Evaluating the CYP-IAPT transformation of child and adolescent mental health services in Cambridgeshire, UK: a qualitative implementation study

Abstract

Background The Children and Young People’s Improving Access to Psychological Therapies (CYP-IAPT) programme was introduced to transform Child and Adolescent Mental Health Services (CAMHS) across England. The programme comprised a set of principles that local CAMHS partnerships were expected to operationalise and embed with the aim of increasing access to services and improving the quality of care. This study explored how the implementation of the CYP-IAPT programme was executed and experienced by CAMHS professionals in the county of Cambridgeshire (UK), and the extent to which the CYP-IAPT principles were perceived to be successfully embedded into everyday practice. Methods We analysed 275 documents relating to the CYP-IAPT programme issued between 2011 and 2015. We also conducted a thematic analysis of 20 qualitative interviews, undertaken at two time points, with professionals from three CAMHS teams in Cambridgeshire. Analysis was informed by implementation science frameworks. Results Document analysis suggested that the CYP-IAPT programme was initially not clearly defined and lacked guidance on how to operationalise key programme principles and apply them in everyday practice. There was also a degree of programme evolution over time, which made it difficult for local stakeholders to understand the scope and aims of CYP-IAPT. Interviews with staff showed low coherent understanding of the programme, variable levels of investment among stakeholders and difficulties in collaborative working. Barriers and facilitators to programme implementation were identified at individual, service and strategic levels. These in turn impacted the local implementation efforts and sustainability of the programme in Cambridgeshire. Conclusions We identified factors relating to programme design and national and local implementation planning, as well as features of inner and outer context, which impacted on the delivery and sustainability of the programme. These findings can be drawn upon to inform the development and delivery of other local and national quality improvement (QI) initiatives relating to children and young people’s mental health.

How does reorganisation in child and adolescent mental health services affect access to services? An observational study of two services in England

“…These are changes that have preceded the current CAMHS transformation, and have focused on ensuring that there are both more CAMHS practitioners and that these practitioners are trained to deliver evidence-based psychological therapies to child and adolescent populations [48]. The studies reporting on these changes do share similar findings on operational difficulties, the need for stakeholder involvement and the importance of leadership, although actual service-related measures, such as in this study, have not been reported [49,50]. The current CAMHS transformation has been described in some publications [51] with qualitative work conducted on key stakeholders [52], although some concerns raised that insufficient young people and parents have been included [53].…”

Early evaluation of the Children and Young People’s Mental Health Trailblazer programme: a rapid mixed-methods study

“…educational psychologists in the TaMHS programme); and having a clear and agreed vision about programme scope and purpose, and how this related to existing provision and pathways. 25,26,31 Across programmes, implementation was further facilitated where relationships between partnering organisations were already established; for example, where individuals from local NHS services and education settings were already familiar with each other's roles, scope and expertise. 28,30,[32][33][34] Implementation was shaped not only by the quality, but also the constitution, of partnership working.…”

“…funding cuts) in the wider environment. 26,27,31 Another central challenge reported for all three programmes was a lack of common understanding and language for mental health, which acted as a barrier to partnership working between sectors (e.g. between health and education) and within them (e.g.…”

“…between primary and secondary care). 25,28,31 What emerged from the evidence was a clear lesson about the need to prioritise, and invest time and resources in, relationship building and collaboration in order to lay the foundation for effective implementation.…”

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“…Local service providers continue facing barriers to communication due to diverse organisational cultures, restraining the development of a joined-up care system (Care Quality Commission, 2018). Finally, efforts of embedding EBPs and ROMs in practice have encountered challenges due to limited implementation guidance (Burn et al , 2020).…”