THRIVE Elaborated
Second Edition
Miranda Wolpert, Rita Harris, Sally Hodges, Peter Fuggle,
Rachel James, Andy Wiener, Caroline McKenna, Duncan
Law, Ann York, Melanie Jones, Peter Fonagy, Isobel Fleming
and Simon Munk
A collaboration with
Getting Advice
Getting Help
Getting
More Help
Getting
Risk
Support
THRIVING
DISCLAIMER
All ideas in this paper and related to this model are independent of any organisational affiliations, committee
membership or other official capacities of any of the authors, other than their roles within the Anna Freud
National Centre for Children and Families and The Tavistock and Portman NHS Foundation Trust.
NOTE ON THE SECOND EDITION OF THRIVE ELABORATED (2015)
Please note that the content of the original THRIVE ELABORATED (2015) publication remains unchanged – apart
from the addition of a 2016 foreword, updates to the reference list, and some small visual and formatting
changes to illustrations.
978-0-9933436-4-3
November 2016
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THRIVE ELABORATED: NOVEMBER 2016
FOREWORD: NOVEMBER 2016
THRIVE: a multi-agency initiative
When we published our emerging ideas on a conceptual framework – THRIVE: The AFC-Tavistock Model for
CAMHS (Wolpert et al., 2014) – we knew that our thinking would develop and we committed to providing
regular updates. In November 2015, we published an updated version with greater elaboration on key points:
THRIVE Elaborated (Wolpert et al., 2015).
For the second edition of THRIVE Elaborated, we have left the content of the framework unchanged. However,
through this foreword we aim to address the most common question we get in relation to THRIVE: “THRIVE
reads as being very health focused, even though it professes to be a multi-agency framework. Can you
clarify in what sense this is a genuinely multi-agency framework?”
THRIVE was originally authored by professionals involved in mental health support for children and young
people, all of whom came from a health background. We acknowledge that this was reflected in our language
but stress that our vision was of genuine multi-agency work in this area. We now have co-authors from the
world of education and social care, and have drawn on views from head teacher panels, CCG leads and local
authority directors. We have also had input from Lorraine Khan of the Centre for Mental Health, for which we are
very grateful. We hope that this will help us to communicate the framework using language that makes sense
across agencies.
Below we highlight four key ways in which the THRIVE framework is inherently multi-agency:
1. THRIVE endorses multi-agency definitions of mental health promoting practices
THRIVE seeks to enhance awareness of the full range of mental health promoting practices (MHPP) and to
facilitate a multi-agency approach to their use. For too long, practices to support the burgeoning and costly
mental health needs across the UK have been conceived of only in terms of health interventions (Evans-Lacko
et al., 2016; Ramon et al., 2011). Models of treatment and intervention have largely drawn on medical models
within a very narrow set of parameters. This has led to increasingly sterile debates about the effectiveness of
different modalities which focus on a very limited set of individual-focused options that are shorn of social
context (e.g. talking therapies, psychoeducation, behaviour change and medication), and with diminishing
differences in efficacy findings (Roth & Fonagy, 2013).
This approach is no longer tenable for a range of reasons. First, there is emerging and increasingly compelling
evidence of a range of social and economic factors that affect mental health. These include poverty, poor
housing, neighbourhood cohesion and national income inequality (Friedli, 2009). Second is the increasing
recognition that more health care does not necessarily mean better mental health outcomes (Mulley,
Richards, & Abbasi, 2015). Within the medical paradigm, less than 50% are likely to be substantially helped for
many difficulties (Lambert, 2011). Third, there is a growing demand for a greater range of interventions that
recognises the social contexts and individual preferences of individuals and communities (Camic & Chatterjee,
2013; Evans-Lacko, et al., 2016; Mulley, et al., 2015; Rogers & Pilgrim, 2014). Finally, the current economic climate
means greater health care provision as a response to rising mental health need is simply not sustainable; the
austerity agenda is itself acting as an important lever for a more radical reconceptualisation of what might
help to promote positive mental health and wellbeing, and prevent or address mental health difficulties (e.g.,
Evans-Lacko et al., 2016). These factors have led to interest in different forms of mental health promoting
practice beyond traditional health interventions, such as those supported by social prescribing (Maughan et al.,
2016), or by the use of personal budgets (Glendinning et al., 2008).
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THRIVE ELABORATED: NOVEMBER 2016
Mental health support desperately needs a common language even to start to think about different forms of
mental health promoting practice or offerings that go beyond a combination of one or more of the four current
modalities: talking therapies, psychoeducation, behaviour change and medication. For example, emerging
evidence of the impact of initiatives, such as volunteering, peer support and engagement in clubs, are currently
not well considered in the literature. Additionally, the literature on social prescribing refers to “non-drug,
non-health-service interventions” (Husk et al., 2016). THRIVE seeks to help by highlighting the need for the
development of a common language not defined by health.
Within each category of THRIVE, a range of interventions may therefore be relevant beyond currently
recognised “therapeutic approaches” delivered by “trained mental health professionals”. An important feature
of the help offered is that it considers and draws on the network of services around the child, which maximises
the young person’s potential for engagement and accommodates their individual preferences, where possible.
Help can take the form of intervention in which any professional – mental health or not – takes responsibility for
input directly with a specified individual or group related to a mental health need.
1
The THRIVE definition of a mental health intervention is as follows:
1. Can you state what the mental health need(s)
2
is/are for the given child?
2. Are you working to address a mental health need?
3
3. Are you clear what you are trying to achieve in relation to the mental health need?
4. Are you taking some responsibility for whether the goal in relation to the mental health need is achieved
or not?
If the answer is yes to 1–4, then by THRIVE’s definition you are providing a mental health intervention regardless
of who is providing it and in what context. For the intervention to be following best practice from a THRIVE
perspective, we would add the following criteria:
5. Have you considered the evidence base and chosen an approach that best fits the needs of the child based
on the latest evidence, and balanced with the preferences of those seeking help or support?
6. Have you collaboratively agreed with the child and/or carers what “goals” they want to achieve?
7. Are you reviewing your progress against the agreed goal and using this information to inform future
decision making, including an appropriate time to end contact?
If the answer is yes to 1–7 above, then by THRIVE’s definition you are providing a best practice mental
health intervention.
2. THRIVE encourages shared multi-agency responsibility for promoting “thriving”
4
All agencies share a responsibility to provide support proactively for the most vulnerable and high-risk children
and young people. There is a strong (though not absolute) link between psychosocial adversity and mental
health need. Vulnerable groups of children living in conditions of multiple adversity, often with experience of a
1
This does not mean that wider interventions with less direct input from a professional (from any agency) may not
also be relevant.
2
Defined as having a distinct problem identifiable on a mental health assessment tool, such as The Current View
tool, which outlines 30 distinct child mental health difficulties.
3
This might be part of one of a number of issues being addressed – some or even the majority of which may not
relate to mental health.
4
See pp. 17–18 for a full definition.