Service design for children and young people with common mental health problems: literature review, service mapping and collective case study

Background
The mental health of children/young people is a growing concern internationally. Numerous reports and reviews have consistently described United Kingdom children's mental health services as fragmented, variable, inaccessible and lacking an evidence base. Little is known about the effectiveness of, and implementation complexities associated with, service models for children/young people experiencing 'common' mental health problems like anxiety, depression, attention deficit hyperactivity disorder and self-harm.


Aim
To develop a model for high-quality service design for children/young people experiencing common mental health problems by identifying available services, barriers and enablers to access, and the effectiveness, cost effectiveness and acceptability of such services.


Design
Evidence syntheses with primary research, using a sequential, mixed-methods design. Inter-related scoping and integrative reviews were conducted alongside a map of relevant services across England and Wales, followed by a collective case study of English and Welsh services.


Setting
Global (systematic reviews); England and Wales (service map; case study).


Data sources
Literature reviews: relevant bibliographic databases and grey literature. Service map: online survey and offline desk research. Case study: 108 participants (41 children/young people, 26 parents, 41 staff) across nine case study sites.


Methods
A single literature search informed both reviews. The service map was obtained from an online survey and internet searches. Case study sites were sampled from the service map; because of coronavirus disease 2019, case study data were collected remotely. 'Young co-researchers' assisted with case study data collection. The integrative review and case study data were synthesised using the 'weaving' approach of 'integration through narrative'.


Results
A service model typology was derived from the scoping review. The integrative review found effectiveness evidence for collaborative care, outreach approaches, brief intervention services and the 'availability, responsiveness and continuity' framework. There was cost-effectiveness evidence only for collaborative care. No service model appeared to be more acceptable than others. The service map identified 154 English and Welsh services. Three themes emerged from the case study data: 'pathways to support'; 'service engagement'; and 'learning and understanding'. The integrative review and case study data were synthesised into a coproduced model of high-quality service provision for children/young people experiencing common mental health problems.


Limitations
Defining 'service model' was a challenge. Some service initiatives were too new to have filtered through into the literature or service map. Coronavirus disease 2019 brought about a surge in remote/digital services which were under-represented in the literature. A dearth of relevant studies meant few cost-effectiveness conclusions could be drawn.


Conclusions
There was no strong evidence to suggest any existing service model was better than another. Instead, we developed a coproduced, evidence-based model that incorporates the fundamental components necessary for high-quality children's mental health services and which has utility for policy, practice and research.


Future work
Future work should focus on: the potential of our model to assist in designing, delivering and auditing children's mental health services; reasons for non-engagement in services; the cost effectiveness of different approaches in children's mental health; the advantages/disadvantages of digital/remote platforms in delivering services; understanding how and what the statutory sector might learn from the non-statutory sector regarding choice, personalisation and flexibility.


Study registration
This study is registered as PROSPERO CRD42018106219.


Funding
This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/09/08) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 13. See the NIHR Funding and Awards website for further award information.


Plain language summary
I n this research study, we explored services for children and young people with 'common' mental health problems like depression, anxiety and self-harm.We aimed to find out what services exist, how children/young people and families find out about and access these services, what the services actually do, whether they are helpful and whether they offer value for money.
We looked at the international literature (reports and research papers) to identify different approaches to providing support, and to find out whether certain approaches worked better than others and whether children/young people and families preferred some approaches over others.The literature provided very little information about the value for money of services.
We also carried out a survey and used the internet to identify 154 relevant services in England and Wales.To explore services in more detail, and hear directly from those using them, we planned to visit 9 of the 154 services to interview children/young people, parents and staff.Unfortunately, coronavirus disease 2019 stopped us directly visiting the nine services and so we conducted phone and video interviews instead.We still managed to speak to, and hear the experiences of, more than 100 people (including children/young people and parents).
We combined information from the literature with information from the interviews to create an evidence-based 'model' of what services should look like.This model considers some basic things like how quickly children/young people could access a service, what information was available, the importance of confidentiality and whether staff make the service fit with the child/young person's needs and interests.It also considers whether the service helps children/young people learn skills to manage their mental health and whether staff at a service work well together.We hope our model will help existing and new services improve what they offer to children/young people and families.The full HSDR archive is freely available to view online at www.journalslibrary.nihr.ac.uk/hsdr.

HSDR programme
The HSDR programme funds research to produce evidence to impact on the quality, accessibility and organisation of health and social care services.This includes evaluations of how the NHS and social care might improve delivery of services.
For more information about the HSDR programme please visit the website at https://www.nihr.ac.uk/explore-nihr/fundingprogrammes/health-and-social-care-delivery-research.htm

This article
The research reported in this issue of the journal was funded by the HSDR programme or one of its preceding programmes as award number 17/09/08.The contractual start date was in October 2018.The draft manuscript began editorial review in May 2022 and was accepted for publication in April 2023.The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work.The HSDR editors and production house have tried to ensure the accuracy of the authors' manuscript and would like to thank the reviewers for their constructive comments on the draft document.However, they do not accept liability for damages or losses arising from material published in this article.This article presents independent research funded by the National Institute for Health and Care Research (NIHR).The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, the HSDR programme or the Department of Health and Social Care.If there are verbatim quotations included in this publication the views and opinions expressed by the interviewees are those of the interviewees and do not necessarily reflect those of the authors, those of the NHS, the NIHR, the HSDR programme or the Department of Health and Social Care.
This article was published based on current knowledge at the time and date of publication.NIHR is committed to being inclusive and will continually monitor best practice and guidance in relation to terminology and language to ensure that we remain relevant to our stakeholders.Published by the NIHR Journals Library (www.journalslibrary.nihr.ac.uk), produced by Newgen Digitalworks Pvt Ltd, Chennai, India (www.newgen.co).
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