Projects

Aim

To evaluate the Children and Young People’s Mental Health Trailblazer programme, a national programme aiming to improve the services and support for mental health and wellbeing provided to children and young people in educational settings. This early evaluation will be exploring what the new approaches and services look like, how they are being implemented and are working, and what progress is made in the first year of the programme.

Background

The Department for Education, Department of Health and Social Care and NHS England have selected areas across England to test out new ways of supporting children and young people with mental health problems. The new approaches and services are based in schools and further education colleges, and the aim is that they will help to prevent children developing mental health problems or mean that children who do have mental health problems are identified and supported earlier. The new ways of working include having a named person who will lead the school or college’s approach to mental health and wellbeing, and creating new mental health support teams which will work directly with those schools and colleges. This national programme started in 2018 and will run until 2023. The areas testing out the new approaches are called ‘trailblazers’ (Find out details of the areas involved in the programme).

In collaboration with the Policy Innovation and Evaluation Research Unit BRACE is carrying out an early evaluation of this programme. We will be focusing on the first 25 trailblazer areas.

Methods

The evaluation is organised into three work-streams:

1. Understanding the starting points and progress made across the 25 trailblazers areas. This involves analysis of programme monitoring and other routine data, and surveys and telephone interviews with key local stakeholders and organisations, which will be undertaken in early 2020 and again in early 2021. 

1. In-depth research in six case study trailblazer areas. Six trailblazer areas will be selected to take part in more detailed research. This work will include interviews with a range of people involved in the design and delivery of the new approaches and services in their area, such as staff members of the new mental health support teams, school staff and professionals working in NHS children and young people’s mental health services. It will also include focus groups with children and young people.
2. Assessing the feasibility and considering options for the design of a longer-term impact evaluation. Working with the national programme team, our project advisors and other key stakeholders, we will map what the main outcomes of the programme will be (in other words, what ‘success’ will look like) and then consider whether and how these outcomes could be measured, over what timescales they should be measured, and what kind of data we would need to do that. 

Working with children and young people

We are working with two groups of children and young people who are helping us to think about what the research should be focusing on and how it should be carried out. In particular, these groups will have an important role in helping us to design the focus groups with children and young people. These groups are:

• The National Children’s Bureau Young Research Advisors 
• The University of Birmingham Institute for Mental Health Youth Advisory Group

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Anticipated outputs

There will be two written reports from the project – one sharing early findings, and the other sharing the full findings from the project. These reports will be available from the BRACE website. We will also report what we found in other ways including:

• Presentations at conferences, seminars and other events
• Publishing our findings in academic journals
• Short summaries of our findings, including a summary for children and young people who are interested in knowing more about the project and what we found
• Blogs on the BRACE and PIRU websites
• Using social media, for example, Twitter

Dates

October 2019- July 2021

Project team

• Jo Ellins (Principal Investigator – contact person)
• Kelly Singh (Project Manager)
• Sarah-Jane Fenton
• Jenny Newbould
• Lucy Hocking
• Jack Pollard
• Katie Saunders
• Nicholas Mays (PIRU)
• Richard Grieve (PIRU)
• Stefanie Ettelt (PIRU)
• Mustafa Al-Haboubi (PIRU) 

Aim

To explore the experience of existing collaborations between GP practices in both rural and urban areas, to determine the costs and benefits of establishing and operating such GP collaborations, and examine what has helped or hindered their progress. 

Background

Many GP practices in England already collaborate with others and in some cases they have done so for many years.  These collaborations take many forms, including GP federations, super-partnerships, out-of-hours cooperatives, community health organisations, and care networks.  

The particular objectives, structures and working arrangements vary between collaborations and can change over time. Objectives for GP collaborations can include: improving health outcomes; managing demand; saving costs; integrating services; and developing new services in primary care settings.

The new GP contract requires all GPs to be in primary care networks by 1 July 2019, these being of 30,000 to 50,000 patient population in scale.  There is clearly a need for policy makers, practitioners and others to understand how best to establish and operate the new primary care networks, and to have evidence to inform how they can best be implemented, supported, and sustained over time.  

Methods

This evaluation project comprises a review of the existing UK and international research evidence on GP collaborations; a workshop with policy makers and researchers active in the field to identify the main gaps and weaknesses in the existing evidence base; and evaluation research within four case study sites.

The case studies will include GP collaborations that have so far experienced differing levels of success and that cover both urban and rural settings.

Anticipated outputs

• A final report submitted to the National Institute for Health Research, Health Services and Delivery Research stream (NIHR HS&DR) to be published in the NIHR Journals Library.
• A short summary report in digital format highlighting the overarching findings.
• Blogs and other comment pieces to highlight interim and final findings.
• Videos of research team members and others reflecting on the evaluation and its conclusions.
• One or more papers published in peer-reviewed, academic journals.
• Oral and/or poster conference presentations. 

Dates

September 2019 - January 2020

Project team

• Judith Smith [PI – contact person]
• Amelia Harshfield (PM)
• Sarah Ball
• Natasha Elmore
• Manni Sidhu
• Jon Sussex

Aim

To understand the early impacts of vertical integration: its objectives; how it is being implemented; whether and how vertical integration can drive the redesigning of care pathways; whether and how services offered in primary care settings change as a result; and the impact on the general practice and hospital workforces.

Background

Vertical integration, where acute hospitals or health boards take over the direct management of GP practices, has been outlined as one response to integrating the planning and delivery of primary and secondary services. There are several locations across the UK where acute trusts or health boards have taken over general practice contracts and are directly managing GP services, and are using this model of integration to redesign local services such as urgent care. Early impacts have been reported from one of these trusts, including a reduction in emergency hospital admissions and increasing access to GP appointments, but this has not been subject to independent evaluation. Beyond that, little is known about this model of integration.

Methods

The study comprises a scoping review of the existing UK and international research evidence on vertical integration; a workshop with policy makers and researchers to develop appropriate research questions; qualitative research with three case study sites; and follow up workshops with each site and policy makers to share findings. 

The case studies will include sites who have adopted three different approaches to directly managing GP practices across the UK.

Anticipated outputs: 

• A final report submitted to the National Institute for Health Research, Health Services and Delivery Research stream (NIHR HS&DR) to be published in the NIHR Journals Library.
• A short summary report in digital format highlighting the overarching findings.
• Blogs and other comment pieces to highlight interim and final findings.
• Videos of research team members and others reflecting on the evaluation and its conclusions.
• One or more papers published in peer-reviewed, academic journals.
• Oral and/or poster conference presentations. 

Project Duration

January 2019- March 2020

Project team and contact person

• Jon Sussex (PI- contact person)
• Jack Pollard
• Manbinder Sidhu

Aim

To rapidly identify and prioritise a shortlist of innovations to evaluate in adult social care and social work.

Background

There are many innovations in adult social care and social work across the UK. Therefore, it is necessary to horizon scan and identify top priorities for evaluation.

Methods

The horizon scanning and prioritisation work was undertaken by a team drawn from BRACE and RSET jointly. The identification of innovations followed an adapted version of the James Lind Alliance method for priority setting. We followed four steps:

1. Identification of innovations, seeking inputs from 182 stakeholders (individuals and organisations);
2. Development of criteria for shortlisting;
3. Grouping and sifting innovations;
4. Prioritisation of innovations in a workshop setting with 23 stakeholders including several service users.

Findings

One hundred and fifty-eight innovations were suggested. Twenty of these were included in the final shortlist. Twenty-three participants attended the prioritisation workshop. They included people who use adult social care services, practitioners, academics/researchers, commissioners/policy makers and carers. The top five priorities, which were agreed during the workshop, are described in the attached report, along with the key themes and principles that informed the prioritisation decisions.

Limitations

Given the short period of time available for the horizon scanning, certain innovations may have been missed from the final shortlist. Similarly, some innovations that were included may have already been, or currently are being evaluated.

Conclusion

This approach was successful in identifying a large number of innovations in a short period of time, developing a shortlist and identifying the top five priorities. The next stage will be to conduct further scoping of the top five innovations (and existing/planned evaluations), in order to identify two innovations that can be evaluated by the two rapid evaluation teams.

Project Duration

July 2019 to November 2019

BRACE project team and contact person

• Jon Sussex
• Amelia Harshfield (contact: aharshfi@rand.org )
• Katherine Cowan