Nurse-led Psycho-education Program for People With First-onset Mental Illness (APN-PEP)
Condition: Mental Illness
MeSH terms: Mental Disorders
Study type: Interventional

Summary: 
      The study aims to test the effectiveness of a nurse-led psycho-education program based on
      motivational interviewing technique for Chinese patients with first-onset mental illness over
      a 12-month follow-up. A randomized controlled trial will be conducted with 180 Chinese
      patients with schizophrenia newly referred to one outpatient clinic in Hong Kong. They will
      be randomly assigned to either the eight-session nurse-led psycho-education program or usual
      psychiatric outpatient care (both n=90). The patients' general and mental health, illness
      insight, self-efficacy, services utilization, and hospitalization rates were measured at
      recruitment and one week, six months and 12 months post-intervention.

      Note: Those who were approached in the clinic and not eligible to participate in this trial
      will be invited to participate in another controlled trial. The controlled trial tests the
      effects of a self-help problem-solving based bibliotherapy program (SPBB) for Chinese family
      caregivers in recent onset psychosis (not more than 1 year onset) at one psychiatric clinic,
      in comparison to routine outpatient service and family support (control group) for 116
      randomly selected family caregivers of outpatients with psychotic disorders over a 6-month
      follow-up.)
    

Detailed description: 
      The development of APNs in Hong Kong is in line with nursing development internationally.
      Since 2001, the Hospital Authority has appointed about 530 nurses as APNs, in whom about 50
      are in mental health practice. Five of these psychiatric APNs function independently and
      interdependently with other health care team members to excel to health educators and care
      coordinators with fulfilments in health assessment, education and care coordination for
      clients with noticeable mental health problems, being referred to psychiatric outpatient
      service. A structured one-to-one psycho-education program has been developed and trial run to
      provide early psychiatric and psychosocial intervention and support to the clients who have
      been triaged by the psychiatric nurses in two outpatient clinics in the Kowloon East Cluster
      as categorised as those who present noticeable mental symptoms but low risks of self-harm or
      violence. These clients are arranged to have their first psychiatrist consultation in the
      clinic within two to eight weeks following triage. Prior to the consultation appointment,
      they are referred to the psychiatric APN in the nurse-led clinic for providing further
      psychosocial health assessment and early intervention and psychological support. As estimated
      by the clinic staff, there are 60% of the clients (i.e. 60 cases per month) triaged and
      classified as such category in the two outpatient clinics.

      This study aims to evaluate the effectiveness of the one-to-one, nurse-led psycho-education
      program provided by the psychiatric APN for those newly referred clients with mental health
      problems on improving their mental and emotional conditions, quality of life, and
      satisfaction with service, and on reducing their rates of hospitalization and default
      follow-up in two psychiatric outpatient clinics (OPD) in Kowloon East region of Hong Kong.

      Objectives of the study

        1. To investigate the effects of the nurse-led psycho-education program for newly referred
           clients with mental health problems triaged as Category 2 on improving their mental
           state, anxiety state, insight and treatment attitude, self-efficacy in life situations,
           general health, and utilisation of and satisfaction with mental health care services
           provided over a period of 12 months follow-up; and

        2. To investigate the effects of the nurse-led psycho-education program on reducing the
           clients' rate of hospitalization and default follow-up in the psychiatric OPD over the
           12-month follow-up.

      [Note: Those are not eligible to participate in this trial will be assessed by an Advanced
      Practice Nurse to join the randomised controlled trial with repeated measures, parallel-group
      (2-arm) design will be carried out at one psychiatric clinic. This pilot trial aims to
      evaluate the effects between the treatment group (i.e., a problem-solving based self-learning
      program, SPBB) and routine outpatient service (control group) for 116 randomly selected
      family caregivers of outpatients with recent-onset psychosis over a 6-month follow-up. The
      study outcomes include the caregivers' burden of care, caregiving experiences, and
      problem-solving abilities, and the patients' mental state, functioning, and
      re-hospitalization rates. They will be measured at recruitment, one week, and 6 months
      following the interventions. Objectives of the study are: 1. To investigate the effects of
      the SPBB program for family caregivers of recent onset psychosis on improving their
      caregivers' burden of care, caregiving experiences, and problem-solving abilities, and the
      patients' mental state, and functioning over a period of 6 months follow-up; and 2. To
      investigate the effects of the SPBB program on reducing the clients' rate of hospitalization
      and default follow-ups in the psychiatric outpatient clinic over the 6-month follow-up.
    

Intervention name(s): Nurse-led Psycho-education (or SPBB: self-learning program); Usual Psychiatric Outpatient Care
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The program was modified from the psycho-educational, motivation-driven and emotionally supportive programs developed and previously tested by the research team in Chinese people with different kinds of serious mental illness, mainly including schizophrenia spectrum disorders and mood disorders by Chien and his colleagues in 2012, and adherence therapy for people with psychotic disorders by Gray et al. (2010).
[Note: SPBB consists of 5 modules (Module 1: Caregiver's well-being; Module 2:Getting the best out of support services; Module 3:Well-being of the person with schizophrenia; Module 4:Dealing with the [psychosocial] effects of the illness; and Module 5: Dealing with [physical and mental health] effects of the illness).]; These services consisted of medical consultation and treatment by the attending psychiatrist (i.e., around every four weeks), brief education sessions (i.e., 3 or 4 one-hour sessions) on mental illness and treatment received by psychiatric nurses, and advices and referrals for community mental health and social welfare services available and/or family counseling by a psychiatric nurse or medical social worker in each clinic.
Other intervention name(s): APN-PEP; UPOC
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Repeated measures, two-arm design
[SPBB: A repeated-measures, two-arm design with 112 outpatients and their family caregivers]
Masking: Single (Outcomes Assessor)
Primary purpose: Health Services Research
Keywords: psychosis; self-learning; problem solving; randomized controlled trial; family carer; recent-onset psychosis