Plain English Summary
Background and study aims
Crisis Resolution Teams (CRTs) have been set up across England in the last decade to provide rapid assessment and intensive home treatment for people experiencing mental health crises, and prevent hospital admission when possible. Research suggests CRTs reduce hospital admissions and healthcare costs and increase service users' satisfaction with acute care. However, their impact appears to vary between areas and service users and carers report some areas of dissatisfaction with CRT care. There is still uncertainty about how CRTs should be organised and what the critical ingredients of care are. The aim of this study is to evaluate the impact of a CRT resource kit upon service user satisfaction with CRT care. Resource kits consist of guidance, training materials, and coaching and support for service managers and staff. We think that using the resource kit will decrease hospital admissions and improve staff morale.
Who can participate?
Crisis Resolution Teams (CRTs) in the UK
What does the study involve?
Participating CRTs are randomly allocated to either receive a CRT resource kit over a one-year period, or to not receive a CRT resource kit. Service user satisfaction, hospital admission rates and staff morale are compared between the two groups.
What are the possible benefits and risks of participating?
Not provided at time of registration
Where is the study run from?
University College London (UK)
When is the study starting and how long is it expected to run for?
July 2014 to April 2017
Who is funding the study?
NIHR Programme Grants for Applied Research (UK)
Who is the main contact?
Dr Brynmor Lloyd-Evans
b.lloyd-evans@ucl.ac.uk
Trial website
Contact information
Type
Scientific
Primary contact
Dr Brynmor Lloyd-Evans
ORCID ID
Contact details
Department of Mental Health Sciences
Charles Bell House
67-73 Riding House Street
London
W1W 7EJ
United Kingdom
-
b.lloyd-evans@ucl.ac.uk
Additional identifiers
EudraCT number
ClinicalTrials.gov number
Protocol/serial number
16636
Study information
Scientific title
Optimising team functioning, preventing relapse and enhancing recovery in Crisis Resolution Teams (CRTs): the CORE Programme (Crisis team Optimisation and RElapse prevention) CORE Phase 4: A Cluster Randomised Controlled Trial: Evaluation of implementation of a CRT Resource Kit
Acronym
CORE: Phase 4
Study hypothesis
Aim: The primary aim is to evaluate the impact of a CRT resource kit upon service user satisfaction with CRT care.
Hypothesis: We hypothesise that the implementation of the CRT resource kit will result in an increase in a CRTs fidelity score. Following on from this, we predict that service user satisfaction and perceived continuity of care will be greater in CRTs that receive the resource kit compared to those that do not. In terms of service measures, we hypothesise that teams randomised to receive the resource kit, when compared to those that do not receive the intervention, will have fewer hospital admissions, compulsory admissions and inpatient bed days (adjusting for population size of the catchment area). We also predict that staff morale, wellbeing and job involvement will be greater in teams that receive the resource kit.
Ethics approval
First MREC approval date 13/03/2014, ref: 14/LO/0107
Study design
Randomised; Interventional; Design type: Process of Care
Primary study design
Interventional
Secondary study design
Cluster randomised trial
Trial setting
Other
Trial type
Treatment
Patient information sheet
Not available in web format, please use the contact details to request a patient information sheet
Condition
Topic: Mental Health; Subtopic: Psychosis; Disease: Psychosis
Intervention
This is a multi-site, cluster-randomised controlled trial (with CRT service as the unit of randomisation) comparing outcomes for 15 CRTs that receive a CRT resource kit over a one-year study period, with 10 CRTs that do not.
CORE CRT Resource Kit: The CRT resource kit is a team-level intervention, designed to provide guidance and coaching to help CRT managers and staff implement sustainable changes to service organisation and practice. It will be delivered and supported by a resource kit facilitator in each service.
Follow-Up Length: 12 month(s); Study Entry: Registration and One or More Randomisations
Intervention type
Other
Phase
Phase IV
Drug names
Primary outcome measure
Service user satisfaction with CRT care measured by Client Satisfaction Questionnaire; Timepoint(s): Approx. 12 months after commencement of intervention compared to baseline
Secondary outcome measures
1. Patient Records Admission Data (admission rates, bed use and readmissions to acute care); Timepoint(s): Admissions and readmissions over 6 months
2. Service user experienced continuity of care measured using Continu-um; Timepoint(s): Approx. 12 months after commencement of intervention compared to baseline
3. The General Health Questionnaire- Staff; Timepoint(s): Baseline and 12 months
4. Maslach Burnout Inventory - Staff; Timepoint(s): Baseline and 12 months
5. The Work Engagement Scale - Staff; Timepoint(s): Baseline and 12 months
6. The Work-Related Acceptance and Action Questionnaire - Staff; Timepoint(s): Baseline and 12 months
Overall trial start date
16/07/2014
Overall trial end date
30/04/2017
Reason abandoned (if study stopped)
Eligibility
Participant inclusion criteria
Service user inclusion criteria:
Adults (aged 18+) who have been on the caseload of a participating Crisis Resolution Team for at least a week
CRT inclusion criteria:
UK CRT
Target Gender: Male & Female; Lower Age Limit 18 years
Participant type
Patient
Age group
Adult
Gender
Both
Target number of participants
Planned Sample Size: 1265; UK Sample Size: 1265
Participant exclusion criteria
Service user exclusion criteria:
1. People who lack capacity to consent to take part in the study
2. People who in the view of the clinical team at their Crisis Resolution Team present such a high risk of harm to others, it would be unsafe for researchers to contact them about participation, even just by phone or email.
3. People who are discharged to addresses outside the catchment area.
4. People who cannot understand the study information sheet or questionnaire when delivered in English.
CRT exclusion criteria:
1. CRT teams identified in a previous national survey conducted at an earlier stage of the CORE study as already operating at high fidelity (mean item score above 4) - i.e. teams with comparatively little capacity for service improvement
2. CRT teams where major change to the organisation of the service is planned during the duration of the trial
3. CRTs taking part in the concurrent CORE Phase 3 trial
Recruitment start date
16/07/2014
Recruitment end date
31/12/2015
Locations
Countries of recruitment
United Kingdom
Trial participating centre
University College London
London
W1W 7EJ
United Kingdom
Funders
Funder type
Government
Funder name
National Institute for Health Research Programme Grants for Applied Research (UK); Grant Codes: RP-PG-0109-10078
Alternative name(s)
NIHR
Funding Body Type
government organisation
Funding Body Subtype
Federal/National Government
Location
United Kingdom
Results and Publications
Publication and dissemination plan
Not provided at time of registration
Intention to publish date
Participant level data
Not provided at time of registration
Basic results (scientific)
Publication list
2015 protocol in: http://www.ncbi.nlm.nih.gov/pubmed/27004517
2019 results in: http://www.ncbi.nlm.nih.gov/pubmed/30986008 [added 16/04/2019]