Cumbria LINK – Young People’s Social Prescribing Service Evaluation Report

Executive Summary
The Barnardo’s LINK service was established in Cumbria to address a critical gap for
children and young people (CYP) experiencing social, emotional, and mental health
difficulties that fall below specialist thresholds (e.g., Child and Adolescent Mental
Health Services, CAMHS). Cumbria is a predominantly rural county in Northwest
England with a dispersed population of approximately 500,000 across a large
geographical area (approx. 2,600 square miles). Co-produced with young people, the
LINK service provides a holistic offer centred on one-to-one support, group work,
social prescribing (including nature-based), and system navigation (i.e., a coordination
pathway). Delivered by trained LINK service workers, the service offers two key
pathways: (1) a coordination-only pathway, in which practitioners complete an initial
assessment, liaise with partner agencies, and connect families to the most appropriate
source of help; and (2) a one-to-one therapeutic pathway that supports children and
young people aged five to nineteen through a flexible, relationship-based approach.
Workers combine emotional support, practical problem-solving, and asset mapping to
connect children and families to local activities and services. The LINK service
positions the child-worker relationship itself as a therapeutic mechanism, offering a
safe, trusted space while building skills for resilience, and confidence. By working in
homes, schools, GP practices, and community spaces, it reduces barriers to
engagement and provides a bridge between multiple systems.
The evaluation conducted from 2022 to 2025 was commissioned as a learning
partnership with Barnardo’s to assess the service’s impact, implementation, and
sustainability of the LINK service model. A multi-methods design was used,
incorporating a process and impact evaluation approach. Routinely collected survey
data from 371 CYP were analysed to assess the effectiveness and cost-effectiveness
of the service. Child Outcome rating Scale (CORS) data were available for one of the
two support pathways of the service (one-to-one support pathway), as outcomes
associated with the coordination pathway were not collected due to the nature of
onward referral and delivery by external services. In addition to survey data, a total of
22 semi-structured interviews were conducted with CYP from 15 families, with a small
number participating in follow-up conversations to capture change over time.
Alongside this, 27 interviews were carried out with parents or caregivers. Nine
interviews were conducted with professionals referring into the LINK service, providing
insight into its positioning within wider systems. From a service delivery perspective,
17 scoping interviews were undertaken with LINK service workers across strategic and
operational levels, complemented by nine interviews with LINK service board
members. In addition to interviews, a logic model workshop was conducted to help
outline the intended outcomes of the service and provide a framework against which
evidence was interpreted. Data collection was concluded in June 2025 and so the
evaluation only reflects the impact of the LINK service prior to this time.
4
EPA
The evaluation findings show that the LINK service delivered meaningful and clinically
significant improvements in children and young people’s (CYP) mental wellbeing
(measured by CORS). Outcome data from 371 participants receiving the one-to-one
support pathway, indicate an average improvement of 7.3 points (CORS), exceeding
accepted thresholds for clinical significance and suggesting tangible gains in mental
wellbeing. The cost-effectiveness analysis revealed an average cost of approximately
£2,672 per outcome-assessed child, with an estimated cost of £368 per CORS point
gained. When contextualised within the wider CYP mental health evidence base, these
costs fall within, and in some cases exceed, expected costs for effective early
intervention models which achieve measurable clinical gain. In contract, cheaper
mental wellbeing focused interventions for CYP are often found to have limited or no
effect on mental wellbeing outcomes. Overall, the analysis indicates that the LINK
service achieves greater or equivalent outcome gains for similar investment, with
added value arising from its integration across primary care, education, and
community systems.
The evaluation findings highlight the added value of the LINK service. Families and
professionals alike praised its timeliness, flexibility, and success in engaging children
who might otherwise disengage from support (due to long waiting lists for specialist
mental health support). The relational approach emerged as the service’s greatest
strength, with young people frequently reporting that they felt heard, safe, and able to
express difficult emotions. Parents valued being listened to and supported, while
General Practitioners (GPs) noted that the service reduced inappropriate referrals and
eased pressures on primary care. Practical coping strategies promoted by LINK
service workers were sustained beyond discharge and translated into improved
functioning in school and family life. Perceived outcomes included greater confidence,
and enhanced ability to manage anxiety. Commissioners emphasised that the LINK
service filled a critical gap in a system under strain, offering timely early help to growing
numbers of CYP experiencing stress and mild anxiety.
At the service level, LINK demonstrated notable flexibility in adapting to the evolving
needs of service users, underpinned by a framework of strong governance. LINK
service workers frequently highlighted the value of specialist supervision and ongoing
professional development. This was a result of Barnardo’s transformational leadership
approach that prioritised staff development, enhancing both professional confidence
and service quality (Howarth et al, 2025). Yet, alongside these strengths, the
evaluation highlighted several challenges that reflect wider systemic issues across the
social care landscape. For example, short-term funding arrangements and the
potential escalation of caseloads (mirrored nationally) put pressure on staff wellbeing
and retention, threatening the sustainability of the service model (Kimberlee et al,
2022). Geographic disparities further compounded these pressures, with families in
rural areas often struggling to access the group-based provision offered by the service.
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EPA
The evaluation highlighted several priorities to strengthen and sustain the quality of
the service. Central to this is the protection of relational quality, that is, the depth,
consistency, and authenticity of the relationships between LINK service workers,
children, young people, and families. This aligns with the principles of relationship
based practice, conceptualised as a ‘holding relationship’ that enables trust, empathy,
and emotional containment as precursors to therapeutic change (Ferguson et al,
2020). Maintaining relational quality depends on manageable caseloads, sufficient
time for reflective supervision, and organisational structures that value emotional as
well as procedural work. Clearer referral pathways are also required, supported by
comprehensive guidance for referrers and more accessible communication materials
to help families understand what to expect from the service.
Operational efficiency emerged as another key area for development. Streamlining
administrative processes particularly through refining electronic patient record
systems (e.g., IAPTUS) and standardising documentation (e.g., data entry templates
for system input), would reduce burden on practitioners and free up time for direct work
with families. Alongside this, workforce development should be broadened to
encompass trauma-informed practice, and systems thinking, thereby equipping staff
with the skills needed for complex, multi-agency environments.
Looking ahead, medium-term priorities include addressing rural inequities, refining
triage processes, and enhancing the service’s visibility among partners and
stakeholders. In the longer term, sustainability will depend on securing multi-year
funding, embedding the LINK service within Family Hubs and local health systems,
and undertaking economic evaluations to quantify the return on investment.
Key findings from the evaluation highlight:
• Impact: the LINK service delivered improvements in children and young
people’s mental wellbeing. Its relational, child-centred approach, combined with
timely access, helped young people better manage mental health difficulties.
• Implementation: The LINK service was supported by strong governance,
specialist supervision, and a flexible model that adapted to the needs of children
and young people. Stakeholders frequently reported that the LINK service
provided timely, accessible early help and effectively engaged CYP who might
otherwise disengage from support.
• Sustainability: the LINK services adaptability, workforce development, and
integration across primary care and community systems acted as key enablers
of sustainability. However, short-term funding, and rural access challenges,
continue to pose risks to the long-term stability of the model.
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EPA
Key lessons from the evaluation emphasised:
• The importance of protecting the LINK service relational approach, flexibility,
and bridging role across systems.
• Small caseloads, continuity with a named worker, and protected supervision
were identified as essential to sustaining a high-quality service.
• Flexibility in delivery and co-produced coping strategies were critical for
engagement and lasting benefit.
• Continued strong governance and the need to reinforce credibility with more
robust data systems to evidence impact.
The learning partnership approach taken by the evaluation supported the ongoing
translation of findings to improve practice, allowing the LINK service to make real-time
adaptations from the above lessons. Consequently, many of the recommendations
have already been implemented (e.g., protected caseloads, streamlining admin,
standardising documentation and enhancing the triage processes) to improve the
effectiveness and efficiency of the service.
In conclusion, this evaluation highlights how a relational, community-based model of
early intervention benefits children, young people, and families by improving wellbeing,
confidence, and resilience. It also provides practical learning for professionals and
commissioners on how social prescribing can be embedded within local systems to
strengthen early help, reduce pressure on statutory services, and inform future policy
and commissioning decisions. Its future, however, will depend on consolidating these
strengths, addressing challenges around equity, and securing the resources
necessary to sustain its impact.