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

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.

Citation

Meadows, G., Brophy, L., Shawyer, F., Enticott, J. C., Fossey, E., Thornton, C. D., …Slade, M. (2019). REFOCUS-PULSAR recovery-oriented practice training in specialist mental health care: a stepped-wedge cluster randomised controlled trial. Lancet Psychiatry, 6(2), 103-114. https://doi.org/10.1016/S2215-0366%2818%2930429-2

• 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.