Title: Improving engagement and recovery in people with early psychosis through Method of Levels therapy delivered by care coordinators: Feasibility cluster randomised controlled trial
Funder: Department of Health and Social Care

Abstract: Background Rates of disengagement from early intervention in psychosis (EIP) services remain high (12-54%), limiting opportunities for this population to benefit from NICE (2014) recommended interventions designed to improve outcomes. Care coordinators make up the largest staff group in EIP services but are not routinely offered training in therapeutic interventions. Improving the quality of support offered by care coordinators could increase service-user engagement and rates of recovery. Aims This study aims to evaluate the feasibility of conducting a cluster-randomised controlled trial that evaluates the effectiveness of training care coordinators in early intervention services to deliver a flexible and theoretically-informed psychological intervention called Method of Levels (MOL). Methods Design: Feasibility cluster-randomised controlled trial design with two conditions (1:2 allocation ratio): treatment as usual (TAU) or TAU with MOL trained care coordinators. Participants: Care coordinator participants (n=24) will be recruited from participating teams (n=12). Patient participants (n=96) will be recruited from the caseloads of participating care coordinators. Conditions: TAU consists of usual care offered by EIP teams. The intervention arm consists of TAU with the addition of support from a care coordinator who has attended a three-day MOL training session and has access to monthly online supervision. Outcomes: Feasibility outcomes: recruitment and retention. Patient outcomes (including personal recovery from psychosis, service satisfaction, and therapeutic relationship quality) will be measured at baseline, three, and six months. Analysis: Feasibility outcomes: numbers, percentages and average number of patient participants recruited per care coordinator. Clinical outcomes: tabulated summaries for participants by group at each time-point. Confidence intervals will be reported as appropriate. Qualitative study: Patient interviews and care coordinator focus groups will be conducted to understand the acceptability of the intervention and refine the training and implementation plan for a larger trial. Results will inform decision making regarding the feasibility of conducting a definitive trial.

Lay abstract: The term psychosis describes a range of distressing experiences, including hearing and seeing things others cannot, holding beliefs others find unusual, and feelings of persecution. People experiencing a first episode of psychosis should receive support from early intervention services for up to three years and be allocated a care coordinator, often a nurse or social worker, who takes a lead in care planning and promoting recovery. Many service-users, however, do not remain in contact with early intervention services for the full three years, limiting their access to evidence-based interventions. There is evidence that what people value about early intervention services is the opportunity to talk openly about their difficulties in an atmosphere of trust. Care coordinators are not routinely offered training on how to make these conversations as beneficial as possible. Improving the quality of support offered by care coordinators could make these services more helpful and encourage service-users to remain in contact with them. We want to find out if it is feasible to conduct a study where care coordinators are trained to deliver a psychological intervention called Method of Levels, which we believe could support people's recovery and improve relationships between care coordinators and service-users. We intend to recruit 24 care coordinators from 12 early intervention teams. We also want to recruit 96 service-users who are working with participating care coordinators. Teams will be randomly allocated to one of two groups. Teams in both groups will continue offering their usual support to service-users. Care coordinators working in teams in the second group, however, will also be offered Method of Levels training and supervision. To help us decide whether a larger trial is justified, we will then examine differences in outcomes and experiences between groups, including psychosis recovery rates and the quality of relationships between service-users and care coordinators.

Research activity codes: 6.6 PSYCHOLOGICAL AND BEHAVIOURAL
Health categories: MENTAL HEALTH