Development of a tic service model for children and young people in England: a Delphi study

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. Agreed features included referral criteria, comprehensive assessment, psychoeducation, behavioural interventions, pharmacological options and integrated cross-service working. Stakeholder workshops highlighted key implementation challenges, including workforce training, funding constraints and coordination across neurodevelopmental and mental health services, informing practical adaptations to the model. CONCLUSIONS: This consensus-informed service model provides structured, UK-specific guidance to support earlier identification, appropriate intervention and improved care coordination for CYP with tic disorders. Future research should assess real-world implementation and impact. CLINICAL IMPLICATIONS: The model offers actionable recommendations for referral pathways, intervention provision and service configuration. Adoption may reduce diagnostic delays, minimise misdiagnosis and strengthen collaboration between primary, neurodevelopmental and mental health services, leading to improved outcomes for CYP with tic disorders.