@article { , title = {REFOCUS-PULSAR recovery-oriented practice training in specialist mental health care: a stepped-wedge cluster randomised controlled trial}, abstract = {Background: Recovery-oriented practice promotes individual strengths and recovery potential. PULSAR, adapting the UK-developed REFOCUS recovery-oriented staff intervention for Australian use, aimed to establish whether consumers accessing mental health services where staff had received the REFOCUS-PULSAR intervention showed increased recovery compared to consumers of non-intervention services. Methods: A pragmatic two-step stepped-wedge randomised controlled trial at 18 sites grouped into 14 clusters across Public Mental Health Services (PMHS) and Mental Health Community Support Services (MHCSS). Staff training was refined between step-one and step-two. The primary (stream-one) outcome measure was the Questionnaire about the Process of Recovery (QPR) with cross-sectional data collected across three time-points. Stream-two, with two data-collection points, included five outcome-measures and five experience-measures. This trial is registered with ANZCTR, number ACTRN12614000957695. Findings: Half of the available staff were trained (190), with substantial staff turnover across the three organisations (27-47\%). Between 2014 and 2017, 942 stream-one consumer participants were recruited over three time-points (T0: 301; T1: 334; T2: 307) with 273 stream-two participants recruited at intervention-related time-points. (baseline: 140, follow-up: 133). The main mixed-effects model showed a small significant overall positive intervention stream-one effect of 37 (95\% Confidence interval: 0 to 5 – 6 to 8). Examining interactions, the mean difference between intervention and control groups at year-one also was 37 (95\% Confidence interval: 0 to 6 – 6 to 8); findings were strongest for PMHS step-two. Stream-two findings of small effects, typically below study power threshold, favoured the intervention condition for all but one measure. Interpretation: The REFOCUS-PULSAR intervention showed modest but distinct effectiveness in promoting recovery-oriented practice across sectors.}, doi = {10.1016/S2215-0366(18)30429-2}, eissn = {2215-0374}, issn = {2215-0366}, issue = {2}, journal = {The Lancet Psychiatry}, note = {6 mo. embargo. OL 07.12.2018}, pages = {103-114}, publicationstatus = {Published}, publisher = {Elsevier}, url = {https://nottingham-repository.worktribe.com/output/1388480}, volume = {6}, year = {2019}, author = {Meadows, Graham and Brophy, Lisa and Shawyer, Frances and Enticott, Joanne C. and Fossey, Ellie and Thornton, Christine D. and Weller, Penelope and Wilson-Evered, Elisabeth and Edan, Vrinda and Slade, Mike} }