Health Services Management Centre, University of Birmingham, Edgbaston, Birmingham, UK.
RAND Europe, Westbrook Centre, Cambridge, UK.
Health Soc Care Deliv Res. 2023 Jun;11(8):1-137. doi: 10.3310/XQWU4117.
The Children and Young People's Mental Health Trailblazer programme is funding the creation of new mental health support teams to work in schools and further education colleges. Mental health support teams directly support children and young people with 'mild to moderate' mental health problems and work with school and college staff to promote well-being for all. A new workforce of education mental health practitioners is being trained for the teams.
OBJECTIVE(S): The National Institute for Health and Care Research Birmingham, RAND and Cambridge Evaluation Rapid Evaluation Centre and Policy Innovation and Evaluation Research Unit undertook an early evaluation of the Trailblazer programme to examine the development, implementation and early progress of mental health support teams in the programme's first 25 'Trailblazer' sites.
A mixed-methods evaluation, comprising three work packages: 1. Establishing the baseline and understanding the development and early impacts of the Trailblazer sites, including two rounds of surveys with key informants and participating education settings in all 25 sites. 2. More detailed research in five purposively selected Trailblazer sites, including interviews with a range of stakeholders and focus groups with children and young people. 3. Scoping and developing options for a longer-term assessment of the programme's outcomes and impacts. Fieldwork was undertaken between November 2020 and February 2022. The University of Birmingham Institute for Mental Health Youth Advisory Group was involved throughout the study, including co-producing the focus groups with children and young people.
Substantial progress had been made implementing the programme, in challenging circumstances, and there was optimism about what it had the potential to achieve. The education mental health practitioner role had proven popular, but sites reported challenges in retaining education mental health practitioners, and turnover left mental health support teams short-staffed and needing to re-recruit. Education settings welcomed additional mental health support and reported positive early outcomes, including staff feeling more confident and having faster access to advice about mental health issues. At the same time, there were concerns about children who had mental health problems that were more serious than 'mild to moderate' but not serious enough to be accepted for specialist help, and that the interventions offered were not working well for some young people. Mental health support teams were generally spending more time supporting children with mental health problems than working with education settings to develop 'whole school' approaches to mental health and well-being, and service models in some sites appeared to be more clinically oriented, with a strong focus on mental health support teams' therapeutic functions.
Despite efforts to maximise participation, survey response rates were relatively low and some groups were less well represented than others. We were not able to gather sufficiently detailed data to develop a typology of Trailblazer sites, as was planned.
Key lessons for future programme implementation include: - Whether mental health support teams should expand support to children and young people with more complex and serious mental health problems. - How to keep the twin aims of prevention and early intervention in balance. - How to retain education mental health practitioners once trained.
The findings have important implications for the design of a longer-term impact evaluation of the programme, which is due to commence in summer 2023.
Ethical approval from the University of Birmingham (ERN_19-1400 - RG_19-190) and London School of Hygiene and Tropical Medicine (Ref: 18040) and Health Research Authority approval (IRAS 270760).
The Birmingham, RAND and Cambridge Evaluation Rapid Evaluation Centre is funded by the National Institute for Health and Care Research Health Services and Delivery Research programme (HSDR 16/138/31). The Policy Innovation and Evaluation Research Unit is funded by the NIHR Policy Research Programme (PR-PRU-1217-20602).
儿童和青少年心理健康开拓者计划正在资助新的心理健康支持团队的创建，以在学校和继续教育学院开展工作。心理健康支持团队直接为“轻度至中度”心理健康问题的儿童和青少年提供支持，并与学校和学院工作人员合作，促进所有人的幸福感。一个新的教育心理健康从业者队伍正在为这些团队接受培训。
国家卫生研究院和护理研究伯明翰、兰德公司和剑桥评估快速评估中心以及政策创新和评估研究单位对开拓者计划进行了早期评估，以检查该计划的前 25 个“开拓者”站点中心理健康支持团队的发展、实施和早期进展。
混合方法评估，包括三个工作包：1. 建立基线并了解开拓者站点的发展和早期影响，包括对所有 25 个站点的关键信息提供者和参与的教育环境进行两轮调查。2. 在五个有针对性选择的开拓者站点进行更详细的研究，包括对各种利益相关者进行访谈，并对儿童和青少年进行焦点小组讨论。3. 确定方案的长期评估的范围和选择方案。实地工作于 2020 年 11 月至 2022 年 2 月进行。伯明翰大学心理健康青年咨询小组参与了整个研究，包括与儿童和青少年共同开展焦点小组。
在具有挑战性的情况下，该计划在实施方面取得了实质性进展，并且对其潜在成果充满乐观。教育心理健康从业者的角色已被证明很受欢迎，但各站点报告称，在留住教育心理健康从业者方面存在挑战，人员流动导致心理健康支持团队人手不足，需要重新招聘。教育环境欢迎提供更多的心理健康支持，并报告了积极的早期成果，包括工作人员感到更有信心，并且能够更快地获得有关心理健康问题的建议。与此同时，人们对那些心理健康问题比“轻度至中度”更严重但又不够严重而无法接受专业帮助的儿童感到担忧，并且所提供的干预措施对一些年轻人效果不佳。心理健康支持团队通常花更多的时间支持有心理健康问题的儿童，而不是与教育环境合作制定“全校”心理健康和幸福感方法，并且一些站点的服务模式似乎更侧重于临床，重点是心理健康支持团队的治疗功能。
尽管我们努力最大限度地提高参与度，但调查的回复率相对较低，有些群体的代表性不如其他群体。我们无法收集足够详细的数据来按计划制定开拓者站点的分类。
未来方案实施的主要经验教训包括：-心理健康支持团队是否应扩大对更复杂和严重心理健康问题的儿童和青少年的支持。-如何在预防和早期干预的双重目标之间保持平衡。-如何在培训后留住教育心理健康从业者。
该研究结果对该计划的长期影响评估的设计具有重要意义，该评估计划将于 2023 年夏季开始。
伯明翰大学（ERN_19-1400-RG_19-190）和伦敦卫生与热带医学院（Ref：18040）的伦理批准以及健康研究管理局的批准（IRAS 270760）。
伯明翰、兰德和剑桥评估快速评估中心由国家卫生研究院和护理研究健康服务和交付研究计划（HSDR 16/138/31）资助。政策创新和评估研究单位由国家卫生研究院政策研究计划（PR-PRU-1217-20602）资助。
