Barriers and facilitators to implementing social prescribing in child and adolescent mental health services: a qualitative analysis using the consolidated framework for implementation research.

Introduction: Interventions are urgently needed for young people waiting for Child and Adolescent Mental Health Services (CAMHS) in England. Long waits can worsen mental health, increase distress for young people and families, and place additional pressure on already stretched services. Social prescribing, a referral system for connecting individuals with resources in the community via one-to-one support from a link worker, has not been routinely implemented or evaluated for young people on CAMHS waitlists. It remains unclear whether, and under what conditions, social prescribing can be implemented successfully within CAMHS. Methods: We conducted semi-structured interviews with 23 staff and link workers involved in implementing social prescribing at 11 CAMHS sites across England as part of a large hybrid type II implementation-effectiveness study. We used a framework analysis approach, deriving the coding from the updated Consolidated Framework for Implementation Research (CFIR). Results: Barriers and facilitators mapped to 12 CFIR constructs, generating 25 themes. Key areas included: the challenges of implementing a non-medical intervention in a clinical environment; the advantage of social prescribing compared to little waitlist support; the need for flexibility in mode, duration, and frequency of sessions; the importance of community assets, funding and external partnerships for delivery; and the capacity, skills, and professional experience of link workers and staff. Barriers within CAMHS related to limited resources and partial understanding of the intervention, as well as difficulties in integrating link workers and providing supervision. Successful implementation depended on tailoring the intervention to the needs and preferences of young people and parents. Alternative social prescribing pathways were proposed, with schools being recommended as a promising setting for preventive delivery or post-treatment transitions for young people. Conclusion: Youth social prescribing for young people on CAMHS waitlists is feasible but requires careful implementation. Successful delivery depends on the capacity of link workers and supportive organisational structures in CAMHS. Alternative pathways, including delivery outside the waitlist through schools may facilitate its implementation and impact.