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REFOCUS-PULSAR recovery-oriented practice training in specialist mental health care: a stepped-wedge cluster randomised controlled trial

Meadows, Graham; Brophy, Lisa; Shawyer, Frances; Enticott, Joanne C.; Fossey, Ellie; Thornton, Christine D.; Weller, Penelope; Wilson-Evered, Elisabeth; Edan, Vrinda; Slade, Mike

REFOCUS-PULSAR recovery-oriented practice training in specialist mental health care: a stepped-wedge cluster randomised controlled trial Thumbnail


Authors

Graham Meadows

Lisa Brophy

Frances Shawyer

Joanne C. Enticott

Ellie Fossey

Christine D. Thornton

Penelope Weller

Elisabeth Wilson-Evered

Vrinda Edan

MIKE SLADE M.SLADE@NOTTINGHAM.AC.UK
Professor of Mental Health Recovery and Social Inclusion



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.

Journal Article Type Article
Acceptance Date Oct 24, 2018
Online Publication Date Jan 8, 2019
Publication Date Feb 1, 2019
Deposit Date Dec 7, 2018
Publicly Available Date Jul 9, 2019
Journal The Lancet Psychiatry
Print ISSN 2215-0366
Electronic ISSN 2215-0374
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 6
Issue 2
Pages 103-114
DOI https://doi.org/10.1016/S2215-0366%2818%2930429-2
Public URL https://nottingham-repository.worktribe.com/output/1388480
Publisher URL https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(18)30429-2/fulltext
Additional Information This article is maintained by: Elsevier; Article Title: REFOCUS-PULSAR recovery-oriented practice training in specialist mental health care: a stepped-wedge cluster randomised controlled trial; Journal Title: The Lancet Psychiatry; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/S2215-0366(18)30429-2; CrossRef DOI link to the associated document: https://doi.org/10.1016/S2215-0366(18)30476-0; Content Type: article; Copyright: © 2019 Elsevier Ltd. All rights reserved.

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