Developing and evaluating i-THRIVE grids for supporting shared decision making in child mental health care The Tavistock and Portman NHS Foundation Trust

THRIVE is a conceptual framework describing a whole-system, needs-led approach to CAMH that moves away from the current tiers-based model, with shared decision making (SDM) a central component. THRIVE is being implemented across the UK in a programme called i-THRIVE. To help address difficulties with SDM, this project developed i-THRIVE grids using Dartmouth’s methodology for Option Grid™ decision aids. The i-THRIVE grids were successfully implemented at one clinic at the Trust in Camden, London.

The grids were adapted by collapsing the treatment options for each into hierarchical categories, representing broad categories of need (eg talking therapy, medication).  In line with THRIVE, the grids were also split into getting help ‘within’ and ‘outside of’ the NHS. Clinicians were engaged in Plan-Do-Study-Act cycles, which provided real-time feedback and resulted in better buy-in.

Project results included:

• Parents reported a significantly higher experience of care, although this was not the case for young people.
• SDM for both young people and parents did not significantly change after the grids were introduced, perhaps because baseline readings were already high.
• Clinicians, young people and parents liked the grids and found them useful.
• Clinicians outlined other settings in which the grids had or could be used, including schools and A&E.

Implementation at another clinic proved challenging, due to clinician resistance to changing practice and logistical issues of data collection. i-THRIVE grid champions have been identified in the Trust to promote sustainability, and the grids will be rolled out to more clinics in Autumn 2017. The grids will be available electronically and possibly built into the Trust’s electronic records management system.

Contact details

For more information about this project, please contact Paul Jenkins, Chief Executive Officer, Tavistock and Portman NHS Foundation Trust or Anna Moore, NHS Innovation Accelerator Fellow.