The ‘Mental Health Service for Children and Young Adults aged 0-25’ in the Greater Birmingham Area: translation of evidence during the development and implementation of a new integrated service

West MidlandsGeneric Health Relevance
Start Date: 1 Jan 2014

Project description

The project investigates the design and implementation of a community and inpatient mental health service for children and young adults aged 0-25. The new service has been commissioned by Birmingham South Central CCG and aims at improving the management of patients in the teenager-adult transition. Before its introduction, patients aged 16-25 experience three separate pathways (i.e. 0-16; 16-18 and adult pathway 18+ patients), each with a different approach and providers. Such segmentation has led to poor clinical outcomes and patient and carer experience. Research-based evidence has called for an integrated pathway, where 16-25 patients are managed with a single approach and set of providers, thus avoiding dramatic transitions in terms of service and settings of care. From the perspective of CLAHRC WM, the development and implementation of the 0-25 Service are extremely precious to investigate how a complex network of organizations acquires, negotiates and transforms knowledge (and, in particular, research-based evidence) to address macro-level demands from patients and commissioning groups as well as micro-level demands and requirements within organizations and professionals groups. In particular, it represents an important occasion to investigate how networks of healthcare providers are able to organize their professional frontline (typically careful to protect their autonomy and practices) for a radical change. Following this, we will investigate the ‘translation’ of knowledge as a complex and pluralist phenomenon, i.e. the research team will investigate how actors in the network use and transform a combination of research-based evidence about clinical and cost effectiveness, patient/carer experience, clinicians’ experiences and viewpoints – to address external and internal demands.Methodologically, the research follows the translation ‘journey’ through which preliminary ideas and templates of reinventing the service are translated into actual practice. Particularly, the process leading to the identification of Forward Thinking Birmingham as preferred provider will be investigated through a retrospective case study; while the implementation process will be investigated in real-time and prospectively. We will in particular investigate: (i) how different partners had developed their proposal (i.e. how they acquired, assimilated and transformed evidence to outline a 0-25 service that proved particularly successful in eliciting CCGs’ positive response); (ii) how CCGs have identified the preferred provider and managed the bidding process; (iii) how the knowledge/evidence embedded in service proposals are translated and possibly transformed during the actual implementation in real-life contexts (and thus: what is the fidelity between the original proposal and the implemented service, and what explain the differences); (iv) how evidence has been selected, used, interpreted, adopted and created throughout these processes; (v) what are the interactions between different personnel within a wide and heterogeneous network of healthcare, social care, and other organizations.

Dr Giovanni Radaelli