Implementing iThrive? Pick priorities and prepare, says commissioner

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Science Journalist for ACAMH

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iThrive is a care framework that aims to replace the four tiered system of CAMHS provision, by grouping children and young people based on their needs.

Initially launched at 10 sites across the UK in October 2015, by April 2017 it had expanded to 44 CCGs. iThrive state that, 30% of young people in England are now served by a trust or CCG implementing the programme.

“It’s a set of principles that local areas can then develop,” said Tessa Weir-Jeffrey, a child and adolescent psychotherapist and Chair of the ACAMH Avon Branch, whose trust recently adopted the framework.

The framework was developed by charity the Anna Freud Centre and the Tavistock and Portman NHS Foundation Trust.

“The research suggests that CAMHS can only be effective with 60% of cases, many young people and families may benefit from alternative community based intervention,” she said.

She has misgivings about how well the current tiered system reflects user needs. “The tiered model leads to the belief that CAMHS is the ultimate destination.  There are a range of other ways that services and ways of helping that can support children, young people and families, which the iThrive model describes,” she said.

Research by thinktank The Education Policy Institute published in September 2017 found that 26.3% of children referred to specialist mental health services were not accepted for treatment.

Waltham Forest CCG in east London was selected as one of the 10 testing sites for iThrive back in 2015. It chose to participate as it was already in the early stages of developing a transformation plan for CAMHS.

“The main thing we wanted was something that had been tried, tested and proven – that’s what attracted us,” said Nuzhat Anjum, deputy director of mental health at Waltham Forest.

She said frontline staff were finding the implementation a challenge: “they’re used to working in a different way and iThrive does have a very different model of intervention” she said.

As part of the framework the Waltham Forest CAMHS team have been training school staff to spot children who are struggling, initially starting with 10 schools. So far they have trained around 400 people, Nuzhat said.

“Our whole idea is to identify children for early intervention in school” she said. “We talk about the pathways, challenges, and what support they need. We also developed a whole new pathway.”

Since starting iThrive 3 years ago, Waltham Forest has seen a 15% decrease in referrals to their CAMHS and have reported an increase in referrals to CAMHS from schools.

Nazhat offered some advice to those thinking of trying out the framework themselves.

“Don’t leave the programme to implement itself, you have to bring your current provider and iThrive to work hand-in-hand, otherwise it can becomes a ‘them and us’ issue,” she said.

“iThrive is a big programme, what we have done is pick five key priorities that we will work through for the whole year.”

She said staff had to see meaningful changes and a beneficial outcome for service users for the framework to stick. She also recommended “more preparatory work in advance, with iThrive and your CAMHS provider.” She said while the framework was working for Waltham Forest, the process takes time.

“It hasn’t been done in a day,” she said.

Getting iThrive

The iThrive framework uses four needs-based groups: ‘Getting Advice’, ‘Getting Help’, ‘Getting More Help’ and ‘Getting Risk Support’.

The intention is that the ‘Getting Advice’ group are helped with minimal resource input and self-management is promoted using digital tools. Both the ‘Getting Help’ groups are intended to operate similarly to existing core services, but with more defined endpoints. Children and young people in the ‘Getting Risk Support’ group are held for their safety – but not for therapy.

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Training professionals with the aim of early intervention is what the Primary CAMH Role was introduced for and worked very well in Wales until the Mental Health Measure (2010) was introduced. The number of referrals by GPS requesting a Mental Health Assessment of a child or young person then outstripped the available capacity as Primary CAMH has only ever had minimal staffing levels. If more resources were put in place at the Primary CAMH level working with all professionals – less referrals would be made to Specialists CAMH

Interested in the effect on the percentage of children being unable to get support, is iThrive effectively reducing this in practice? I.e. are you helping other children than camhs? Is this mostly through a specific pathway?

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