Title: SUstaining Positive Engagement and Recovery (SuperEDEN) – the next step after Early Intervention for Psychosis
Funder: Department of Health (England)

Abstract: Aims and Objectives: SuperEDEN will provide the evidence base to develop the 'next generation' of early intervention in psychosis services (EIS) which will: ensure that the gains made during EIS are maintained once users are discharged; enable the development of a 'stepped care' model of EIS to improve the targetting of interventions appropriate to emerging needs, illness trajectories and user preference; and evaluate a new intervention to improve structured activity levels in those who show a poor recovery from the first psychotic episode. Background: Psychosis is the most disabling of the psychiatric disorders and develops in adolescence. EIS targets this early phase: trials show improved early outcome and overall cost savings, but we do not know a) the full impact of EIS over 3 years in 'routine' settings, b) the different illness trajectories seen under EIS (eg. 'good' vs 'poor' responders) and c) as there are some who, while making strong gains, can lose these once they are transferred to lower intensity care, we do not know what is the ideal form of care needed to maintain gains following discharge. Research Plans: In study 1 we plan to follow-up annually for 2 years a unique sample of patients (n=1032) receiving EIS in 6 services, collected as part of the DH National EDEN evaluation of EIS.This sample will be followed up into their discharge services (primary care, CMHT, assertive outreach) and the same measures collected (symptoms, activity, relapse) including the level of contact with, and treatment from, the discharge services. Using longitudinal modelling we will characterise their illness trajectories and how they can be predicted by premorbid, baseline and EIS treatment variables. We will identify any changes in trajectory and cost-effectiveness post-EIS, and their prediction by: a) initial trajectory b) engagement with and qualities of the discharge service and c) treatments offered and taken. In study 2, using qualitative methods we will: i) ascertain the user and carer view about the experience of discharge from a high to lower intensity services; and the experience of care received in the various discharge services, ii) document the views of key staff in discharge services about the ability of the service to provide the specialist care and the process of transition. Study 3: Using data from National EDEN, we have identified a group of patients who have demonstrated poor social recovery by 12 months and where recovery appears impeded by symptoms and loss of motivation. We propose to undertake a 'proof of principle' trial of the effectiveness of our recently developed motivational based intervention to restore social recovery in this group, and to test whether it is durable and cost-effective. Research Team: The EDEN team have worked as a clinical and research network for over 10 years and are internationally recognised leaders in the epidemiology, treatment and prevention of psychosis. The team were responsible for the development and implementation of EIS in the UK and wrote the DH Mental Health Policy Implementation Guide for EIS and are therefore ideally placed to ensure that the outcome of this research translates into NHS practice. Research environment: The EDEN team are embedded in the Mental Health Research Network. Each centre is an acknowledged centre of excellence, with eg. CLAHRC infrastructure and numerous MRC/NIHR projects; and partnerships with 5 Universities who have excelled in the RAE. Anticipated outputs: Dependent on results, we will develop a revision of the EIS guidelines to include: a stepped care model; early identification and targetting of poor social recovery; strategies to maintain gains after discharge; strategies to maximise cost-effectiveness. Public involvement: The team includes 2 PIs from user and carer organisations. They have been part of the design of the programme and jointly developed the protocol for study 2 and will have responibility for its implementation. They will formally involve consumer groups in the process of translating the findings into proposed changes in EIS. Ethical implications: We will seek a major amendment to our existing National EDEN study; a separate application for study 3 will be informed by previous pilot work for which approval was granted. Justification for resources: A programme manager will be needed to co-ordinate the sites; 9 RAs and 2 methodologist RAs are proposed. These resources are largely based on solid experience from DH National EDEN--the progenitor of the proposed programme application.


Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MENTAL HEALTH