title: Development of a framework for prospective payment for child mental health services.
abstract: OBJECTIVE
  There is a need to develop a payment system for services for children with mental health problems that allows more targeted commissioning based on fairness and need. This is currently constrained by lack of clinical consensus on the best way forward, wide variation in practice, and lack of data about activity and outcomes. In the context of a national initiative in England our aim was to develop a basis for an improved payment system.
  
  
  METHODS
  Three inter-related studies: a qualitative consultation with child and adolescent mental health services (CAMHS) stakeholders on what the key principles for establishing a payment system should be, via online survey (n = 180) and two participatory workshops (n = 91); review of relevant national clinical guidelines (n = 15); and a quantitative study of the relationship between disorders and resource use (n = 1774 children from 23 teams).
  
  
  RESULTS
  CAMHS stakeholders stressed the need for a broader definition of need than only diagnosis, including the measurement of indirect service activities and appropriate outcome measurement. National clinical guidance suggested key aspects of best practice for care packages but did not include consideration of contextual factors such as complexity. Modelling data on cases found that problem type and degree of impairment independently predicted resource use, alongside evidence for substantial service variation in the allocation of resources for similar problems.
  
  
  CONCLUSIONS
  A framework for an episode-based payment system for CAMHS should include consideration of: complexity and indirect service activities; evidence-based care packages; different needs in terms of impairment and symptoms; and outcome measurement as a core component.
authors.affiliation: Professor of Child Psychiatry, University of Leicester, UK pv11@le.ac.uk.
authors.forename: Panos
authors.initials: P
authors.lastname: Vostanis
authors.affiliation: Lead Statistician, Evidence Based Practice Unit, University College London and the Anna Freud Centre, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Martin
authors.affiliation: Clinical Psychologist, City and Hackney CAMHS, East London Foundation Trust, UK.
authors.forename: Roger
authors.initials: R
authors.lastname: Davies
authors.affiliation: Lecturer in Statistics, University College London, UK.
authors.forename: Davide
authors.initials: D
authors.lastname: De Francesco
authors.affiliation: Improvement Programme Lead, Evidence Based Practice Unit, University College London and the Anna Freud Centre, UK.
authors.forename: Melanie
authors.initials: M
authors.lastname: Jones
authors.affiliation: Clinical Psychologist, City and Hackney CAMHS, East London Foundation Trust, UK.
authors.forename: Ruth
authors.initials: R
authors.lastname: Sweeting
authors.affiliation: Pilot Site Manager, Evidence Based Practice Unit, University College London and the Anna Freud Centre, UK.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Ritchie
authors.affiliation: Reader in Health Services Organisation, Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, UK.
authors.forename: Pauline
authors.initials: P
authors.lastname: Allen
authors.affiliation: Director, Evidence Based Practice Unit and Child Outcomes Research Consortium, University College London and the Anna Freud Centre, London.
authors.forename: Miranda
authors.initials: M
authors.lastname: Wolpert
mesh_terms: D002648:Child; D002662:Child Health Services / Q000191:economics*; D004739:England; D005102:Health Expenditures; D006801:Humans; D008605:Mental Health Services / Q000191:economics*; D011787:Quality of Health Care / Q000191:economics*; D012051:Reimbursement Mechanisms / Q000191:economics*
keywords: case-mix; child mental health services; episode of care; provider payment