Q&A with Julian Edbrooke-Childs on service-level variation

Lead author, Julian Edbrooke-Childs, discusses this research.

6 January 2017

Service-level variation, patient-level factors and treatment outcome in those seen by child mental health services by Julian Edbrooke-Childs, Amy Macdougall, Daniel Hayes, Jenna Jacob, Miranda Wolpert and Jessica Deighton, published in January 2017

What did this research aim to find out?

The research aimed to find out whether child mental health outcomes varied across different mental health services. Comparing the outcome of treatment across services is a priority in healthcare in order to find out the impact and quality of the service, and because it is important to be able to demonstrate what the service is achieving – to secure future funding, for example.

We also wanted to find out whether there were particular characteristics of patients which were associated with the difference in the services.

How did you investigate this?

We had a sample of 3,256 young people from 13 child mental health services. Their parents had completed a commonly used questionnaire, the Strength and Difficulties Questionnaire. We applied a statistical method, multilevel regression, to the scores on the questionnaire in order to examine service level variation and whether this was explained by the demographics and characteristics of the patients.

What did you find?

We found that there was a slight variation in outcomes (4–5%) and that children with autism – and less common characteristics (termed ‘infrequent cases characteristics’), such as substance misuse, had a greater risk of poor outcomes.

What does this mean?

Although the findings showed variation between services, it is important to treat these cautiously. This is because there appears to be more variation between patients than between the child mental health services. For this reason, we would recommend using methods which account for differences across services, such as funnel plots.

We should also be particularly careful when looking at services with high proportions of young people with autism, or less common characteristics, who require specialist input. It may appear that these services are performing less well than other services, when the differences may be because of the patients’ characteristics.