Supporting young people who are leaving child and adolescent mental health services
Intended for healthcare professionals
Evidence and practice    

Supporting young people who are leaving child and adolescent mental health services

Sarah Bisp Lecturer in mental health nursing, Department of Nursing, Midwifery & Health, Northumbria University, Newcastle-upon-Tyne, England
Wendy Robertson Deputy chief executive officer, Thurrock and Brentwood Mind, Grays, England
Stevie Attree Personalised care lead, Mid and South Essex Integrated Care Board, Basildon, England

Why you should read this article:
  • To recognise the challenges faced by young people, families and clinicians at discharge from CAMHS

  • To enhance your understanding of the benefits of personalised care planning

  • To read how the Positive Pathways service in Essex supports young people leaving CAMHS

Transitioning from child and adolescent mental health services (CAMHS) to adult services can be challenging for young people, their families and clinicians. Assessment of, and support for, young people’s needs at the point of transition can be enhanced through personalised care and support planning. This article describes a service improvement project which aimed to provide ‘step-down’ support for young people on discharge from a CAMHS. The service, called Positive Pathways, involved collaborative personalised care planning with a dedicated youth facilitator, social prescribing, and in some cases the provision of a personal health budget, to enable young people to access individualised support in their local community.

Mental Health Practice. doi: 10.7748/mhp.2022.e1628

Peer review

This article has been subject to external double-blind peer review and checked for plagiarism using automated software

Correspondence

s.bisp@northumbria.ac.uk

Conflict of interest

None declared

Bisp S, Robertson W, Attree S (2022) Supporting young people who are leaving child and adolescent mental health services. Mental Health Practice. doi: 10.7748/mhp.2022.e1628

Acknowledgements

The authors would like to thank Helen Farmer, associate director of children’s services, Mid and South Essex Integrated Care Board; Jane Itangata, (interim) deputy director of mental health and health inequalities, Mid and South Essex Integrated Care Board; Janet Blair, senior programme manager, Personalised Care Group, NHS England; the local CAMHS teams; and the participants in the service improvement project, who are at its centre

Funding

The service improvement project described here was funded through Transformation in Mental Health as part of the NHS England NHS Long Term Plan

Published online: 29 September 2022

In recent years there has been increased recognition of the need to address the inequities experienced by people with mental health issues in their access to care and in the quality of care they receive. The promotion of mental health and well-being was included in the United Nations Sustainable Development Goals (United Nations 2015), which emphasised that mental health is a priority for global development (Votruba and Thornicroft 2016). Sharing innovations in mental health care is central to meeting the Sustainable Development Goals (Votruba et al 2014, Patel et al 2016).

This article describes a service improvement project designed to provide ‘step-down’ support for young people on discharge from a child and adolescent mental health service (CAMHS), which involved collaboration between several mental health professionals and organisations. The article outlines how personalised care planning in collaboration with a dedicated youth facilitator, social prescribing and, in some cases the provision of a personal health budget, have enabled young people to access individualised support in their local community.

Mental health issues

Mental health issues affect between 10% and 20% of children and young people globally, with long-lasting negative effects throughout life (Kieling et al 2011). In England, the prevalence of mental health issues among children aged between five years and 15 years rose from 9.7% in 1999 to 11.2% in 2017 (Royal College of Paediatrics and Child Health 2020). Some authors have suggested that this increase was due in part to a lack of resources to adequately meet demand (Vostanis 2017).

A report by the Children’s Commissioner in England noted that the proportion of children and young people aged between five years and 19 years with a ‘probable’ mental health condition had increased from one in nine in 2017 to one in six in 2020 (Children’s Commissioner for England 2021). The report also noted there had been a 35% increase in the number of children and young people referred to CAMHS in 2019-20 compared with 2018-19, but only a 4% increase in the number of children and young people receiving support from CAMHS in the same period (Children’s Commissioner for England 2021).

The UK government has made several proposals to improve and increase investment in CAMHS (NHS England 2016, Department of Health and Department for Education 2017, Fonagy et al 2017). Initiatives such as the Children and Young People’s Improving Access to Psychological Therapies programme (Fonagy et al 2017) aim to improve access to services and reduce waiting times (Ludlow et al 2020, Ellins et al 2021). There is, however, always scope for further improvement.

Mental health services in the UK focus on person-centred care, well-being and recovery (Turner et al 2015). This is emphasised in the NHS Long Term Plan (NHS England 2019), which sets out an agenda for the NHS to engage with people in a more person-centred way, with a shift in philosophy from ‘What’s the matter with you?’ to ‘What matters to you?’. Person-centred care can be facilitated by personalised care and support planning, described by NHS England (2022a) as a collaborative exploration of the management of a person’s health and well-being in the context of their life and family situation and an ‘essential tool to integrate the person’s experience of all the services they access so they have one joined-up plan that covers their health and wellbeing needs’.

Transition from CAMHS

Key points

  • Young people discharged from children and adolescent mental health services (CAMHS) are at high risk of fragmented support

  • Person-centred care for young people with mental health issues can be facilitated by personalised care and support planning

  • Personal health budgets are a way of personalising care based on a person’s individual strengths and needs

  • The Positive Pathways service in Essex provides ‘step-down’ support to young people discharged from CAMHS using personalised care planning and personal health budgets

Transition from children’s to adult health or social care services is identified as a point at which young people are at high risk of fragmented support and suboptimal outcomes (National Institute for Health and Care Excellence 2016). It has been reported that the gap between discharge from CAMHS and admission to adult mental health services can pose significant risks to young people in terms of their recovery and quality of life (Abidi 2017, Dunn 2017, Appleton et al 2021, Cajão et al 2021). Research has also shown that young people involved with CAMHS can experience anxiety about being discharged (Dunn 2017) and that clinicians can experience personal and professional challenges when discharging young people, including anxiety about, and a lack of skills and training in, managing the transition process (Abidi 2017, Cajão et al 2021).

To allay clinicians’ and families’ concerns about the lack of post-discharge support, young people often remain in CAMHS beyond the point at which they could be discharged. In the authors’ experience, this can create further issues, such as increased waiting times for children and young people who are on the waiting list for support from CAMHS and increased workload for clinicians. The assessment of young people’s needs at the point of transition between children’s and adult mental health services can be enhanced by personalised care and support planning, which can support young people and their families to maintain mental health and develop resilience (Abidi 2017, Appleton et al 2021, Cajão et al 2021).

Service improvement project

Thurrock and Brentwood Mind, an affiliate of the national mental health charity Mind, is based in Essex, south-east England. It works in partnership with Thurrock Council, Thurrock clinical commissioning group (CCG), Southend, Essex and Thurrock CAMHS (SET CAMHS) and with local voluntary, community and faith groups to develop mental health services with and for local people.

In 2015, the Southend, Essex and Thurrock transformation plan for the emotional well-being and mental health of children and young people identified several priorities for development (Smith 2015). These included improving transition support for young people leaving CAMHS, improving access to and equality of mental health services for children and young people, building capacity and capabilities in the system, and building resilience in the local community (Smith 2015).

In 2017, Thurrock and Brentwood Mind used the national charity’s coproduction service improvement framework – called Service Design in Mind (Mind 2022) – to undertake a feasibility study of the development of local youth services, the findings of which would be presented to the charity’s board of trustees. The feasibility study used several means of engagement to generate insight into mental health support for young people in the local area. These included ten workshops, and 17 individual interviews, with 76 young people from local youth organisations linked to social care, education and the voluntary sector (some of whom were involved with, or had been recently discharged from, SET CAMHS), as well as interviews with SET CAMHS clinicians, social care professionals, education professionals, local voluntary organisations and parents and carers.

The workshops revealed that young people wanted to know how they could support their own mental health and how they could access mental health support in their local community. Some of the young people believed that revealing their mental health needs at school was stigmatising and that their teachers and parents were not well informed enough to support them. The interviews with SET CAMHS clinicians identified that they were concerned about the lack of services and support for young people of transition age – that is, between 14 years and 18 years – and about how young people would maintain their recovery after discharge.

Positive Pathways service

The Southend, Essex and Thurrock transformation plan recommendations and the findings of the feasibility study informed the development of a personalised approach to supporting young people at the point of discharge from SET CAMHS. The service, called Positive Pathways, was launched in 2018 and aims to provide ‘step-down’ support on discharge using personalised care planning, social prescribing and, for some young people, access to a personal health budget. The step-down support is led by a youth facilitator, recruited through Thurrock and Brentwood Mind and based in SET CAMHS, who collaborates with the young person, their family and their SET CAMHS clinician. The Positive Pathways service is intended to enable young people and their families to co-design creative, individual support packages to assist them to meet their goals at the point of discharge from SET CAMHS.

When a young person is identified by their CAMHS clinician as approaching the end of their treatment, the option of entering the Positive Pathways service is discussed with them and their family. If they agree to it, a referral is made to the youth facilitator and an introductory meeting between the youth facilitator and the young person, their family or carer and their CAMHS clinician is organised for them to discuss the care transfer.

The youth facilitator then meets with the young person in a non-clinical environment and starts a conversation framed by the ‘Five ways to wellbeing’ model – a set of evidence-based actions that aim to improve personal well-being (Aked et al 2008) – to co-produce a personalised care and support plan.

The youth facilitator and the young person identify goals and, using a social prescribing approach, explore opportunities available in the community that may support them to achieve these goals. If there are no appropriate opportunities, the youth facilitator assists the young person to apply for a personal health budget that will enable them to access the support outlined in their personalised care and support plan. The youth facilitator then works to connect the young person with that support. Ongoing support and evaluation are tailored to each young person and written into their personalised care and support plan. There is also a follow-up session 12 months after the start of the personal health budget intervention.

Personal health budgets

A personal health budget is an amount of money used to support a person’s health and well-being that is planned and agreed between the person, their representative and their local CCG. Personal health budgets are a way of personalising care based on what is important to the person and their individual strengths and needs. They can be used for a range of interventions to meet agreed health and well-being outcomes (NHS England 2022b). An evaluation of the personal health budgets pilot programme, funded by the Department of Health, provided evidence that personal health budgets can improve people’s quality of life significantly and well-being and that they are cost effective (Forder et al 2012). The NHS Long Term Plan (NHS England 2019) recommended the expansion of personal health budgets, with an expectation that these would have been offered in mental health services to up to 200,000 people by 2023-24.

Personal health budgets used in the Positive Pathways service differ from those accessible through the National Framework for Children and Young People’s Continuing Care (Department of Health and Social Care 2016) or through after-care services under section 117 of the Mental Health Act 1983 (NHS England and NHS Improvement 2019). To assess a young person’s eligibility for a personal health budget through the National Framework for Children and Young People’s Continuing Care, a decision-support tool is used to identify specific health needs above a set threshold of complexity that indicates that ordinarily commissioned services cannot meet these needs (Department of Health and Social Care 2016). To be eligible for a personal health budget through after-care services under section 117 of the Mental Health Act 1983, a person must have been detained in hospital under sections 3, 37, 45A, 47 or 48 of the Act (NHS England and NHS Improvement 2019). Applicants for a personal health budget in the Positive Pathways service do not need to meet any of these criteria. A personal health budget is offered to young people who are approaching the point of discharge from SET CAMHS and have ongoing mental health needs, but do not qualify for support from adult mental health services.

An approval pathway for personal health budgets has been developed as part of the Positive Pathways service. The steps of the approval pathway are as follows:

  • The youth facilitator and young person develop an application for a personal health budget and submit it to Thurrock CCG.

  • The Thurrock CCG quality and commissioning team reviews the application.

  • The outcome of the application is communicated to the youth facilitator within ten working days.

  • If the application has been approved, the money is either transferred directly to the young person (or more commonly to their nominated adult), transferred directly to the organisation that will be providing the intervention or activity, or used to buy items that are then given to the young person.

The young person can then undertake the identified activity or intervention, the details of which are incorporated in their personalised care and support plan. Once the activity or intervention has been completed, the young person’s well-being is re-assessed. At regular intervals, including at the end of the young person’s time with the service, the youth facilitator informs Thurrock CCG of the developments and outcomes.

Since the implementation of the Positive Pathways service, young people – or their nominated adult, often a parent or carer – have received one-off personal health budgets to fund a range of interventions or items that are not ordinarily commissioned by healthcare services. Examples include: a provisional driving licence to support a young person to access volunteering and work opportunities; peer mentoring sessions; music lessons; purchase of musical instruments; and purchase of equipment to pursue creative self-expression, such as photography and art supplies. One young person used their personal health budget to attend a taster session for a music course and started the course the following week.

Interagency collaboration within the Positive Pathways service has enabled young people to access befriending services, advocacy services and volunteering and employment opportunities, including through third-sector providers such as:

  • Open Door, an organisation that enables young people without financial means to attend a leading UK drama school.

  • Inspire Youth, a local organisation that collates information on career opportunities, training and grants for young people and information on employers looking to hire and support young people in the local area.

  • ‘be YOU unique’, an online support group hosted by Thurrock and Brentwood Mind during the coronavirus disease 2019 pandemic when face-to-face contact was not possible, and aimed at enhancing young people’s self-esteem and self-confidence.

At the time of writing, the average personal health budget per young person was £330 (range £20 to £455). None of the young people who received a personal health budget were found to require support from adult mental health services at the 12-month follow-up session.

Effects of the Positive Pathways service

The Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS) (NHS Health Scotland, University of Warwick and University of Edinburgh 2008) was used to explore the effects of the Positive Pathways service on young people. The SWEMWBS comprises seven positively worded statements about subjective mental well-being and psychological functioning, each measured on a five-point Likert scale (ranging from 0=none of the time to 5=all of the time). The SWEMWBS was administered to the young person by the youth facilitator at their initial personalised care and support planning meeting and again at the end of their time with the service.

At the time of writing, 98 young people have been involved with the Positive Pathways service, 52 of whom have completed a pre- and post-intervention SWEMWBS and undertaken the planned activity or intervention. Twenty eight of the 98 young people who have been involved with the service have received a personal health budget, of whom 18 have completed a pre- and post-intervention SWEMWBS and undertaken the planned activity or intervention. In all 18 cases, the post-intervention SWEMWBS score was higher than the pre-intervention SWEMWBS score. More robust research is required to examine the relationship between the various components of the service and respondents’ self-reported experiences and outcomes. This would allow a comparison with the experiences and outcomes of young people who have not been involved with the service.

A report by the National Children’s Bureau (2021) on the use of personalised care interventions – for which staff, young people and parents, some of whom had been involved with the Positive Pathways service, were interviewed – identified that personalised care and support planning models were highly effective in supporting children and young people from deprived and complex backgrounds and with multiple disadvantages. The young people who were interviewed reported that personalised care made them feel understood and provided them with choice and control that they would never otherwise have had due to their circumstances.

One of the main themes that have emerged from informal feedback from SET CAMHS clinicians, generated through conversations and multidisciplinary team meetings, is that using personal health budgets has embedded flexibility into clinical systems. Clinicians reported that it felt ‘liberating’ that individual solutions decided with young people and appropriate for their specific needs could be applied.

Several young people, their families and SET CAMHS clinicians have featured in a video, Changing Young People’s Lives Through Personalised Care: Thurrock Story (www.youtube.com/watch?v=U7wL0UMiGH0). In this video, SET CAMHS clinicians expressed confidence in being able to discharge young people knowing that support is available through the Positive Pathways service. The SET CAMHS team manager described the service as ‘having French windows’, in the sense that it enables the team to ‘see the community and all the resources available there’.

The youth facilitator has attended SET CAMHS multidisciplinary meetings and shared information about the support available in the local community, thus enabling clinicians to start planning young people’s discharge much earlier than before the implementation of the Positive Pathways service. Referring young people to Positive Pathways means that SET CAMHS clinicians can discharge them more quickly, knowing that they will be supported, and can then accept, onto their caseloads, other young people who have been on the waiting list.

Next steps

Discussions between stakeholders – such as Thurrock CCG, SET CAMHS, Thurrock and Brentwood Mind, young people and parent representatives – are under way regarding extending the Positive Pathways service to young people with special educational needs aged between 14 years and 25 years. Consideration is also being given to how the service could be used to challenge the health inequalities experienced by young people and their families in the catchment area (Ministry of Housing, Communities and Local Government 2019, Marmot et al 2020). Examples could include assisting autistic young people in SET CAMHS to develop social connections, supporting parents who have children with complex needs by identifying gaps in service provision, and improving families’ access to services such as advocacy for debt management and housing.

Conclusion

The Positive Pathways service aims to support safe discharge of young people from CAMHS and to use personal health budgets to enable them to access activities and interventions that would not usually be available to them. The 18 young people who received a personal health budget and completed the pre- and post-intervention SWEMWBS all reported an improvement in their psychological functioning and mental well-being. This innovative approach to service delivery demonstrates the benefits of personalised care when working with young people in terms of empowerment and meaningful involvement in care planning. The outcomes of this service improvement project are informing further service developments, including an expansion of personal health budgets to a wider range of young people and to families. The Positive Pathways service appears to have increased CAMHS clinicians’ confidence in discharging young people, which potentially reduces the length of time young people remain involved with CAMHS and therefore could reduce waiting times for others who need treatment and support.

Further resources

More information on this project can be found by requesting to join the Personalised Care Collaborative Network via the FutureNHS.uk website

References

  1. Abidi S (2017) Paving the way to change for youth at the gap between child and adolescent and adult mental health services. Canadian Journal of Psychiatry. 62, 6, 388-392. doi: 10.1177/0706743717694166
  2. Appleton R, Elahi E, Tuomainen H et al (2021) “I’m just a long history of people rejecting referrals” experiences of young people who fell through the gap between child and adult mental health services. European Child & Adolescent Psychiatry. 30, 3, 401-413. doi: 10.1007/s00787-020-01526-3
  3. Aked J, Marks M, Cordon C et al (2008) Five Ways to Wellbeing. http://neweconomics.org/uploads/files/five-ways-to-wellbeing-1.pdf (Last accessed: 22 September 2022.)
  4. Cajão R, Martins M, Estrada J et al (2021) Mind the gap! Transition from child and adolescent to adult mental health services: a narrative review and results of 18 months consultation. European Psychiatry. 64, 1, s400. doi: 10.1192/j.eurpsy.2021.1072
  5. Children’s Commissioner for England (2021) The State of Children’s Mental Health Services 2019/20. http://childrenscommissioner.gov.uk/report/mental-health-services-2019-20 (Last accessed: 22 September 2022.)
  6. Department of Health, Department for Education (2017) Transforming Children and Young People’s Mental Health Provision: A Green Paper. http://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/664855/Transforming_children_and_young_people_s_mental_health_provision.pdf (Last accessed: 22 August 2022.)
  7. Department of Health and Social Care (2016) National Framework for Children and Young People’s Continuing Care. http://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/499611/children_s_continuing_care_Fe_16.pdf (Last accessed: 22 September 2022.)
  8. Dunn V (2017) Young people, mental health practitioners and researchers co-produce a Transition Preparation Programme to improve outcomes and experience for young people leaving Child and Adolescent Mental Health Services (CAMHS). BMC Health Services Research. 17, 293. doi: 10.1186/s129 201413-017-2221-4
  9. Ellins J, Singh K, Al-Haboubi M et al (2021) Early Evaluation of the Children and Young People’s Mental Health Trailblazer Programme. http://birmingham.ac.uk/documents/college-social-sciences/social-policy/brace/trailblazer.pdf (Last accessed: 22 September 2022.)
  10. Fonagy P, Pugh K, O’Herlihy A (2017) The Children and Young People’s Improving Access to Psychological Therapies (CYP IAPT) programme in England. In Skuse D, Bruce H, Dowdney L (Eds). Child Psychology and Psychiatry: Frameworks for Clinical Training and Practice. Third edition. John Wiley & Sons, Chichester, 429-436.
  11. Forder J, Jones K, Glendinning C et al (2012) Evaluation of the Personal Health Budget Pilot Programme. http://www.york.ac.uk/inst/spru/research/pdf/phbe.pdf (Last accessed: 22 September 2022.)
  12. Kieling C, Baker-Henningham H, Belfer M et al (2011) Child and adolescent mental health worldwide: evidence for action. The Lancet. 378, 9801, 1515-1525. doi: 10.1016/S0140-6736(11)60827-1
  13. Ludlow C, Hurn R, Lansdell S (2020) A current review of the Children and Young People’s Improving Access to Psychological Therapies (CYP IAPT) program: perspectives on developing an accessible workforce. Adolescent Health, Medicine and Therapeutics. 11, 21-28. doi: 10.2147/AHMT.S196492
  14. Marmot M, Allen J, Boyce T et al (2020) Health Equity in England: The Marmot Review 10 Years On. Institute of Health Equity, London.
  15. Mind (2022) Service Design: Deciding Together. http://mind.org.uk/workplace/influence-and-participation-toolkit/how/methods/service-design (Last accessed: 22 September 2022.)
  16. Ministry of Housing, Communities and Local Government (2019) English Indices of Deprivation 2019. http://www.gov.uk/government/statistics/english-indices-of-deprivation-2019 (Last accessed: 22 September 2022.)
  17. NHS England (2016) The Five Year Forward View for Mental Health. http://england.nhs.uk/publication/the-five-year-forward-view-for-mental-health (Last accessed: 22 September 2022.)
  18. NHS England (2019) The NHS Long Term Plan. NHS England, London.
  19. NHS England (2022a) Personalised Care and Support Planning. http://www.england.nhs.uk/publication/personalised-care-and-support-planning/ (Last accessed: 22 September 2022.)
  20. NHS England (2022b) What are Personal Health Budgets (PHBs)? http://england.nhs.uk/personal-health-budgets/what-are-personal-health-budgets-phbs (Last accessed: 22 September 2022.)
  21. NHS England and NHS Improvement (2019) Personalised Care: Guidance on the Legal Rights to Have Personal Health Budgets and Personal Wheelchair Budgets. http://england.nhs.uk/wp-content/uploads/2014/09/guidance-on-the-legal-rights-to-personal-health-budgets.pdf (Last accessed: 22 September 2022.)
  22. NHS Health Scotland, University of Warwick, University of Edinburgh (2008) Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS). http://corc.uk.net/outcome-experience-measures/short-warwick-edinburgh-mental-wellbeing-scale-swemws (Last accessed: 22 September 2022.)
  23. National Children’s Bureau (2021) Making a Difference to Young People’s Lives Through Personalised Care: Mental Health Inequalities and Social Deprivation. http://ncb.org.uk/personalisedcare (Last accessed: 22 September 2022.)
  24. National Institute for Health and Care Excellence (2016) Transition from Children’s to Adults’ Services for Young People Using Health or Social Care Services. NICE Guideline No. 43. NICE, London.
  25. Patel V, Saxena S, Frankish H et al (2016) Sustainable development and global mental health – a Lancet commission. The Lancet. 387, 10024, 1143-1145. doi: 10.1016/S0140-6736(16)00208-7
  26. Royal College of Paediatrics and Child Health (2020) Prevalence of Mental Health Conditions. Key Findings. http://stateofchildhealth.rcpch.ac.uk/evidence/mental-health/prevalence/#page-section-5 (Last accessed: 22 September 2022.)
  27. Smith W (2015) Open Up, Reach Out: Transformation Plan for the Emotional Wellbeing and Mental Health of Children and Young People in Southend, Essex and Thurrock. http://westessexccg.nhs.uk/news-and-publications/publications/children-and-young-people-local-transformation-plans/2182-12745-mental-health-services-for-essex-open-up-reach-out-oct-2015-v17-1/file (Last accessed: 22 September 2022.)
  28. Turner J, Hayward R, Angel K et al (2015) The history of mental health services in modern England: practitioner memories and the direction of future research. Medical History. 59, 4, 599-624. doi: 10.1017/mdh.2015.48
  29. United Nations (2015) Resolution Adopted by the General Assembly on 25 September 2015. Transforming Our World: The 2030 Agenda for Sustainable Development. UN, New York NY.
  30. Vostanis P (2017) Editorial: Global child mental health – Emerging challenges and opportunities. Child and Adolescent Mental Health. 22, 4, 177-178. doi: 10.1111/camh.12246
  31. Votruba N, Eaton J, Prince M et al (2014) The importance of global mental health for the Sustainable Development Goals. Journal of Mental Health. 23, 6, 283-286. doi: 10.3109/09638237.2014.976857
  32. Votruba N, Thornicroft G (2016) Sustainable development goals and mental health: learnings from the contribution of the FundaMentalSDG global initiative. Global Mental Health. 3, e26. doi: 10.1017/gmh.2016.20

Share this page

Related articles

How play specialists can reduce use of anaesthesia during radiotherapy
Radiotherapy practice is complex and daunting for children....

Holistic needs assessment: Rationale and practical implementation
Many people are living with or beyond a cancer diagnosis in...

An assessment of the value of music therapy for haemato-oncology patients
The aim of this service evaluation was to assess the value...

Collectively inspiring nurses to advance practice
Growing cancer survival rates in the UK mean there will be...

Assessing the benefits of social prescribing
Social prescribing provides GPs and other healthcare...