Evaluating the Children and Young People's Mental Health Trailblazer programme
An early evaluation of the Children and Young People’s Mental Health Trailblazer programme examined the development, implementation and early progress of the 25 mental health support teams created as the first step of the programme.
What is the issue?
The Children and Young People’s Mental Health Trailblazer programme was launched by the government in 2018. Jointly led by the Department of Health and Social Care, Department for Education and NHS England and Improvement, the programme aims to test out new ways of supporting children and young people with mild to moderate mental health problems in educational settings.
The first step of the programme created mental health support teams (MHSTs) in 25 Trailblazer sites across the country. MHSTs are intended to provide early intervention on some mental health and emotional wellbeing issues as well as to help school or college staff provide a ‘whole school approach’ to mental health and wellbeing.
How did we help?
The BRACE Rapid Evaluation Centre, of RAND Europe, the University of Birmingham and the University of Cambridge, with partners from the Policy Innovation and Evaluation Research Unit, undertook an early evaluation of the Trailblazer programme to examine the development, implementation and early progress of the MHSTs in the Trailblazer sites.
This involved a survey of participating educational settings; a key informants survey of local stakeholders who played a central role in the design and implementation of MHSTs in their site; in-depth research in 5 case study sites; focus groups with children and young people; group interviews with members of the regional teams that were supporting and overseeing implementation of the programme; and analysis of programme monitoring data and documents. We also scoped and developed options for a longer term impact evaluation of the programme.
What did we find?
- The Trailblazer sites had achieved a great deal in a relatively short space of time. The local set up process had been extensive, complex and rushed, involving establishing new governance bodies and engaging stakeholders across sectors. There was a view that the way in which the programme had been set up was dominated by the NHS and 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.
- MHSTs had implemented strategies to reach and engage diverse groups and different mental health needs. However, some groups were felt to be underserved by MHSTs, including those who were neurodiverse or with special educational needs, those from ethnic minority backgrounds and some religious backgrounds, and children with challenging family or social circumstances.
- Defining what was within the scope of 'mild to moderate' mental health was challenging. Some sites held a firm boundary whereas others provided support to those with more complex needs. Concern was expressed about young people falling through the gap between MHSTs' 'mild to moderate' remit and the criteria for specialist support.
- Retaining education mental health practitioners once in post was one of the biggest challenges reported by Trailblazers. Interviewees identified various reasons for poor retention including the role being seen as a stepping-stone to other careers, lack of opportunities for career development and progression, high workloads, and frustration about the limitations of the CBT approach.
- Children and young people were not always aware that there was an MHST in their education setting, or what it did. Those who had had direct contact with the team had reported universally positive experiences.
- Education settings reported positive early effects of the programme, including staff feeling more confident talking to young people about mental health issues; being able to access advice about mental health issues more easily; and having quicker access to support for young people. Improvements in children and young people's understanding of mental health and wellbeing was also widely reported, as was strengthened relationships between education settings, mental health services and other local partners. However, a mismatch between education settings' expectations or perceived support needs and what MHSTs could offer was sometimes reported, which hampered relationship building.
What can be done?
Key implications of the study findings for a longer-term evaluation include:
- The substantial heterogeneity between sites, in terms of what has been implemented and how, points away from making on an overall assessment of 'programme impact', and towards making comparisons within the programme.
- There is considerable value in the longer-term evaluation focusing on understanding which groups of children and young people, and which mental health problems, the standard MHST intervention is less suitable or beneficial for.
- Consideration must be given to which outcomes to measure, in consultation with young people and parents/carers. Some of the outcomes expected at the start of the programme may no longer be realistic, especially those relating to service use, given the impact of COVID-19.
- Careful work will be required to define the programme's 'ecological' impacts, and when these might be expected to occur since whole school effects are likely to be more diffuse and take longer to become visible.