Longitudinal comparative evaluation of the equivalence of an integrated peer-support and clinical staffing model for residential mental health rehabilitation: a mixed methods protocol incorporating multiple stakeholder perspectives

Abstract

BackgroundA novel staffing model integrating peer support workers and clinical staff within a unified team is being trialled at community based residential rehabilitation units in Australia. A mixed-methods protocol for the longitudinal evaluation of the outcomes, expectations and experiences of care by consumers and staff under this staffing model in two units will be compared to one unit operating a traditional clinical staffing. The study is unique with regards to the context, the longitudinal approach and consideration of multiple stakeholder perspectives.Methods/designThe longitudinal mixed methods design integrates a quantitative evaluation of the outcomes of care for consumers at three residential rehabilitation units with an applied qualitative research methodology. The quantitative component utilizes a prospective cohort design to explore whether equivalent outcomes are achieved through engagement at residential rehabilitation units operating integrated and clinical staffing models. Comparative data will be available from the time of admission, discharge and 12-month period post-discharge from the units. Additionally, retrospective data for the 12-month period prior to admission will be utilized to consider changes in functioning pre and post engagement with residential rehabilitation care. The primary outcome will be change in psychosocial functioning, assessed using the total score on the Health of the Nation Outcome Scales (HoNOS). Planned secondary outcomes will include changes in symptomatology, disability, recovery orientation, carer quality of life, emergency department presentations, psychiatric inpatient bed days, and psychological distress and wellbeing. Planned analyses will include: cohort description; hierarchical linear regression modelling of the predictors of change in HoNOS following CCU care; and descriptive comparisons of the costs associated with the two staffing models. The qualitative component utilizes a pragmatic approach to grounded theory, with collection of data from consumers and staff at multiple time points exploring their expectations, experiences and reflections on the care provided by these services.DiscussionIt is expected that the new knowledge gained through this study will guide the adaptation of these and similar services. For example, if differential outcomes are achieved for consumers under the integrated and clinical staffing models this may inform staffing guidelines.

Understanding consumers’ initial expectations of community‐based residential mental health rehabilitation in the context of past experiences of care: A mixed‐methods pragmatic grounded theory analysis

“…A detailed description of the research team, methods, and context is provided in the parent study protocol (Parker et al . ). The focus of the current study is consumers’ expectations on commencement at a CCU and how these compare with previous experiences of care.…”

“…The qualitative analysis followed a pragmatic grounded theory approach (Parker et al . ,b, ), using an inductive–deductive interplay to analyse content with a view to developing, confirming, refuting, and refining emergent themes and the relationships between these across transcripts. The data collection, analysis, and associated theorizing occurred in tandem.…”

Reality of working in a community‐based, recovery‐oriented mental health rehabilitation unit: A pragmatic grounded theory analysis

“…The present study reflects one component of a longitudinal, mixed‐methods evaluation. The full research protocol provides a detailed description of the study context, research design, analytic approach, and research team (Parker et al, ). The methods, analysis, and findings are documented in accordance with the consolidated criteria for reporting qualitative research (Tong et al, ).…”

An Integrated Recovery-oriented Model (IRM) for mental health services: evolution and challenges

“…Evaluating the formulation, implementation and impact of specific intervention programs or MH service/practice changes can be a daunting task, especially when viewed from multiple stakeholder perspectives [91]. Expressed simply, the relevant issues are: what aspects of the service model are under evaluation (e.g., perceptions of practices and processes; EBI information, availability, uptake, fidelity and completion; compliance with guidelines and documentation; impact on clinical and/or personal outcomes; training and resource utilisation; and so on); from whose perspective (e.g., clients, carers, clinicians and/or service providers); with regard to what timeframes (e.g., initial impact, medium-term, ongoing); and using what evaluation methods or strategies (e.g., quantitative/qualitative, self-report, independent assessments, service data or other linkages).…”