Peer-reviewed article
Building consensus on the core clinical competencies and outcomes related to effective child and adolescent mental health services (CAMHS) crisis team provision: findings from a Delphi study.
Nader C, Tindall L, Sayal K, Holland J, Hewitt CE et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study used a three-round Delphi expert consultation to identify the most important clinical skills and outcomes for mental health crisis teams serving adolescents and young adults. Participants with lived experience, parents and clinicians reached strong consensus that relationship-building, cultural competency, and validation are more important than diagnostic processes. The findings emphasize the need for trauma-informed, collaborative approaches rather than traditional risk-focused management.
Key points
- Over 90% agreement reached on proposed competencies and outcomes, with 43 of 69 participants completing all three rounds
- Strongest agreement for therapeutic alliance competencies: cultural competency (93%) and validation (91%)
- Key outcomes prioritised: improved communication with support networks (91%), better understanding of young person (88%), feeling validated (88%), reduced involuntary admissions (88%)
- Consensus favours relationship-based, trauma-informed, culturally responsive care over paternalistic risk management
- Findings integrated into a Theory of Change logic model to guide service development and training
Limitations
The study does not report which countries participated or evaluate whether implementing these competencies actually improves outcomes for young people in practice. The completion rate of 62% raises questions about whether dropouts had different views from those who persisted.
Abstract
Background Young peoples' mental health is worsening, increasing demands on Child and Adolescent Mental Health Services (CAMHS) crisis teams. However, evidence is lacking regarding the effectiveness of such services. To pave the way for service developments and robust evaluation, it is crucial to establish a consensus on the core competencies for CAMHS crisis clinicians and the most desirable outcomes from their input. Objective To elicit and establish consensus among experts, including those with relevant lived experience, regarding the most important staff competencies and outcomes in this service context. Methods A three-round Delphi study was conducted with young people (aged 18-25 years with relevant lived experience of CAMHS crisis team input), parents/carers and mental health clinicians/academics. The study aimed to establish consensus (≥70% agreement) on which core staff competencies and outcomes were perceived as 'essential'/'very important' in relation to CAMHS crisis services. Findings Of 69 initial participants, 43 (62%, mainly young people) completed all three rounds. A broad consensus was reached, with over 90% of proposed items meeting the consensus threshold. The strongest agreement was found for competencies in the therapeutic alliance domain, particularly cultural competency (93%) and validation (91%). For the case formulation domain, a holistic mental state examination (91%) was highly prioritised. Key outcomes with high consensus included improved communication with support networks (91%), better understanding of the young person (88%), feeling validated (88%) and reduced involuntary inpatient admissions (88%). The findings were integrated into a Theory of Change-based logic model illustrating how these skills and knowledge could lead to the desired outcomes. Conclusions Our results demonstrate a clear stakeholder consensus prioritising relational, validating and personalised approaches to assessment and intervention over an emphasis on administrative or diagnostic processes in CAMHS crisis care. The findings also highlight a desire to move from a perception of a paternalistic risk management style to collaborative, community-based support. Clinical implications These findings underscore the need for crisis team clinicians to be trained and supported to deliver care that is relationship-based, trauma-informed and culturally responsive. These should potentially translate into better outcomes for young people, their families and the crisis team workforce itself.