Recovery-based staff training intervention within mental health rehabilitation units: a two-stage analysis using realistic evaluation principles and framework approach

Abstract

BackgroundLong-term change in recovery-based practice in mental health rehabilitation is a research priority.MethodsWe used a qualitative case study analysis using a blend of traditional ‘framework’ analysis and ‘realist’ approaches to carry out an evaluation of a recovery-focused staff training intervention within three purposively selected mental health rehabilitation units. We maximised the validity of the data by triangulating multiple data sources.ResultsWe found that organisational culture and embedding of a change management programme in routine practice were reported as key influences in sustaining change in practice. The qualitative study generated 10 recommendations on how to achieve long-term change in practice including addressing pre-existing organisational issues and synergising concurrent change programmes.ConclusionsWe propose that a recovery-focused staff training intervention requires clear leadership and integration with any existing change management programmes to facilitate sustained improvements in routine practice.

Rapid realist review of the evidence: achieving lasting change when mental health rehabilitation staff undertake recovery‐oriented training

“…One unit participating in the GetREAL intervention incorporated the training with an existing Productive Ward programme (thereby reducing the effect of change fatigue) to good effect (Bhanbhro et al . ).…”

“…Rather, the theories we produced have had specific utility as a framework for a realist evaluation of the GetREAL intervention (Bhanbhro et al . ) (ensured through stakeholder engagement). Subjecting our theories to a further level of abstraction and explanation using existing substantive theories of individual and organizational behavioural change would be of interest (Wong et al .…”

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

“…The process evaluation draws on the findings of the UK REFOCUS process evaluation [30] which explored service users’ experience of receiving a complex pro-recovery intervention. Furthermore, Bhanbhro and colleagues’ [31] recent work confirmed the crucial importance of taking account of practitioner, trainer and organizational factors when implementing a training intervention to achieve practice change in diverse mental health settings [31]. …”

The Rehabilitation Effectiveness for Activities for Life (REAL) study: a national programme of research into NHS inpatient mental health rehabilitation services across England

“…Self-care is the sum of scores for items 10,12,13,14,15,16,23,24,26,30 (possible range 10 to 40) Non-turbulence is the sum of scores for items 5,6,25,27,28,29,32,34,35,36,37,38 The subscales will not be analysed in this study.…”

“…36 An additional component of the programme, a realistic evaluation, was carried out, the results of which have been submitted for publication. 37,38 SUMMARY OF THE MAIN FINDINGS FROM THE REAL PROGRAMME NIHR Journals Library www.journalslibrary.nihr.ac.uk 5. The results from all phases of the project will be submitted for publication in peer-reviewed journals with national and international readership.…”