Department of Psychology, University of Roehampton, London, UK.
Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.
Child Care Health Dev. 2021 Jul;47(4):442-450. doi: 10.1111/cch.12855. Epub 2021 Feb 17.
The i-THRIVE Programme is a needs-based model of care, based on the THRIVE Framework, that is being implemented across the United Kingdom with the aim of improving outcomes for children and young people's mental health and wellbeing. This study aimed to investigate the impact that this programme has on accessibility and quality of care, as viewed by key stakeholders.
Interviews with professionals and service users were conducted during the implementation of the THRIVE Framework in four sites of one mental health and community service provider.
Three themes are identified: 'impact of needs-based groupings on referral', 'impact of collaborative and interagency approach' and 'impact of i-THRIVE on clinical practice'. Findings suggest that accessibility was seen to be promoted through the integration of a needs-based approach, flexible re-referral, signposting and information sharing, the use of goal-orientated interventions and collaboration over risk and treatment endings. Shared decision making was perceived to improve the experience of care for young people, as was interagency working. Goal-focused interventions and upfront discussion of treatment endings were seen to help clinicians manage expectations and discharge but could also compromise effectiveness and engagement. Obstacles to impact were resistance to interagency working and a shortage of resources across the system.
i-THRIVE is a promising approach with the potential to facilitate the accessibility and quality of mental health care. However, a tension exists between enhancing accessibility and quality of care, which points towards the importance of outcome and satisfaction monitoring. Obstacles to impact point to the importance of a whole-system approach supported by sufficient resources across the locality.
i-THRIVE 计划是一种基于 THRIVE 框架的以需求为基础的护理模式，正在英国各地实施，旨在改善儿童和年轻人心理健康和福祉的结果。本研究旨在调查该计划对关键利益相关者所看到的护理的可及性和质量的影响。
在一家心理健康和社区服务提供商的四个地点实施 THRIVE 框架期间，对专业人员和服务使用者进行了访谈。
确定了三个主题：“基于需求的分组对转诊的影响”、“协作和跨机构方法的影响”和“i-THRIVE 对临床实践的影响”。研究结果表明，通过整合以需求为基础的方法、灵活的重新转诊、转介和信息共享、使用以目标为导向的干预措施以及合作以应对风险和治疗结束，可以提高可及性。共同决策被认为改善了年轻人的护理体验，跨机构合作也是如此。目标导向的干预措施和提前讨论治疗结束被认为有助于临床医生管理期望和出院，但也可能影响效果和参与度。影响的障碍包括对跨机构合作的抵制以及整个系统资源短缺。
i-THRIVE 是一种很有前途的方法，有可能促进心理健康护理的可及性和质量。然而，在增强可及性和护理质量之间存在紧张关系，这表明结果和满意度监测的重要性。影响的障碍表明需要整个系统的方法，并在当地提供足够的资源支持。
