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Article
Publication date: 15 February 2016

Ayla Humphrey, Lynne Eastwood, Helen Atkins, Maris Vainre and Caroline Lea-Cox

The purpose of this paper is to draw attention to commissioning and service structures enabling implementation of evidence-based cost-effective care as illustrated by the “1419”…

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Abstract

Purpose

The purpose of this paper is to draw attention to commissioning and service structures enabling implementation of evidence-based cost-effective care as illustrated by the “1419” young people’s service treating mild to moderate severity mental health difficulties in teenagers old 14 to 19 years. The authors describe relevant local contextual factors: “relational commissioning”, demand capacity planning and a receptive and safe clinical context.

Design/methodology/approach

The authors used a participant observer qualitative research design to describe commissioning and service design. Treatment outcomes were analysed using a quantitative design and found significant improvement in service user mental health and daily function. These results will be reported elsewhere.

Findings

The dynamics and structures described here enabled clear shared goals between service user, service purchaser, service provider and service partners. The goals and design of the service were not static and were subject to ongoing development using routine outcome measures and conversations between referrers, commissioners, service users and within the team about what was and was not working.

Research limitations/implications

The methods are limited by the lack of a prospective systematic evaluation of the implementation process and by the time limitations of the service.

Practical implications

Implementation of whole system change such as that envisioned by Children and Young People’s Improving Access to Psychological Therapies requires consideration of local context and process of implementation. The authors suggest key factors: consideration of “relational commissioning” with purchasers, providers and service users designing services together; case-level collaboration between services and partner agencies; smaller child and adolescent mental health teams eliminating competing task demands, permitting speed of action, providing psychological safety for staff, promoting shared goals and innovation; rigorous demand/capacity planning to inform funding.

Social implications

The failings of child and adolescent mental health services (CAMHS) are detailed in the Department of Health report “Future in mind: promoting, protecting and improving our children and young people’s mental health and wellbeing” (2015). The aims of the report are contingent on the ability of local health providers to implement its recommendations. The authors provide a theoretical approach to enable this implementation.

Originality/value

To date there are no published papers addressing the key characteristics enabling implementation of evidence-based practice within CAMHS. The unique experience in forming the“1419” service has important implications nationally and brings together evidence of an effective service within a theoretical underpinned context.

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Article
Publication date: 5 August 2014

Fergus Gracey, Suzanna Watson, Meghan McHugh, Andrew Swan, Ayla Humphrey and Anna Adlam

Clinically significant childhood acquired brain injury (ABI) is associated with increased risk of emotional and behavioural dysfunction and peer relationship problems. The purpose…

238

Abstract

Purpose

Clinically significant childhood acquired brain injury (ABI) is associated with increased risk of emotional and behavioural dysfunction and peer relationship problems. The purpose of this paper is to determine how emotional and peer related problems for children with ABI compare with those of children referred to mental health services, and to identify clinical predictors of peer relationship problems in a heterogeneous sample typical of a specialist community rehabilitation setting.

Design/methodology/approach

Participants were 51 children with clinically significant ABI (32 traumatic brain injury; 29 male) referred for outpatient neuropsychological rehabilitation. Emotional, behavioural and social outcomes were measured using the Strengths and Difficulties Questionnaire (SDQ), and executive functioning was measured with the Behaviour Rating Inventory of Executive Functions. Correlational analyses were used to explore variables associated with peer relationships. A subgroup (n=27) of children with ABI were compared to an age and sex matched mental health group to determine differences on SDQ subscales.

Findings

The SDQ profiles of children with clinically significant ABI did not significantly differ from matched children referred to mental health services. Time since injury, peer relationship problems, metacognitive, and behavioural problems correlated with age at injury. These variables and SDQ emotional problems correlated with peer relationship problems. Linear multiple regression analysis indicated that only metacognitive skills remained a significant predictor of peer relationship problems, and metacognitive skills were found to significantly mediate between age at injury and peer relationship problems.

Research limitations/implications

The study confirms the significant effect of childhood ABI on relationships with peers and mental health, those injured at a younger age faring worst. Within the methodological constraints of this study, the results tentatively suggest that age of injury influences later peer relationships via the mediating role of poor metacognitive skills within a heterogeneous clinical sample.

Originality/value

This is the first study to examine the roles of emotional, behavioural and executive variables on the effect of age at injury on peer relationship problems in a sample with a wide range of ages and ages of injury.

Details

Social Care and Neurodisability, vol. 5 no. 3
Type: Research Article
ISSN: 2042-0919

Keywords

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Article
Publication date: 15 February 2016

Robin Miller, Sue White and Jon Glasby

145

Abstract

Details

Journal of Integrated Care, vol. 24 no. 1
Type: Research Article
ISSN: 1476-9018

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