How Kooth aligns with THRIVE

Aligned with THRIVE, Kooth’s approach has always been to support people in exploring their wants and needs, giving them autonomy and choice over their mental health journey.

In this article, consultant psychologist Dr Hannah Wilson, head of Kooth’s clinical governance and clinical psychology lead, discusses the benefits of THRIVE’s person-centred and needs-led approach.

The traditional tiered approach to mental health has been criticised as not reflecting the reality of mental health and emotional wellbeing. This has led to the development of the THRIVE framework, and more recently to the iTHRIVE programme. 

The THRIVE framework (2014) is a person-centred and needs-led approach to delivering mental health support for children, young people and families. 

It considers these ‘needs’ across five categories: Thriving; Getting Advice and Signposting; Getting Help; Getting More Help; and Getting Risk Support. It also aims for a collaborative and consistent approach to mental health across services, and to talk about mental health and wellbeing using words that everyone understands.

The iTHRIVE programme is a national approach to translate the framework into models of care. This supports a move towards an integrative, whole population health approach, with the aim of enabling everyone to ‘thrive.’ The THRIVE framework enables services to consider how best to help children and young people (CYP) presenting with different needs, and to utilise a values-based approach instead of being diagnosis-led. It also aims to empower children, young people and families to be part of shared decisions about their care. 

This approach helps to encourage a system-wide model of healthcare which builds resource-efficient communities of mental health and wellbeing support instead of using a tiered model, which focuses only on specialist service provision.

Measuring the effectiveness of THRIVE

There are various ways to measure the effectiveness or impact of THRIVE. The iTHRIVE framework recommends including a measure of multi-agency working, a measure of shared decision making and surveys with CYP to explore their experience of the different parts of the framework. It is also relevant to explore engagement data with services, and changes in statistics, such as particular incidents, admissions, and presentations at A&E. 

Also important are satisfaction measures, as well as measuring change in whatever ‘need(s)’ the young person is presenting with. 

At Kooth, we include a questionnaire after every chat session to see how satisfied the person was with the conversation. We have also developed an outcome measure specific to single-session models, so that we can explore whether a one-off session can help someone to meet their immediate goals and needs.

We have embedded goal-based outcomes within our platform, as we believe this enables us to approach outcomes in a person-centred way, focusing on whatever is important or needed for that individual. 

This table shows how Kooth is aligned with THRIVE across each category:

At Kooth, children and young people can easily move between the different THRIVE categories, depending on their current needs or presentation.

This short case study demonstrates how this happens:

One of our experienced practitioners heard from a young person joining Kooth who described historical self-harm, and urges to do this again. They reported having low mood and stress, and a diagnosis of chronic fatigue. They had had counselling before, which helped at the time, but were finding that their coping strategies were no longer effective. Their initial psychometric scores suggested a high level of need and distress.   

The young person initially chose to ‘get advice and signposting,’ engaging with useful and relevant content on the site. They also used our journal tool, and engaged with peer support. They moved into ‘getting help’, first by setting goals around addressing their self-harm urges, then engaging in a one-to-one session with a Kooth practitioner. They discussed different support options, and collaboratively agreed to pursue structured support with a named worker to ‘get more help’. 

The young person’s level of risk increased in response to exam stress, which did lead to some further self-harm and panic attacks. They worked with their practitioner to build a safety and wellbeing plan, and their risk was de-escalated. 

By the end of their weekly structured support sessions, the young person’s CORE score was in the ‘healthy’ range. They have continued to use Kooth to support them to ‘thrive,’ including engaging with the peer community and continuing to journal. 

While only one person’s journey, we see similar fluidity and flexibility in how young people typically use Kooth. This highlights the importance of the THRIVE approach. 

Mental health - and being human - can be ‘messy,’ and change is rarely linear; having a flexible framework is vital.