A cluster randomised controlled trial and process evaluation of a training programme for mental health professionals to enhance user involvement in care planning in service users with severe mental health issues (EQUIP): study protocol for a randomised controlled trial

Bower, Peter; Roberts, Chris; O’Leary, Neil; Callaghan, Patrick; Bee, Penny; Fraser, Claire; Gibbons, Chris; Olleveant, Nicola; Rogers, Anne; Davies, Linda; Drake, Richard; Sanders, Caroline; Meade, Oonagh; Grundy, Andrew; Walker, Lauren; Cree, Lindsey; Berzins, Kathryn; Brooks, Helen; Beatty, Susan; Cahoon, Patrick; Rolfe, Anita; Lovell, Karina

doi:10.1186/s13063-015-0896-6

Cited by 24 publications

(24 citation statements)

References 26 publications

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“…Researchers had neither prior relationships nor current therapeutic relationship with participants. The starting point of the study was one informed by the value of involving service users and carers in the design and delivery of mental health care . All interviews were undertaken by HB, a female postdoctoral Research Fellow with significant qualitative research experience.…”

Section: Methodsmentioning

confidence: 99%

Is it time to abandon care planning in mental health services? A qualitative study exploring the views of professionals, service users and carers

Brooks

Lovell

Bee

et al. 2017

Health Expectations

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BackgroundIt has been established that mental health‐care planning does not adequately respond to the needs of those accessing services. Understanding the reasons for this and identifying whose needs care plans serve requires an exploration of the perspectives of service users, carers and professionals within the wider organizational context.ObjectiveTo explore the current operationalization of care planning and perceptions of its function within mental health services from the perspectives of multiple stakeholders.Settings and participantsParticipants included 21 mental health professionals, 29 service users and 4 carers from seven Mental Health Trusts in England. All participants had experience of care planning processes within secondary mental health‐care services.MethodsFifty‐four semi‐structured interviews were conducted with participants and analysed utilizing a qualitative framework approach.FindingsCare plans and care planning were characterized by a failure to meet the complexity of mental health needs, and care planning processes were seen to prioritize organizational agendas and risk prevention which distanced care planning from the everyday lives of service users.Discussion and conclusionsCare planning is recognized, embedded and well established in the practices of mental health professionals and service users. However, it is considered too superficial and mainly irrelevant to users for managing mental health in their everyday lives. Those responsible for the planning and delivery of mental health services should consider ways to increase the relevance of care planning to the everyday lives of service users including separating risk from holistic needs assessment, using support aids and utilizing a peer workforce in this regard.

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Section: Methodsmentioning

confidence: 99%

Is it time to abandon care planning in mental health services? A qualitative study exploring the views of professionals, service users and carers

Brooks

Lovell

Bee

et al. 2017

Health Expectations

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“…Professor 160,161 This programme is now delivering user-and carer-led training to CMHTs in a cluster randomised controlled trial designed to bring about more user-focused care planning. We keenly await the results.…”

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confidence: 99%

Cross-national comparative mixed-methods case study of recovery-focused mental health care planning and co-ordination: Collaborative Care Planning Project (COCAPP)

Simpson

Hannigan

Coffey

et al. 2016

Health Serv Deliv Res

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BackgroundConcerns about fragmented community mental health care have led to the development of the care programme approach in England and care and treatment planning in Wales. These systems require those people receiving mental health services to have a care co-ordinator, a written care plan and regular reviews of their care. Care planning and co-ordination should be recovery-focused and personalised, with people taking more control over their own support and treatment.Objective(s)We aimed to obtain the views and experiences of various stakeholders involved in community mental health care; to identify factors that facilitated, or acted as barriers to, personalised, collaborative and recovery-focused care planning and co-ordination; and to make suggestions for future research.DesignA cross-national comparative mixed-methods study involving six NHS sites in England and Wales, including a meta-narrative synthesis of relevant policies and literature; a survey of recovery, empowerment and therapeutic relationships in service users (n = 449) and recovery in care co-ordinators (n = 201); embedded case studies involving interviews with service providers, service users and carers (n = 117); and a review of care plans (n = 33).Review methodsA meta-narrative mapping method.ResultsQuantitative and qualitative data were analysed within and across sites using inferential statistics, correlations and the framework method. Our study found significant differences for scores on therapeutic relationships related to positive collaboration and clinician input. We also found significant differences between sites on recovery scores for care co-ordinators related to diversity of treatment options and life goals. This suggests that perceptions relating to how recovery-focused care planning works in practice are variable across sites. Interviews found great variance in the experiences of care planning and the understanding of recovery and personalisation within and across sites, with some differences between England and Wales. Care plans were seen as largely irrelevant by service users, who rarely consulted them. Care co-ordinators saw them as both useful records and also an inflexible administrative burden that restricted time with service users. Service users valued their relationships with care co-ordinators and saw this as being central to their recovery. Carers reported varying levels of involvement in care planning. Risk was a significant concern for workers but this appeared to be rarely discussed with service users, who were often unaware of the content of risk assessments.LimitationsLimitations include a relatively low response rate of between 9% and 19% for the survey and a moderate level of missing data on one measure. For the interviews, there may have been an element of self-selection or inherent biases that were not immediately apparent to the researchers.ConclusionsThe administrative elements of care co-ordination reduce opportunities for recovery-focused and personalised work. There were few shared understandings of recovery, which may limit shared goals. Conversations on risk appeared to be neglected and assessments kept from service users. A reluctance to engage in dialogue about risk management may work against opportunities for positive risk-taking as part of recovery-focused work.Future workResearch should be commissioned to investigate innovative approaches to maximising staff contact time with service users and carers; enabling shared decision-making in risk assessments; and promoting training designed to enable personalised, recovery-focused care co-ordination.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…The EQUIP team aimed to recruit a minimum of 10 participants per cluster (no upper limit was specified). Details of the EQUIP trial design have been reported elsewhere [58]. …”

Section: Methodsmentioning

confidence: 99%

“…No consent was needed for patients to participate in the embedded trial, on the basis that the embedded trial was not withholding information: we obtained approval for the embedded trial and to not consent patients from NRES Committee Yorkshire and the Humber – South Yorkshire (REC Reference 11/YH/0271). The embedded trial has been registered by EQUIP as a substudy [58], and as a ‘Study Within a Trial’ by the MRC Hubs for Trials Methodology Research. The protocol for the embedded trial can be found here – (SWAT-26).…”

Section: Acknowledgementsmentioning

confidence: 99%

The impact of advertising patient and public involvement on trial recruitment: embedded cluster randomised recruitment trial

Hughes-Morley

Hann

Fraser

et al. 2016

Trials

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BackgroundPatient and public involvement in research (PPIR) may improve trial recruitment rates, but it is unclear how. Where trials use PPIR to improve design and conduct, many do not communicate this clearly to potential participants. Better communication of PPIR might encourage patient enrolment, as trials may be perceived as more socially valid, relevant and trustworthy. We aimed to evaluate the impact on recruitment of directly advertising PPIR to potential trial participants.MethodsThis is a cluster trial, embedded within a host trial (‘EQUIP’) recruiting service users diagnosed with severe mental illness. The intervention was informed by a systematic review, a qualitative study, social comparison theory and a stakeholder workshop including service users and carers. Adopting Participatory Design approaches, we co-designed the recruitment intervention with PPIR partners using a leaflet to advertise the PPIR in EQUIP and sent potential participants invitations with the leaflet (intervention group) or not (control group). Primary outcome was the proportion of patients enrolled in EQUIP. Secondary outcomes included the proportions of patients who positively responded to the trial invitation.ResultsThirty-four community mental health teams were randomised and 8182 service users invited. For the primary outcome, 4% of patients in the PPIR group were enrolled versus 5.3% of the control group. The intervention was not effective for improving recruitment rates (adjusted OR = 0.75, 95% CI = 0.53 to 1.07, p = 0.113). For the secondary outcome of positive response, the intervention was not effective, with 7.3% of potential participants in the intervention group responding positively versus 7.9% of the control group (adjusted OR = 0.74, 95% CI = 0.53 to 1.04, p = 0.082). We did not find a positive impact of directly advertising PPIR on any other outcomes.ConclusionTo our knowledge, this is the largest ever embedded trial to evaluate a recruitment or PPIR intervention. Advertising PPIR did not improve enrolment rates or any other outcome. It is possible that rather than advertising PPIR being the means to improve recruitment, PPIR may have an alternative impact on trials by making them more attractive, acceptable and patient-centred. We discuss potential reasons for our findings and implications for recruitment practice and research.Trial registration numbersISRCTN, ISRCTN16488358. Registered on 14 May 2014.Study Within A Trial, SWAT-26. Registered on 21 January 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1718-1) contains supplementary material, which is available to authorized users.

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A cluster randomised controlled trial and process evaluation of a training programme for mental health professionals to enhance user involvement in care planning in service users with severe mental health issues (EQUIP): study protocol for a randomised controlled trial

Cited by 24 publications

References 26 publications

Is it time to abandon care planning in mental health services? A qualitative study exploring the views of professionals, service users and carers

Is it time to abandon care planning in mental health services? A qualitative study exploring the views of professionals, service users and carers

Cross-national comparative mixed-methods case study of recovery-focused mental health care planning and co-ordination: Collaborative Care Planning Project (COCAPP)

The impact of advertising patient and public involvement on trial recruitment: embedded cluster randomised recruitment trial

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