The NHS Long term plan recommends the ‘i-THRIVE’ framework* as an operating model of mental health services that provides an integrated approach across health, social care, education and the voluntary sector.
The i-THRIVE framework is needs-led which means that mental health needs are defined by children, young people and families alongside professionals through shared decision making, and not on a service-led definition of severity, diagnosis or pathway. The aim is for children and young people’s mental health needs to be identified and appropriately responded to earlier. i-THRIVE offers the opportunity to move away from specialist mental health clinicians including Child and Adolescent Psychotherapists being confined to tier 3 CAMH services, with a high boundary wall for admission, and instead being integrated with other professionals across the whole system and able to offer expertise in a more timely and appropriate way. This is an approach that CAPTs have always supported** and they are an important element of the i-THRIVE model, providing consultation, assessment or treatment in the right time and place across all four of its quadrants of activity:
They can contribute to ‘Getting Advice’, where the i-THRIVE model recommends that “health input in this group should involve our most experienced workforce, to provide experienced decision making about how best to help people in this group and to help determine whose needs can be met by this approach.”
In ‘Getting Help’, the i-THRIVE model suggests that “health input in this group might draw on specialised technicians in different treatments”. CAPTs work effectively in multi-disciplinary teams to provide case consultation across the children’s workforce as well as offering training, for example to those working in schools.
CAPTs are primarily located within multi-disciplinary teams in the ‘Getting More Help’ section, which says that “health input in this group should involve specialised health workers”. The model notes that this group might include children with a range of overlapping needs that mean they may require greater input, such as the coexistence of autistic spectrum disorder, major trauma or broken attachments. These are the kinds of children and young people with complex needs that CAPTs are well placed to treat.
In ‘Getting Risk Support’, CAPTs meet the criteria that “health input should be from staff trained to work with this group and skilled in shared thinking with colleagues in social care”.
Fundamental to the aims of the i-THRIVE model is empowering children, young people and their families through active involvement in decisions about their care. Tailoring treatment to individual needs with personalisation of care and choice is a strength of CAPT.
*Wolpert et al (2019) THRIVE Framework for System Change, available at: http://implementingthrive.org/about-us/the-thrive-framework/
**A classic paper describing the benefits of a CAPT being able to ‘stand next to the weighing scales’ of a GP baby clinic and offer informal support to mothers, and advice to professionals, is: Dilys Daws (1985) Two papers on work in a baby clinic: (i) Standing next to the weighing scales, Journal of Child Psychotherapy, 11:2, 77-85, DOI: 10.1080/00754178508254776