The impact of a needs-based model of care on accessibility and quality of care within children's mental health services: A qualitative investigation of the UK i-THRIVE Programme.

BACKGROUND: The i-THRIVE Programme is a needs-based model of care, based on the THRIVE Framework, that is being implemented across the United Kingdom with the aim of improving outcomes for children and young people's mental health and wellbeing. This study aimed to investigate the impact that this programme has on accessibility and quality of care, as viewed by key stakeholders. METHODS: Interviews with professionals and service users were conducted during the implementation of the THRIVE Framework in four sites of one mental health and community service provider. RESULTS: Three themes are identified: 'impact of needs-based groupings on referral', 'impact of collaborative and interagency approach' and 'impact of i-THRIVE on clinical practice'. Findings suggest that accessibility was seen to be promoted through the integration of a needs-based approach, flexible re-referral, signposting and information sharing, the use of goal-orientated interventions and collaboration over risk and treatment endings. Shared decision making was perceived to improve the experience of care for young people, as was interagency working. Goal-focused interventions and upfront discussion of treatment endings were seen to help clinicians manage expectations and discharge but could also compromise effectiveness and engagement. Obstacles to impact were resistance to interagency working and a shortage of resources across the system. CONCLUSIONS: i-THRIVE is a promising approach with the potential to facilitate the accessibility and quality of mental health care. However, a tension exists between enhancing accessibility and quality of care, which points towards the importance of outcome and satisfaction monitoring. Obstacles to impact point to the importance of a whole-system approach supported by sufficient resources across the locality.

Correction and repair: a comparative analysis of a boy with ASD interacting with a parent and with an ABA trainer.

Applied Behaviour Analysis (ABA) is a widely used therapeutic intervention for children with autism spectrum disorder (ASD) yet there has been little research into the interactional organization of ABA sessions. We report a comparative case study of two interactions in which the same child, a 12-year-old boy with ASD, interacts with his father and interacts with an Applied Behaviour Analysis (ABA) trainer. Both interactions occur at home and are drawn from a small corpus (2 h) of children with ASD in domestic settings. Drawing on CA to delineate the sequential relationships between the actions of the adult participant and the child, we present a quantitative and microstructural analysis of 156 directive sequences in order to examine the similarities and differences between the two interactions. We first show that the rate of the production of directives is higher in the ABA session. The analysis then demonstrates the applicability of Schegloff, Jefferson and Sacks' (1977) treatment of repair in conversation to some problems that occur in how the child responses to adults' directives. However, we show that whilst some correction-initiations target problems with hearing, speaking, and understanding, some target substantive problems. We identify a practice, explicating an error, whereby correction-initiations are expanded to point out the nature of the error. This practice can show that the correction-target is being construed as a substantive error. In such cases, the correction-initiation is not a subtype of repair-initiation in the sense of Schegloff, Jefferson and Sacks' (1977) analysis of repair.

Gearing up to a new activity: how teachers use object adjustments to manage the attention of children with autism.

Children with autism have characteristic difficulties with joint attention. In educational settings, this can present a challenge when directing a child's attention to new objects and activities. Drawing on videotaped interactions between teachers and two children with autism recorded in Finland, we use conversation analysis to examine how teachers manage such transitions during one-to-one teaching. We show how adjusting material objects can be used to manage the child's engagement and how these adjustments can escalate into more conspicuous actions so as to direct the child's attention. Rather than examining participants' use of communicational objects, we are instead concerned with practices that use task-related objects. We thereby offer an empirically grounded account of the interactional practices involved in achieving joint attention through the objects themselves.