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Table 3 Barriers and facilitators to implementation of CYP-IAPT

From: Evaluating the CYP-IAPT transformation of child and adolescent mental health services in Cambridgeshire, UK: a qualitative implementation study

Domain/element Barriers Facilitators
Intervention characteristics
 Evidence strength and quality
 Relative advantage
  Many staff held the view that the CYP-IAPT programme was underpinned by evidence and provided a relative advantage over previous ways of working by standardising practice and widening the provision of evidence-based treatments
Outer setting
 Cosmopolitanism Organisational differences and competing priorities within the CAMHS partnership impeded effective collaboration during local CYP-IAPT implementation  
Inner setting
 Compatibility Some staff felt disenfranchised from a programme that was perceived to be at odds with their professional training and ethos A key facilitator to CYP-IAPT implementation was highly invested staff. This was particularly the case where practitioners’ norms and values were compatible with the CYP-IAPT principles
 Implementation climate Programme was introduced at a time when the local climate was one of upheaval and change fatigue  
 Readiness for implementation
Leadership engagement A lack of engagement from senior management in the Trust hindered local implementation efforts and prevented timely decisions being made at a higher level regarding much needed resources The formally appointed local leadership team facilitated strategies and activities, and provided valuable links between CAMHS teams and other partnership organisations
Available resources The limitations of the IT system were a barrier to practitioners recording and reporting outcome data and this reduced the quality of service evaluation and reflection on progress with young people
First cohort’s impressions were that the training course was rolled out in haste. This negatively impacted their learning experiences and restricted access to knowledge and information
Although national funding was a key facilitator for implementing CYP-IAPT, the funding was time limited and a lack of available resources meant backfill, training and dedicated staff roles could not continue.
New staff did not benefit from training and were not familiar with the CYP-IAPT principles.
Low staff capacity coupled with increasing service demands was a continual challenge for service managers.
Training was valued by trainees. Courses skilled up staff and embedded EBP and ROMs into everyday practice
Access to knowledge and information At the start of the initiative, there was lack of readiness for implementation as staff felt they did not have sufficient information to understand the scope and aims of the initiative or to adequately understand their role in delivering it.
A high turnover of staff led to a loss of skills and prevented knowledge continuity in the service.
 
Process
 Champions Dedicated staff moved on due to limited funding for their roles which impacted sustainability of the programme Dedicated staff drove forward implementation and embedded EBP, ROMs and participation
 Formally appointed internal implementation leaders Local team lacked implementation expertise  
 Reflecting and evaluating A lack of feedback about measurable objectives or markers of success relating to CYP-IAPT made it difficult for staff to adequately reflect and evaluate overall progress of the initiative and it was unclear how the data was used or if at all, to drive service improvements.