Background Severe mental illness (SMI) is associated with care delivery problems because of the high levels of clinical resources needed to address patient’s psychosocial impairment and to support inclusion in society. Current routine appointment systems do not adequately foster recovery care and are not systematically capturing information suggestive of urgent care needs. This study aimed to assess the feasibility, acceptability, and potential clinical benefits of a mobile technology health management tool to enhance community care for people with severe mental illness. Methods This randomised-controlled feasibility pilot study utilised mixed quantitative (measure on subjective quality of life as primary outcome; questionnaires on self-management skills, medication adherence scale as secondary outcomes) and qualitative (thematic analysis) methodologies. The intervention was a simple interactive technology (Short Message Service - SMS) communication system called ‘Florence’, and had three components: medication and appointment reminders, daily individually defined wellbeing scores and optionally coded request for additional support. Eligible participants (diagnosed with schizophrenia, schizoaffective disorder or bipolar disorder ≥1 year) were randomised (1:1) to either treatment as usual (TAU, N = 29) or TAU and the technology-assisted intervention (N = 36). Results Preliminary results suggest that the health technology tool appeared to offer a practicable and acceptable intervention for patients with SMI in managing their condition. Recruitment and retention data indicated feasibility, the qualitative analysis identified suggestions for further improvement of the intervention. Patients engaged well and benefited from SMS reminders and from monitoring their individual wellbeing scores; recommendations were made to further personalise the intervention. The care coordinators did not utilise aspects of the intervention per protocol due to a variety of organisational barriers. Quantitative analysis of outcomes (including a patient-reported outcome measure on subjective quality of life, self-efficacy/competence and medication adherence measures) did not identify significant changes between groups over time in favour of the Florence intervention, given high baseline scores. The wellbeing scores, however, were positively correlated with all outcome measures. Conclusion It is feasible to conduct an adequately powered full trial to evaluate this intervention. Inclusion criteria should be revised to include patients with a higher level of need and clinicians should receive more in-depth assistance in managing the tools effectively. The preliminary data suggests that this intervention can aid recovery care and individually defined wellbeing scores are highly predictive of a range of recovery outcomes; they could, therefore, guide the allocation of routine care resources. Trial registration ISRCTN34124141; retrospectively registered, date of registration 05/11/2019.
BackgroundRecent national policy and strategic workforce commissioning has created quality-monitored low intensity working in children and young people’s mental health (CYP-MH), that follows a stepped care model seen in adult services. This study explored the experiences of members of this new workforce to better understand factors that might support the effectiveness and sustainability of the role from a practitioner perspective.MethodsInterpretive Phenomenological Analysis was used to analyse (N=12) semi-structured interview transcripts from CYP Wellbeing Practitioners (CWPs) in London and the Southeast.ResultsFive main themes emerged from analysis, suggesting practitioners value their role and its place within the workforce, but have concerns about the low intensity remit meeting high intensity demands, their professional identity and career progression within the speciality.ConclusionsLow-intensity services provide a welcome addition to CYP-MH services with encouraging outcomes so far. Themes that emerged from practitioner experience highlighted clearly defined service remits, careful integration into existing service provision, and professional recognition with career progression as factors that might support the sustainability of the low intensity CYP-MH workforce.
Why wait until the Stage 2 Qualification Health Psychology to develop the core competencies?
Background: Severe mental illness (SMI) is associated with care delivery problems due to the patient’s psychosocial impairment and corresponding functional disability. Current routine appointment systems do not adequately foster recovery care and are not systematically capturing information suggestive of urgent care needs. This study aimed to assess the feasibility, acceptability, and potential clinical benefits of a mobile technology health management tool to enhance community care in people with severe mental illness. Methods: This randomised-controlled feasibility pilot study utilised mixed quantitative (measure on subjective quality of life as primary outcome; questionnaires on self-management skills, medication adherence scale as secondary outcomes) and qualitative (thematic analysis) methodologies. The intervention was a simple interactive technology (Short Message Service (SMS) communication system called ‘Florence’, and had three components: medication and appointment reminders, daily individually defined wellbeing scores and optionally coded request for additional support. Eligible participants (diagnosed with schizophrenia, schizoaffective disorder or bipolar disorder ≥ 1 year) were randomised (1:1) to either treatment as usual (TAU) or TAU and the technology-assisted intervention. Results: The health technology tool appeared to offer a practicable and acceptable intervention for patients with SMI in managing their condition. Recruitment and retention data indicated feasibility, the qualitative analysis identified suggestions for further improvement of the intervention. Preliminary results suggest that service users engaged well and benefited from SMS reminders and from monitoring their individual wellbeing scores. The care coordinators did not utilise the intervention per protocol due to a variety of organisational barriers. Quantitative analysis of outcomes (including a patient-reported outcome measure (PROM) on subjective quality of life, self-efficacy/competence and medication adherence) did not reveal significant differences between groups over time, given high baseline scores. The wellbeing scores, however, were positively correlated with all outcome measures. Conclusion: It is feasible to conduct an adequately powered full trial to evaluate this intervention. Inclusion criteria should be revised to include service users with a higher level of need and clinicians should receive more in-depth assistance in managing the tools effectively. The preliminary data suggests that this intervention can aid recovery care and individually defined wellbeing scores are highly predictive of a range of recovery outcomes; they could, therefore, guide the allocation of routine care resources. Trial registration ISRCTN 34124141; retrospectively registered, date of registration 05/11/2019.
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