Aims and Scope
The Scottish Government has long recognised the importance of early intervention and prevention approaches to mental health and wellbeing, in order to help children and young people have the best start in life. Through the Government’s commitment to the improvement of mental health and wellbeing in Scotland, there has been notable progress in increasing services to children and young people with significant mental health difficulties. It is well recognised, however, that there is still a gap in provision for those who would benefit from mental health intervention but whose needs do not meet referral criteria for specialist mental health services, or who may be at future risk of adverse outcomes. As part of the Scottish Government’s commitments in the current Mental Health Strategy (2017-2027), the Early Intervention Framework has been developed with the aim of improving the use of prevention and early intervention approaches for children and young people’s mental health and wellbeing. Well targeted prevention and early intervention programmes can substantially reduce the risk of future mental health difficulties, which will ultimately, improve the health and wellbeing of Scotland’s children and young people, and their families.
Whilst there are already clearinghouses and published evidence summaries which provide information about different psychosocial intervention programmes for children and young people’s mental health and wellbeing, and which often have included effectiveness ratings about different programmes, the aim of this Framework is to extend beyond the evidence by including information about implementation considerations and how programmes and approaches might fit within a local Scottish context.
The Early Intervention (EI) Framework utilises an Implementation Science approach and draws upon the work of the National Implementation Research Network (NIRN), specifically the Hexagon Exploration Tool (Metz & Louison, 2018). It uses the six dimensions of the Hexagon Tool to rate each intervention: three factors related to the early intervention programme itself (usability, supports and evidence), and three factors relating to the ability of the implementing site to properly apply the intervention (capacity, fit and need). Each of these criteria are scored on a 1-5 rating scale.
The development of the EI Framework was undertaken in phases, in partnership with multi-sector stakeholders throughout Scotland with experience and expertise around Children and Young People’s Mental Health, from across Health and Social Care, Education and the Third Sector.
What is included in the Early Intervention Framework?
The focus of the Early Intervention Framework is psychologically informed prevention and early intervention approaches which could be used to help a child or young person who would not be diagnosed with a mental health difficulty. The focus is on approaches which concentrate on how to respond to different types of mental health and wellbeing needs, rather than how to respond to diagnosis.
In order to ensure that the interventions and approaches included in the Framework met the aims of the Framework, a series of inclusion and exclusion criteria were developed to guide this work, which are listed below. All interventions and approaches captured within the Early Intervention Framework need to have a prevention and/or early intervention focus and have been designed with a primary intention of improving mental health and wellbeing. Exclusion of interventions or approaches from the Framework does not suggest that the programme is problematic, but rather that it is not sufficiently aligned with the focus of the Framework.
The following requirements for inclusion and exclusion underpin the programmes and approaches outlined in the Framework:
- Is applicable to children and/or families at some point between the antenatal period until age 18 years
- A psychosocial prevention or early intervention approach with a primary intended outcome of improving children’s mental health
- Has the potential to achieve measurable mental health and mental wellbeing outcomes for children
- Is evidence based– approaches must meet a minimum standard of evidence before being included
- The minimum standard of evidence is:
- The programme or practice is guided by a well-developed theory of change or logic model, including clear inclusion and exclusion criteria for the target population, that may not yet have demonstrated effectiveness through a research study
- Must be sufficiently specified so they can be replicated:
- The programme or practice with operationalised principles and values and core components that are measurable and observable but may not yet have a fidelity assessment or identified modifiable practice components
Programmes were excluded based on the following criteria:
- If the programme or approach was not developed with a primary intended outcome of improving children’s mental health and mental well-being (If mental health or mental well-being was and secondary or tertiary outcome, the programme or approach was excluded)
- If the practice was related principally to professional development
- If the practice was conceptually too broad or was intended to be just conceptual in nature
- If the practice was a framework/implementation system or general approach to working
The Range of Interventions and Approaches Included
The Early Intervention Framework includes prevention and early intervention approaches for mental health and wellbeing for children and young people from the antenatal period, until 18 years. As such, the range of programmes included in the Framework is quite broad. Interventions and approaches include:
- at those where there is early indication of difficulty
- at those considered at risk of developing difficulties
- At whole population, community or service level
- Those that work with
- parents or carers
- parents or carers and children and young people
- children or young people
- A focus on the social, emotional or behavioural needs of children and young people, including the development of strong and supportive relationships between parents and their children
The Early Intervention Framework provides a range of information for each identified intervention or approach including:
- A summary of the core components of the intervention or approach
- Implementation requirements such as; training components, ongoing coaching and supervision requirements, implementing related costs and available supports
- Information on the effectiveness and supporting evidence of programmes and approaches
Crucially, the Framework captures key implementation considerations, specifically related to the local community’s needs, capacity to implement and how well or not this aligns with the core values and priorities specific to a programme or approach (fit). This is to allow greater emphasis to be placed on the specifically Scottish context in which each programme or approach would be used. The Framework does not make recommendations about which interventions services should use, but rather, supports an exploration of implementation issues needing examination at a local level, in order to compare what options are available and guide robust investment decision making.