The CORE service improvement programme for mental health crisis resolution teams: results from a cluster-randomised trial

Abstract

BackgroundCrisis resolution teams (CRTs) offer brief, intensive home treatment for people experiencing mental health crisis. CRT implementation is highly variable; positive trial outcomes have not been reproduced in scaled-up CRT care. AimsTo evaluate a 1-year programme to improve CRTs' model fidelity in a non-masked, cluster-randomised trial (part of the Crisis team Optimisation and RElapse prevention (CORE) research programme, trial registration number: ISRCTN47185233). MethodFifteen CRTs in England received an intervention, informed by the US Implementing Evidence-Based Practice project, involving support from a CRT facilitator, online implementation resources and regular team fidelity reviews. Ten control CRTs received no additional support. The primary outcome was patient satisfaction, measured by the Client Satisfaction Questionnaire (CSQ-8), completed by 15 patients per team at CRT discharge (n = 375). Secondary outcomes: CRT model fidelity, continuity of care, staff well-being, in-patient admissions and bed use and CRT readmissions were also evaluated. ResultsAll CRTs were retained in the trial. Median follow-up CSQ-8 score was 28 in each group: the adjusted average in the intervention group was higher than in the control group by 0.97 (95% CI −1.02 to 2.97) but this was not significant (P = 0.34). There were fewer in-patient admissions, lower in-patient bed use and better staff psychological health in intervention teams. Model fidelity rose in most intervention teams and was significantly higher than in control teams at follow-up. There were no significant effects for other outcomes. ConclusionsThe CRT service improvement programme did not achieve its primary aim of improving patient satisfaction. It showed some promise in improving CRT model fidelity and reducing acute inpatient admissions. Declaration of interestNone.

Crisis resolution and home treatment in the UK: A survey of model fidelity using a novel review methodology

“…Priorities for the development and validation of the CORE CRT Fidelity Scale are discussed elsewhere (Lloyd‐Evans et al, ): they include further exploration of its reliability; establishing its criterion validity, and its relationship to key CRT outcomes; and testing its international applicability in non‐UK settings. The feasibility of utilizing the scale in research has been demonstrated by its use in a cluster‐randomized trial of a CRT service improvement intervention (Lloyd‐Evans et al, ).…”

“…Work in this area has been undertaken as part of the CORE study. The results of a cluster‐randomized trial evaluating a CRT service improvement programme (Lloyd‐Evans et al, ; Lloyd‐Evans et al, ) demonstrate that such interventions are feasible, acceptable and can increase model fidelity and reduce inpatient admissions. Better understanding of the impact of, and barriers and facilitators to, implementation of such improvement programmes is needed, and a qualitative analysis of these issues from the CORE study will be available shortly.…”

Crisis resolution teams for people experiencing mental health crises: the CORE mixed-methods research programme including two RCTs

“…The mean age of staff participants was 43 years (SD 10 years) at baseline and follow-up; the majority identified as female (66% at baseline and 63% at follow-up) and white (68% at baseline and 65% at follow-up). (For further information about recruitment rates and service user and staff participants' characteristics, see the paper 84 referred to in Appendix 6.) No serious adverse events (SAEs) were identified during participant recruitment and data collection, and no study-related harms were reported by participating CRTs during the trial intervention.…”

“…No significant association was found between the change in fidelity scores and changes in hospital admission rates, inpatient bed-days or staff well-being. For a breakdown of CRTs' fidelity scores and relationships with outcomes, see the paper 84 referred to in Appendix 6. The qualitative evaluation established three broad domains capturing stakeholder views and experiences of the SIP (for a more detailed description, see Appendix 7):…”

“…Data were collected only for patients aged 18-64 years, that is, the age range included by all CRTs to ensure comparability of data across sites. Details of how patient records data were defined and operationalised are provided in the published results paper 84 for the workstream 1 trial (see Appendix 6). l Participating teams' CRT model fidelity was assessed at the 1-day 'fidelity review' audit, to be conducted at baseline and at the 1-year follow-up using the CORE CRT fidelity scale.…”