Supporting recovery in patients with psychosis using adult mental health teams (REFOCUS): a multi-site cluster randomised controlled trial
Background: Mental health policy in many countries is oriented around recovery. The evidence base for service-level pro-recovery interventions is lacking. Methods: Two-site cluster randomised controlled trial in England (ISRCTN02507940). REFOCUS is a one-year team-level intervention targeting staff...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
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Elsevier
2015
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| Online Access: | https://eprints.nottingham.ac.uk/34258/ |
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| author | Slade, Mike Bird, Victoria Clarke, Eleanor Le Boutillier, Clair McCrone, P. Macpherson, Rob Pesola, Francesca Wallace, Genevieve Williams, Julie Leamy, Mary |
| author_facet | Slade, Mike Bird, Victoria Clarke, Eleanor Le Boutillier, Clair McCrone, P. Macpherson, Rob Pesola, Francesca Wallace, Genevieve Williams, Julie Leamy, Mary |
| author_sort | Slade, Mike |
| building | Nottingham Research Data Repository |
| collection | Online Access |
| description | Background: Mental health policy in many countries is oriented around recovery. The evidence base for service-level pro-recovery interventions is lacking.
Methods: Two-site cluster randomised controlled trial in England (ISRCTN02507940). REFOCUS is a one-year team-level intervention targeting staff behaviour (increasing focus on patient values, preferences, strengths, goal-striving) and staff-patient relationships (coaching, partnership). 27 community-based adult mental health teams were randomly allocated to treatment-as-usual (n=13) or treatment-as-usual plus REFOCUS (n=14). Baseline (n=403) and one-year follow-up (n=297) outcomes were assessed for randomly selected patients with psychosis, representing 88% of target recruitment. Primary outcome was recovery, assessed using Questionnaire about Processes of Recovery (QPR).
Findings: Intention-to-treat analysis using multiple imputation found no difference in QPR Total (control 40·0 (s.d.10·2), intervention 40·6 (s.d.10·1), adjusted difference 0·68, 95%CI: -1·7 to 3·1, p=·58), or sub-scales. Secondary outcomes which improved in the intervention group were functioning (adjusted difference 6·96, 95%CI 2·8 to 9·2, p<·001) and staff-rated unmet need (adjusted difference 0·80, 95%CI 0·2 to 1·4, p=·01). This pattern remained after covariate adjustment and completer analysis (n=275). Higher-participating teams had higher staff-rated pro-recovery behaviour change (adjusted difference -0·4, 95%CI -0·7 to -0·2, p=·001) and patients had higher QPR Interpersonal scores (adjusted difference -1·6, 95%CI -2·7 to -0·5, p=·005) at follow-up. Intervention-group patients incurred £1,062 (95%CI -£1,103 to £3,017) lower adjusted costs.
Interpretation: Supporting recovery may, from the staff perspective, improve functioning and reduce needs. Overcoming implementation barriers may increase staff pro-recovery behaviours and interpersonal aspects of patient-rated recovery.
Funding: National Institute for Health Research. |
| first_indexed | 2025-11-14T19:22:06Z |
| format | Article |
| id | nottingham-34258 |
| institution | University of Nottingham Malaysia Campus |
| institution_category | Local University |
| last_indexed | 2025-11-14T19:22:06Z |
| publishDate | 2015 |
| publisher | Elsevier |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | nottingham-342582024-08-15T15:16:56Z https://eprints.nottingham.ac.uk/34258/ Supporting recovery in patients with psychosis using adult mental health teams (REFOCUS): a multi-site cluster randomised controlled trial Slade, Mike Bird, Victoria Clarke, Eleanor Le Boutillier, Clair McCrone, P. Macpherson, Rob Pesola, Francesca Wallace, Genevieve Williams, Julie Leamy, Mary Background: Mental health policy in many countries is oriented around recovery. The evidence base for service-level pro-recovery interventions is lacking. Methods: Two-site cluster randomised controlled trial in England (ISRCTN02507940). REFOCUS is a one-year team-level intervention targeting staff behaviour (increasing focus on patient values, preferences, strengths, goal-striving) and staff-patient relationships (coaching, partnership). 27 community-based adult mental health teams were randomly allocated to treatment-as-usual (n=13) or treatment-as-usual plus REFOCUS (n=14). Baseline (n=403) and one-year follow-up (n=297) outcomes were assessed for randomly selected patients with psychosis, representing 88% of target recruitment. Primary outcome was recovery, assessed using Questionnaire about Processes of Recovery (QPR). Findings: Intention-to-treat analysis using multiple imputation found no difference in QPR Total (control 40·0 (s.d.10·2), intervention 40·6 (s.d.10·1), adjusted difference 0·68, 95%CI: -1·7 to 3·1, p=·58), or sub-scales. Secondary outcomes which improved in the intervention group were functioning (adjusted difference 6·96, 95%CI 2·8 to 9·2, p<·001) and staff-rated unmet need (adjusted difference 0·80, 95%CI 0·2 to 1·4, p=·01). This pattern remained after covariate adjustment and completer analysis (n=275). Higher-participating teams had higher staff-rated pro-recovery behaviour change (adjusted difference -0·4, 95%CI -0·7 to -0·2, p=·001) and patients had higher QPR Interpersonal scores (adjusted difference -1·6, 95%CI -2·7 to -0·5, p=·005) at follow-up. Intervention-group patients incurred £1,062 (95%CI -£1,103 to £3,017) lower adjusted costs. Interpretation: Supporting recovery may, from the staff perspective, improve functioning and reduce needs. Overcoming implementation barriers may increase staff pro-recovery behaviours and interpersonal aspects of patient-rated recovery. Funding: National Institute for Health Research. Elsevier 2015-05-05 Article PeerReviewed Slade, Mike, Bird, Victoria, Clarke, Eleanor, Le Boutillier, Clair, McCrone, P., Macpherson, Rob, Pesola, Francesca, Wallace, Genevieve, Williams, Julie and Leamy, Mary (2015) Supporting recovery in patients with psychosis using adult mental health teams (REFOCUS): a multi-site cluster randomised controlled trial. The Lancet Psychiatry, 2 (6). pp. 503-514. ISSN 2215-0374 http://www.sciencedirect.com/science/article/pii/S2215036615000863 doi:10.1016/S2215-0366(15)00086-3 doi:10.1016/S2215-0366(15)00086-3 |
| spellingShingle | Slade, Mike Bird, Victoria Clarke, Eleanor Le Boutillier, Clair McCrone, P. Macpherson, Rob Pesola, Francesca Wallace, Genevieve Williams, Julie Leamy, Mary Supporting recovery in patients with psychosis using adult mental health teams (REFOCUS): a multi-site cluster randomised controlled trial |
| title | Supporting recovery in patients with psychosis using adult mental health teams (REFOCUS): a multi-site cluster randomised controlled trial |
| title_full | Supporting recovery in patients with psychosis using adult mental health teams (REFOCUS): a multi-site cluster randomised controlled trial |
| title_fullStr | Supporting recovery in patients with psychosis using adult mental health teams (REFOCUS): a multi-site cluster randomised controlled trial |
| title_full_unstemmed | Supporting recovery in patients with psychosis using adult mental health teams (REFOCUS): a multi-site cluster randomised controlled trial |
| title_short | Supporting recovery in patients with psychosis using adult mental health teams (REFOCUS): a multi-site cluster randomised controlled trial |
| title_sort | supporting recovery in patients with psychosis using adult mental health teams (refocus): a multi-site cluster randomised controlled trial |
| url | https://eprints.nottingham.ac.uk/34258/ https://eprints.nottingham.ac.uk/34258/ https://eprints.nottingham.ac.uk/34258/ |