Killaspy Helen, Priebe Stefan, McPherson Peter, Zenasni Zohra, McCrone Paul, Dowling Sarah, Harrison Isobel, Krotofil Joanna, Dalton-Locke Christian, McGranahan Rose, Arbuthnott Maurice, Curtis Sarah, Leavey Gerard, MacPherson Rob, Eldridge Sandra, King Michael
Division of Psychiatry, University College London, London, United Kingdom.
Camden and Islington NHS Foundation Trust, London, United Kingdom.
Front Psychiatry. 2019 Apr 17;10:258. doi: 10.3389/fpsyt.2019.00258. eCollection 2019.
Mental health supported accommodation services are implemented across England, usually organised into a 'step-down' care pathway that requires the individual to repeatedly move as they gain skills and confidence for more independent living. There have been no trials comparing the effectiveness of different types of supported accommodation, but two widely used models (supported housing and floating outreach) have been found to provide similar support. We aimed to assess the feasibility of conducting a large-scale trial comparing these two models. Individually randomised, parallel group feasibility trial in three regions of England (North London, East London, and Cheltenham and Gloucestershire). We aimed to recruit 60 participants in 15 months, referred to supported accommodation, randomly allocated on an equal basis to receive either a local supported housing or floating outreach service. We assessed referrals to the trial, participants recruited, attrition, time from recruitment to moving into either type of supported accommodation, and feasibility of masking. We conducted a process evaluation to examine our results further. We screened 1,432 potential participants, of whom 17 consented to participate, with 8 agreeing to randomisation (of whom 1 was lost to attrition) and 9 participating in naturalistic follow-up. Our process evaluation indicated that the main obstacle to recruitment was staff and service user preferences for certain types of supported accommodation or for specific services. Staff also felt that randomisation compromised their professional judgement. Our results do not support investment in a large-scale trial in England at this time. UK CRN Portfolio database, Trial ID: ISRCTN19689576. National Institute of Health Research (RP-PG-0707-10093).
心理健康支持性住宿服务在英格兰各地实施,通常组织成一条“逐步降级”的护理路径,要求个人在获得更多独立生活的技能和信心时反复搬家。目前尚无比较不同类型支持性住宿有效性的试验,但已发现两种广泛使用的模式(支持性住房和流动外展服务)提供的支持相似。我们旨在评估进行一项比较这两种模式的大规模试验的可行性。在英格兰的三个地区(北伦敦、东伦敦以及切尔滕纳姆和格洛斯特郡)进行个体随机、平行组可行性试验。我们的目标是在15个月内招募60名转介至支持性住宿的参与者,将他们平等随机分配,以接受当地的支持性住房或流动外展服务。我们评估了试验的转介情况、招募的参与者、损耗情况、从招募到入住任何一种支持性住宿的时间以及设盲的可行性。我们进行了过程评估以进一步检查结果。我们筛选了1432名潜在参与者,其中17人同意参与,8人同意随机分组(其中1人失访),9人参与自然主义随访。我们的过程评估表明,招募的主要障碍是工作人员和服务使用者对某些类型的支持性住宿或特定服务的偏好。工作人员还认为随机分组会损害他们的专业判断。我们的结果目前不支持在英格兰进行大规模试验的投资。英国临床试验网络组合数据库,试验编号:ISRCTN19689576。国家卫生研究院(RP - PG - 0707 - 10093)。