Development of a Tic Service Model for Children and Young People in England: A Delphi Study

28 Apr 20264 min read0 viewsJournal Feed

GIST

Objectives To develop an evidence-based, consensus-driven service model for the identification, assessment and treatment of tic disorders in children and young people (CYP) in England, addressing the absence of dedicated pathways and national clinical guidance. Design Two-stage consensus study comprising a Delphi survey, expert/patient and public involvement (PPI) review and regional stakeholder workshops.

Setting UK healthcare and community settings relevant to tic disorder assessment and management (primary care, neurodevelopmental services, child and adolescent mental health services). Participants Stage 1: UK-based clinicians, researchers and practitioners with expertise in tic disorders (Delphi panel; n=49; 98% retention across rounds).

Stage 2: regional stakeholders including clinicians, commissioners, service managers, third-sector representatives and parents/carers (n=36). Eligibility required relevant professional or lived experience; no exclusions applied beyond this criterion.

Primary outcome Identification of a consensus-based component of a best-practice service model for tic disorders and barriers and facilitators to implementation across regional pathways. Results The Delphi process generated consensus on 40 core components, refined to 43 following expert and PPI review.

Clinical Editorial

Scope and purpose

The study aimed to create an evidence-based, consensus-driven model for identification, assessment, and treatment of tic disorders in children and young people (CYP) within England, addressing gaps in dedicated pathways and national guidance.
Design integrated a two-stage consensus process: a Delphi survey with expert input, followed by expert/PPI (patient and public involvement) review and regional stakeholder workshops to refine and contextualize the model.

Participants and settings

Eligibility required relevant professional or lived experience; no other exclusions.

Stage 1 Delphi panel consisted of UK-based clinicians, researchers, and practitioners specializing in tic disorders (n=49; 98% retention across rounds).
Stage 2 involved regional stakeholders—clinicians, commissioners, service managers, third-sector representatives, and parents/carers (n=36).

Core findings and model components

The Delphi process yielded consensus on an initial set of 40 core components, which were refined to 43 after expert and PPI input.
Agreed elements encompassed referral criteria, comprehensive assessment, psychoeducation, behavioural interventions, pharmacological options, and integrated cross-service collaboration.

Implementation context and challenges

Regional stakeholder workshops underscored practical barriers to implementation, notably workforce training needs, funding constraints, and the necessity for coordination across neurodevelopmental and mental health services.
These insights informed adaptations to ensure the model is feasible within real-world regional pathways.

Conclusions and implications for practice

The resulting consensus-informed service model provides structured, UK-specific guidance intended to support earlier identification, appropriate intervention, and improved care coordination for CYP with tic disorders.
The authors advocate future research to evaluate real-world implementation and impact, recognizing that evidence on outcomes and scalability remains to be established.

Limitations and uncertainty

The report notes the need for real-world evaluation to determine practical effects, and acknowledges implementation challenges identified by stakeholders, such as workforce and funding constraints.
The summary reflects only information explicitly reported in the source; no additional data on outcomes or quantitative impact were provided.