

cost, in order to inform the development of a system by which payment, such as for children and young people 

mental health services, is determined according to need. The final report of the payment systems project was 

published in June 2015 (Wolpert, et al., 2015) and reports on the work are being produced (Vostanis, et al., 

2015). The payment system work was jointly led by Miranda Wolpert (lead author for THRIVE) and Professor 

Panos Vostanis. Simon Young (Tavistock and Portman) chaired the steering group, working in close liaison with 

colleagues from South London and Maudsley Trust (Dr Gordana Milakovic and Dr Bruce Clark). Many others 

were also involved (see list of acknowledgements p.4)

Miranda Wolpert shared and updated thinking between the groups (THRIVE and Payment Systems) as the 

work progressed. Thus the emerging learning from the analysis of data from the Payment Systems Project, as it 

became publicly available, informed the thinking about the THRIVE needs-based groupings.

Perhaps not surprisingly given membership of the groups, the payment systems work was informed by many of 

the same values of the THRIVE authors – including a commitment to shared decision making wherever possible, 

and a wish to develop needs-based groupings that were meaningful to those providing and using services and 

not necessarily purely diagnostically driven (Wolpert, et al., 2015).  

Three aspects of this data-analytic work from the Payment Systems project that particularly informed THRIVE are 

elaborated below. Their implications for each needs-based grouping within the THRIVE framework are outlined 

within each section as relevant (e.g. getting advice p.19, getting help p.21, getting more help p.22):

1. Analysis of resource use by those accessing outpatient CAMHS – existing data from the Child 

Outcomes Research Consortium (CORC) (2012-13)

Using existing routinely collected data relating to children and young people mental health service users 

submitted by services who are part of the Child Outcomes Research Consortium (CORC) – a learning 

collaboration of the majority of services across England committed to using outcome measurement to improve 

and inform service delivery (Fleming, Jones, Bradley, & Wolpert, 2014), the payment systems group considered 

data from 38,794 periods of contact for children (0-18) from 107 clinical teams in 21 services, submitted to CORC 

between March 2012 and December 2013. 

The analysis found that “the modal number of appointments was 1; almost a quarter (24%) of periods of contact 

were closed after the first appointment. The median number was 3, that is, half of all cases were closed after 

three appointments or fewer had been attended. The distribution was strongly positively skewed: 37.8% of 

all appointments were attended by the 5.25% most ‘resource-intensive’ patients, who attended more than 30 

appointments each” (Wolpert, et al., 2015, p.21) Greater resource use was associated with greater clinician-rated 

severity (e.g. on CGAS – child global assessment scale) and some types of problems were more highly 

represented in the “resource-intensive” group such as eating disorders and psychosis. However it is important 

to note that there was great variability in terms of the amount of resource use, and type and severity of 

problem, and no correlation was possible to find in terms of any other indicators of need available in the dataset 

(Vostanis, et al., 2015; Wolpert, et al., 2015).

2. Analysis of resource use in relation to need by those accessing NHS outpatient CAMHS collected 

specifically as part of the Payment System Pilot Project (2012-14) 

In order to look more carefully at the factors that might account for the variations in resource use found above, 

pilot sites across the UK agreed to collect data using the Current View tool (Jones et al., 2013), to try to capture 

key information about case mix at the outset of contact. The tool is a one-page form completed at intervention 

outset. It was developed drawing on existing literature, and in consultation with both service providers and 

service users to try to capture key attributes of the young person and their family, in terms of presenting 

problem or context, that were thought likely to impact on ether resource use or outcome (Jones, et al., 2013; 

Wolpert, et al., 2015). Clinicians in the pilot sites were trained to use the tool to promote consistency in use and 

item completion (

http://pbrcamhs.org/training/current-view-tool-training/

).

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