Case Study: The Kent and Medway Therapeutic Alliance
Overview
With a number of community based mental health contracts due for renewal, NHS Kent and Medway (NHSKM) identified an opportunity to redesign its contracting model with a stronger focus on early intervention, prevention, and reducing unnecessary referrals to specialist mental health services. Guided by national and local policy—including Future in Mind, the NHS Long Term Plan, and the Kent and Medway Local Transformation Plan—the ambition was to create a more connected, responsive offer for children, young people and families, aligned with the THRIVE framework.
Extensive consultation with children, young people, families, professionals, providers and partners highlighted gaps in connectivity, clarity and transition within the existing system. Many young people experienced fragmented support and confusing pathways, with some being moved unnecessarily between services. In response, a new contracting approach was developed, centred on three core areas working in partnership to deliver shared outcomes—collectively forming the Mental Health Collaborative (MHC). This model, known as the Therapeutic Alliance, aims to provide seamless, joined-up care, ensuring that children and young people receive the right support at the right time.
A strong emphasis was placed on co-design, with over 1,000 children and young people contributing through online activities, surveys, group work and interviews. Their feedback significantly shaped the service specification, and a full engagement report is available. Young people also created an evaluation question for the procurement process, focusing on communication, accessibility, coproduction and person-centred support. They were directly involved in assessing provider responses, including reviewing how bidders explained the service pathway “as if to a young person.”
To ensure lived experience remains central throughout the contract lifecycle, the specification includes requirements for a Lived Experience Lead, ongoing participation and engagement activity, and use of the Lived Experience Engagement and Employment Framework.
i-THRIVE in Action
The Therapeutic Alliance will support children and young people within the ‘Seeking Advice’ and ‘Getting Help’ categories of the i-THRIVE framework, providing earlier intervention to reduce demand on Specialist Mental Health Services—particularly for anxiety, depression, and relationship difficulties. By offering clinically appropriate support for moderate mental health needs, the service will help ensure specialist services can focus on those with the most severe and complex needs.
Proactive, Prevention & Promotion: Referral and Advice Point (RAP): Providing consultation across the wider system, processes referrals, navigates families to the right support, and signposts to universal or specialist services.
Through partnership working, RAP will ensure effective triage, risk discussion, and seamless movement into therapeutic support, including access to self-help resources.
Needs Led: Core Therapeutic Offer: Deliver evidence-based and NICE-concordant interventions—such as CBT, DBT, trauma-informed therapy, and creative therapies—via 1:1, groups, peer support, workshops for parents and carers, and a fully accessible digital offer.
Specialist Topic Offers: Include targeted support for care leavers, traumatic bereavement, challenging behaviour using Positive Behaviour Support, LGBTQIA+ peer support, and a range of psychoeducation workshops for young people, parents/carers, and professionals.
System Enablers: Use lived experience, digital, and participation leads to support
continuous service innovation.
Partnership Working and Shared Decision Making: Build strong local relationships, including termly mental health and wellbeing clinics for state-funded schools, close collaboration with Medway Council services, improved navigation pathways, transparent case updates (where appropriate), and contributions to partnership boards.
Work with the specialist mental health provider to establish a robust clinical governance framework, including structured supervision for high-risk or escalating cases, serious incidents, and near misses.
Provide opportunities for peer supervision and reflective practice across providers.
Implement a collaborative learning network to share expertise, reduce risk, and drive service improvements.
Embed the i-THRIVE framework, strengthens workforce development, champions co-production, and enhances professional relationships across the system.
Accessibility: The service will exceed statutory obligations for reasonable adjustments to ensure children and young people with protected characteristics can fully access and benefit from support. Any service changes must include proactive consideration of required adjustments, which will be monitored and reported on.
Conclusion
The Kent and Medway Therapeutic Alliance will actively support wider system adoption of THRIVE principles and maintain a dynamic, up-to-date directory of services aligned with i-THRIVE needs-based categories.
The Kent and Medway Therapeutic Alliance represents a significant and transformative step forward in delivering integrated, needs-led mental health services for children and young people. Key lessons include the value of coproduction, the importance of lived experience, collaboration and the effectiveness of a needs-led, partnership-based approach.
The i-Thrive Framework will be woven throughout the Therapeutic Alliance with the new model addressing several longstanding challenges and provides a foundation for a more responsive, inclusive and thrive-aligned system to deliver meaningful outcomes.
Next Steps:
- The Kent and Medway Therapeutic Alliance will co-design (with children, young people, their families and professionals) a referral pathway that is easy to understand, recognisable, and simple to navigate.
- Develop standard operating procedures including operational aspects of the Referral and Advice Point. These should be co-produced where appropriate
- Adopt and embed robust clinical governance and risk protocols so that there is explicit clarity regarding thresholds and acceptance criteria so that children and young people can access the most appropriate support and interventions
- The Kent and Medway Therapeutic Alliance model is in the early stages of development, it will continue to evolve, with ongoing feedback, continuous improvement, embedding lived experience, co-design and learning used to drive improvement.