Organising, sustaining, experiencing and integrating mental health crisis care for children and young people: qualitative findings from eight contrasting case studies in England and Wales.

<ns5:p>Background Crisis services are an important part of the system of mental health care for children and young people (CYP), but little is known about them or the experiences of CYP and families. This article reports findings from a normalisation process theory (NPT)-informed sequential mixed methods study, comprising three work packages (WPs), which set out to generate new knowledge in this area. Methods Approaches to CYP crisis care across England and Wales were mapped in WP1 using survey design. Previously reported findings from this WP point to heterogeneity in service types and interventions. In WP2 eight contrasting services (five in England, three in Wales) were selected from WP1 survey returns as case studies. In each case, interviews were held with CYP, parents/carers, commissioners, managers, practitioners and others. Within-case data were analysed using both NPT-informed framework, and inductive, approaches. In WP3 a cross-case synthesis led to the identification of key principles for future policy, services and practice. Results A total of 137 people took part in interviews (25 CYP, 25 parents/carers, 45 practitioners, 28 managers, seven commissioners and seven local stakeholders). Each service’s planned, deliberative, approach to crisis care implementation for CYP revealed strategic intentions, but variation was found in aims, goals and experiences. Differences were found in local capacities to adapt, negotiate and reframe available resources. Significant variation existed in the coherence of the crisis care offer, and with how individuals and groups worked alone and together to participate in implementation. Likewise, diversity was revealed in the effects crisis services exerted within their local systems. Conclusions Key principles underpinning the whole-system provision of sustainable mental health crisis care for CYP include: accessibility; the need for support in navigating complex systems; clarity on the offer; staff expertise and interpersonal skills; targeted services; continuity; flexibility balanced with stability; and service integration.</ns5:p>