Abstract
Aims Developing integrated mental health services that focus on the needs of children and young people is a key policy goal in England. The THRIVE Framework and its associated implementation programme, i-THRIVE, are now used in areas covering over 65% of England’s children. This study explores the experiences of staff involved with the i-THRIVE programme, assesses its effectiveness, and examines how local system working relationships influence the programme’s success.
Methods The i-THRIVE programme was evaluated among twenty participating sites (ten implementation and ten comparison sites). Measurements included surveys of staff and leaders at each site and assessment of the “THRIVE-like” features of each site. Additional site-level characteristics were collected from health system reports. The effect of i-THRIVE was evaluated using a four-group propensity-score weighted difference-in-differences model; the moderating effect of local system working relationships was evaluated with a difference- in-difference-in-differences model.
Results The results show that strong working relationships in the local system significantly enhances the effectiveness of the i-THRIVE programme. Sites with highly effective working relationships showed a notable improvement in “THRIVE-like” features, with an average increase of 16.41 points (95% confidence interval: 1.69–31.13, p-value: 0.031) compared to control sites. In contrast, sites with ineffective working relationships did not benefit from the i- THRIVE programme (-2.76, 95% confidence interval: -18.25–12.73, p-value: 0.708). This influence of working relationship effectiveness was consistent across various levels of THRIVE features.
Conclusions The findings underscore the importance of working relationship effectiveness in the successful adoption and implementation of health policies like i-THRIVE.
Competing Interest Statement
AM was the lead for i-THRIVE between January 2015 and January 2017 during which she led the development of the i-THRIVE implementation approach and established the community of practice. She was an employee of one i-THRIVE implementation site during the evaluation. LE was an employee of one i-THRIVE implementation site during the evaluation. PF is currently on the board of the i-THRIVE Implementation Programme. Anna Freud Centre hosted the development and on-going implementation of the THRIVE Framework in collaboration with the Tavistock & Portman NHS Foundation Trust. He is Programme Director of Mental Health at UCLPartners which provides programme management of the i-THRIVE Implementation Programme.
Funding Statement
This study is independent research funded by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration North Thames (grant number CRJM, 46AZ74-/RCF/CLAHRC/UCL004, 52AZ95/AA2/UCL5, 52AZ95/AA2/UCL6, UCLP) and UCLPartners, both awarded to AM. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR, the Department of Health and Social Care or UCLPartners. All research at the Department of Psychiatry in the University of Cambridge is supported by the NIHR Cambridge Biomedical Research Centre (BRC-1215-20014) and NIHR Applied Research Centre. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
Author Declarations
I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.
Yes
The details of the IRB/oversight body that provided approval or exemption for the research described are given below:
The NHS/University Joint Research Office reviewed this study and classified it as a service evaluation, meaning it does not need ethical approval or a review by the Research Ethics Committee (IRAS application number: 250439). For the qualitative parts of the study, participants included implementation leads, managers, and front-line staff, who were interviewed about their service transformation projects. At the start of each interview, verbal informed consent was obtained, which included explicit permission for the interview to be recorded, analysed, and used in the service evaluation. This consent was recorded, and transcripts of each interview were made to document it. The data for the quantitative evaluation is retrospective and was routinely collected from service records. It was anonymised at the source by the business intelligence staff at each trust, with all identifying information removed. After review by local information governance leads, this anonymised data was provided to the evaluation team. As the data is retrospective and de-identified, consent for its use in the evaluation is neither legally nor ethically required. The requirement for ethical approval was therefore waived by the joint research office.
I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.
Yes
I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).
Yes
I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.
Yes
Data Availability
All datasets and code are accessible on GitHub (Sippy, 2023).