1. How is i-THRIVE different to THRIVE?
The THRIVE Framework for system change (Wolpert et al., 2019) is a conceptual framework for a new way of thinking about CAMHS. The National i-THRIVE (implementing THRIVE) Programme is taking the principles of the THRIVE Framework and translating them into a local model of care.
2. Is the THRIVE Framework just replacing the existing child and adolescent mental health service tiers with needs based groupings (Getting Advice and Signposting, Getting Help, Getting More Help and Getting Risk Support)?
The tier model has its strengths. The THRIVE Framework is distinct by emphasising the need for a common language when talking about the needs of young persons rather than trying to create a service structure. For example, an individual therapist could be giving advice to one person in the morning, and giving more help to a different person in the afternoon. The THRIVE Framework is a way to best address needs while acknowledging how CAMHS services do not have all the answers. The THRIVE Framework should help to tackle assumptions made in treatment for children and young people using mental health services, that are based on professional views. Using a broader lens for mental health services, and one that incorporates the wider system, the narrative can move towards asking how we can support young people where ever they are. The THRIVE Framework would encourage the allocation of resources according to best use of multi-agency input and pilot sites are currently exploring with NHSEngland how this might work in practice and whether this would lead to changes in service design (http://pbrcamhs.org/final-report/)
3. What is the difference between need and severity? Aren’t they two sides of the same coin?
This distinction between severity and need is a key part of the THRIVE Framework. It sits on a model of shared decision making, and so it is based around coming to an agreement on what seems right for a young person in that moment of time, balanced against the risk of not doing things and taking into account a range of views and factors. This is often not a simple decision, and sometimes the young person’s wish to be left alone may be felt not to be in their best interests. Parents, children and therapist may all see things differently. These are common dilemmas in child mental health services and much of the work is about coming to an agreement on these complex issues. The THRIVE Framework stresses the need for explicit discussion of these issues and to allow for more explicit acknowledgment that sometimes not receiving professional help is a valid choice.
A simplified example of shared decision making that treats need and severity differently is as follows: a practitioner might decide that a young person has severe OCD and offer them medication which will control the OCD but which also has certain side effects. The young person might decide that there are other ways they are managing their OCD, and that the side effects are undesirable for what they are doing at that certain point in their lives. Alternatively, a young person might have mild OCD symptoms but could decide that they need treatment, and are willing at that point in their lives to take the medication that is on offer, even with the side effects, in order to achieve a certain goal. Further examples of the difference between severity and need can be found in the work on assigning needs based groupings developed by the team working on the Payment Systems project (http://pbrcamhs.org/final-report/ see annex A in particular).
4. What’s the difference between ‘Getting Risk Support’ and ‘Getting More Help’?
A simple slide has been developed to draw out the differences between these two needs based groupings in the THRIVE Framework.
5. What’s the difference between being an i-THRIVE accelerator site and being part of the National i-THRIVE Community of Practice (CoP)?
The accelerator sites were the very first sites to come on board with i-THRIVE as part of the NHS Innovation Accelerator Programme. They received slightly more input from the National i-THRIVE Programme team. Both the accelerator sites and i-THRIVE CoP sites share learning about their implementation of the THRIVE Framework.
6. Is the THRIVE Framework compatible with CAPA and CYP IAPT?
i-THRIVE is not looking to replace existing service transformation programmes, rather it has been designed to be complementary to successful existing models including CYP IAPT and the Choice and Partnership Approach (CAPA).
If you have any further questions about the National i-THRIVE Programme, please contact Bethan Morris at firstname.lastname@example.org.