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Supporting Shared Decision Making with i-THRIVE Grids in Child Mental Health

The Health Foundation, Innovating Improvement project

This project is part of the Health Foundation’s Innovating for Improvement programme. The Health Foundation is an independent charity committed to bringing about better health and health care for people in the UK.

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Shared decision making is a key feature of the THRIVE conceptual framework and was highlighted as a priority for child and adolescent mental health in the Department of Health/NHS England Taskforce report Future in Mind. However, implementation of shared decision making within a CAMHS setting remains problematic with barriers including training, medical culture, concern about time required and fear of loss of practitioner autonomy. While many clinicians believe they are already participating in shared decision making with clients, a rapid internal audit of CYP IAPT CAMHS service users in 2015 indicated that only 30% of young people felt that they were given enough information at assessment to make a choice about the treatment they received.

Camden have implemented shared decision making as part of their assessment clinics and this work fed into the development of the THRIVE conceptual framework. However, there is still variability in patient experience of shared decision making in Camden. Evidence shows that tools supporting the shared decision making process can improve its quality.

In this project, the Tavistock and Portman NHS Foundation Trust, the Anna Freud National Centre for Children and Families and the Dartmouth Institute for Health Policy and Clinical Practice are developing and translating Option Grids™ into a shared decision making tool to support children and young people at key decision points within their CAMHS journey.

Option Grid™ decision aids are a trademarked shared decision making tool that helps patients and health providers compare alternative treatment options. For more information please see optiongrid.org. We have adapted Dartmouth’s rigorous process for producing Option Grids™ to create our young person-friendly i-THRIVE Grids.

As part of the project, four i-THRIVE Grids have been developed and are currently being piloted in three assessment clinics in Camden. This follows extensive baseline data collection from November 2016 to February 2017 during which shared decision making and experience of service were measured within the clinics.

The grids were developed from June 2016 to February 2017 with extensive input from young people, service users, parents, clinical experts, and other professionals with knowledge of young people’s mental health. The grids are separated by support for particular presenting difficulties that is either available inside or outside of the NHS. Two of the grids address support for low mood/depression, and the other two address support for difficulties sitting still or concentrating/ADHD. Two additional grids for self-harm are also being developed.

It is anticipated that as a result of this quality improvement project, experience of care and patient involvement will be improved, more patients will be signposted to a wider range of providers and intervention types, and more children and young people will engage in self-help. Measurement of this is through a variety of evaluation tools including psychometric symptomatology scales.

 

Quantitative methodology

  • A shared decision making measure (CollaboRATE, Barr et al., 2014)
  • A service satisfaction measure — Commission for Health Improvement Evaluation of Service Questionnaire (CHI ESQ, Attride-Stirling., 2002) (some qualitative elements)
  • A behavioural problem screening measure – the Strengths and Difficulties Questionnaire (SDQ, Goodman., 2001)
  • A measure for assessing anxiety and depressive disorder – the Revised Child Anxiety and Depression Scales (RCADS, Weiss & Chorpita., 2011)

Qualitative methodology

  • Interviews and focus groups with service users and clinicians
  • Feedback from PDSA cycles at the clinics (Plan-Do-Study Act, a quality improvement method)

 

Baseline data has been collected via CollaboRATE. Data was collected from 33 parents and 22 young people who attended one of three assessment clinics in Camden from November 2016 to March 2017. The overall mean of the CollaboRATE score (ranging from one being the lowest and nine being the highest) was 8.15 for parents and 7.60 for young people. Also calculated was the “Top Score” percentage which was the proportion of participants who gave a perfect score (nine on all questions) to the total number of participants. For the “Top Score,” 39% of parents gave perfect shared decision making scores while only 14% of young people gave a perfect score. These scores will be used to look at change over time and to determine if the i-THRIVE grids improve shared decision making within these clinics.


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Contact the project team

To find out more about the i-THRIVE Grids project please contact Daniel Hayes, i-THRIVE  Grids Project Manager at daniel.hayes@annafreud.org or Rosa Town, i-THRIVE Grids Research Assistant at rosa.town@annafreud.org.

 

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