Are codesigned programmes more difficult to implement? A qualitative study of staff perceptions on the implementation of a new youth mental health programme

Abstract

BackgroundCodesigned interventions are becoming more common in health services and, in particular, in the design and development of mental health programmes and interventions. However, previous research has established that the transition from codesign to implementation can experience several challenges and that this transition process has received little research attention.ObjectiveThe aim of this study was to explore the experience of staff members charged with the implementation of a codesigned intervention for young people and adolescents at risk of suicide.Setting and ParticipantsFive staff members involved in the implementation of the new codesigned programme took part in semi‐structured interviews.MethodThe study involved qualitative evaluation of staff experiences during the implementation of a new child and youth suicide intervention. Interviews were analysed using reflexive thematic analysis.ResultsThe analysis identified four themes of ‘disconnect’, ‘operational challenges, ‘service user’ and ‘being authentic’. ‘Disconnect’ captures the difficulties of implementing a codesigned programme which leads to ‘operational challenges’ in meeting broader expectations while ensuring the feasibility of the programme. The third theme, ‘service user’, captures the realisation that the young people accessing the new service were different to those involved in the codesign process. The final theme, ‘being authentic’, highlights how staff needed to be responsive and flexible while remaining true to the principles proposed in the codesign.DiscussionThis study yielded some valuable insights into the challenges around the implementation of a codesigned intervention, an under‐researched area. The findings suggest that adaption of the design may be necessary, if it is not informed by implementation constraints, making it necessary for the implementation team to be well‐briefed on the initial design and given plenty of time to make the necessary adjustments in a coproduction process. Limitations for the generalisation of the results include a small sample of staff and particular challenges that may be unique to this study.ConclusionThe present study highlights that for health services undertaking codesign approaches, appropriate time and resources need to be considered for the implementation phase of an initiative, to ensure that there is effective translation from design to implementation and that new codesigned services can be effective within operational constraints.Patient and Public ContributionThe authors would like to thank and acknowledge the young people with a lived‐experience and their carers who participated in the codesign process and research evaluation component of this study. We also wish to thank the clinical staff, peer workers and family peer workers who participated in the evaluation.

Evaluation of a service introduced to support young people at risk of suicide using a cohort design, a mixed methods analysis and cost-benefit analysis

“…As recommended by the Royal Commission into Victoria's Mental Health System, a codesign process was used to design this service, in order to acquire a comprehensive understanding of user needs and a greater diversity of ideas for meeting these needs [16]. As reported elsewhere, co-design processes often pose implementation challenges, and the same was true for this program [17][18][19].…”

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“…The priorities that emerged from the co-design process in regard to the importance of peer support for the young person, their support network as well as psycho-social support, have clearly resonated with these young people. This suggests an effective implementation of these aspects of the design despite the delays, staffing changes and conflicting stakeholder expectations that may have acted as implementation barriers [19]. However, although the codesign process did recognise the importance of engagement with external services as soon as possible, this aspect of the design appears to have been less well implemented, suggesting an area where more work is required.…”

“…As recommended by the Royal Commission into Victoria's Mental Health System, a codesign process was used to design this service, in order to acquire a comprehensive understanding of user needs and a greater diversity of ideas for meeting these needs [16]. As reported elsewhere, co-design processes often pose implementation challenges, and the same was true for this program [17][18][19].…”

Untitled

“…The priorities that emerged from the co-design process in regard to the importance of peer support for the young person, their support network as well as psycho-social support, have clearly resonated with these young people. This suggests an effective implementation of these aspects of the design despite the delays, staffing changes and conflicting stakeholder expectations that may have acted as implementation barriers [19]. However, although the codesign process did recognise the importance of engagement with external services as soon as possible, this aspect of the design appears to have been less well implemented, suggesting an area where more work is required.…”

“…As recommended by the Royal Commission into Victoria's Mental Health System, a codesign process was used to design this service, in order to acquire a comprehensive understanding of user needs and a greater diversity of ideas for meeting these needs [16]. As reported elsewhere, co-design processes often pose implementation challenges, and the same was true for this program [17][18][19].…”