Rolling out a psychological resilience hub for children and young people: Scotland

Overview

In a matter of weeks, NHS Grampian rolled out a virtual support service to help children and young people (CYP) experiencing mental health issues related to the pandemic. The service, based on the principles of Psychological First Aid (PFA), has so far supported more than 500 CYP and their families.

Key benefits and outcomes

• The Psychological Resilience Hub (PRH) has supported over 500 CYP and their families during a time of unprecedented change and uncertainty, and the service received praise from parents and primary care through service evaluation.
• It supported local mental health service provision and primary care through an early intervention approach for CYP experiencing mental health issues related to the pandemic.
• The self-referral method reduced barriers for CYP to access care.

The challenge

The pandemic created many implications for access to services and service delivery, resulting in some necessary service delivery changes. It also highlighted that there would be a potential impact on COVID-19-related mental health experiences for children and young people.

The solution

In response, NHS Grampian created the Grampian Psychological Resilience Hub. The aim of the service was to:

• provide CYP with early intervention support using PFA to manage their COVID-19 related mental health concerns
• aimed to help reduce the demand on Child and Adolescent Mental Health Services (CAMHS) and primary care
• signpost CYP to appropriate support services, such as the third sector and online cognitive behavioural therapy
• ensure CYP had their basic needs met and that any risk issues were addressed and supported
• provide CYP with resources to support the PFA they had received.

An online system was created so CYP could access support through the NHS Grampian website, or a QR code from a child-friendly infographic that was circulated to all primary and secondary schools across the Grampian area for distribution via their parent contact e-mails. CYP or their parents were then required to complete an online self-referral form made up of demographic and risk assessment questions.

The forms were scored using a computer-generated system – this determined the tier of service required. Tier 1 was the lowest level of support, Tier 4 the highest. Initial guidance stated that Tier 4 referrals would be contacted within a 48-hour period and all other calls within seven days. Calls could be escalated if the level of risk increased. Following service-evaluation, in September 2020, this was updated to seven days for those requiring Tier 3 and 4 support, and three weeks for level 1 and 2 support. Service-user feedback did not change after this was implemented and staff feedback was improved.

Tiers 1 and 2 were supported by clinicians or assistant psychologist, mostly via telephone contact. Tier 3 and 4 were supported by clinical psychologists and clinicians via telephone calls or by using the NHS Near Me video calling platform.

PRH call users were offered up to three appointments and could be re-referred at another point in time if necessary.

At the outset a coaching model was put in place to support staff. After feedback from staff evaluations of the service this was changed to regular virtual group supervision sessions.

A quality improvement (QI) specialist provided a high level of QI support such that data collected could be used to implement service changes as the service developed.

Results and benefits

Over 500 CYP accessed the service in just under 18 months. Had the PRH not been implemented, demands on already busy CYP mental health services would have most certainly been higher.

The main reasons for referral were CYP experiencing symptoms of anxiety and depression. 18-month longitudinal data suggest around 55 per cent presented at Tier 1, around 15 per cent at Tier 2, around 10 per cent at Tier 3 and around 20 per cent at Tier 4. 53 per cent of the referrals were successfully closed after just one contact.

There are multiple online formal evaluations of the service being undertaken at any one point, for parents, CYP, primary care staff and PRH staff. Analysis from this data was used to re-design services where appropriate.

Service development has also significantly benefitted from having support from a quality improvement specialist. Evaluation data and the QI support means there is a longitudinal picture of the effects the pandemic has had on the mental health of CYP in the Grampian area which can also serve to inform future service development.

An example of feedback from a parent:

“I cannot praise PRH enough… it was a serious issue my child was facing and I am very grateful PRH could intervene…before my child’s psychological problem escalated further.”

An example of feedback from a general practitioner:

“This has been an excellent resource….The self-referral option has also eased the burden for GP referrals and helped patients when initial access to us has been more difficult.”

Overcoming obstacles

The service was originally staffed by NHS and third sector staff who were diverted from their substantive roles, however, as services adjusted to the challenges of the pandemic, staff returned to their substantive posts.

A recruitment drive was undertaken and staff were employed directly by the PRH, either through a temporary contract or through a bank contract.

For bank staff, it was a challenge to offer shifts consistently due to balancing work demands and managing work pressures during the pandemic.

Ensuring that CYP and parents were aware of the service was another barrier. This was communicated via social media and email, and by contacting parents directly through schools.

There was also a financial barrier that was overcome by using data to evidence-base the need for the service

Future proofing

The data from the various evaluations and the QI methodology supports the effectiveness of early intervention support for CYP. This data will help ensure this innovative service is made sustainable by making the case for ongoing financial support.

Takeaway tips

• Evaluation data and using a quality improvement approach is invaluable in assessing service-design and making the case for ongoing financial support.
• Early intervention support for CYP is valued by parents, primary care and can help reduce demand on more specialist services.
• A tiered approach, which use a computer analysis of referral forms, helps ensure that the CYP is accessing the appropriate level of support in a timely manner.
• Linking with schools is an effective way to communicate the availability of services for CYP.
• The self-referral method reduced barriers for CYP to access care.

Contact details

To find out more about this innovation, please contact Dr Gillian Strachan, Consultant Clinical Psychologist, NHS Grampian at: Gillian.strachan4@nhs.scot