The introduction of the THRIVE model from the Anna Freud Centre in 2014 changed a lot of perspectives. Supporting children and young people’s mental health since then has evolved – in my opinion, for the better.
The tiered system of mental health care, which saw support being given along a linear path with one point of entry, is gradually disappearing. In its place, THRIVE represents a more accessible approach which better reflects the fluid nature of mental health.
There were a number of issues I found difficult working within the tier system as a practitioner in children and young people’s mental health.
First, it was clear that people didn’t necessarily fall into specific tiers. They would travel between tiers, overlap and often regress.
Secondly, over time the thresholds for each tier became so high that young people were often only seen once they’d become extremely sick.
It also seemed almost that a child or young person couldn’t receive help from two different places at the same time, despite experiencing complex mental health issues and needing a mix of support services.
If a child, for example, was developing an eating disorder and wanted to speak to a school nurse about their feelings at the same time as accessing help from the school psychiatrist, they would probably have been asked to choose one or the other.
Also, in the old system, a young person would have to “re-enter” the whole system from the start if they had completed a course of treatment but at a later date needed further support.
In contrast, the THRIVE model, developed by the Anna Freud National Centre for Children and Families and the Tavistock and Portman NHS Foundation Trust, takes a more flexible and fluid view.
By replacing the tiers with four quadrants – Getting Advice, Getting Help, Getting More Help and Getting Risk Support – and making the access points more fluid, practitioners working to the THRIVE model are able to be more responsive and take a more holistic approach to care.
Commissioners too are in a much better position, being able to invest in the right areas.
On Kooth, for example, we’ve been able to show that most children and young people (59%) stay within the Getting Advice quadrant. Here, they will be taking part in moderated forum discussions, reading psycho-educational materials and maybe using some of our tools to set goals or track their mood.
Most of the remaining young people will do this too, but will also engage in one-to-one text chat sessions with trained counsellors, which, consequently, is where more resource need to be directed.
A much smaller percentage, who we work with in partnership with social services and psychiatrists, are in the Getting Risk Support quadrant, which again needs resourcing so that their specific needs can be met.
A key aspect of THRIVE is its focus on accessibility, making prevention and early intervention possible. Offering support to children earlier, with the right prevention services and with support from psychiatrists, means we can support that child better.
The shift to a tierless model of care continues; there is a growing number of CCGs choosing to go down that route, recognising that support should be tailored around the young person and not around the services.
It’s my belief that if we can provide more early help for the “there and then” problems which may be just surfacing, then we can really make a difference to the future mental health of thousands of children and young people. THRIVE helps us do just that.