Children’s Mental Health Beyond the Green Paper: The role of practice based evidence (UK)

A report by the all-party parliamentary group on a fit and healthy childhood

SUMMARY OF RECOMMENDATIONS

For the full report: https://www.playtherapy.org.uk/

and

https://www.basw.co.uk/resources/childrens-mental-health-beyond-green-paper-role-practice-based-evidence

 

  1. PRACTICE BASED EVIDENCE: A DEFINITION AND HISTORY:

1.1

A parallel hierarch of practice based evidence (PBM) to be established alongside the existing EBM hierarch.

  1. THE PRESENT SITUATION IN THE DEVOLVED UK WITH ILLUSTRATIVE EXAMPLES OF GOOD PRACTICE AND SHORTCOMINGS:

2.1

The creation of a Non-Cabinet Committee reporting to the Cabinet Office with responsibility for monitoring and advising the inspection and regulatory organisations about the implementation of evidence based children’s mental heath.  A priority is to educate officials responsible for  setting policies and standards and ensuring that these are based on the importance of practice based evidence

2.2

Full implementation of the recommendations as set out in the National Audit Office Report ‘Improving Children and Young People’s Mental Health Services’; provided that clear, quantifiable objectives are then established and progress measured through practice based evidence

2.3

The NAO to co-opt individuals with demonstrable expertise and practice in  children’s and young people’s mental health to assist in the implementation of their recommendations

2.4

The active involvement of the PSA and HCPC to be sought in setting and applying standards of practice based evidence to those registrants who work therapeutically with children.

  1. ‘CONTENTIOUS INTERVENTIONS’ INCLUDING TOUCH METHODS AND TECHNIQUES, ON-LINE THERAPIES AND SCREEN TIME:

3.1

Government to commission and fund research into new therapies (in particular touch therapies) and extensions of play and creative arts. Pilot projects designed to test the outcomes of such research must use practice based evidence and be at all times, sensitive to safeguarding needs

3.2

Systems designed to record practice based evidence for consistency must be flexible and accommodating. They will need to consider the qualities that cannot be measured and power of the therapeutic process and relationship and it should be understood that outcome cannot always be quantified in the present yet may have life enhancing and lifelong benefits to the needs and wellbeing of the child

3.3

Practice based evidence must be child-centred and accessible for both the child and practitioner to measure the child’s progress throughout counselling. The collection of such data would aim to be flexible and accommodating to the ever-changing needs and desires of the child.

  1. PRACTICE BASED EVIDENCE VIEWED IN RELATION TO, AND IN THE CONTEXT OF, OTHER RESEARCH METHODS

4.1

Data relating to the adverse effects of medicines to be included in therapists’ record management systems

4.2

The National Audit Office (NAO) to become the central repository of data related to the costs and outcomes of all research projects funded directly or indirectly by national government

4.3

The proposed parallel practice evidence based hierarchies (as above) to be added to the existing evidence based classifications for use by all bodies concerned with the evaluation of the quality of research or children’s mental health and commissioning policies

4.4

A working party to be convened to agree a set of standards for the development of practice based evidence systems for the interventions for children with mental health and emotional welfare problems. The envisaged time span for this is one year

4.5

1% of the national budget for children’s mental health care to be devoted to measuring the effectiveness of the funded programmes followed by NAO evaluation.

  1. EVIDENCE DISSEMINATION AND AUDIENCE

5.1

In evidence dissemination, an integrated ‘joined-up’ approach is essential, including voices of parents, children and professionals such as mental health practitioners and teachers who work regularly with children themselves

5.2

Children’s mental health professional organisations are required and supported to provide systems for registrants to gather data for, and use, practice based evidence guidelines

5.3

Expansion of The Health and Social Care Regulators’ remit to include the dissemination of practice based evidence for children’s mental health

5.4

The NHS Commissioning Board and Monitor to be expanded to embrace the full spectrum of provision for children’s mental health, especially within the education service.

  1. CONTRIBUTION TO ‘JOINED UP CARE’ AND IN RELATION TO CHILDREN WITH ACEs, DISABILITY, FROM MIGRANT, REFUGEE, CULTURALLY AND ETHNICALLY

DIVERSE AND SOCIOECONOMICALLY DEPRIVED COMMUNITIES

6.1

Practice based evidence to be integral to the design of strategies to engage joined-up services in the delivery of mental health and wellbeing support to children and their families belonging to ‘difficult to reach’ groups (in particular child refugees and migrants)

6.2

Training modules for therapists and practitioners in the community and within school to reflect ways in which practice based evidence may be best used and disseminated in the interests of children from difficult to reach groups

6.3

The Government to allocate sufficient resources to cover additional training and staffing arrangements and inter agency coordination arrangements as required.

  1. INTERNATIONAL PRACTICES AND EXAMPLES

7.1

Some of the 2018 Budget Statement money allocated to children’s mental health to be used to prepare a Directory of practice based evidence examples from national and international sources to inform ongoing therapy and treatments

7.2

Professional training modules and CPD for therapeutic practitioners to include national and international examples of practice based evidence that have been recommended as examples and for use and modelling by Accredited Professional Registers.

  1. APPLICATION TO CLINICAL PRACTICE INCLUDING CASE STUDIES

8.1

We need to establish clearer terminology, reliable measures and be able to more effectively develop, collect, record, share and use the evidence of what works to improve wellness and wellbeing in promoting and safeguarding the mental health of all children and young people

8.2

It is important that examples of practice based evidence that work and are capable of successful replication are harvested and made use of so that their benefit is not circumscribed by one setting, one group, or one geographical location. The best of practice based evidence excellence must be allowed and enabled to ‘travel’.

  1. PRACTICE BASED EVIDENCE WITHIN THE CONTEXT OF THE GOVERNMENT’S GREEN PAPER ON MENTAL HEALTH

The Green Paper: Transforming Children and Young People’s Mental Health:

9.1

The processes of conducting Consultations upon Green Papers is reviewed to provide more effective input from the people involved in implementing the proposals in practice; also taking into account the extent to which opinions are supported by evidence.

The Children and Young People’s Improving Access to Psychological Therapies programme (CYP-IAPT) is a ‘change’ programme for existing services delivering CYP mental health care:

9.2

The CYP-IAPT programme to be revisited and aligned with Green Paper aspirations and NICE guidelines to be revised and extended in accordance.

The Children and Young People’s Health Services Data Set (CYPHS) provides information about children and young people who are in contact with health services:

9.3

Either the CYPHS Data Set definition is extended (in scope of coverage) to include all locations that deliver children’s mental health services through the Data Coordination Board, or a group of professional organisations managing Accredited Registers and the HCPC assume this responsibility. The Green Paper is insufficiently specific; failing to acknowledge that this is not a health service responsibility alone

9.4

More data items must be included so that the data to manage the effectiveness and efficiency of these services is improved and guidelines provided for the development of the practitioner’s practice.

The workforce for children’s mental health falls within the remit of the NHS:

9.5

Responsibility for developing the children’s mental health workforce must be extended beyond DHSC to include the DfE and other departments with a demonstrable interest. The range of interventions should also be grown substantially beyond the existing limited ones of behavioural family therapy and cognitive behavioural therapy (CBT)

9.6

Learning objectives must be relevant to practice based evidence as well as to other forms of evidence based practice

9.7

Training must include placements providing at least 100 hours of clinical practice and have outcomes measured by an appropriate psychometric questionnaire.

The current inspection regime for mental health services contains significant gaps in the way in which the services are regulated: 

9.8

An authority is commissioned to ensure the establishment of unified  policies and standards for the inspection of children’s mental health

9.9

The Charity Commission should review its rules for Public Service Delivery to ensure that in delivering services for children’s mental health, regular reports on the application for funds, the activities and resulting outcomes are provided

9.10

The Gambling Commissions in its regulation of the National Lottery in reviewing applications for funding services related to children’s emotional wellbeing as well as mental health should place an emphasis on the application of funds, the activities and the resulting outcomes.

A high quality workforce for children’s mental health by means of:

9.11

A training loan scheme; eligibility to include postgraduate level 7 training provided by a university for Play and Creative Arts Therapists

9.12

Therapists to qualify for a PSA Accredited Register or the HCPC posts with a minimum of 100 clinical placement hours, including the collection of practice based evidence

9.13

Trainees to be part time with a course intensity of 50%

9.14

Placement organisations to warrant employment following successful completion of training

9.15

Loan to be repaid on a similar basis to the existing undergraduate scheme (ie a repayment threshold of £25,000).

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