Evaluating Best for You: A new service for Children and Young People with mental health problems in Northwest London

The mental health of children and young people (CYP) in the UK has been declining and continued to worsen during the COVID-19 pandemic. 

Even before the pandemic, one in eight people under the age of 18 suffered from a clinically significant mental illness, equating to 112 000 individuals in London alone and representing a threefold increase in mental health-related (MHR) emergency department (ED) attendances. Consequently, the number of YP admitted to paediatric wards primarily with a mental health condition has risen. 

NIHR ARC Northwest London (ARC NWL) has developed and published a protocol to evaluate a new acute model of care being set up in NWL, designed to provide a rapid, personalised response for children and young people (CYP) aged 11-17, presenting at the paediatric emergency department of an NHS Trust in mental health crisis (e.g. suicide attempt, non-suicidal self-injury including self-poisoning, substance abuse, disordered eating - starvation/bingeing/purging behaviour, medically unexplained symptoms.)  The research is led by Dr Dasha Nicholls, Clinical Reader in Child Psychiatry at Imperial College London and theme lead for Multimorbidity and Mental Health.

Integrated care services across paediatric and mental health services are under-researched. ARC NWL evaluation team carried out a systematic literature review which demonstrated this and details evidence from successful models of care which is being adapted to the NWL context.

`Best for You’ is a new model of care that aims to integrate mental health care within paediatric and emergency settings in NWL. The service was developed in response to the needs of children and young people and their families and aims to provide a model for collaborative working and partnership building across NHS and community services by offering CYP and their families more agency in their care. 

The service aims to integrate paediatric and mental health services around the needs of CYP with a focus on providing:

• Seamless care for the patient

• Staff trained to provide mental health and physical health interventions at the same time

• Early therapeutic intervention

• Potential to reduce onward referrals because of earlier intervention and more robust community arrangements

• Care for the whole family in one place

•  A dedicated unit to assess and manage medical and mental health needs for 72 hours

•  Better relationships between Inpatient and Child and Adolescent Mental Health Services (CAMHS) providers when needed

• A new model of care to be adopted nationally.

The service comprises:

• A Rapid Assessment Unit where care is provided on in an appropriate inpatient setting.

• A Day Service for CYP with eating disorders, and potentially other non-medical health conditions.

• A Digital Hub to provide resources to support self-help.

• A Community Partnership programme to provide signposting and support through existing community settings and resources.

The Best for You evaluation draws on both a realist approach using the Context, Mechanisms, Outcomes (CMO) framework, to understand what works for who, and the Consolidated Framework for Implementation Research to identify factors that are important in the planning and implementation of the new service that can help scale up successful elements.  The approach comprises of several stages:

·   a process evaluation which aims to develop an understanding of the problems that young people have when presenting in mental health crisis and evidence how the programme sets out to improve patient pathways;

·   an outcome evaluation which will demonstrate the programme’s effects on patients and services; an economic evaluation to evidence quantifiable impact and costs, critically analyse cost-effectiveness and cost consequence, and ascertain value for money;

·   implementation research to consider to what extent the programme theory corresponds to the programme delivery, if and where there are areas of under-implementation, and if so, why.

In November 2022, the evaluation team held a Learning Event, designed to share the experience of service planners and evaluators of the planning phase of Best for You. In May 2023, a second Learning Event will consider the experience of the early implementation of the Digital Hub, and its potential strengths and weaknesses as a model for adoption or adaptation to other geographical contexts and organizational cultures. For more information and to be invited to join the next Learning event, please contact Susan Barber.