Development of the REFOCUS intervention to increase mental health team support for personal recovery

Slade, Mike; Bird, Victoria; Boutillier, Clair Le; Farkas, Marianne; Grey, Barbara; Larsen, John; Leamy, Mary; Oades, Lindsay G.; Williams, Julie

doi:10.1192/bjp.bp.114.155978

Cited by 42 publications

(43 citation statements)

References 38 publications

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“…However, research suggests that there is persistent confusion among mental health staff as to the meaning of recovery and how it should be applied (Le Boutillier et al., ). Our results highlight the need for continued emphasis on embedding recovery‐based practice within supported accommodation services; existing, team‐focussed toolkits and training programs, such as REFOCUS (Slade et al., ) and TRIP (Repper & Perkins, ), may be appropriate for use in these settings. Any intervention, however, must be undertaken with an emphasis on sustaining change; collaborative action planning, explicit management endorsement and modifying organisational structures will be essential to ensure that recovery orientation is embedded within an existing culture (Gee, Bhanbhro, Cook, & Killaspy, ).…”

Section: Discussionmentioning

confidence: 79%

Service user experiences of specialist mental health supported accommodation: A systematic review of qualitative studies and narrative synthesis

Krotofil¹,

McPherson²,

Killaspy³

2018

Health Soc Care Community

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Specialist supported accommodation services have become a key component of most community-based mental healthcare systems. While mental health policies highlight the importance of service user involvement in service development and care planning, there are no comprehensive literature reviews synthesising services users' perspectives on, or experiences of, supported accommodation services. This systematic review was undertaken to fill this gap. We searched electronic databases (January 2015, updated June 2017), conducted hand searches and used forward-backward snowballing to identify 13,678 papers. We inspected the full-text of 110 papers and included 50 of these in the final review. Data extraction and quality assessments were conducted. We used narrative synthesis to develop a conceptual model of service users' experiences that included structural, process, relational and contextual factors, such as the characteristics of the service, relationships with staff and other service users, the intensity and nature of support, the physical environment, and social and community integration. The review highlights the complex interplay of individual, service-level and community factors in shaping the lived experience of service users and their impact on personal identity and recovery. Our approach addressed some of the widely reported limitations of the quantitative research in this field, providing a conceptual model relevant to service user experiences across supported accommodation service types, population groups and countries.

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Section: Discussionmentioning

confidence: 79%

Service user experiences of specialist mental health supported accommodation: A systematic review of qualitative studies and narrative synthesis

Krotofil¹,

McPherson²,

Killaspy³

2018

Health Soc Care Community

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“…The intervention is based on a package of tools promoting recovery-oriented practice in mental health care that were developed by the REFOCUS team [30, 31] and adapted for the Australian public clinical mental health care setting and the MHCSS Sector [25]. The adaptation of the REFOCUS materials was guided by consultations with: the REFOCUS research team; staff members from participating specialist care organizations in two group sessions based on the Promoting Action of Research Implementation in Health Services (PARIHS) framework [32, 33]; and LEAP.…”

Section: Methodsmentioning

confidence: 99%

The PULSAR Specialist Care protocol: a stepped-wedge cluster randomized control trial of a training intervention for community mental health teams in recovery-oriented practice

et al. 2017

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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.

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“…An experienced family/carer worker also participates, providing a minimum of one hour of content over the total of eight hours of training. The intervention draws heavily on the REFOCUS program [15] and the General Practitioner Mental Health Treatment Plan-Recovery (GPMHTP-R). The latter was developed in the Better Mental Health Treatment Plans Project, which was conducted by the Southern Synergy group with the support of a Commonwealth Government funding grant.…”

Section: Methodsmentioning

confidence: 99%

“…An evidence-based package of tools, developed [15] and trialed [16] by the REFOCUS Team (Institute of Psychiatry, King’s College London) and known as the REFOCUS Intervention, has been used to promote recovery-oriented practice in specialist mental health teams in the UK. In Australia, recovery-oriented practice has been endorsed through the Australian National Mental Health strategy from the early 2000s [17] with various efforts to promote a recovery framework made in the eight States and Territories [18].…”

Section: Introductionmentioning

confidence: 99%

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The PULSAR primary care protocol: a stepped-wedge cluster randomized controlled trial to test a training intervention for general practitioners in recovery-oriented practice to optimize personal recovery in adult patients

et al. 2016

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BackgroundGeneral practitioners (GPs) in Australia play a central role in the delivery of mental health care. This article describes the PULSAR (Principles Unite Local Services Assisting Recovery) Primary Care protocol, a novel mixed methods evaluation of a training intervention for GPs in recovery-oriented practice. The aim of the intervention is to optimize personal recovery in patients consulting study GPs for mental health issues.MethodsThe intervention mixed methods design involves a stepped-wedge cluster randomized controlled trial testing the outcomes of training in recovery-oriented practice, together with an embedded qualitative study to identify the contextual enablers and challenges to implementing recovery-oriented practice. The project is conducted in Victoria, Australia between 2013 and 2017. Eighteen general practices and community health centers are randomly allocated to one of two steps (nine months apart) to start an intervention comprising GP training in the delivery of recovery-oriented practice. Data collection consists of cross-sectional surveys collected from patients of participating GPs at baseline, and again at the end of Steps 1 and 2. The primary outcome is improvement in personal recovery using responses to the Questionnaire about the Process of Recovery. Secondary outcomes are improvements in patient-rated measures of personal recovery and wellbeing, and of the recovery-oriented practice they have received, using the INSPIRE questionnaire, the Warwick-Edinburgh Mental Well-being Scale, and the Kessler Psychological Distress Scale. Participant data will be analyzed in the group that the cluster was assigned to at each study time point. Another per-protocol dataset will contain all data time-stamped according to the date of intervention received at each cluster site. Qualitative interviews with GPs and patients at three and nine months post-training will investigate experiences and challenges related to implementing recovery-oriented practice in primary care.DiscussionRecovery-oriented practice is gaining increasing prominence in mental health service delivery and the outcomes of such an approach within the primary care sector for the first time will be evaluated in this project. If findings are positive, the intervention has the potential to extend recovery-oriented practice to GPs throughout the community.Trial registrationAustralian and New Zealand Clinical Trial Registry (ACTRN12614001312639). Registered: 8 August 2014.

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Development of the REFOCUS intervention to increase mental health team support for personal recovery

Abstract: The REFOCUS intervention is an empirically supported pro-recovery intervention for use in mental health services. It will be evaluated in a multisite cluster randomised controlled trial (ISRCTN02507940).

Cited by 42 publications

References 38 publications

Service user experiences of specialist mental health supported accommodation: A systematic review of qualitative studies and narrative synthesis

Service user experiences of specialist mental health supported accommodation: A systematic review of qualitative studies and narrative synthesis

The PULSAR Specialist Care protocol: a stepped-wedge cluster randomized control trial of a training intervention for community mental health teams in recovery-oriented practice

The PULSAR primary care protocol: a stepped-wedge cluster randomized controlled trial to test a training intervention for general practitioners in recovery-oriented practice to optimize personal recovery in adult patients

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