Title: Optimising team functioning, preventing relapse and enhancing recovery in crisis resolution teams: the CORE programme (CRT Optimisation and RElapse prevention)
Funder: Department of Health (England)

Abstract: Aims and objectives Crisis resolution teams (CRTs) have been introduced nationwide, aiming to reduce acute psychiatric bed use and improve service user experiences. We aim to establish evidence at both team and individual patient level as to how their functioning may be optimised to reduce reliance on inpatient care and enhance recovery. Objectives are; 1. To investigate best practice in CRTs, using existing evidence and the perspectives of services users, carers, professionals and experts. 2. To formulate a model for achieving best practice in CRT organisation and operation, and a fidelity measure to assess whether this is achieved. 3. To develop an implementation resource kit for achieving high fidelity care and conduct a mixed methods investigation of its impact. 4. To develop, pilot and assess the effectiveness and cost-effectiveness of a peer-facilitated self-management intervention, designed to reduce relapse and enhance progress towards personal recovery goals among CRT service users. Background CRTs are established throughout England, and pioneer services have reduced admissions and improved patient satisfaction. However, recent national reports identify significant limitations in implementation, including problems achieving continuity of care and the intended reductions in bed use, and service user and carer dissatisfaction with therapeutic relationships and the range of help available to support recovery. Resource constraints and the requirement for rapid national implementation are likely to contribute to the problems identified. However, the model is still loosely specified, and we lack evidence on the critical ingredients of effective CRT care and on specific interventions that promote recovery in this context. Research plans The CORE programme consists of two workstreams Workstream 1 develops the CRT model and addresses difficulties identified in recent reports at a team level. Multiple perspectives on best practice in CRTs will be investigated, informing the development and piloting of a fidelity measure to assess the extent to which CRTs achieve good practice. An implementation resource kit for achieving high fidelity care will be developed and its impact investigated in 15 CRTs with varying fidelity scores, comparing them with 10 control services. We will explore whether the resource kit enhances fidelity and whether higher team fidelity is associated with better outcomes. While Workstream 1 focuses on team-level change, Workstream 2 addresses limitations in CRT care at an individual service user level. A peer-facilitated self-management intervention, bridging the gap between the episode of acute care and continuing care, will be piloted and its effectiveness and cost-effectiveness tested in a randomised controlled trial. The primary outcome will be readmission to acute care (CRT or hospital) over a 12 month period. Secondary outcomes will include self-rated recovery, symptoms and illness management skills. Research team These plans originate in the Mental Health Research Network’s Acute Care Research Group, in which most applicants have participated. Several have already collaborated on a programme of work on alternatives to hosptial of which this programme is the continuation: they have thus acquired wide experience in this setting. Others bring expertise in development and testing of complex interventions, organisational research and team development, service user engagement, statistics, qualitative research and health economics. Research environment The main base at UCL has a long track record in policy-relevant research on complex mental health interventions, so that researchers will benefit from wide local expertise. Our programme spans several other departments with internationally recognised research in this area, and is supported by a specialist mental health Clinical Trials Unit. Anticipated outputs and impact Potential impacts include a reduction in acute bed use in the NHS mental health system, as well as better service user experiences and progress towards recovery. A range of papers for different audiences and conference presentations will describe our progress. Public involvement A wide consultation with service users and carers informs this proposal, and an applicant is a service user researcher. We plan input throughout from service user and carer working groups, and from a public involvement coordinator in the research team. Ethical implications Careful assessment of capacity and readiness to participate will be needed when working with service users in crisis: researchers will be trained for this. Justification for resources The main resources are for a programme manager, team of research assistants, clinical psychologist coordinating development of measures and interventions, public involvement coordinator, service user and carer participation, statistical, health economic and qualitative methods input, and the applicants’ time.


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