Study protocol for a randomised controlled trial evaluating an evidence-based, stepped and coordinated care service model for mental disorders (RECOVER)

Lambert, Martin; Karow, Anne; Gallinat, Jürgen; Lüdecke, Daniel; Kraft, Vivien; Rohenkohl, Anja; Schröter, Romy; Finter, Constanze; Siem, Anna-Katharina; Tlach, Lisa; Werkle, Nathalie; Bargel, Susann; Ohm, Gunda; Hoff, M.; Peter, Helmut; Scherer, Martin; Mews, Claudia; Pruskil, Susanne; Lüke, Johannes; Härter, Martin; Dirmaier, Jörg; Schulte‐Markwort, Michael; Löwe, Bernd; Briken, Peer; Peper, Heike; Schweiger, Michael J.; Mösko, Mike; Böck, Thomas; Wittzack, Martin; Meyer, Hans-Jochim; Deister, Arno; Michels, Rolf; Herr, Stephanie; Konnopka, Alexander; König, HH; Wegscheider, Karl; Daubmann, Anne; Zapf, Antonia; Peth, Judith; König, Hans‐Helmut; Schulz, Holger

doi:10.1136/bmjopen-2019-036021

Cited by 19 publications

(19 citation statements)

References 25 publications

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“…Flexible, stepped care models have been developed internationally and can offer a prompt crisis response to new referrals, as well as longer‐term care of varying intensity, to meet people’s current needs. Two examples (for both of which a robust evidence base has yet to be established) are the German RECOVER programme 40 and the FACT (flexible ACT) model developed in the Netherlands 41 . However, most community mental health services are not 24‐hour, or resourced or organized to respond rapidly to needs for crisis assessment across a whole community, including people not previously known to services.…”

Section: Assessment and Immediate Management Of The Crisismentioning

confidence: 99%

Acute psychiatric care: approaches to increasing the range of services and improving access and quality of care

et al. 2022

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Acute services for mental health crises are very important to service users and their supporters, and consume a substantial share of mental health resources in many countries. However, acute care is often unpopular and sometimes coercive, and the evidence on which models are best for patient experience and outcomes remains surprisingly limited, in part reflecting challenges in conducting studies with people in crisis. Evidence on best approaches to initial assessment and immediate management is particularly lacking, but some innovative models involving extended assessment, brief interventions, and diversifying settings and strategies for providing support are potentially helpful. Acute wards continue to be central in the intensive treatment phase following a crisis, but new approaches need to be developed, evaluated and implemented to reducing coercion, addressing trauma, diversifying treatments and the inpatient workforce, and making decision‐making and care collaborative. Intensive home treatment services, acute day units, and community crisis services have supporting evidence in diverting some service users from hospital admission: a greater understanding of how best to implement them in a wide range of contexts and what works best for which service users would be valuable. Approaches to crisis management in the voluntary sector are more flexible and informal: such services have potential to complement and provide valuable learning for statutory sector services, especially for groups who tend to be underserved or disengaged. Such approaches often involve staff with personal experience of mental health crises, who have important potential roles in improving quality of acute care across sectors. Large gaps exist in many low‐ and middle‐income countries, fuelled by poor access to quality mental health care. Responses need to build on a foundation of existing community responses and contextually relevant evidence. The necessity of moving outside formal systems in low‐resource settings may lead to wider learning from locally embedded strategies.

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Section: Assessment and Immediate Management Of The Crisismentioning

confidence: 99%

Acute psychiatric care: approaches to increasing the range of services and improving access and quality of care

et al. 2022

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“…Crisis resolution teams (CRTs) are multidisciplinary teams that provide rapid assessment and intensive home treatment for a limited period during a crisis, and have become almost universal in England since being mandated in the NHS Plan in 2000 [5]. CRTs have also been widely implemented in Norway [6] and Germany [7]. Trials suggest CRTs can help reduce admissions and improve satisfaction with acute care [8], although little is known about the critical components of CRT care [9].…”

Section: Introductionmentioning

confidence: 99%

Emerging models and trends in mental health crisis care in England: a national investigation of crisis care systems

Dalton-Locke

Harju-Seppänen

Lyons

et al. 2021

BMC Health Serv Res

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Background Inpatient psychiatric care is unpopular and expensive, and development and evaluation of alternatives is a long-standing policy and research priority around the world. In England, the three main models documented over the past fifty years (teams offering crisis assessment and treatment at home; acute day units; and residential crisis services in the community) have recently been augmented by several new service models. These are intended to enhance choice and flexibility within catchment area acute care systems, but remain largely undocumented in the research literature. We therefore aimed to describe the types and distribution of crisis care models across England through a national survey. Methods We carried out comprehensive mapping of crisis resolution teams (CRTs) using previous surveys, websites and multiple official data sources. Managers of CRTs were invited to participate as key informants who were familiar with the provision and organisation of crisis care services within their catchment area. The survey could be completed online or via telephone interview with a researcher, and elicited details about types of crisis care delivered in the local catchment area. Results We mapped a total of 200 adult CRTs and completed the survey with 184 (92%). Of the 200 mapped adult CRTs, there was a local (i.e., within the adult CRT catchment area) children and young persons CRT for 84 (42%), and an older adults CRT for 73 (37%). While all but one health region in England provided CRTs for working age adults, there was high variability regarding provision of all other community crisis service models and system configurations. Crisis cafes, street triage teams and separate crisis assessment services have all proliferated since a similar survey in 2016, while provision of acute day units has reduced. Conclusions The composition of catchment area crisis systems varies greatly across England and popularity of models seems unrelated to strength of evidence. A group of emerging crisis care models with varying functions within service systems are increasingly prevalent: they have potential to offer greater choice and flexibility in managing crises, but an evidence base regarding impact on service user experiences and outcomes is yet to be established.

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“…Data used for this study were collected within a randomized controlled trial evaluating an evidence-based, stepped and coordinated care service model for mental disorders (RECOVER) [31]. Patients were recruited in the regular psychiatric care of the University Medical Center Hamburg-Eppendorf, Germany, from beginning of 2018 until the end of 2019.…”

Section: Samplementioning

confidence: 99%

Psychometric evaluation of the German version of the Recovering Quality of Life (ReQoL) measures in patients with affective disorders

et al. 2022

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Background The generic self-reported Recovering Quality of Life (ReQoL) measures were developed for measuring recovery-focused health-related quality of life (HrQoL) in persons with mental health conditions. The aim of this study was to assess the psychometric properties of the German version of the ReQoL measures in patients with affective disorders in Germany. Methods Data from a patient sub-sample in a randomized controlled trial have been used (N = 393). The internal consistency and the test–retest reliability of the ReQoL measures were assessed using Cronbach’s Alpha and the intra-class correlation coefficient (ICC). The concurrent validity and the known-group validity of the ReQoL measures were assessed using Pearson’s Correlation coefficient and Cohen’s d. The responsiveness was assessed using Glass' Δ and the standardized response mean (SRM). Results The reliability among the items of the ReQoL-20 was overall excellent. The ICC of the ReQoL-20 was r = 0.70, indicating moderate test–retest reliability. The concurrent validity of the ReQoL-20 with the clinical measure PHQ-9 was strong with a correlation coefficient of r = − 0.76. The known-group validity of the ReQoL-20 using PHQ-9 cut-off points was large with an effect size of d = 1.63. The ReQoL measures were sensitive to treatment response and remission of symptoms measured by the PHQ-9 with large effect sizes/SRM. Discussion The psychometric properties of the ReQoL measures for the assessment of patients with affective disorders were overall good. With the ReQoL, valid and reliable measures for the assessment of recovery-focused HrQoL for persons with affective disorders are available in German language.

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Study protocol for a randomised controlled trial evaluating an evidence-based, stepped and coordinated care service model for mental disorders (RECOVER)

Cited by 19 publications

References 25 publications

Acute psychiatric care: approaches to increasing the range of services and improving access and quality of care

Acute psychiatric care: approaches to increasing the range of services and improving access and quality of care

Emerging models and trends in mental health crisis care in England: a national investigation of crisis care systems

Psychometric evaluation of the German version of the Recovering Quality of Life (ReQoL) measures in patients with affective disorders

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