Relational care models, especially ICCS, are vital in addressing the complex needs of Children and Young People, with flexible, family-centred approaches improving trust, engagement, and long-term recovery outcomes.
Key Findings
Results
Three main themes emerged from healthcare provider (HCP) data describing staff experiences of young people's engagement and recovery: Relational Ecologies (barriers and enablers to engagement), flexibility of approach amidst systemic pressures, and the web of trust in the relationship-building process.
Thirty-four semi-structured interviews were conducted with staff across various services.
Twenty interviews were conducted with ICCS staff and 14 with Treatment as Usual (TAU) service staff.
TAU services included inpatient or core community CAMHS.
A thematic decomposition analysis was conducted on the data.
Results
HCPs highlighted the necessity of developing trust and rapport through non-clinical engagement strategies such as informal visits and personalised interactions.
Staff identified that without trust, treatment effectiveness diminishes.
HCPs emphasised that a tailored approach rather than a one-size-fits-all model was necessary.
Non-clinical engagement strategies were identified as key enablers of therapeutic relationships.
These findings were part of the 'web of trust in the relationship-building process' theme.
Results
Flexibility in duration of treatment and methods of engagement was noted as crucial in accommodating individual client needs and fostering an open, trusting environment necessary for long-term recovery.
Flexibility of approach was identified as one of three core themes in staff experiences.
Staff noted that flexibility was exercised amidst systemic pressures.
This theme encompassed both the duration of treatment and the variety of engagement methods used.
Flexible approaches were linked to fostering environments conducive to long-term recovery.
Results
Relational Ecologies — encompassing both barriers and enablers to engagement — were identified as a primary theme shaping how staff experienced young people's participation in care.
This theme captured the broader environmental and relational context influencing engagement.
Both ICCS and TAU staff contributed perspectives on barriers and enablers.
Systemic pressures were identified as part of the relational ecology affecting care delivery.
The theme addressed the contextual factors that shape therapeutic relationships in community mental health.
Results
Family-centred approaches were identified by HCPs as improving trust, engagement, and long-term recovery outcomes for Children and Young People (CYP).
Flexible, family-centred approaches were highlighted specifically within the ICCS model.
Findings were drawn from a process evaluation embedded within a Randomised Controlled Trial (RCT).
The RCT examined the effectiveness of ICCS versus Treatment as Usual.
Recommendations from the findings include expanding relational care models within CAMHS to meet increasing mental health demands.
Conclusions
The study recommends tackling systemic barriers and expanding relational care models within CAMHS, and calls for further research on scalable strategies for integrating these insights into wider mental health service frameworks.
Recommendations were based on qualitative findings from staff interviews across ICCS and TAU services.
Authors identified a need for scalable strategies to integrate relational care insights into broader mental health frameworks.
The study noted increasing mental health demands as a context for expanding these models.
Further research was specifically recommended to address the scalability of relational care approaches.
What This Means
This research suggests that the quality of mental health care for children and young people depends heavily on the relationships built between staff and their clients. Researchers interviewed 34 staff members working in two types of services — an Intensive Community Care Service (ICCS) and standard services (inpatient care or community mental health teams) — and analysed what staff said about helping young people engage with care and recover. Three major themes emerged: the relational environment (what helps or hinders young people from connecting with services), the importance of flexibility despite organisational pressures, and the central role of trust in building effective therapeutic relationships.
Staff consistently highlighted that informal, non-clinical interactions — such as casual visits and personalised conversations — were essential for building the trust needed for treatment to work. Without that trust, staff felt that even well-designed treatments would fall short. The ICCS model, which allows for more flexible timing, duration, and methods of engagement, was seen as particularly well-suited to meeting the individual and family needs of young people with complex mental health difficulties. Staff from this model emphasised that a one-size-fits-all approach was insufficient for this population.
This research suggests that mental health services for children and young people should prioritise relational, family-centred, and flexible approaches over more rigid, standardised models. The findings point to a need for health systems to address structural barriers that make it hard for staff to build meaningful relationships with young clients, and to consider expanding intensive community care approaches more broadly. The authors also note that more research is needed to understand how these relationship-centred approaches can be scaled up without losing what makes them effective.
Atanda O, Reavey P, Wong B, Baker E, Collier J, Thaventhiran T, et al.. (2026). Relational care in community mental health: Evaluating staff experiences in Intensive Community Care Services (ICCS) vs treatment as usual.. PloS one. https://doi.org/10.1371/journal.pone.0356608