Abstract
BackgroundRecovery features strongly in Australian mental health policy; however, evidence is limited for the efficacy of recovery-oriented practice at the service level. This paper describes the Principles Unite Local Services Assisting Recovery (PULSAR) Specialist Care trial protocol for a recovery-oriented practice training intervention delivered to specialist mental health services staff. The primary aim is to evaluate whether adult consumers accessing services where staff have received the intervention report superior recovery outcomes compared to adult consumers accessing services where staff have not yet received the intervention. A qualitative sub-study aims to examine staff and consumer views on implementing recovery-oriented practice. A process evaluation sub-study aims to articulate important explanatory variables affecting the interventions rollout and outcomes.MethodsThe mixed methods design incorporates a two-step stepped-wedge cluster randomized controlled trial (cRCT) examining cross-sectional data from three phases, and nested qualitative and process evaluation sub-studies. Participating specialist mental health care services in Melbourne, Victoria are divided into 14 clusters with half randomly allocated to receive the staff training in year one and half in year two. Research participants are consumers aged 18–75 years who attended the cluster within a previous three-month period either at baseline, 12 (step 1) or 24 months (step 2). In the two nested sub-studies, participation extends to cluster staff. The primary outcome is the Questionnaire about the Process of Recovery collected from 756 consumers (252 each at baseline, step 1, step 2). Secondary and other outcomes measuring well-being, service satisfaction and health economic impact are collected from a subset of 252 consumers (63 at baseline; 126 at step 1; 63 at step 2) via interviews. Interview-based longitudinal data are also collected 12 months apart from 88 consumers with a psychotic disorder diagnosis (44 at baseline, step 1; 44 at step 1, step 2). cRCT data will be analyzed using multilevel mixed-effects modelling to account for clustering and some repeated measures, supplemented by thematic analysis of qualitative interview data. The process evaluation will draw on qualitative, quantitative and documentary data.DiscussionFindings will provide an evidence-base for the continued transformation of Australian mental health service frameworks toward recovery.Trial RegistrationAustralian and New Zealand Clinical Trial Registry: ACTRN12614000957695. Date registered: 8 September 2014.
Highlights
Recovery features strongly in Australian mental health policy; evidence is limited for the efficacy of recovery-oriented practice at the service level
Findings will provide an evidence-base for the continued transformation of Australian mental health service frameworks toward recovery
Using a mixed methods design, the primary objective of the Principles Unite Local Services Assisting Recovery (PULSAR) Specialist Care study is to evaluate whether adults accessing study cluster specialist mental health services where staff receive the recovery-oriented practice training intervention report superior recovery outcomes compared to adults accessing services where staff have not received the intervention
Summary
Recovery features strongly in Australian mental health policy; evidence is limited for the efficacy of recovery-oriented practice at the service level. In 2011, the Victorian Government commissioned a framework document supporting the development of evidence-based recovery-oriented mental health services with an emphasis on facilitating personal recovery and dismantling barriers to full participation in community life for people with experiences of mental illness [8] This was followed in 2014 by the implementation of a new Mental Health Act in Victoria that established recovery as a fundamental guiding principle in the provision of mental health care. Recovery has emerged as a core feature of contemporary reform to mental health service planning and delivery at both the state and national level Complementing these developments has been an increasing emphasis on the importance of “co-design” or “co-production” to ensure that consumers, families and carers are centrally involved in the design, development and delivery of mental health services [10, 11]. Little is known about the effectiveness of mental health interventions across people of different cultural and linguistic groups and whether the contemporary emphasis on recovery orientated practice is having the presumed positive impacts on consumers
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