Our model
Our research led us to create a co-produced, evidence-based model of what services should look like.
The model consists of two main elements: the core characteristics a service requires to be considered a high-quality service, and the necessary underpinning characteristics than cut across these core characteristics.
Our model identifies the key components of high-quality services such as how quickly children, young people and families can access a service, the information available, the importance of confidentiality and whether staff make the service fit with the child or young person’s needs and interests.
It also considers whether the service helps children and young people learn skills to manage their mental health and whether staff at a service work well together.
We hope our model will help those who commission and run services improve what they offer to children, young people and families, regardless of whether the service is an NHS or non-NHS service.
Model Development
This paper outlines how a co-produced, evidence based, general model of service design for CYP experiencing common mental health problems was developed via a mixed-methods study that encompassed an evidence synthesis, primary research and a model building phase:
Model diagram
Why this model is important for commissioners and service providers
Our model is based on evidence from more than 300 documents and interviews with over 100 stakeholders. This evidence is consistent with previous research and supports the current policy direction.
In short, we found that a consistent organisational evidence base spanning more than 15 years appears to have had little impact on service delivery.
We believe that using our model components to support the design and delivery of mental health services for children and young people can help improve the consistency of such services, and the experiences of children, young people and families using such services.
Many of the recommendations and tips we offer commissioners and service providers do not require significant additional resources.
For more information on each of the model components, including some tips for commissioners and service providers, click on the relevant section below.
Core characteristics
High-quality services for children and young people experiencing common mental health problems are those that provide the following:
Rapid access and short waiting times
“When I did get on the waiting list I had to wait for an initial assessment and then I had to wait again, months, for an actual worker to be allocated to me, even though it was urgent.” (Young person)
Children, young people and families want to be able to access services quickly and, once services are accessed, receive therapies or mental health support in a timely manner.
Tips for commissioners and service providers
- Think about not only how quickly children, young people and parents can access a service for assessment but also how quickly they can gain access to therapeutic support.
Opportunities to learn practical skills and strategies for self-care
“You’ve always got those techniques that you’ve learned in the past that you can use… over and over again to help.” (Young person)
Providing practical skills to enable children, young people and their families to help themselves is key to providing effective and acceptable support for children and young people experiencing common mental health problems.
Tips for commissioners and service providers
- While this component is about ‘self-care’, it is self-care in the sense of skills acquisition rather than self-care as simple activities like listening to music or being outside (though these activities can, of course, be useful).
- Services can provide support for this sort of self-care through the training, facilitation or coaching of children/young people and their families in specific skills, e.g. in managing anxiety or improving sleep.
Individualised support
“Everybody’s experience differs… I wouldn’t want what some of my friends would want.” (Young person)
Children, young people and families want services that offer choice and flexibility, and which consider the needs, views interests and hobbies of children and young people.
Tips for commissioners and service providers
- This is about ensuring that any therapies and support are tailored to the child/young person and/or family.
- An ideal service will offer a range of approaches so that the children/young people can choose which works best for them. Choice might relate to therapy type, modality (online vs. face-to-face), individual vs. group approaches, etc.
- Therapies or support offered should be flexible so that they can be adapted to meet the child or young person’s needs.
Clear and accessible information
“More publicity about the service because… I know there’s a lot of people that don’t like going to the doctors about mental health.” (Young person)
Children, young people, parents and professionals want clear information about services to be available in a variety of media.
Information should also be available that helps children, young people and families navigate the most appropriate services when given a choice.
Tips for commissioners and service providers
- Children, young people, parents and professionals want specific, rather than general, information about services, such as:
- local service information (including where they are)
- how services might be accessed
- the type of support offered
- what happens once the child or young person leaves the service.
- Not all families have private access to the internet so information should be available through a variety of media.
- Young people want more publicity about services to be available in schools.
Compassionate and competent staff
“It wasn’t just any old person. It was someone that knew what they were doing and had dealt with this type of thing before.” (Young person)
Regarding compassionate staff, children, young people and families want staff in services who are approachable, caring, empathic and person-centred. Regarding competent staff, they want staff who are appropriately qualified and experienced.
Tips for commissioners and service providers
- Feedback from, and listening to, children, young people and families should influence how a service defines compassion and competence amongst its staff.
- Lived experience in service provision can be valuable, but it may work better when delivered alongside professional support rather than as a substitute.
Aftercare planning
“That reassurance again that they were there, we could always go back to them if we were really struggling.” (Parent)
Aftercare planning covers transitions to adult services, ongoing support, potential for re-referrals and continuity of care.
Services should have processes and systems for navigating out of services, as well as into services.
Tips for commissioners and service providers
- Consider aftercare/discharge arrangements as well as access arrangements.
- Aftercare covers not just transitions to adult services but also the exiting and re-entering of a service, longer-term ‘ad hoc’ support and continuity of care.
- Those aged 16-17 are particularly disadvantaged, caught between children’s services not accepting post-16 referrals and adult services not accepting referrals for those under 18.
- Services catering for those aged up to 25 tend to avoid issues associated with the transition to adult services.
Underpinning characteristics
High-quality services are those that provide the above core characteristics and are underpinned by the following.
Values that respect confidentiality
“Them telling my parents… Because I was 16, they were like we need to tell them ’cause you’re not an adult… that was a really hard thing to go through.” (Young person)
The way confidentiality is managed in services is an important issue for children, young people and parents. A child or young person’s autonomy and their perspectives on confidentiality should be given credibility and balanced against any safeguarding concerns.
Tips for commissioners and service providers
- Remember that confidentiality and safeguarding can sometimes get conflated.
- Confidentiality can influence decisions about which services children and young people will access or the extent to which they will share information with practitioners. For example, children and young people may worry about peers finding out about them accessing help in school settings, and at-home, remote services may not provide the same levels of privacy as office-based appointments.
Engagement and involvement of children and young people at the core
“The young person says, ‘I’ve changed my mind, I don’t want to try and get this’, then we’ll say ‘okay, what is it you want to do?’… Their voice is really important.” (Service provider)
Engagement and involvement of children and young people means services delivering activities and therapies that are accessible, engaging, developmentally appropriate, creative and fun.
Children and young people should be involved in shared decision-making for their own care as well as for service design and delivery.
Tips for commissioners and service providers
- Co-produced care means that best evidence in therapies or support is balanced against child, young person and family preferences rather than imposed.
- Also overlaps with ‘individualised support’ in that engagement requires a degree of choice and some flexibility in how therapies and support are delivered.
- The non-statutory sector often appears to better engage children, young people and families than the statutory sector. Closer working between these sectors may help improve engagement and personalised care and support.
Collaborative relationships: with children/young people, families and other disciplines and agencies
“I’m hoping that the child services and the adult services work together more so I don’t have to keep repeating stuff over and over again.” (Young person)
Trust in service provision is predicated on good interagency/interprofessional relationships and good therapeutic (practitioner-family) relationships.
Tips for commissioners and service providers
- Collaborative relationships are the backbone of high-quality services.
- When thinking about the relationships involved, consider not only relationships between sectors and agencies but also relationships between differing professions and team members and between practitioners and those using services.
A learning culture
“The team are really passionate about pushing boundaries… so if anybody has a new idea… they’re encouraged to put that into place and give it a try.” (Service provider)
A learning culture is demonstrated through good team relationships and a reflective learning environment that includes learning from other team members as well as from those using services.
Tips for commissioners and service providers
- A learning culture is more than mere staff training and development.
- When considering workforce development bear in mind that a learning culture requires leadership and workforce development strategies that incorporate learning opportunities, regular clinical supervision, reflexive learning, reflective practice, and the freedom to try out alternatives.
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