Expect The Unexpected: A Qualitative Study of The Ripple Effects of Children’s Mental Health Services Implementation Efforts

Background: Strategies to implement evidence-based interventions (EBIs) in children’s mental health services have complex direct and indirect causal impacts on multiple outcomes. Ripple effects as outcomes that are caused by EBI implementation efforts and are indirect, unplanned, unanticipated, and/or more salient to stakeholders other than to researchers and implementers. The purpose of the current paper is to provide a compilation of possible ripple effects associated with EBI implementation strategies in children’s mental health services, to be used for treatment development, implementation planning, research, and quality improvement.Methods: Participants were identified via expert nomination and snowball sampling. Online surveys were completed by 81 participants representing one of five roles: providers of mental health services to children or youth, researchers, policy makers, caregiver, and youth. Participants brainstormed possible ripple effects. A partially directed conventional content analysis with consensus decision making was used to code ripple effects. Results: Four hundred and four unique responses were coded into 66 ripple effects and 14 categories. Example categories include general knowledge, skills, attitudes, and confidence about using EBI’s; general job-related ripple effects; EBI treatment adherence, fidelity, and alignment; gaming the system; equity and stigma; shifting roles, role clarity, and task shifting; economic costs and benefits; EBI treatment availability, access, participation, attendance, barriers, and facilitators; clinical process and treatment quality; client engagement, therapeutic alliance, and client satisfaction; clinical organization structure, relationships in the organization, process, and functioning; youth client and caregiver outcomes; and use of EBI strategies and insights in one’s own life.Conclusions: This research advances the field by providing implementers, researchers, funders, policy makers, and consumers with a “menu” of potential ripple effects for consideration when evaluating the full balance of any implementation effort. It can be a practical tool to ensure compliance with the guidance of experts from Quality Improvement/Quality Assurance, Complexity Science, Diffusion of Innovation Theory, and the Medical Research Council. Future phases will match potential ripple effects with the most salient implementation strategies for each participant role.Trial Registration: None.

GP perceptions of community-based children’s mental health services in Pennine Lancashire: a qualitative study

BackgroundGP satisfaction with specialist Child & Adolescent Mental Health Services (CAMHS) is often reported as low in the UK, and internationally.AimTo explore GP perceptions of local children’s mental health services and to understand their experiences of a novel GP-attached Primary Mental Health Worker (PMHW) service.Design & settingQualitative research involving GPs in Pennine Lancashire.MethodSemi-structured face-to-face interviews of GPs (n = 9) were carried out. Thematic analysis was undertaken.ResultsThemes identified included: 1) The role of the GP: most GPs perceived their role to be signposting and referring patients with mental health issues to specialist services, rather than offering care directly; 2) Clarity on help available: GPs were unclear about specialist CAMHS referral criteria and alternative resources available. GPs experienced communication challenges with specialist CAMHS; 3) Getting advice and support: PMHWs enabled GPs to have informal discussions, and to seek advice about children. Some GPs felt they could recognise problems earlier and were able to access help more quickly; and 4) Development needs: some GPs felt they required increased training in supporting children with mental health problems, and identified a need for further collaboration with schools and specialist CAMHS.ConclusionThe study identified challenges that GPs face with accessing and utilising specialist CAMHS. GPs who had PMHWs based in their practices expressed increased satisfaction with these services. GP-attached PMHWs can potentially reduce the challenges faced by GPs in primary care by offering timely and accessible advice, and improving access to specialist CAMHS.