Designing a community based service model to promote mental health and well-being of children in the East of England.
Three round adapted DELPHI study.
Poor mental health amongst children and young people has sparked a national conversation about the best ways to prevent mental health difficulties form occurring in the first place, and when they do, to ensure that children, young people and their families get the right help at the right time to help them recover and carry on with their lives.
In 2015, NHS England the Department of Health published ‘The Future in Mind‘ report, which outlined a national vision for mental health services. Future in Mind set out how local agencies should develop Local TRansformation Plans (LTPs) to apply the national vision for services at a local level. The plans should detail how services will be improved, and how services will work together to achieve changes. The first plans were submitted in 2015, and will be continually refreshed to reflect progress.
It is important that LTPs reflect the local context and needs of the community, as well as the priorities of children, young people and those who care for them along with the providers, commissioners and other key partners.
This study was undertaken to identify priorities shared by the public and professionals with respect to the types of services and support that should be available and the way in which they should be delivered. These shared priorities can be used to inform the ongoing transformation of mental health provision in the East of England, to ensure that services reflect the needs and ideas of those who deliver and receive them.
Specifically, this study aimed:
- To define consensus on the aims and characteristics of service model promoting children and young people’s mental health and wellbeing
- Identify the barriers and facilitators to establishing and delivering such service model.
- To map the population needs of Cambridgeshire as well as the current resources available to respond to need.
- To map the steps needed to implement a new service model.
ARC EoE and the Strategic Clinical Network (SCN) collaborated with members of the general public, people using mental health services and their carers, and professionals working with children and young people. The study used a modified three round Delphi method to identify important components of a regional community based mental health response for Children and Young People (CYP).
- Round 1: employed qualitative methods (open ended questionnaire, interviews and focus groups) to elicit ideas about important features of community based Child and Adolescent Mental Health Services (CAMHS)
- Rounds 2 and 3:public and professional panels rated the importance of the ideas put forward in round one. Items not reaching a pre-specified threshold for consensus in round two were presented back to panels in round three, accompanied by structured feedback detailing individual and group scores for each item. In an effort to ensure that public views remained salient the professional panel also received feedback on the median public score for each item.
To the best of our knowledge this is the first study in the UK to use the Delphi method to inform the development of a comprehensive model of CAMH services. Further this is the first time that this adapted Delphi methodology (where experts are informed of service user/patient ratings) has been used with vulnerable groups of service users/patients, therefore this study also has the potential to make a methodological contribution to the health services research.
Key findings and outputs
The study identified features of comprehensive community based MH services for CYP, that are important to those who may use them (public) and those who are responsible for funding and delivering services (professionals).
The priorities identified by participants in the study could be grouped in four categories:
- preventing problems, promoting resilience and well-being
- getting help
- measuring success
- working together
Priorities relating to the prevention of mental health difficulties and the promotion of good mental health, emphasis the role of education in: developing a school culture that values and supports children’s emotional wellbeing; supporting children as stressful times; and providing specific activities to build children’s resilience against future stresses and strains.
Priorities relating to the delivery of treatment and support to CYP experiencing mental health difficulties placed greater emphasis on the way in which care is delivered and the qualities of those delivering care, than on specific types of intervention that should be delivered.
The evidence can be used to inform service transformation in the East of England and is particularly useful for guiding commissioning decisions that reflect the priorities of those who use and deliver services.
- Howarth E, Vainre M, Humphrey A, et al. Delphi study to identify key features of community-based child and adolescent mental health services in the East of England BMJ Open 2019;9:e022936. doi: 10.1136/bmjopen-2018-022936
For further information about this project, please contact Dr Emma Howarth email@example.com