Clinical effectiveness of a staff training intervention in mental health inpatient rehabilitation units designed to increase patients' engagement in activities (the Rehabilitation Effectiveness for Activities for Life [REAL] study): single-blind, cluster-randomised controlled trial

Killaspy, Helen; Marston, Louise; Green, Nick; Harrison, Isobel; Lean, Melanie; Cook, Sarah; Mundy, Timothy; Craig, Tom; Holloway, Frank; Leavey, Gerard; Koeser, Leonardo; McCrone, Paul; Arbuthnott, Maurice; Omar, Rumana; King, Michael

doi:10.1016/s2215-0366(14)00050-9

Cited by 45 publications

(59 citation statements)

References 32 publications

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“…The results showed that the implementation had positive outcomes for the participants, in terms of reduced stress, retained social functioning, and increased understanding (Jönsson et al, 2011). Killaspy et al (2015) argue that more research is needed to increase the understanding of complexities regarding the implementation of new working models in the psychiatric healthcare contexts. Willman, Stoltz, and Bahtsevani (2011) emphasize the importance of evidence-based practices as well as evaluations within the healthcare sector.…”

Section: Introductionmentioning

confidence: 93%

A New Working Method in Psychiatric Care – The Impact of Implementation

Alverbratt

Berlin

Åström

et al. 2016

International Journal of Public Administration

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An equal mix of organizational cultures is important for a successful implementation process. The aim of this study was to examine the implementation of a new working method in psychiatric hospital wards, representing different cultural characteristics. Descriptive quantitative data were collected at two hospitals (intervention and control). The results revealed one ward characterized by a mix of organizational cultures. This ward, compared with other intervention wards, showed the best results regarding patient assessed empowerment and participation. The result shows tentatively that organizational culture may have an impact on the implementation processes.

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Section: Introductionmentioning

confidence: 93%

A New Working Method in Psychiatric Care – The Impact of Implementation

Alverbratt

Berlin

Åström

et al. 2016

International Journal of Public Administration

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“…78 The main results of the trial and its associated health economic components have been published. 33 The results of the associated qualitative component have also been published. 34 A further paper describing the specific role of the OTs as 'agents of change' during the intervention has been published.…”

Section: Unitmentioning

confidence: 99%

“…33 The qualitative component of phase 3 of the REAL study included focus groups with staff at the intervention units. These revealed that the increased staff skills and changes in practice that were facilitated in units by the GetREAL teams during the enabling stage of the intervention were not sustained during the reinforcing stage (once the GetREAL teams had left the units).…”

Section: Introductionmentioning

confidence: 99%

“…The main results, including the health economic analysis, have been published in Lancet Psychiatry. 33 A total of 40 units participated (randomly selected from the sampling pool of 64 eligible units identified in phase 1: those scoring below the median on our quality assessment tool and that had at least eight beds). Randomisation was carried out by an organisation independent of the research team, and units that agreed to participate were randomised in batches of 10 on an equal basis either to receive the 'GetREAL' intervention or to continue to deliver usual care.…”

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confidence: 99%

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The Rehabilitation Effectiveness for Activities for Life (REAL) study: a national programme of research into NHS inpatient mental health rehabilitation services across England

Killaspy

King

Holloway

et al. 2017

Programme Grants Appl Res

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BackgroundThe REAL (Rehabilitation Effectiveness for Activities for Life) research programme, funded by the National Institute for Heath Research (NIHR) from 2009 to 2015, investigated NHS mental health rehabiliation services across England. The users of these services are people with longer-term, complex mental health problems, such as schizophrenia, who have additional problems that complicate recovery. Although only around 10% of people with severe mental illness require inpatient rehabilitation, because of the severity and complexity of their problems they cost 25–50% of the total mental health budget. Despite this, there has been little research to help clinicians and commissioners to plan and deliver effective treatments and services. This research aimed to address this gap.MethodsThe programme had four phases. (1) A national survey, using quantitative and qualitative methods, was used to provide a detailed understanding of the scope and quality of NHS mental health rehabilitation services in England and the characteristics of those who use them. (2) We developed a training intervention for staff of NHS inpatient mental health rehabilitation units to facilitate service users’ activities. (3) The clinical effectiveness and cost-effectiveness of the staff training programme was evaluated through a cluster randomised controlled trial involving 40 units that scored below average on our quality assessment tool in the national survey. A qualitative process evaluation and a realistic evaluation were carried out to inform our findings further. (4) A naturalistic cohort study was carried out involving 349 service users of 50 units that scored above average on our quality assessment tool in the national survey, who were followed up over 12 months. Factors associated with better clinical outcomes were investigated through exploratory analyses.ResultsMost NHS trusts provided inpatient mental health rehabilitation services. The quality of care provided was higher than that in similar facilities across Europe and was positively associated with service users’ autonomy. Our cluster trial did not find our staff training intervention to be clinically effective [coefficient 1.44, 95% confidence interval (CI) –1.35 to 4.24]; staff appeared to revert to previous practices once the training team left the unit. Our realistic review suggested that greater supervision and senior staff support could help to address this. Over half of the service users in our cohort study were successfully discharged from hospital over 12 months. Factors associated with this were service users’ activity levels [odds ratio (OR) 1.03, 95% CI 1.01 to 1.05] and social skills (OR 1.13, 95% CI 1.04 to 1.24), and the ‘recovery’ orientation of the unit (OR 1.04, 95% CI 1.00 to 1.08), which includes collaborative care planning with service users and holding hope for their progress. Quality of care was not associated with costs of care. A relatively small investment (£67 per service user per month) was required to achieve the improvement in everyday functioning that we found in our cohort study.ConclusionsPeople who require inpatient mental health rehabilitation are a ‘low-volume, high-needs’ group. Despite this, these services are able to successfully discharge most to the community within 18 months. Our results suggest that this may be facilitated by recovery-orientated practice that promotes service users’ activities and social skills. Further research is needed to identify effective interventions that enhance such practice to deliver these outcomes. Our research provides evidence that NHS inpatient mental health rehabilitation services deliver high-quality care that successfully supports service users with complex needs in their recovery.Main limitationOur programme included only NHS, non-secure, inpatient mental health rehabilitation services.Trial registrationCurrent Controlled Trials ISRCTN25898179.FundingThe NIHR Programme Grants for Applied Research programme.

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“…In order to better understand the overall picture of a changing mental health care sector we need highquality efficacy research using randomised controlled trials such as those so brilliantly performed in the UK on the one hand (Burns et al 2013;Killaspy et al 2015) because that type of research can guide us and provide the building blocks in moving forward in intervention research. However, we also need large-scale social, political and economic science studies of complex health care systems and of how they achieve reform and innovation in 'real world' settings.…”

Section: Guidelines and Guideline Implementationmentioning

confidence: 99%

Policies, guideline implementation and practice change – how can the process be understood?

Becker

Kilian

Kösters

2016

Epidemiol Psychiatr Sci

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Politics and policy: It is important to understand why, in the translational continuum from pilot research and randomised controlled efficacy trials to roll-out programmes and routine effectiveness studies, some service innovations are taken up by health service purchasers and providers, while others are not. Why do some innovative interventions or models of care get to the stage of implementation, while others fail to be funded?

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Clinical effectiveness of a staff training intervention in mental health inpatient rehabilitation units designed to increase patients' engagement in activities (the Rehabilitation Effectiveness for Activities for Life [REAL] study): single-blind, cluster-randomised controlled trial

Abstract: National Institute for Health Research.

Cited by 45 publications

References 32 publications

A New Working Method in Psychiatric Care – The Impact of Implementation

A New Working Method in Psychiatric Care – The Impact of Implementation

The Rehabilitation Effectiveness for Activities for Life (REAL) study: a national programme of research into NHS inpatient mental health rehabilitation services across England

Policies, guideline implementation and practice change – how can the process be understood?

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