Abstract
BackgroundAs an alternative to hospital admission, crisis resolution teams (CRTs) provide intensive home treatment to people experiencing mental health crises. Trial evidence supports the effectiveness of the CRT model, but research suggests that the anticipated reductions in inpatient admissions and increased user satisfaction with acute care have been less than hoped for following the scaling up of CRTs nationally in England, as mandated by the National Health Service (NHS) Plan in 2000. The organisation and service delivery of the CRTs vary substantially. This may reflect the lack of a fully specified CRT model and the resources to enhance team model fidelity and to improve service quality. We will evaluate the impact of a CRT service improvement programme over a 1-year period on the service users’ experiences of care, service use, staff well-being, and team model fidelity.Methods/designTwenty-five CRTs from eight NHS Trusts across England will be recruited to this cluster-randomised trial: 15 CRTs will be randomised to receive the service improvement programme over a 1-year period, and ten CRTs will not receive the programme. Data will be collected from 15 service users and all clinical staff from each participating CRT at baseline and at the end of the intervention. Service use data will be collected from the services’ electronic records systems for two 6-month periods: the period preceding and the period during months 7-12 of the intervention. The study’s primary outcome is service user satisfaction with CRT care, measured using a client satisfaction questionnaire. Secondary outcomes include the following: perceived continuity of care, hospital admission rates and bed use, rates of readmission to acute care following CRT support, staff morale, job satisfaction, and general health. The adherence of the services to a model of best practice will be assessed at baseline and follow-up. Outcomes will be compared between the intervention and control teams, adjusting for baseline differences and participant characteristics using linear random effects modelling. Qualitative investigations with participating CRT managers and staff and programme facilitators will explore the experiences of the service improvement programme.DiscussionOur trial will show whether a theoretically underpinned and clearly defined package of resources are effective in supporting service improvement and improving outcomes for mental health crisis resolution teams.Trial registrationCurrent Controlled Trials ISRCTN47185233Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1283-7) contains supplementary material, which is available to authorized users.
Highlights
As an alternative to hospital admission, crisis resolution teams (CRTs) provide intensive home treatment to people experiencing mental health crises
Our trial will show whether a theoretically underpinned and clearly defined package of resources are effective in supporting service improvement and improving outcomes for mental health crisis resolution teams
Some positive findings have been reported from naturalistic studies and a randomised controlled trial, suggesting that CRTs reduce inpatient admissions [7,8,9,10,11] and healthcare costs [12, 13] and increase service user satisfaction with acute care [7, 10]
Summary
Strengths Strengths of the CORE phase 4 study include the following: 1. A multi-site, cluster-randomised trial will provide quality evidence regarding the effectiveness of the CORE CRT Service Improvement Programme. A multi-site, cluster-randomised trial will provide quality evidence regarding the effectiveness of the CORE CRT Service Improvement Programme. 2. The Service Improvement Programme follows a developed US evidence-based practice programme template for achieving high-fidelity implementation of a complex intervention or service model. 3. The mixed methods approach involving measurement of changes in team fidelity, process data, and qualitative evaluation will help to understand trial outcomes, mechanisms of change and barriers and facilitators to implementation and contextual factors that may influence the effectiveness of the trial intervention. The trial will investigate the impact of the CORE Service Improvement Programme on other outcomes relevant to the services’ clinical and cost effectiveness, i.e. local admission rates and service users’ recovery following CRT care, and will measure any impact of the team-level intervention on CRT staff well-being
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