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

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The Current View tool (see p.31, appendix 1 for copy of the tool) records: 

•  30 presenting problems

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 (e.g. social anxiety, family relationship problems, carer management of child’s 

behaviour)

•  4 contextual problems (relation to home, school, community, and service engagement)

•  2 education, employment or training issues (attendance and attainment), 

  Each rated “None”, “Mild”, “Moderate”, “Severe”, or “Not known”. 

•  14 complexity factors (e.g. presence of learning disability, parental health issues, refugee status)Each rated 

“Yes, “No”, or “Not known”. 

Data on resource use (in terms of number of contacts)

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 and on ending of contact were collected from 11 NHS 

outpatient CAMHS, amounting to some 4573 episodes of care with data that included Current View tool and 

resource use information. 

Attempts were made to derive needs-based groupings bottom-up from the data using a variety of statistical 

techniques including: unsupervised cluster analysis (k-medoids cluster analysis) and supervised cluster analysis 

(regression trees) (Wolpert, et al., 2015, p.23) However, no stable or meaningful groupings were identified 

using these methods. In contrast, a “clinically driven classification approach” based on rigorous review of NICE 

guidance and clinical practice resulted in clinically meaningful groupings, which were as good as or better than 

statistical approaches (see algorithm development, below). 

3. Development of an algorithm to potentially allocate children, young people and families 

to groupings. 

Two senior clinicians (consultant psychiatrist Professor Panos Vostanis and consultant psychologist Dr Roger 

Davies), both members of the payment systems group, independently reviewed the 15 existing NICE guidelines 

(11 specifically for children, and 4 for adults but with reference to children) in relation to factors affecting 

resource use (Vostanis, et al., 2015). From this analysis it was found that the NICE guidelines related largely to 

symptomatic severity and, to a lesser degree, impairment – but were not influenced or amended according 

to contextual factors in the children’s or their families’ lives. In light of this, an algorithm was developed that 

assigns children and young people mental health services clients to a NICE guidance category based on the 

presenting problems rated on the Current View tool. Because of the lack of consideration of contextual factors 

in the NICE guidance these elements on the Current View tool were not included in the algorithm, but it was 

hypothesised that these factors might account for additional variance in resource use within each grouping.

What emerged from this work was an algorithm that allocated children, young people and families accessing 

mental health services to three superordinate categories termed “getting advice” (analogous to the getting 

advice grouping in THRIVE), getting help (as the THRIVE grouping) and getting more help (as the THRIVE 

grouping). Within each of these categories there were subcategories (2 in getting advice, 13 in getting help and 

4 in getting more help) leading to an overall set of 19 clusters (14 of which are guided by specific NICE guidance 

and 5 of which are not) within the Payment System model (Wolpert, et al., 2015). The implications of these 

categories and sub-categories for the THRIVE framework are discussed in more detail below. It should be noted 

at this point that risk support and thriving were not groupings identified by the Payment Systems work, though 

they were referred to in the final report to show how they could be aligned with the payment systems approach 

(Wolpert, et al., 2015).

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 Ratings need not imply a diagnosis.

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 Data quality on inpatient work was not sufficient to be included in the analysis. 

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Mutually

exclusive

groupings

Getting Help: ADHD (Guided by NICE Guideline 72) 

 

 

 

 

(ADH)

Getting Advice: Neurodevelopmental Assessment (NICE Guidance as Relevant) 

 

 

(NEU)*

Getting Advice: Signposting and Self-management Advice (NICE Guidance as Relevant) 

 

(ADV)

Getting More Help: Presentation Suggestive of Potential BDP (Guided by NICE Guideline 78) 

(PBP)

Getting More Help: Psychosis (Guided by NICE Guidelines 155 and/or 185)   

 

(PSY)†

Getting Help: Behavioural and/or Conduct Disorders (Guided by NICE Guideline 158)   

(BEH)

Getting Help: Bipolar Disorder (Guided by NICE Guideline 185)  

 

 

(BIP)†

Getting Help: GAD and/or Panic Disorder (Guided by NICE Guideline 113)   

 

(GAP)

Getting Help: Social Anxiety Disorder (Guided by NICE Guideline 159) 

 

 

(SOC)

Getting Help: Difficulties Not Covered by Other Groupings (NICE Guidance as Relevant)  

(DNC)

Getting Help: Autism Spectrum (Guided by NICE Guideline 170) 

 

 

 

(AUT)

Getting Help: Depression (Guided by NICE Guideline 28) 

 

 

 

 

(DEP)

Getting Help: OCD (Guided by NICE Guideline 31)  

 

 

 

(OCD)

Getting Help: Self-harm (Guided by NICE Guidelines 16 and/or 133) 

 

 

 

(SHA)

Getting Help: Co-occurring Emotional Difficulties (NICE Guidance as Relevant) 

 

 

(EMO)‡

Getting Help: PTSD (Guided by NICE Guideline 26) 

 

 

 

 

(PTS)

Getting Help: Co-occurring Behavioural and Emotional Difficulties (NICE Guidance as Relevant) 

(BEM)‡

Getting More Help: Eating Disorders (Guided by NICE Guideline 9) 

 

 

 

(EAT)

Getting More Help: Difficulties of Severe Impact (NICE Guidance as Relevant) 

 

 

(DSI)

Getting

Advice

Getting

More Help

Getting

Help

‘Super groupings’

(n=3)

Needs-based groupings

(n=19)

Figure 4: 

The payment 

systems groupings 

The payment systems groupings are outlined in the figure above. 

The exact algorithm can be found in the Payment Systems report (Wolpert, et al., 2015. Appendix C). Key 

elements are outlined overleaf.

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