Authors' objectives: The Children and Young People’s Mental Health Trailblazer programme is funding the creation of new mental health support teams to work in schools and further education colleges. Mental health support teams directly support children and young people with ‘mild to moderate’ mental health problems and work with school and college staff to promote well-being for all. A new workforce of education mental health practitioners is being trained for the teams. The National Institute for Health and Care Research Birmingham, RAND and Cambridge Evaluation Rapid Evaluation Centre and Policy Innovation and Evaluation Research Unit undertook an early evaluation of the Trailblazer programme to examine the development, implementation and early progress of mental health support teams in the programme’s first 25 ‘Trailblazer’ sites. The Children and Young People’s Mental Health Trailblazer programme was launched in 2018 to take forward the proposals set out in the Transforming Children and Young People’s Mental Health Provision Green Paper. The programme is being implemented in successive waves, with the first wave funding the creation of 58 mental health support teams (MHSTs) in 25 ‘Trailblazer’ sites. Across these sites, 1050 schools and further education colleges were recruited to participate in the programme, each of which received support from an MHST and was encouraged to appoint a senior lead for mental health for their setting (if they did not already have one in place). MHSTs have three core functions: (1) providing direct support to children and young people with mild to moderate mental health issues; (2) supporting education settings to introduce or develop their whole school/college approach to mental health and well-being; and (3) giving advice to staff in education settings and liaising with external specialist services to help children and young people to get the right support and stay in education. A new professional role has been created for the programme: education mental health practitioner (EMHP). The programme is being implemented in the context of a children’s mental health service under strain. Considerable and increasing levels of mental ill health in children and young people, historic underinvestment in children’s mental health services and the COVID-19 pandemic have contributed to services struggling to cope with increasing demand. The National Institute for Health and Care Research (NIHR) Birmingham, RAND and Cambridge Evaluation Rapid Evaluation Centre and Policy Innovation and Evaluation Research Unit undertook an early, process-oriented evaluation of the Trailblazer programme to examine the development, implementation and early progress of the MHSTs in the Trailblazer sites. The aims of the evaluation were to: 1.Understand the baseline position and contextual features of the Trailblazer sites, including the accessibility, quality and effectiveness of existing mental health services and support in education settings and perceived gaps in provision prior to the programme commencing. 2.Describe and understand the emerging delivery models, their leadership and governance, and explore how these vary across the Trailblazer sites and the potential implications of this variation for future effectiveness of the programme. 3.Describe the experience of MHSTs, education settings, clinical commissioning groups and local authority commissioners, children and young people’s mental health services and others of taking part in the delivery of the programme. 4.Capture views about the progress being made by Trailblazers towards the goals of the programme, early impacts and any unanticipated consequences in the initial phases of the programme. 5.Identify measures and data sources of relevance to assessing programme outcomes and costs as well as appropriate comparator areas and education settings to assess the feasibility and develop the design of a long-term outcome and economic evaluation. 6.Conduct formative and learning-oriented research, producing timely findings and highlighting their practical implications to inform ongoing implementation and support roll-out to sites in later waves of the programme. 7.Understand how MHSTs adapted their services and ways of working in response to the COVID-19 pandemic, and explore experiences of and learning from these changes, as well as their legacy.

Authors' results and conclusions: Substantial progress had been made implementing the programme, in challenging circumstances, and there was optimism about what it had the potential to achieve. The education mental health practitioner role had proven popular, but sites reported challenges in retaining education mental health practitioners, and turnover left mental health support teams short-staffed and needing to re-recruit. Education settings welcomed additional mental health support and reported positive early outcomes, including staff feeling more confident and having faster access to advice about mental health issues. At the same time, there were concerns about children who had mental health problems that were more serious than ‘mild to moderate’ but not serious enough to be accepted for specialist help, and that the interventions offered were not working well for some young people. Mental health support teams were generally spending more time supporting children with mental health problems than working with education settings to develop ‘whole school’ approaches to mental health and well-being, and service models in some sites appeared to be more clinically oriented, with a strong focus on mental health support teams’ therapeutic functions. Key lessons for future programme implementation include: –Whether mental health support teams should expand support to children and young people with more complex and serious mental health problems. –How to keep the twin aims of prevention and early intervention in balance. –How to retain education mental health practitioners once trained. Implementation and governance The Trailblazers had achieved a great deal in a relatively short space of time. While the local set-up process had been extensive, complex and rushed, some 12 months after the first cohort of EMHPs started their training all 58 MHSTs were operational in some form. The involvement of young people, parents and carers in the design and delivery of MHSTs was variable and often low, despite it being an aspiration that they be involved throughout the programme. There was a view that local governance and leadership was not yet truly shared across health, education and other key stakeholder groups and that the way in which the programme had been set up was dominated by the NHS as funder and by local mental health services. The pandemic created significant challenges for implementation, including delays to whole school activities; however, MHSTs adapted their offer and ways of working to ensure the continuation of support for young people and to education settings. These adaptations included the use of remote support. Stakeholders suggested that a hybrid model of in-person and remote delivery will be used going forward. The pandemic also had a considerable impact on the mental health and well-being of children and young people, and staff in education settings, as well as on access to specialist services. Children and young people described how home schooling had left them feeling disconnected, demotivated and sometimes without adequate support, as well as the difficulties transitioning back into school or college. There have been substantial and unprecedented changes in the wider context since the programme started. The COVID-19 pandemic has further increased inequalities in mental health and access to support, and gaps between services appear to be widening. Critical decisions will need to be taken about what, if any, role MHSTs should have in providing support to children and young people beyond the ‘mild to moderate’ remit that the programme was designed to address. There is also the question of how the programme can continue to retain a dual focus on mental health promotion (e.g. through the development of whole school approaches) and early intervention, and what additional support or resources might help educational partners and settings maximise the opportunities offered by the programme. Alongside strategies for workforce creation and training, more work is needed to ensure that trained staff are retained and can develop in their roles.

Authors' methods: A mixed-methods evaluation, comprising three work packages: 1.Establishing the baseline and understanding the development and early impacts of the Trailblazer sites, including two rounds of surveys with key informants and participating education settings in all 25 sites. 2.More detailed research in five purposively selected Trailblazer sites, including interviews with a range of stakeholders and focus groups with children and young people. 3.Scoping and developing options for a longer-term assessment of the programme’s outcomes and impacts. Fieldwork was undertaken between November 2020 and February 2022. The University of Birmingham Institute for Mental Health Youth Advisory Group was involved throughout the study, including co-producing the focus groups with children and young people. Despite efforts to maximise participation, survey response rates were relatively low and some groups were less well represented than others. We were not able to gather sufficiently detailed data to develop a typology of Trailblazer sites, as was planned. We completed a mixed-methods evaluation combining quantitative and qualitative data collection across all 25 sites with in-depth qualitative insights from five purposively selected Trailblazers. The study comprised three work packages: •Work package 1: establishing the baseline and understanding the development and early impact of the Trailblazers. Participating education settings and key individuals who had a central role in the design and implementation of the MHSTs in their area were surveyed twice: December 2020 to May 2021 and October–November 2021. We received responses from 299 (30%, first survey) and 159 (17%, second survey) education settings; and from 76 (30%, first survey) and 65 (27%, second survey) key informants. We also interviewed the programme’s national leads (n  establishing the baseline and understanding the development and en  establishing the bn  establishing the baseline and understanding the development and early impact of the Trailblazers. d documentation, and the development of demographic and mental health service profiles for the 25 sites, using publicly available data. •Work package 2: more detailed research with a range of stakeholders in five purposively selected Trailblazer sites, including focus groups with children and young people. A total of 71 interviews were completed with local stakeholders including MHST lead organisations and staff, school and college staff, individuals in Trailblazer governance and management roles, and wider partners including specialist NHS mental health services, voluntary organisations and local authorities. Five online focus groups were held with a total of 32 children and young people who attended schools where MHSTs were operating. •Work package 3: scoping and developing options for a longer-term assessment of the programme’s outcomes and impacts. This work was highly responsive and included reviewing the design and methods of recent evaluations of initiatives and pilots similar to the Trailblazers; ongoing advice and discussions with, and commentary on preparatory work undertaken by, the national programme team; a draft theory of change; and a full proposal for an initial impact evaluation. The Institute for Mental Health Youth Advisory Group at the University of Birmingham acted as an expert reference group for this research, and were involved throughout: from design through to preparation of this report. A key part of their role was co-producing the focus group research with children and young people, including co-designing the recruitment materials and topic guides, co-facilitating the focus groups and contributing to the analysis and presentation of the findings (see Chapter 9). The study focused only on the first 25 Trailblazer sites in the programme. These sites were chosen for characteristics thought likely to drive rapid progress and learning and therefore the findings from this evaluation may not be reflective of experiences across the programme as a whole. Survey response rates were generally low, and some groups were less well represented in interview samples, including staff from educational settings and specialist NHS mental health services. The study did not include research to explore children and young people’s experiences of receiving mental health support from an MHST.

Project Status: Completed

URL for project: https://www.journalslibrary.nihr.ac.uk/programmes/hsdr/NIHR130818

Year Published: 2023

URL for published report: https://www.journalslibrary.nihr.ac.uk/hsdr/XQWU4117

URL for additional information: English

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: England, United Kingdom

DOI: 10.3310/XQWU4117

Organisation Name: NIHR Health Services and Delivery Research programme

Contact Address: NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK

Contact Name: journals.library@nihr.ac.uk

Contact Email: journals.library@nihr.ac.uk