Early evaluation of the Children and Young People’s Mental Health Trailblazer programme: a rapid mixed-methods study

In 2017, the then Department of Health and Department for Education published the ‘Transforming Children and Young People’s Mental Health’ Green Paper. The Green Paper set out proposals for improving the services and support available to children and young people with mental health problems, with a particular focus on enhancing provision for those with low-moderate needs within school and college settings. The proposals had three main elements: 

• Incentivising schools and colleges to identify a Designated Senior Lead (DSL) for Mental Health to oversee the approach to mental health and wellbeing. 

• The creation of Mental Health Support Teams (MHSTs), providing specific extra capacity for early intervention and ongoing help, and supporting the promotion of good mental health and wellbeing in education settings. 

• Trialling a four week waiting time for access to specialist NHS children and young people’s mental health services. 

 The proposals were implemented as a large-scale pilot programme in four cumulative waves of MHSTs, with the aim of including 20-25% of children and young people in England by 2022-23. The programme roll-out has continued with further waves of MHSTs.

The first wave involved 25 trailblazer sites and the creation of 59 MHSTs to support children and young people in more than a thousand education settings (including primary and secondary schools, special schools, colleges and other settings such as pupil referral units). 

MHSTs were designed to have three functions:

i)   delivering evidence-based interventions to children and young people with mild-moderate mental health needs;

ii)  working with education settings to support a ‘whole school approach’ to mental health and wellbeing; and

iii) supporting coordination and joint working with other providers in the area. Areas will have flexibility to tailor their approach to local needs and circumstances and therefore some variation in service models and how they are implemented is expected. 

The first teams began in January 2020, coinciding with the very beginnings of the COVID-19 pandemic. 

The aim of the early evaluation was to examine the development, implementation and early impacts of the trailblazer programme. The evaluation explored how service delivery models and implementation strategies differed across trailblazer areas, highlighting the factors (e.g. local contexts) that inhibited or promoted success and drawing out the practical implications of the findings for the development of the programme and any longer term evaluation. 
 
The specific objectives were to:  

• Contribute to wider work being undertaken by the Department of Health and Social Care (DHSC), Department for Education (DfE) and NHS England (NHSE) to assess the accessibility, quality and effectiveness of existing mental health services and support in education settings and identify gaps in current provision in the trailblazer areas. 

• Describe and understand the emerging delivery models, their leadership and governance, and explore how these vary across the trailblazer areas and the potential implications of this variation for future effectiveness. This includes examining how new roles and services are working in practice, what is working well and what is not, and barriers and facilitators to successful implementation. 

• Describe the experience of MHSTs, school leads, clinical commissioning groups (CCGs), child and adolescent mental health services (CAMHS) and others of taking part in the delivery of the programme. 

• Capture the progress of the trailblazers towards key milestones and objectives, early impacts and any unanticipated consequences in the initial phases of the programme. 

• Identify measures and data sources of relevance to assessing programme outcomes and costs as well as appropriate comparator areas and education settings in order to assess the feasibility and develop the design of a long-term outcome and economic evaluation. 

• Conduct formative and learning-oriented research, producing timely findings and highlighting their practical implications to inform future implementation as the programme progresses. 

A two-phase evaluation was undertaken as a collaboration between PIRU and the Birmingham, RAND and Cambridge Evaluation (BRACE) Centre. The early evaluation, July 2019-February 2021, focussed on the first wave (trailblazer) of the programme and two of the programme’s main components: designated senior leads for mental health and mental health support teams.

This was to be followed by a summative assessment of the programme’s longer-term outcomes and impacts, including an economic evaluation to be competitively tendered by NIHR.

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 MHSTs 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. MHSTs 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 MHSTs’ therapeutic functions.

Issues for future programme development included:

• 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.