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The CORE service improvement programme for mental health crisis resolution teams: results from a cluster-randomised trial

BACKGROUND: Crisis resolution teams (CRTs) offer brief, intensive home treatment for people experiencing mental health crisis. CRT implementation is highly variable; positive trial outcomes have not been reproduced in scaled-up CRT care. AIMS: To evaluate a 1-year programme to improve CRTs’ model fi...

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Autores principales: Lloyd-Evans, Brynmor, Osborn, David, Marston, Louise, Lamb, Danielle, Ambler, Gareth, Hunter, Rachael, Mason, Oliver, Sullivan, Sarah, Henderson, Claire, Onyett, Steve, Johnston, Elaine, Morant, Nicola, Nolan, Fiona, Kelly, Kathleen, Christoforou, Marina, Fullarton, Kate, Forsyth, Rebecca, Davidson, Mike, Piotrowski, Jonathan, Mundy, Edward, Bond, Gary, Johnson, Sonia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cambridge University Press 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7511901/
https://www.ncbi.nlm.nih.gov/pubmed/30761976
http://dx.doi.org/10.1192/bjp.2019.21
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author Lloyd-Evans, Brynmor
Osborn, David
Marston, Louise
Lamb, Danielle
Ambler, Gareth
Hunter, Rachael
Mason, Oliver
Sullivan, Sarah
Henderson, Claire
Onyett, Steve
Johnston, Elaine
Morant, Nicola
Nolan, Fiona
Kelly, Kathleen
Christoforou, Marina
Fullarton, Kate
Forsyth, Rebecca
Davidson, Mike
Piotrowski, Jonathan
Mundy, Edward
Bond, Gary
Johnson, Sonia
author_facet Lloyd-Evans, Brynmor
Osborn, David
Marston, Louise
Lamb, Danielle
Ambler, Gareth
Hunter, Rachael
Mason, Oliver
Sullivan, Sarah
Henderson, Claire
Onyett, Steve
Johnston, Elaine
Morant, Nicola
Nolan, Fiona
Kelly, Kathleen
Christoforou, Marina
Fullarton, Kate
Forsyth, Rebecca
Davidson, Mike
Piotrowski, Jonathan
Mundy, Edward
Bond, Gary
Johnson, Sonia
author_sort Lloyd-Evans, Brynmor
collection PubMed
description BACKGROUND: Crisis resolution teams (CRTs) offer brief, intensive home treatment for people experiencing mental health crisis. CRT implementation is highly variable; positive trial outcomes have not been reproduced in scaled-up CRT care. AIMS: To evaluate a 1-year programme to improve CRTs’ model fidelity in a non-masked, cluster-randomised trial (part of the Crisis team Optimisation and RElapse prevention (CORE) research programme, trial registration number: ISRCTN47185233). METHOD: Fifteen CRTs in England received an intervention, informed by the US Implementing Evidence-Based Practice project, involving support from a CRT facilitator, online implementation resources and regular team fidelity reviews. Ten control CRTs received no additional support. The primary outcome was patient satisfaction, measured by the Client Satisfaction Questionnaire (CSQ-8), completed by 15 patients per team at CRT discharge (n = 375). Secondary outcomes: CRT model fidelity, continuity of care, staff well-being, in-patient admissions and bed use and CRT readmissions were also evaluated. RESULTS: All CRTs were retained in the trial. Median follow-up CSQ-8 score was 28 in each group: the adjusted average in the intervention group was higher than in the control group by 0.97 (95% CI −1.02 to 2.97) but this was not significant (P = 0.34). There were fewer in-patient admissions, lower in-patient bed use and better staff psychological health in intervention teams. Model fidelity rose in most intervention teams and was significantly higher than in control teams at follow-up. There were no significant effects for other outcomes. CONCLUSIONS: The CRT service improvement programme did not achieve its primary aim of improving patient satisfaction. It showed some promise in improving CRT model fidelity and reducing acute in-patient admissions.
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spelling pubmed-75119012020-10-01 The CORE service improvement programme for mental health crisis resolution teams: results from a cluster-randomised trial Lloyd-Evans, Brynmor Osborn, David Marston, Louise Lamb, Danielle Ambler, Gareth Hunter, Rachael Mason, Oliver Sullivan, Sarah Henderson, Claire Onyett, Steve Johnston, Elaine Morant, Nicola Nolan, Fiona Kelly, Kathleen Christoforou, Marina Fullarton, Kate Forsyth, Rebecca Davidson, Mike Piotrowski, Jonathan Mundy, Edward Bond, Gary Johnson, Sonia Br J Psychiatry Papers BACKGROUND: Crisis resolution teams (CRTs) offer brief, intensive home treatment for people experiencing mental health crisis. CRT implementation is highly variable; positive trial outcomes have not been reproduced in scaled-up CRT care. AIMS: To evaluate a 1-year programme to improve CRTs’ model fidelity in a non-masked, cluster-randomised trial (part of the Crisis team Optimisation and RElapse prevention (CORE) research programme, trial registration number: ISRCTN47185233). METHOD: Fifteen CRTs in England received an intervention, informed by the US Implementing Evidence-Based Practice project, involving support from a CRT facilitator, online implementation resources and regular team fidelity reviews. Ten control CRTs received no additional support. The primary outcome was patient satisfaction, measured by the Client Satisfaction Questionnaire (CSQ-8), completed by 15 patients per team at CRT discharge (n = 375). Secondary outcomes: CRT model fidelity, continuity of care, staff well-being, in-patient admissions and bed use and CRT readmissions were also evaluated. RESULTS: All CRTs were retained in the trial. Median follow-up CSQ-8 score was 28 in each group: the adjusted average in the intervention group was higher than in the control group by 0.97 (95% CI −1.02 to 2.97) but this was not significant (P = 0.34). There were fewer in-patient admissions, lower in-patient bed use and better staff psychological health in intervention teams. Model fidelity rose in most intervention teams and was significantly higher than in control teams at follow-up. There were no significant effects for other outcomes. CONCLUSIONS: The CRT service improvement programme did not achieve its primary aim of improving patient satisfaction. It showed some promise in improving CRT model fidelity and reducing acute in-patient admissions. Cambridge University Press 2020-06 /pmc/articles/PMC7511901/ /pubmed/30761976 http://dx.doi.org/10.1192/bjp.2019.21 Text en © The Royal College of Psychiatrists 2019 http://creativecommons.org/licenses/by-nc-nd/4.0/ http://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work.
spellingShingle Papers
Lloyd-Evans, Brynmor
Osborn, David
Marston, Louise
Lamb, Danielle
Ambler, Gareth
Hunter, Rachael
Mason, Oliver
Sullivan, Sarah
Henderson, Claire
Onyett, Steve
Johnston, Elaine
Morant, Nicola
Nolan, Fiona
Kelly, Kathleen
Christoforou, Marina
Fullarton, Kate
Forsyth, Rebecca
Davidson, Mike
Piotrowski, Jonathan
Mundy, Edward
Bond, Gary
Johnson, Sonia
The CORE service improvement programme for mental health crisis resolution teams: results from a cluster-randomised trial
title The CORE service improvement programme for mental health crisis resolution teams: results from a cluster-randomised trial
title_full The CORE service improvement programme for mental health crisis resolution teams: results from a cluster-randomised trial
title_fullStr The CORE service improvement programme for mental health crisis resolution teams: results from a cluster-randomised trial
title_full_unstemmed The CORE service improvement programme for mental health crisis resolution teams: results from a cluster-randomised trial
title_short The CORE service improvement programme for mental health crisis resolution teams: results from a cluster-randomised trial
title_sort core service improvement programme for mental health crisis resolution teams: results from a cluster-randomised trial
topic Papers
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7511901/
https://www.ncbi.nlm.nih.gov/pubmed/30761976
http://dx.doi.org/10.1192/bjp.2019.21
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