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Reform models for children and young people mental health services in the UK : evaluation of the 0-19 model's early intervention approach
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Vusio, Frane (2020) Reform models for children and young people mental health services in the UK : evaluation of the 0-19 model's early intervention approach. PhD thesis, University of Warwick.
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Official URL: http://webcat.warwick.ac.uk/record=b3715250~S1
Abstract
Background:
Prevalence data both in global and UK contexts shows an early onset of mental health issues in early adolescence, supporting the need for effective early intervention and prevention services to prevent escalation of young people’s mental health and to facilitate their recovery. If these disorders are not treated or prevented early, they may well persist into adulthood. However, the current state of children and adolescent mental health services in the UK, and the main weaknesses (e.g. barriers to access) associated with children and young people mental health provision, prevents attempts of early intervention and prevention. To deal with these weaknesses a range of different policies was brought in the UK to improve overall mental health services and their provision to meet CYP needs. A gradual and visible step have been taken since implementing these policies to re-transform existing service provision, paving the way for newly introduced service models in the UK (i.e. 0-25, 16-24 and 0-19 models). Therefore, this research aimed to use the exemplar of a newly developed and retransformed model and its crisis service component for children and young people aged 0- 19 in England to assess the accessibility and acceptability of this model for its service users, professionals and parents. In addition, this research also aimed to understand the impact of the model on local community.
Methods:
A mixed-methods approach was conducted which involved: 1) a systematic review of the experiences and satisfaction of children, young people and their families with alternative models of mental health care; 2) a qualitative study of stakeholders’ perceptions of the accessibility and acceptability of the 0-19 model; 3) a novel application of the qualitative Lego Serious Play approach to understanding young people’s perceptions of the accessibility and acceptability of the 0-19 model; 4) a mixed-methods study of the duty/triage line to understand its accessibility, effectiveness and acceptability; 5) a quantitative study that analysed the crisis pathway and inspected its effectiveness as well as relapse and recovery rates post-crisis discharge; 6) a qualitative study exploring stakeholders’ perception regarding accessibility and acceptability of the 0-19 crisis component; 7) a qualitative study with local professional community stakeholders to understand the impact of the model on its local xx community; and 8) a qualitative study that explored parental and CYP journeys through mental health crisis and the crisis service.
Results:
This research found that the 0-19 model has particular strengths, such as partnerships with the voluntary sector, the presence of a crisis service within the model that prevents and reduces the need for hospitalisation, being considered by its service users as an alternative to more clinical settings, and most importantly being both community orientated and youth-friendly. In addition, children, young people and their parents’ experiences of mental health crisis journeys supported the need for early intervention and prevention models similar to the 0-19 model and identified a preference for community-based treatments. On the other hand, the research also identified a number of weaknesses of the 0-19 model such as inaccessibility of service locations (i.e. clinics), long waiting times, lack of adequate resources (e.g. staff), extensive use of signposting, the need to retell personal stories, a lack of therapeutic alliances and discontinuity of staff care. The weakest parts of the 0-19 model were identified as its psychiatric services and its third sector partner – Autism West Midlands.
Conclusion:
The 0-19 model is a bold attempt to improve CYP mental health services and their provision. However, despite some of the strengths of the model, major weaknesses of the model remain persistent and similar to other retransformed models of CYP mental health in the UK. However, the 0-19 model is a positive step forward, and as such may be further developed by focusing on turning its weaknesses to its strengths. The strengths and weaknesses of this PhD project and potential implications on further research and clinical practice are discussed in the thesis summary.
Item Type: | Thesis (PhD) | ||||
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Subjects: | R Medicine > RJ Pediatrics | ||||
Library of Congress Subject Headings (LCSH): | Child mental health services -- Great Britain, Youth -- Mental health services -- Great Britain, Crisis intervention (Mental health services) -- Great Britain, Child mental health -- Great Britain, Youth -- Mental health -- Great Britain | ||||
Official Date: | November 2020 | ||||
Dates: |
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Institution: | University of Warwick | ||||
Theses Department: | Warwick Medical School | ||||
Thesis Type: | PhD | ||||
Publication Status: | Unpublished | ||||
Supervisor(s)/Advisor: | Birchwood, M. J. ; Thompson, Andrew D., FRCPsych | ||||
Sponsors: | NHS Birmingham and Solihull Clinical Commissioning Group ; NHS Birmingham and Solihull Mental Health Foundation Trust | ||||
Format of File: | |||||
Extent: | xxii, 563, 42 leaves : colour illustrations, colour maps | ||||
Language: | eng |
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