The THRIVE Framework https://www.annafreud.org/mental-health-professionals/thrive-framework/ helps people think about the mental health and wellbeing needs of children, young people and their families through the lens of four needs-based groupings: (1) Getting Advice and Signposting, (2) Getting Help, (3) Getting More Help, and (4) Getting Risk Support. Shared engagement is fundamental to the approach; children, young people, and their families are empowered through active involvement in decisions about their care. They are able to opt for help from any agency capable of providing it for whichever of those four groupings (‘quadrants’) they currently find themselves. The emphasis is on prevention, and on the promotion of mental health and wellbeing across the whole population.
THRIVE requires a major shift from the current system of care where different agencies engage separately with children and young people according to their diagnosis and severity, which often compromises continuity of care and leads to an uncoordinated system and/or having to wait for a long time before the person is (re-) assessed and treated. Cambridge and Peterborough Foundation Trust (CPFT) had been experiencing a chronic delay for young people accessing mental health services, and some senior managers believed that a potential solution was a renewed reorientation towards the THRIVE framework.
Several of CPFT’s ‘system partners’ (i.e. organisations such as the local authority community services and third sector organisations helping young people with mental health difficulties) were similarly minded. Some had already begun to embrace the THRIVE principles in the hope of developing a coordinated approach that makes the most of all the organisations and community assets able to provide help in each of the four ‘quadrants’. By also ensuring mutual support across all these organisations, THRIVE might also help minimise the resource required to meet the immediate needs of young people.
Recognising the complexity of implementing this reconfiguration, CPFT approached the ARC EoE Implementation leads to help create a readily accessible, proactive and unified system of evidence-based mental health interventions for children and young people, based as far as possible on the THRIVE framework.
There was a long incubation phase during which local service activity data were gathered and analysed, and the ARC Implementation Leads became familiar with the complexities of the local context and the history of previous attempts at change. Eventually, with the help of a core design group of five senior CPFT staff, they were able convene a community of practice (CoP) consisting of ~20 senior clinicians and managers from within the trust. The CoP met three times over a period of five weeks. They started by reviewing the data and the evidence, as well as the organisational and cultural obstacles to any desired change. They then progressed rapidly to agreeing what the shape of that change should be, and the organisational principles upon which it should be based. Building on that consensus, the CoP then went on to derive a series of service principles, which they then matched to the principles of THRIVE. As a result, they were able to agree that THRIVE was indeed a desirable basis for reconfiguring the service. An initial THRIVE training session was agreed and arranged.
Meanwhile, another design group was setting up a separate CoP consisting of staff from the local authority and voluntary sector (CPFT’s ‘system partners’), which was able in just one meeting of ~20 senior staff from those organisations to agree independently a set of service principles. Some of the members of that CoP had already attended THRIVE training and many others joined the training that CPFT had arranged following its third CoP meeting. Thereafter the two CoPs merged and were enabled to merge their service principles. They are beginning to work together to put these principles into action. A pool of over 40 members are continuing to attend joint CoP meetings facilitated by the ARC Implementation Leads.
The joint CoP has been making plans to strengthen the organisational partnerships over the next year, as well as to work with staff, so that NHS and non-NHS organisations form an inclusive, comprehensive, cross-sector system within which children, young people and their families obtain the care and services that they need. The overarching aim is to work to stop children and young people ‘bouncing’ between services and to minimise waits for advice and help. Progress towards these goals will be monitored to maintain momentum and identify what needs to be changed and sustained to ensure success.
The CoP members have formed a series of cross-organisational working groups to tackle what they see as the main cultural and organisational obstacles that need to be overcome to achieve this, and are continuing to meet online, working towards a ‘soft launch’ of this programme of change in the Autumn of 2021.