Thrive: The AFC-Tavistock Model for CAMHS

All ideas in this paper and related to this model are independent of any organisational affiliations, committee membership or other official capacities of any of the authors, other than their roles within the Anna Freud Centre and The Tavistock and Portman NHS Foundation Trust. ..

THRIVE elaborated

Introduction to THRIVE Elaborated: Since we published the THRIVE framework a year ago in November 2014 it has generated a lot of interest. We are delighted by this. We want to take this opportunity to clarify and elaborate as relevant, including addressing areas of potential confusion, as well as updating the document in light of our emerging thinking and elaboration of elements of the framework. It is important to note that nothing relating to the central ideas of the framework has been changed

THRIVE framework for system change

What is the THRIVE Framework? The THRIVE Framework provides a set of principles for creating coherent and resource-efficient communities of mental health and wellbeing support for children, young people and families.It aims to talk about mental health and mental health support in a common language that everyone understands.The Framework is needs-led. This means that mental health needs are defined by children, young people and families alongside professionals through shared decision making. Needs are not based on severity, diagnosis or health care pathways

Kailo: a systemic approach to addressing the social determinants of young people’s mental health and wellbeing at the local level [version 1; peer review: awaiting peer review]

The mental health and wellbeing of children and young people is deteriorating. It is increasingly recognised that mental health is a systemic issue, with a wide range of contributing and interacting factors. However, the vast majority of attention and resources are focused on the identification and treatment of mental health disorders, with relatively scant attention on the social determinants of mental health and wellbeing and investment in preventative approaches. Furthermore, there is little attention on how the social determinants manifest or may be influenced at the local level, impeding the design of contextually nuanced preventative approaches. This paper describes a major research and design initiative called Kailo that aims to support the design and implementation of local and contextually nuanced preventative strategies to improve children's and young people’s mental health and wellbeing. The Kailo Framework involves structured engagement with a wide range of local partners and stakeholders - including young people, community partners, practitioners and local system leaders - to better understand local systemic influences and support programmes of youth-centred and evidence-informed co-design, prototyping and testing. It is hypothesised that integrating different sources of knowledge, experience, insight and evidence will result in better embedded, more sustainable and more impactful strategies that address the social determinants of young people’s mental health and wellbeing at the local level

Realist Process Evaluation of the implementation and impact of an organisational cultural transformation programme in the Children and Young People's Secure Estate (CYPSE) in England : study protocol

Introduction Young people in contact with the youth justice system are more likely to present with complex ongoing needs than young people in the general population. To address this, the Framework for Integrated Care (SECURE STAIRS) is being implemented in the Children and Young People's Secure Estate: a 'whole systems' approach to support secure settings to develop trauma-informed and relationally based environments, supporting staff to provide consistent, therapeutic care. This paper aims to present the protocol for a national cohort study examining the impact and implementation of this cultural transformation programme. Methods and analysis A mixed-methods realist evaluation will be conducted. Data collection will take place between August 2018 and December 2020. Eighteen sites will collect routine service activity data and questionnaires completed by young people, parents/guardians and staff. Semi-structured interviews and non-participant observations will be conducted across five qualitative focus sites with young people and staff. An economic evaluation will examine value for money. The results will be triangulated at the analysis stage to gain an in-depth understanding of experiences. Ethics and dissemination Ethical approval was granted by the Health Research Authority, Her Majesty's Prison and Probation Service and UCL Ethics Committee. Findings will be disseminated via project reports, site feedback, peer-reviewed journal publications and conference presentations

A mixed-methods Realist Evaluation of the implementation and impact of Community Forensic CAMHS to manage risk for young people with forensic and mental health needs : study protocol

Introduction: Young people in contact with forensic child and adolescent mental health services present with more complex needs than young people in the general population. Recent policy has led to the implementation of new workstreams and programmes to improve service provision for this cohort. This paper aims to present the protocol for a national study examining the impact and implementation of Community Forensic Child and Adolescent Mental Health Services (F:CAMHS). Methods and analysis: The study will use a mixed-methods Realist Evaluation design. Quantitative service activity and feedback data will be collected from all 13 sites, as well as questionnaires from staff. Non-participant observations and qualitative interviews will be conducted with staff, young people and parents/guardians from four focus study sites. An economic evaluation will examine whether Community F:CAMHS provides good value for money. The results will be triangulated to gain an in-depth understanding of young people's, parents/guardians' and staff experiences of the service. Ethics and dissemination: Ethical approval was granted by the Health Research Association and UCL Ethics. The results will be disseminated via project reports, feedback to sites, peer-reviewed journal publications and conference presentations

Long- and short-term outcomes in renal allografts with deceased donors: A large recipient and donor genome-wide association study.

Improvements in immunosuppression have modified short-term survival of deceased-donor allografts, but not their rate of long-term failure. Mismatches between donor and recipient HLA play an important role in the acute and chronic allogeneic immune response against the graft. Perfect matching at clinically relevant HLA loci does not obviate the need for immunosuppression, suggesting that additional genetic variation plays a critical role in both short- and long-term graft outcomes. By combining patient data and samples from supranational cohorts across the United Kingdom and European Union, we performed the first large-scale genome-wide association study analyzing both donor and recipient DNA in 2094 complete renal transplant-pairs with replication in 5866 complete pairs. We studied deceased-donor grafts allocated on the basis of preferential HLA matching, which provided some control for HLA genetic effects. No strong donor or recipient genetic effects contributing to long- or short-term allograft survival were found outside the HLA region. We discuss the implications for future research and clinical application

Psychological outcome in early treated children with congenital hypothyroidism

The aim of the study was to determine the intellectual and behavioural status of children with congenital hypothy­ roidism (CH) following the introduction of neonatal screen­ ing and early treatment in the UK in 1982. All 472 children with CH detected by this programme in England, Wales and Northern Ireland during 1982-84 were recruited for the study. Diagnostic data and treatment records were obtained to the age of five years when a standard psychological assessment was carried out on the CH children along with matched classroom controls. Children were assessed for intelligence, motor skills and behaviour problems using the Wechsler Pre-school and Primary scale of Intelligence (WPPSI), the Bruinincks-Oseretsky test of Motor Proficiency and the Conners Teacher and Parent behaviour questionnaires and the Richman Behaviour Checklist. Intellectual outcome was significantly associated with the severity of CH at diagnosis as measured by pre-treat­ ment T4. This association was significantly non-linear. After controlling for parental occupation and educational background, children with a pre-treatment T4 less than 4Onmol/1 had a significant IQ deficit (df=2; F=20.16; p<0.0001) of 9.75 points (95% C/I 6.74-12.76) compared with controls. This represented a fivefold increased risk of learning impairment. In contrast, children with T4 greater than 40 nmol/1 showed no intellectual impairments compared with controls. CH children also showed significant deficits with respect to motor skills compared with their peers (t=~7.56; p<0.0001) and there was a significant positive association between pre-treatment T4 and motor skills after controlling for gender and parental educational background (df=5; F= 13.30; p<0.0001). Both parents and teachers reported an increased frequency of attentional problems (20-30%) for all CH children compared with 10-15% of their peers. Although the introduction of early treatment has clearly reduced the overall impairment of CH, this study suggests that a significant impairment remains. The prena­ tal thyroid/neurological mechanisms that may underpin these deficits are discussed

Outreachend mentaliserend werken met moeilijk te bereiken jongeren - AMBIT:Uitgangspunten en basishouding

De basishouding en uitgangspunten van de bij het Anna Freud Centre ontwikkelde werkwijze rondom jongeren met complexe problematiek, waaronder psychiatrische problemen, wordt besproken. AMBIT (Adolescent Mentalization-Based Integrative Therapy) richt zich op jongeren die moeilijk te bereiken zijn voor de hulpverlening, en gebruikt daarvoor het gedachtegoed van het mentaliserend werken en richt zich niet alleen op het werken met de jongere en zijn gezin, maar bovenal ook op de samenwerking tussen organisaties, binnen het eigen team en hoe in de hectiek het mentaliserend vermogen zo goed mogelijk in stand te houden