i-THRIVE Grids are an exciting new advancement in the area of shared decision making with young people, families and clincians. Supported by a generous Health Foundation grant, researchers at the Anna Freud National Centre for Children and Families have now created six distinct grids for initial use within child and adolescent mental health services, or CAMHS.
Snapshot of the i-THRIVE Grid for "Difficulties sitting still or concentrating: Support outside of the NHS" (Image credit: Author's own)
These decision aids have been co-created with service users, experienced clinicians, i-THRIVE Community of Practice members, educators, researchers, and other experts working with children and young people. The grids are grounded in the THRIVE framework for conceptualising need, which is a much-needed alternative to the current tier-based system in mental health care.
The i-THRIVE Grids cover three of the four quadrants of the THRIVE framework -- Getting Advice, Getting Help, and Getting More Help. Three of the most common presenting difficulties are covered, including low mood, difficulties sitting still or concentrating, and self harm.
Theoretical underpinning of the i-THRIVE Grids
The Dartmouth Institute for Health Policy and Clinical Practice in the United States has developed a decision aid called an "Option Grid™" which is a concise, one-page tool for comparing different treatment options for various physical and mental health difficulties. These grids have been user-tested and have been shown not to significantly increase the time spent in the clinical encounter, which is a common worry amongst clinicians about introducing decision aids into their practice. Additionally, the grids appear to facilitate shared decision making and to lead to increased patient knowledge physical health care.
Researchers at the Anna Freud NCCF are collaborating with Dartmouth to design the i-THRIVE Grids in a similar manner to the Option Grids™. These decision aids will be designed for use in CAMHS as well as community and voluntary sector services working with children and young people. In fact, the simplicity of the Option Grids™ format suggests that, in the future, these tools could even be used in more informal settings like schools and youth groups.
As Option Grids™ were originally designed for adults (or parents) rather than young people, researchers at the Anna Freud NCCF have employed a graphic designer, Elizabeth Raby, to make the i-THRIVE Grids more appealing and accessible to children and young people. The overall look of the grids is still being refined with help from the young person and parent Expert Reference Groups at the Anna Freud NCCF and clinicians who are currently trialling the grids in their practice.
Current work on the i-THRIVE Grids and future directions
In developing the i-THRIVE Grids, researchers followed the process for determining what matters most to patients that was laid out by Paul Barr in a national survey of individuals with depression. After an exhaustive review of the literature, the research team at the Anna Freud defined a list of frequently asked questions around patient and parent treatment preferences for each presenting difficulty.
Some of the most common questions included, "What will this involve?," "Are there any risks or side effects to this type of treatment/support?," and "Will I see the same person for the duration of this treatment?" This list of FAQs was then placed on SurveyMonkey, and parents and young people (recruited through the Anna Freud, Facebook, message boards and support groups) then chose their top five most important questions when considering treatment or care.
Current i-THRIVE Grid for "Low mood: Support in the NHS" (Image Credit: Author's Own)
Using What Works for Whom, the NICE guidelines, NHS Choices, and expert consensus, researchers determined the range of treatments available for each presenting difficulty. This has been challenging as service provision differs from one region to another and even across boroughs within London.
However, the aim of the grids is to be general enough to be relevant to many different areas, while specific enough to delineate distinct treatment options and generate conversation around patient preference and choice. Overwhelmingly positive feedback about the grids that was received at the i-THRIVE Community of Practice meeting in Manchester was particularly helpful in distinguishing the support that is available in different areas across the UK.
Feedback from attendees at the i-THRIVE Community of Practice event in Manchester - November 2016 (Photo Credit: Author's own)
Trialling the Grids at the Tavistock and Portman NHS Foundation Trust in London
The Tavistock and Portman NHS Foundation Trust, an i-THRIVE accelerator site, is leading the way by being the first location to trial the i-THRIVE Grids in clinical practice as part of a Quality Improvement Project. Clinicians in assessment clinics at the Tavistock are currently assisting researchers in gathering data about parents' and young people's experience of the service and their current perceptions about shared decision making in the service. These data will be compared with data after the introduction of the I-THRIVE grids (which took place in February, 2017) to determine whether the i-THRIVE Grids significantly improve shared decision making in clinical practice.
The Tavistock is also helping to refine the grids by participating in Plan-Do-Study-Act (PDSA) cycles, a quality improvement technique for gaining knowledge and continually improving the grids. This ensures that the grids are clinically relevant and creates a feedback loop between clinicians at the Tavistock and researchers from the Anna Freud NCCF that will promote learning and swift application of findings. Once refined, the i-THRIVE Grids will be available for i-THRIVE Community of Practice members to download as part of the i-THRIVE Toolkit and to use in their clinical work.
The grids are still being refined and any comments and feedback are welcome. Please email firstname.lastname@example.org or email@example.com with any feedback, questions or comments and to receive an updated draft of the grids to look over.