title: A systems relations model for Tier 2 early intervention child mental health services with schools: an exploratory study.
abstract: Over the last 15 years, policy initiatives have aimed at the provision of more comprehensive Child and Adolescent Mental Health care. These presented a series of new challenges in organising and delivering Tier 2 child mental health services, particularly in schools. This exploratory study aimed to examine and clarify the service model underpinning a Tier 2 child mental health service offering school-based mental health work. Using semi-structured interviews, clinician descriptions of operational experiences were gathered. These were analysed using grounded theory methods. Analysis was validated by respondents at two stages. A pathway for casework emerged that included a systemic consultative function, as part of an overall three-function service model, which required: (1) activity as a member of the multi-agency system; (2) activity to improve the system working around a particular child; and (3) activity to universally develop a Tier 1 workforce confident in supporting children at risk of or experiencing mental health problems. The study challenged the perception of such a service serving solely a Tier 2 function, the requisite workforce to deliver the service model, and could give service providers a rationale for negotiating service models that include an explicit focus on improving the children's environments.
authors.affiliation: Community CAMH Early Intervention and Prevention Service, Alma Street, Luton, UK. marc.vanroosmalen@sept.nhs.uk
authors.forename: Marc
authors.initials: M
authors.lastname: van Roosmalen
authors.forename: Catherine
authors.initials: C
authors.lastname: Gardner-Elahi
authors.forename: Crispin
authors.initials: C
authors.lastname: Day
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services; D019090:Case Management; D002648:Child; D002662:Child Health Services; D002675:Child, Preschool; D003695:Delivery of Health Care / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services; D008962:Models, Theoretical; D012017:Referral and Consultation; D012572:School Health Services