Supporting recovery in patients with psychosis through care by community-based adult mental health teams (REFOCUS): a multisite, cluster, randomised, controlled trial

Abstract

(2015) Supporting recovery in patients with psychosis using adult mental health teams (REFOCUS): a multi-site cluster randomised controlled trial. The Lancet Psychiatry, 2 (6). pp. 503-514. ISSN 2215-0374 Access from the University of Nottingham repository: http://eprints.nottingham.ac.uk/34258/1/AFD%20Lancet%20Psychiatry%20REFOCUS %20Cost-effectiveness.pdf Copyright and reuse:The Nottingham ePrints service makes this work by researchers of the University of Nottingham available open access under the following conditions. This article is made available under the University of Nottingham End User licence and may be reused according to the conditions of the licence. For more details see: http://eprints.nottingham.ac.uk/end_user_agreement.pdf A note on versions:The version presented here may differ from the published version or from the version of record. If you wish to cite this item you are advised to consult the publisher's version. Please see the repository url above for details on accessing the published version and note that access may require a subscription. Abstract BackgroundMental health policy in many countries is oriented around recovery. The evidence base for service-level pro-recovery interventions is lacking. MethodsTwo-site cluster randomised controlled trial in England (ISRCTN02507940). REFOCUS is a one-year team-level intervention targeting staff behaviour (increasing focus on patient values, preferences, strengths, goal-striving) and staff-patient relationships (coaching, partnership). 27 community-based adult mental health teams were randomly allocated to treatment-as-usual (n=13) or treatment-as-usual plus REFOCUS (n=14).Baseline (n=403) and one-year follow-up (n=297) outcomes were assessed for randomly selected patients with psychosis, representing 88% of target recruitment. Primary outcome was recovery, assessed using Questionnaire about Processes of Recovery (QPR). FindingsIntention-to-treat analysis using multiple imputation found no difference in QPR Total (control 40·0 (s.d.10·2), intervention 40·6 (s.d.10·1), adjusted difference 0·68, 95%CI: -1·7 to 3·1, p=·58), or sub-scales. Secondary outcomes which improved in the intervention group were functioning (adjusted difference 6·96, 95%CI 2·8 to 9·2, p<·001) and staff-rated unmet need (adjusted difference 0·80, 95%CI 0·2 to 1·4, p=·01). This pattern remained after covariate adjustment and completer analysis (n=275). Higherparticipating teams had higher staff-rated pro-recovery behaviour change (adjusted difference -0·4, 95%CI -0·7 to -0·2, p=·001) and patients had higher QPR Interpersonal scores (adjusted difference -1·6, 95%CI -2·7 to -0·5, p=·005) at follow-up. Interventiongroup patients incurred £1,062 (95%CI -£1,103 to £3,017) lower adjusted costs. InterpretationSupporting recovery may, from the staff perspective, improve functioning and reduce needs. Overcoming implementation barriers may increase staff pro-recovery behaviours and interpersonal aspects of patient-rated recovery.

Randomised controlled trial of a digitally assisted low intensity intervention to promote personal recovery in persisting psychosis: SMART-Therapy study protocol

“…Although staff training in recovery-oriented practice is a common model, a major trial of training in recovery-oriented practice observed limited impact on a measure of these recovery processes [37]. On the other hand, positive outcomes for measures of recovery have been found for group-format self-management interventions that incorporate material on recovery [11–13].…”

Psychopathological Symptoms and Satisfaction with Mental Health in Patients with Schizophrenia

“…The original 8 studies from which the full sample was drawn consisted of: (1) a Nordic multisite study [7], which investigated predictors of subjective well-being in community patients with schizophrenia in the 5 Nordic countries; (2) an explanatory-model study [8] comparing patients’ explanatory models for schizophrenia across 4 ethnic groups in a London community sample; (3) the DIALOG trial [9], which tested the effectiveness of a structured patient-clinician communication intervention in community samples across 6 European countries; (4) the EDEN trial [10], which compared day hospital versus inpatient treatment in 5 European countries; (5) InvolvE [11], which followed patients who had been involuntarily admitted to 22 UK hospitals; (6) EPOS [12], which tested the advanced DIALOG+ intervention involving a patient-centred solution-focused approach in a London community sample; (7) REFOCUS [13], a 2-site cluster randomised controlled trial testing the effectiveness of a staff-based intervention on recovery for patients with psychosis in England; and (8) NESS [14], which was a randomized controlled trial to examine the effectiveness of body psychotherapy for schizophrenia in several UK sites.…”

Service user experiences of REFOCUS: a process evaluation of a pro-recovery complex intervention

“…The present study was conducted as part of a wider process evaluation nested within the REFOCUS RCT [21]. Within the RCT there were no group differences in recovery scores at the end of the intervention.…”

“…Service users described how being 'genuinely' caring and supportive, as well as honest and open in a constructive manner, were necessary qualities of staff. [21] …”

“…The intervention and evaluation was based on best practice in recovery support, and systematic reviews of personal recovery [2], strengths [15], recovery measures [16] and recovery support measures [17]. The REFOCUS intervention was evaluated within a cluster randomised controlled trial [18].…”