Training to enhance user and carer involvement in mental health-care planning: the EQUIP research programme including a cluster RCT

Project report


Lovell, K., Bee, P., Bower, P., Brooks, H., Cahoon, P., Callaghan, P., Cater, L-A., Cree, L., Davies, L., Drake, R., Fraser, C., Gibbons, C., Grundy, A., Hinsliff-Smith, K., Meade, O., Roberts, C., Rogers, A., Rushton, K., Sanders, C., Shields, G. and Walker, L. (2019). Training to enhance user and carer involvement in mental health-care planning: the EQUIP research programme including a cluster RCT. Southampton Programme Grants for Applied Research. doi:10.3310/pgfar07090
AuthorsLovell, K., Bee, P., Bower, P., Brooks, H., Cahoon, P., Callaghan, P., Cater, L-A., Cree, L., Davies, L., Drake, R., Fraser, C., Gibbons, C., Grundy, A., Hinsliff-Smith, K., Meade, O., Roberts, C., Rogers, A., Rushton, K., Sanders, C., Shields, G. and Walker, L.
TypeProject report
Abstract

Background: Service users and carers using mental health services want more involvement in their care and the aim of this research programme was to enhance service user and carer involvement in care planning in mental health services.
Objectives: Co-develop and co-deliver a training intervention for health professionals in community mental health teams, which aimed to enhance service user and carer involvement in care planning. Develop a patient-reported outcome measure of service user involvement in care planning, design an audit
tool and assess individual preferences for key aspects of care planning involvement. Evaluate the clinical effectiveness and the cost-effectiveness of the training. Understand the barriers to and facilitators of
implementing service user- and carer-involved care planning. Disseminate resources to stakeholders.
Methods: A systematic review, focus groups and interviews with service users/carers/health professionals informed the training and determined the priorities underpinning involvement in care planning. Data from focus groups and interviews were combined and analysed using framework analysis. The results of the systematic review, focus groups/interviews and a review of the training interventions were synthesised to develop the final training intervention. To develop and validate the patient-reported outcome measure,
items were generated from focus groups and interviews, and a psychometric analysis was conducted. Patient-reported outcome measure items and a three-round consensus exercise were used to develop an audit tool, and a stated preference survey was undertaken to assess individual preferences for key aspects
of care planning. The clinical effectiveness and cost-effectiveness of the training were evaluated using a
pragmatic cluster trial with cohort and cross-sectional samples. A nested longitudinal qualitative process
evaluation using multiple methods, including semistructured interviews with key informants involved locally and nationally in mental health policy, practice and research, was undertaken. A mapping exercise was used to determine current practice, and semistructured interviews were undertaken with service users and mental health professionals from both the usual-care and the intervention arms of the trial at three time points (i.e. baseline and 6 months and 12 months post intervention).
Results: The results from focus groups (n = 56) and interviews (n = 74) highlighted a need to deliver training to increase the quality of care planning and a training intervention was developed. We recruited 402 participants to develop the final 14-item patient-reported outcome measure and a six-item audit tool. We recruited 232 participants for the stated preference survey and found that preferences were strongest for the attribute ‘my preferences for care are included in the care plan’. The training was delivered to
304 care co-ordinators working in community mental health teams across 10 NHS trusts. The cluster trial and cross-sectional survey recruited 1286 service users and 90 carers, and the primary outcome was the Health Care Climate Questionnaire. Training was positively evaluated. The results showed no statistically significant difference on the primary outcome (the Health Care Climate Questionnaire) (adjusted mean difference –0.064, 95% confidence interval –0.343 to 0.215; p = 0.654) or secondary outcomes at the 6-month follow-up. Overall, the training intervention was associated with a net saving of –£54.00 (95% confidence interval –£193.00 to £84.00), with a net quality-adjusted life-year loss of –0.014 (95% confidence interval –0.034 to 0.005). The longitudinal process evaluation recruited 54 service
users, professionals and carers, finding a failure of training to become embedded in routine care.
Limitations: Our pragmatic study was designed to improve service user and care involvement in care
planning among routine community mental health services. We intervened in 18 sites with > 300 care co-ordinators. However, our volunteer sites may not be fully representative of the wider population, and we lacked data with which to compare our participants with the eligible population.
Conclusions: We co-developed and co-delivered a training intervention and developed a unidimensional measure of service user and carer involvement in care planning and an audit tool. Despite a high level of satisfaction with the training, no significant effect was found; therefore, the intervention was ineffective. There was a failure of training to become embedded and normalised because of a lack of organisational readiness to accept change. Working with NHS trusts in our ‘Willing Adopters’ programme with enhanced
organisational buy-in yielded some promising results.
Future work: Research should focus on developing and evaluating new organisational initiatives in addition to training health-care professionals to address contextual barriers to service and carer involvement in care planning, and explore co-designing and delivering new ways of enhancing service users’ and carers’ capabilities to engage in care planning.
Trial registration: Current Controlled Trials ISRCTN16488358.

Year2019
PublisherProgramme Grants for Applied Research
National Institute of Health Research
Place of publicationSouthampton
ISSN2050-4322
Digital Object Identifier (DOI)doi:10.3310/pgfar07090
Web address (URL)https://www.journalslibrary.nihr.ac.uk/pgfar/pgfar07090/#/abstract
File
License
CC BY-NC 4.0
File Access Level
Open
Publication dates
Print23 Oct 2019
Publication process dates
Accepted01 Dec 2018
Deposited20 Nov 2019
Permalink -

https://openresearch.lsbu.ac.uk/item/88837

  • 2
    total views
  • 2
    total downloads
  • 1
    views this month
  • 1
    downloads this month

Related outputs

Cost-effectiveness of a preferred intensity exercise programme for young people with depression compared with treatment as usual: An economic evaluation alongside a clinical trial in the UK
Turner, D, Carter, T, Sach, T, Guo, B and Callaghan, P (2017). Cost-effectiveness of a preferred intensity exercise programme for young people with depression compared with treatment as usual: An economic evaluation alongside a clinical trial in the UK. BMJ Open. 7 (11), pp. e016211-e016211.
A pragmatic randomised controlled trial of preferred intensity exercise in depressed adult women in the United Kingdom: secondary analysis of individual variability of depression
Callaghan, P, Morres, I, Hinton-Bayre, A, Motakis, E and Carter, T (2019). A pragmatic randomised controlled trial of preferred intensity exercise in depressed adult women in the United Kingdom: secondary analysis of individual variability of depression. BMC Public Health. 19 (941), pp. 1-11.
Behavioural activation therapy for post-stroke depression: the BEADS feasibility RCT
Thomas, S., Drummond, A., Lincoln, N., Palmer, R., das Nair, R., Latimer, N., Hackney, G., Mandefield, L., Walters, S., Hatton, R., Cooper, C., Chater, T., England, R., Callaghan, P., Coates, E., Sutherland, K., Eshtan, S.J. and Topcu, G. (2019). Behavioural activation therapy for post-stroke depression: the BEADS feasibility RCT. National Institute for Health Research. doi:10.3310/hta23470
Bringing meaning to user involvement in mental health care planning: a qualitative exploration of service user perspectives
Grundy, AC, Bee, P, Meade, O, Callaghan, P, Beatty, S, Olleveant, N and Lovell, K (2015). Bringing meaning to user involvement in mental health care planning: a qualitative exploration of service user perspectives. Journal of psychiatric and mental health nursing. 23 (1), pp. 12-21.
‘We have got the tools’: Qualitative evaluation of a mental health Wellness Recovery Action Planning (WRAP) education programme in Ireland
Keogh, B, Higgins, A, DeVries, J, Morrissey, J, Callaghan, P, Ryan, D, Gijbels, H and Nash, M (2014). ‘We have got the tools’: Qualitative evaluation of a mental health Wellness Recovery Action Planning (WRAP) education programme in Ireland. Journal of psychiatric and mental health nursing. 21 (3), pp. 189-196.
An exploration of predictors of children's nurses' attitudes, knowledge, confidence and clinical behavioural intentions towards children and young people who self-harm.
Carter, T, Latif, A, Callaghan, P and Manning, JC (2018). An exploration of predictors of children's nurses' attitudes, knowledge, confidence and clinical behavioural intentions towards children and young people who self-harm. Journal of Clinical Nursing. 27 (13-14), pp. 2836-2846.
Embedding shared decision-making in the care of patients with severe and enduring mental health problems: The EQUIP pragmatic cluster randomised trial.
Lovell, K, Bee, P, Brooks, H, Cahoon, P, Callaghan, P, Carter, L-A, Cree, L, Davies, L, Drake, R, Fraser, C, Gibbons, C, Grundy, A, Hinsliff-Smith, K, Meade, O, Roberts, C, Rogers, A, Rushton, K, Sanders, C, Shields, G, Walker, L and Bower, P (2018). Embedding shared decision-making in the care of patients with severe and enduring mental health problems: The EQUIP pragmatic cluster randomised trial. PLoS ONE. 13 (8).
The concept of compassion within UK media generated discourse: a corpus informed analysis
Bond, C, Stacey, G, Lymn, J, Redsell, S, Spiby, H, Callaghan, P and Keeley, P (2018). The concept of compassion within UK media generated discourse: a corpus informed analysis. Journal of Clinical Nursing.
The effect of exercise on depressive symptoms in adolescents: a systematic review and meta-analysis
Carter, T, Morres, I, Meade, O and Callaghan, P (2016). The effect of exercise on depressive symptoms in adolescents: a systematic review and meta-analysis. Journal of the American Academy of Child and Adolescent Psychiatry. 55 (7), pp. 580-590.
The effectiveness of the Penn Resiliency Programme (PRP) and its adapted versions in reducing depression and anxiety and improving explanatory style: A systematic review and meta-analysis
Bastounis, A, Callaghan, P, Banerjee, A and Michail, M (2016). The effectiveness of the Penn Resiliency Programme (PRP) and its adapted versions in reducing depression and anxiety and improving explanatory style: A systematic review and meta-analysis. Journal of Adolescence. 52, pp. 37-48.
Exploring Students’ Participation in Universal, Depression and Anxiety, Prevention Programmes at School: A Meta-aggregation
Bastounis, A, Callaghan, P, Lykomitrou, F, Aubeeluck, A and Michail, M (2017). Exploring Students’ Participation in Universal, Depression and Anxiety, Prevention Programmes at School: A Meta-aggregation. School Mental Health. 9 (4), pp. 372-385.
Behavioural activation therapy for depression after stroke (BEADS): a study protocol for a feasibility randomised controlled pilot trial of a psychological intervention for post-stroke depression
Thomas, SA, Coates, E, Nair, RD, Lincoln, N, Cooper, C, Palmer, R, Walters, SJ, Latimer, NR, England, TJ, Mandefield, L, Chater, T, Callaghan, P and Drummond, AER (2016). Behavioural activation therapy for depression after stroke (BEADS): a study protocol for a feasibility randomised controlled pilot trial of a psychological intervention for post-stroke depression. Pilot and Feasibility Studies. 2 (1), pp. 45/1-45/12.
The impact of advertising patient and public involvement on trial recruitment: embedded cluster randomised recruitment trial
Hughes-Morley, A, Hann, M, Fraser, C, Meade, O, Lovell, K, Young, B, Roberts, C, Cree, L, More, D, O’Leary, N, Callaghan, P, Waheed, W and Bower, P (2016). The impact of advertising patient and public involvement on trial recruitment: embedded cluster randomised recruitment trial. Trials. 17 (1).
"Our Care through our eyes": impact of a co-produced digital education programme on nurses’ knowledge, confidence and attitudes in providing care for children and young people who have self-harmed: a mixed-methods study in the UK
Manning, JC, Carter, T, Latif, A, Cooper, J, Horsley, A, Armstrong, M, Crew, J, Wood, D, Callaghan, P and Wharrad, H (2017). "Our Care through our eyes": impact of a co-produced digital education programme on nurses’ knowledge, confidence and attitudes in providing care for children and young people who have self-harmed: a mixed-methods study in the UK. BMJ Open. 7 (4).
Violence risk assessment and management in mental health: a conceptual, empirical and practice critique
Callaghan, P and Grundy, A (2018). Violence risk assessment and management in mental health: a conceptual, empirical and practice critique. Journal of Mental Health Training, Education and Practice. 13 (1), pp. 3-13.
Managing preconceived expectations: mental health service users experiences of going home from hospital: a grounded theory study
Keogh, B, Callaghan, P and Higgins, A (2015). Managing preconceived expectations: mental health service users experiences of going home from hospital: a grounded theory study. Journal of psychiatric and mental health nursing. 22 (9), pp. 715-723.
EQUIP training the trainers: an evaluation of a training programme for service users and carers involved in training mental health professionals in user-involved care planning
Fraser, C, Grundy, A, Meade, O, Callaghan, P and Lovell, K (2017). EQUIP training the trainers: an evaluation of a training programme for service users and carers involved in training mental health professionals in user-involved care planning. Journal of psychiatric and mental health nursing. 24 (6), pp. 367-376.
Evaluation of a co-delivered training package for community mental health professionals on service user- and carer-involved care planning
Grundy, AC, Walker, L, Meade, O, Fraser, C, Cree, L, Bee, P, Lovell, K and Callaghan, P (2017). Evaluation of a co-delivered training package for community mental health professionals on service user- and carer-involved care planning. Journal of psychiatric and mental health nursing. 24 (6), pp. 358-366.
The strengths based approach as a service delivery model for severe mental illness: a meta-analysis of clinical trials
Ibrahim, N, Michail, M and Callaghan, P (2014). The strengths based approach as a service delivery model for severe mental illness: a meta-analysis of clinical trials. BMC Psychiatry. 14 (1).
Evaluating and Quantifying User and Carer Involvement in Mental Health Care Planning (EQUIP): Co-Development of a New Patient-Reported Outcome Measure
Bee, P, Gibbons, C, Callaghan, P, Fraser, C and Lovell, K (2016). Evaluating and Quantifying User and Carer Involvement in Mental Health Care Planning (EQUIP): Co-Development of a New Patient-Reported Outcome Measure. PLoS ONE. 11 (3), pp. e0149973-e0149973.
Qualitative process evaluation of a psycho-educational intervention targeted at people diagnosed with schizophrenia and their primary caregivers in Jordan
Al-HadiHasan, A, Callaghan, P and Lymn, JS (2017). Qualitative process evaluation of a psycho-educational intervention targeted at people diagnosed with schizophrenia and their primary caregivers in Jordan. BMC Psychiatry. 17 (1).
Monitoring oral health of people in Early Intervention for Psychosis (EIP) teams: The extended Three Shires randomised trial
Adams, C, Clark-Wells, N, Clifton, A, Jones, H, Simpson, J, Tosh, G, Callaghan, P, Liddle, P, Guo, B, Furtado, V, Khokar, MA and Aggarwal, VR (2017). Monitoring oral health of people in Early Intervention for Psychosis (EIP) teams: The extended Three Shires randomised trial. International Journal of Nursing Studies. 77, pp. 106-114.
The feasibility of nurse-delivered, low-intensity cognitive behavioural therapy for irritable bowel syndrome
Dainty, A., Hunt, M., Holtham, E., Kinsella, P., Timmons, S., Fox, M. and Callaghan, P. (2017). The feasibility of nurse-delivered, low-intensity cognitive behavioural therapy for irritable bowel syndrome. Gastrointestinal Nursing. 15 (9).