Effect of a needs-based model of care on the characteristics of healthcare services in England: the i-THRIVE National Implementation Programme

Aims: Developing integrated mental health services that focus on the needs of children and young people is a key policy goal in England. The THRIVE Framework and its associated implementation programme, i-THRIVE, are now used in areas covering over 65% of England's children. This study explores the experiences of staff involved with the i-THRIVE programme, assesses its effectiveness, and examines how local system working relationships influence the programme's success. Methods: The i-THRIVE programme was evaluated using a quasi-experimental study among twenty participating sites (ten implementation and ten comparison sites). Measurements included surveys of staff and leaders at each site and assessment of the "THRIVE-like" features of each site. Additional site-level characteristics were collected from health system reports. The effect of i-THRIVE was evaluated using a four-group propensity-score weighted difference-in-differences model; the moderating effect of local system working relationships was evaluated with a difference-in-difference-in-differences model. Results: Staff at implementation sites were more likely to report using THRIVE in their own practice and exhibited better knowledge of THRIVE principles than comparison sites. The mean improvement among i-THRIVE sites was 16.7, and 8.8 among comparison sites. The results show that strong working relationships in the local system significantly enhances the effectiveness of the i-THRIVE programme. Sites with highly effective working relationships showed a notable improvement in "THRIVE-like" features, with an average increase of 16.41 points (95% confidence interval: 1.69—31.13, p-value: 0.031) compared to control sites. In contrast, sites with ineffective working relationships did not benefit from the i-THRIVE programme (-2.76, 95% confidence interval: -18.25—12.73, p-value: 0.708). This influence of working relationship effectiveness was consistent across various levels of THRIVE features. Conclusions: The findings underscore the importance of working relationship effectiveness in the successful adoption and implementation of health policies like i-THRIVE.