1. Emma Louisy i-THRIVE Programme Manager

2. THRIVE and i-THRIVE
The THRIVE conceptual framework was developed as a collaboration between the Anna Freud National Centre for Children and Families and the Tavistock and Portman NHS Foundation Trust.
i-THRIVE is the implementation programme that supports sites to translate the THRIVE conceptual framework into a model of care that fits local context.
The i-THRIVE programme is a collaboration between the Anna Freud National Centre for Children and Families, the Tavistock and Portman NHS Foundation Trust, Dartmouth Institute for Health Policy and Clinical Practice (US), and UCLPartners.

3. i-THRIVE (Implementing-THRIVE)
i-THRIVE is the implementation programme that supports sites to translate the THRIVE conceptual framework into a model of care that fits local context
i-THRIVE is an NHS Innovation Accelerator, led by Dr Anna Moore

4. Support for sites implementing THRIVE
Website at
i-THRIVE Community of Practice member with access to shared learning events – next one April 2017
i-THRIVE Academy; four training modules funded by Health Education England
i-THRIVE Illustrated; a series of case studies highlighting how different sites have approached the implementation of THRIVE
i-THRIVE Toolkit; a range of tools to support an evidence based approach to implementation

5. The THRIVE Conceptual Framework

6. The THRIVE Conceptual Framework
The THRIVE framework is a new approach to supporting children and young people’s emotional wellbeing.
The THRIVE framework is an integrated, person centred and needs led approach to delivering mental health services for children, young people and their families.
It conceptualises need in five categories; Thriving, Getting Advice and Signposting, Getting Help, Getting More Help and Getting Risk Support.
Emphasis is placed on prevention and the promotion of mental health and wellbeing.
Children, young people and their families are empowered through active involvement in decisions about their care through shared decision making, which is fundamental to the approach.

7. The THRIVE Conceptual Framework
Description of the THRIVE-groups
Input offered
Distinction between advice/support and evidence based ‘treatment’
The five needs based groups are distinct in terms of the:
needs and/or choices of the individuals within each group
skill mix of professionals required to meet these needs
resources required to meet the needs and/or choices of people in that group

8. The THRIVE Conceptual Framework: Latest Iteration (November 2016)
THRIVE: The AFC-Tavistock Model for CAMHS (Wolpert et al., 2014) 
THRIVE Elaborated (Wolpert et al., 2015)
An updated version with greater elaboration on key points
THRIVE Elaborated (Second Edition) (Wolpert et al., 2016) 
New foreword that aims to address the most common question raised in relation to THRIVE:
“THRIVE reads as being very health focused, even though it professes to be a multi-agency framework. Can you clarify in what sense this is a genuinely multi-agency framework?”
THRIVE is a needs based model that enables care to be provided according to four distinct groupings, determined by a patient’s needs and preferences for care
Emphasis is placed on prevention and the promotion of mental health and wellbeing
Children and young people are empowered to be actively involved in decisions about their care through shared decision making
It provides a clearer distinction than before between:
treatment and support
self-management and intervention
more systematic integration of shared decision making and routine collection of preference data
THRIVE is all about building resilience

9. The THRIVE Conceptual Framework: Latest Iteration (November 2016)
THRIVE was originally authored by professionals involved in mental health support for children and young people, all of whom came from a health background.
THRIVE Elaborated (Second Edition) now has co-authors from the world of education and social care, and have drawn on views from head teacher panels, CCG leads and local authority directors.
Highlights four key ways in which the THRIVE framework is inherently multi-agency:
1. THRIVE endorses multi-agency definitions of mental health promoting practices
2. THRIVE encourages shared multi-agency responsibility for promoting “thriving”
3. THRIVE promotes multi-agency proactive “advice” and “help”
4. THRIVE supports multi-agency clarity on endings as well as beginnings
THRIVE is a needs based model that enables care to be provided according to four distinct groupings, determined by a patient’s needs and preferences for care
Emphasis is placed on prevention and the promotion of mental health and wellbeing
Children and young people are empowered to be actively involved in decisions about their care through shared decision making
It provides a clearer distinction than before between:
treatment and support
self-management and intervention
more systematic integration of shared decision making and routine collection of preference data
THRIVE is all about building resilience

10. The THRIVE Conceptual Framework: Summary
The THRIVE framework:
replaces tiers with a whole system approach
is based on the identified needs of children, young people and their families
advocates the effective use of data to inform delivery and meet needs
identifies groups of children and young people and the sorts of support they need
draws a clearer distinction between treatment and support
builds on individual and community strengths wherever possible
ensures children, young people and their families are active decision makers

11. The THRIVE Conceptual Framework: Needs Groups
There are 5 needs-based groups set out in the THRIVE framework:
Thriving: prevention and promotion in the community
Getting Advice and Signposting: signposting, self management and one off contact
Getting Help: goals focused, evidence informed, outcomes focused intervention
Getting More Help: extensive treatment
Getting Risk Support: focus of intervention is providing risk management

12. How the THRIVE Conceptual Framework addresses the issues set out in “Future in Mind”
Whole system approach focusing on needs and preferences
Builds on an draws from community resources, and an individual’s resources to create a diverse range of options for care
Shared decision making and child and young person preferences are core principles
Identifies resource-homogenous groups of young people with common needs and preferences, rather than an escalator/severity approach
Focus on early intervention and building resilience in children, young people and families
THRIVE advocates the effective use of data to inform service delivery and meet needs
* Future In Mind: Department of Health & NHS England Joint Taskforce Report on CAMHS, 2015.

13. For more information: THRIVE
Download the THRIVE Framework at:
Twitter:
@AFNCCF
@TaviAndPort

14. i-THRIVE

15. i-THRIVE (Implementing-THRIVE)
i-THRIVE is the implementation programme that supports sites to translate the THRIVE conceptual framework into a model of care that fits local context
i-THRIVE is an NHS Innovation Accelerator, led by Dr Anna Moore

16. Key Principles of an i-THRIVE Model of Care
Core THRIVE principles delivered using evidence based approaches to delivery that fit the local context
Needs based care (not severity or diagnosis led)
Shared decision making at each point in pathway
Integration: multiagency teams that are trained and located together, with common processes and outcome frameworks
Training clinicians to:
have clarity about when treatment is being provided vs. support
promote and support self help
enable shared decision making

17. i-THRIVE is a ‘Whole-Systems Approach’
MACRO
Consideration of Population Health Improvement
How agencies work together and commission services for the population
MESO
Needs based groups of young people and the services/ teams that enable delivery of care according to those needs
MICRO
Ways of working with young people and their families, and how professionals can work best in a collaborative and integrated way

18. Getting Advice and Signposting
Possible Components of an i-THRIVE Model of Care
Getting Advice and Signposting
Getting Help
Digital ‘front – end’
Short, evidence based interventions aligned with NICE Guidance
Single point of access with multi-agency assessment & effective signposting
Creating a comprehensive network of community providers: Youth Wellbeing Directory
CYP IAPT
Wide variety of choice of modality and location, provided by health or alternatives (3rd sector, community providers)
Outreach to Hard-to-reach groups
Schools and primary care in-reach
Self-help and peer-support
Outcomes plus goal based measures
AMBiT: Integrated multi-agency approach with joint accountability for outcomes
Longer, evidence based interventions
CYP IAPT
Safety plans co-produced between agencies & young people
Provided by health primarily
Emphasis on developing Personal support network
Outcomes plus goal based measures
Self-help and peer-support
Getting More Help
Risk Support

19. i-THRIVE Implementation Sites Emma Louisy i-THRIVE Programme Manager

20. i-THRIVE implementation sites
Ten national accelerator sites
Manchester and Salford
Waltham Forest
Stockport
Hertfordshire
Bedfordshire
Camden
Cambridgeshire & Peterborough
Bexley
East London Foundation Trust
Luton
30+ implementation sites in the i-THRIVE Community of Practice

21. i-THRIVE national accelerator sites
Bexley Bexley have focused on ‘thriving’, shared decision making, ‘getting advice and signposting’ and ‘getting help’. Key successes to date include a new website called Headscape where children and young people can access information about mental health and get signposted to local services and other helpful websites, and the design of a new community CAMHS service that is built on the eligibility of the THRIVE groups and that will support children and young people in the ‘getting advice and signposting’ and ‘getting help’ needs based groups.
Cambridgeshire and Peterborough ‘Thriving’ was an initial focus for Cambridgeshire and Peterborough, with a website called Keep Your Head developed to improve the information that was available for children, young people and their families who may need help and to support with self-help and promote emotional wellbeing. Another focus is the whole-system approach (which is a key feature of i-THRIVE) to supporting children and young people’s mental health – new Wellbeing Leads have been recruited to improve the knowledge and skills of GPs, teachers and support workers and provide advice and support to those professionals. Cambridgeshire and Peterborough were also supported to successfully win a grant from Health Education England so that they could improve their ‘getting advice and signposting’ by improving assessment skills within primary care and localities.

22. i-THRIVE national accelerator sites
Camden The two key priorities for Camden were ‘getting risk support’ and shared decision making. Camden have used an AMBiT model to design their approach to risk support and have successfully implemented a new set of multi-agency local protocols to share the responsibility and accountability for the support of this group of children and young people by creating one single multi-agency plan. This was supported by funding obtained by Health Education England. Camden is also at the forefront of improving shared decision making with a Health Foundation funded project to develop, design and trial the use of a decision aid for young people and their families, based on the Option Grids created by Dartmouth. In addition to this, THRIVE categories have become embedded into the data system used by CAMHS with a view to all children and young people having a THRIVE plan by the end of the year.
ELFT (incorporating Bedfordshire, Luton and Tower Hamlets) ELFT chose to bid to become an Accelerator Site in order to support their service transformation aim of moving towards more integrated care, reducing barriers to access support and becoming more needs-led. ELFT have focused on ensuring that their ‘getting advice and signposting’ service is first class and are now giving advice to other accelerator sites about how they have improved this part of their service, with ELFT rated outstanding by the CQC in Tower Hamlets in particular is working with local CCG commissioners in linking their trial of the Power Up app developed by EBPU with its CYP IAPT programme and its drive towards goal-based outcomes, shared decision-making and improvements in service-user participation.

23. i-THRIVE national accelerator sites
Hertfordshire Hertfordshire chose to use the THRIVE framework in their transformation because a recent review of their child mental health services suggested that the current tier system was acting as a barrier for children and young people to receiving help. The THRIVE framework offers the five needs groups as a different way to think about and organise services. Hertfordshire focused on engaging the whole system, with a particular focus on schools as its first priority, holding a multi-agency engagement event in October 2016 that was delivered in collaboration with the i-THRIVE Team and included an assessment of how THRIVE-like Hertfordshire currently is. The event helped to begin to disseminate a wider understanding of i-THRIVE and how it would be the vehicle for delivering better support for the emotional wellbeing of children and young people in Hertfordshire. A big success for Hertfordshire so far has been their introduction of a CQUIN (Commissioning for Quality and Innovation) target of 28 days to assessment and also the pilot of a new ‘Nurture Group’ at a local primary school to support those children in the ‘getting risk support’ group which is now a case study for the i-THRIVE CoP.
Manchester and Salford Manchester and Salford applied to become a National Accelerator site as they believed that it would help them to deliver on the aims set out in Future in Mind including increasing access to services for children and young people. A particular focus for Manchester and Salford was creating a shared understanding across the system about the services available to meet the needs of children and young people in all five THRIVE needs based groups. They have started off with engaging staff across their system in pathway design, defining the services and teams that will provide care for the children and young people in each of the THRIVE needs groups. They are using i-THRIVE’s suggested evidence-based Approach to Implementation by first establishing an in depth understanding of their current system, including what young people and staff from all agencies think about how it is working now. A key success to date has been the development of their integrated access and care pathways which were designed to improve the smoothness of care for children, young people and their families. This is now a case study for the i-THRIVE CoP.

24. i-THRIVE national accelerator sites
Stockport Stockport believes that i-THRIVE will enable them to fulfil the drive in Future in Mind to move away from a tiered CAMHS system to one that could organise care around the needs of children and young people. Its priorities are to reduce silo working and the boundaries between services; reducing the likelihood of children falling through the gaps with an initial plan to integrate current tier two and three CAMHS teams across health, education and social care. Another focus it so strengthen joint commissioning for CAMHS between the CCG, local authority and schools using the language of the THRIVE framework and the i-THRIVE Approach to Implementation. The local Integrated CAMHS Partnership is embedding the i-THRIVE Approach to Implementation into their planning and has agreed to further develop the knowledge and skill of the partnership in relation to i-THRIVE.
Waltham Forest Waltham Forest CCG, with support from CORC have completed an in-depth analysis of their current system of services for children and young people’s mental health. Their main priorities for transformation are to improve support for children and young people ‘getting advice’ and ‘getting risk support’. Some real progress has been made already with the development of an app by NELFT called ‘My Mind’, which children and young people linked to CAMHS can use to more easily communicate with their clinicians, track their progress and set their own goals. This features as a case study for the i-THRIVE CoP. Since the start of their transformation process, Waltham Forest have seen a 15% decrease in referrals to their CAMHS and have seen increased referrals to CAMHS from schools. Waltham Forest CAMHS are also a part of a two year Health Foundation Scaling Up Improvement project which sets out to take the core set of THRIVE principles and translate them into a model of care across Waltham Forest and the three other CAMHS localities within NELFT.

25. i-THRIVE implementation sites: Case Studies

26. www.implementingTHRIVE.org Twitter @iTHRIVEinfo
For more information: i-THRIVE

27. Currently on Maternity Leave
For more information: the i-THRIVE Programme Team
Anna Moore:
i-THRIVE Lead
Emma Louisy:
i-THRIVE Programme Manager
Rachel James:
i-THRIVE Clinical Lead
Ilse Lee:
Research Officer and Community of Practice Manager
Currently on Maternity Leave