Internet Explorer is no longer supported by Microsoft. To browse the NIHR site please use a modern, secure browser like Google Chrome, Mozilla Firefox, or Microsoft Edge.

22/25 HSDR Evaluating the implementation of the Transforming Children and Young People's Mental Health Provision Green Paper - Commissioning Brief

Published

18 February 2022

Version

1.0 February 2022

Contents

Background

This call is for a national alongside-evaluation of the implementation of the Transforming Children and Young People’s Mental Health Provision Green Paper. This Green Paper aims to promote good mental health and wellbeing for all children and young people, providing targeted early intervention for emerging issues and access to appropriate services. An evaluation of the implementation is needed to understand the embedding and impact of changes, including the introduction of mental health support teams in schools and colleges.

There is an urgent need to promote mental health and wellbeing for children and young people, as well as increase the support for those with mild to moderate mental health conditions in England, and to reduce the length of time waiting for treatment by those needing specialist NHS care. In addition to existing, unmet demand, the pandemic has impacted on children and young people’s mental health and is likely to continue to do so . In 2017, the Government published a consultation to gather views on proposals, set out in its Green Paper, for Transforming children and young people’s mental health to expand access to mental health care for children and young people. The aim of the transformation programme is to improve early intervention and access to support, and promote good mental health and wellbeing for all children and young people. Following the consultation, the Government published its response and next steps, which set out three core elements for transformation:

  • creating Mental Health Support Teams (MHST), to work with schools and colleges, to promote wellbeing and good mental health, introduce mental health expertise, deliver interventions for mild to moderate mental health needs, strengthen existing support in education settings and to bridge the gap between education and the NHS to encourage a more collaborative approach to tackling mental health issues in children and young people in a timely way;
  • piloting 4 week waiting times (4WW), in a select number of areas for NHS Children and Young People Mental Health Services to test how young people can access support quickly and easily;
  • providing training and support for a Senior Mental Health Lead in schools and colleges to provide the knowledge and skills to establish a holistic approach to mental health and wellbeing in schools and colleges, including embedding an integrated, positive mental health ethos in educational settings.

Implementation of the transformation programme was in successive waves, with the first wave funding the creation of 58 MHSTs in 25 trailblazer sites, from 2018, with further waves now operational and in development. The total number of MHSTs will reach 399, covering an estimated 3 million children and young people (around 35% of pupils in England), by 2023. The programme design combines a national framework, including operating principles and national training programmes for the new practitioners, with local flexibility so that service models can be shaped to suit local needs and circumstances. Further information about the core elements of the transformation programme is available in the supporting information document.

The NIHR Health and Social Care Delivery Research (HSDR) Programme supported an early process evaluation of the first wave of the trailblazer sites, focusing on the development, implementation and early progress of the MHSTs in these sites (however, it did not aim to assess the impact of the transformation programme). National lockdown, in response to COVID-19, had a major impact on implementation of the transformation programme, day-to-day delivery of MHSTs and the process evaluation. In addition to an interim process evaluation report (published July 2021), there will be a final report in summer 2022 sharing the full findings.

Scope

Building on the early process evaluation, the HSDR Programme would now like to commission a national alongside-evaluation of the Children and Young People’s Mental Health Implementation programme to the end of 2024/25. We would like to receive proposals for well-designed research studies, with strong theoretical grounding, evaluating to what extent, and how, the vision and intended outcomes of the three pillars of the transformation programme have been achieved, as well as generating evidence-based guidance to support further roll-out of the programme. Assessing the theory of change and the causal links between inputs, activities, outcomes and impacts, the proposed evaluation will look across the three pillars with a focus on interaction between pillars and progress against the intended outcomes of the programme, as well as capturing any unforeseen effects across the wider system. Any discrete evaluation of Senior Mental Health Leads training and 4WW pilots is out of scope for this call. The proposed evaluation will include both analysis of routine data sets (such as the Mental Health Services Data Set and the National Pupil Database) and primary data collection from a broad range of stakeholders, including education staff, pupils and parents, MHST staff, service managers and commissioners.

Proposed research studies should be designed to track outcomes and impact up to 2025, however, the proposed evaluation may extend beyond the end of the transformation programme with built-in plans to provide regular, interim learning and reporting. The successful research team(s) should expect to have regular contact with key stakeholders at DHSC, DfE and NHSEI and set out appropriate plans to share regular, interim outputs. The focus of this national evaluation is England, however, this call does not exclude collaboration with researchers and organisations from other parts of the UK.


Areas of interest

The HSDR Programme wishes to fund a high-quality, mixed-methods evaluation to establish the effectiveness and impact of the implementation of the Transforming Children and Young People’s Mental Health Green Paper. This research may be delivered by a single team or a collaboration/syndicate of researchers. Given the complexity of the transformation programme, the research team will have a combination of specialist content knowledge of both children and young people’s mental health and education services and research, ideally including mental health activities in education, and a track record in mixed-methods evaluation, along with skills in areas such as organisational studies, qualitative research and health economics. The proposed research study will develop an understanding of how the different methods of delivery of the programme work, for whom, and in what circumstances. The proposed research study will also capture any important unintended effects or consequences of the transformation programme.

Design of the research study should take account of complexity of the flexible and phased roll-out of MHSTs, extensive variation in local contexts and delays/adaptations due to the COVID-19 pandemic. The proposed evaluation will include national mapping through routine data from different sources and survey or other work as well as `deep dive’ case studies. Sampling should take account of important differences in schools and colleges, geography (e.g. urban/rural), demography including deprivation and ethnicity, maturity of intervention (i.e. trailblazer sites and following waves of implementation), and differences in existing mental health provision.

The proposed evaluation is likely to contain multiple work packages, similar to the large-scale National Diabetes Prevention programme.  Some of the longer-term impacts of the transformation programme are expected to emerge after roll-out has been completed, therefore, the proposed research study should also inform what monitoring and what data collection needs to be undertaken on an ongoing basis. The successful research team will work closely with policy and service partners throughout the research study.

The exact research design is not prescribed, but should address the following elements:

  • Identification and development of measures and data sources which can be used to assess programme outcomes and impacts at different levels. This includes -
    • Outcomes for individual children/young people (both those who have worked directly with MHSTs and those who have not but attend education settings working with an MHST) including: improved mental health and wellbeing; changes in perception, and experience, of mental health support and promotion available to them (including transition between services); improved understanding of mental health, wellbeing and how to access support; ability to stay and participate in education; and understanding (for those children and young people working with MHSTs) to what extent they have had positive change towards goals.
    • Outcomes for parents/families (both those whose children have worked directly with MHSTs and those who have not) including: parents/families having improved understanding of children’s mental health and wellbeing; knowing how to access support for their child; changes in perception of mental health support and promotion available to them and their child; and improved experiences of support offered for their child.
    • Outcomes for schools/colleges: staff knowledge; staff confidence in being able to respond to children and young people with mental health needs; development and embedding of a holistic approach to mental health and wellbeing in the setting, including pathways for specialist referrals; and education outcomes such as attendance, behaviour or attainment.
    • Outcomes related to Children and Young People’s Mental Health Services including: improvement in appropriateness, timeliness and quality of referrals to specialist NHS and other services; improved joint working between schools and mental health services; and improved local pathways.
  • Understanding how the three pillars of the programme, MHSTs, Senior Mental Health Leads’ training and 4WW pilots interact with one another to support the intended outcomes of the transformation programme and the development and implementation of the whole school/college approach. For instance, it would be helpful to assess any patterns in appropriateness of specialist referrals for sites with both MHSTs and 4WW pilots, and to understand the contribution of Senior Mental Health Leads with different characteristics (such as, level and type of training, time in role, other roles in school, etc.) to programme outcomes.
  • Scoping and analysis of different models of MHST delivery; analysis of the key characteristics of MHSTs (including, but not limited to, type of lead organisation, governance structures, extent and approach to digital delivery, staffing make up) and understanding what helps in embedding the teams in the wider education and local system; the relationship between MHSTs and existing staff/services in schools/colleges and the extent to which it is additional (i.e. the extent to which MHST provision complements and is in addition to, existing mental health and wellbeing provision); understanding how the balance across the MHST functions vary and how these have been developed with local stakeholders and informed by local needs; understanding how the balance of functions interacts with different outcomes (e.g. child/young person/family experience, whole school/college approach). Exploring how these factors and variations in delivery, or others that emerge in the research study, support or hinder achievement of programme outcomes.
  • Evaluating the experience and support from the perspectives of children/young people, parents/families and staff working in both education settings and mental health services. Other perspectives, including those training and supporting new practitioner roles, would also be helpful.
  • Exploring the range of evidence-based interventions delivered by MHSTs and the extent to which these meet the needs of the local population, including understanding different impact (or not) for particular groups of children and young people (individual characteristics, as well as, for example, school phase and type).
  • Identifying how the programme is addressing access inequalities or tailoring parts of the offer for particular needs and students, and the extent to which diversity and inclusion considerations are improving support for underserved groups and communities.
  • Assessing how Senior Mental Health Leads work with support teams in different educational settings, and vice versa, and what conditions are needed to optimise impact.
  • Exploring whether changes have resulted in better coordination between schools/colleges, mental health services, workforces and other partners, including voluntary sector providers and social care, particularly for children with complex and multiple needs.
  • Assessing the impact of the programme in developing, promoting and improving a whole school/college approach to mental health and wellbeing and the impact this has on other outcomes such as for children and young people, organisational culture, etc.
  • Although it may not be feasible to conduct a value for money assessment of the whole transformation programme, bottom-up and comparative costing would be helpful including any hidden costs of implementation that would be important for continued sustainability of the programme (for example, resource implications for schools in terms of staff time). Research teams should also conduct initial work to explore what measurable benefits or cost savings might be linked to improvements associated with the transformation programme, contributing to wider government work on making an economic case for wellbeing outcomes.

Criteria for assessing applications

Successful applicants will be able to demonstrate:

  • A track record in delivering evaluations of complex programmes/services at a national level;
  • A range of relevant mixed-methods expertise, including large-scale, data analysis and high-quality observational research;
  • Broad content knowledge of mental health and education services and research;
  • Experience in working closely with policy and service customers and an ability to respond to changes in external environment;
  • Engagement with relevant community and service partners and attention to inclusive research; and
  • Experience in developing a range of research outputs, including service-facing findings.                                                                                                                                 

 Relevant studies of ambitious, mixed-methods evaluations in the HSDR portfolio include:

Other, relevant NIHR studies, in this space, include research assessing highly-complex wellbeing interventions in school settings, such as a £1.5m evaluation of an anti-bullying approach.

Other, relevant, national studies include:

Equality, diversity and inclusion

The NIHR is committed to actively, and openly, supporting and promoting equality, diversity and inclusion (EDI). All NIHR applications need to demonstrate that they have met the requirements of the Equality Act (2010) by embedding EDI throughout the research proposal, ensuring there is no discrimination across the following domains: age; disability; race (including colour, nationality, ethnic or national origin); religion or belief; sex; sexual orientation; gender reassignment; being married or in a civil partnership; being pregnant or on maternity leave. Applicants are expected to pay attention to populations that have been underserved, to conduct research in locations where the need is greatest, and to promote the inclusion of diverse participants.

General Guidance

The HSDR Programme supports applied research with the aim of improving health and social care services across the nation and is open to any methodology which is appropriate to answer the proposed research question; this must be fully explained and justified. In order to enhance the success of a proposal, a clear theory of change and pathway to impact, with links into the health and social care delivery processes, is suggested. It is useful to consider, in the research design, how outcomes could be scaled up to maximise impact and value for money across health and social care services – the focus is on applied research with tangible impacts on systems that improve the quality, accessibility and organisation of health and social care services. This includes stakeholder engagement and the development of processes, tools and guidelines to strengthen workforce capacity. Further general information can be found on the HSDR Programme webpage.

Research proposals should be co-produced with national organisations and professional bodies, with health and social care services professionals, and with service users. Links with health and social care planners and with professional bodies is required to ensure impact and scaling up of any research findings to benefit the wider health and social care systems.

The COVID-19 pandemic is having a significant impact across the health and social care systems. As this research study may be conducted during the COVID-19 response and recovery period, applicants should consider how the impact of COVID-19 response and recovery may affect their ability to conduct and deliver the research study proposed.


For the purpose of this commissioning brief, where health and social care services are mentioned in the general guidance above, this extends to include education services and their delivery, professionals, bodies and system.