Griffiths Robert, Tai Sara, Sutton Chris, Camacho Elizabeth, Dixon James, Palmier-Claus Jasper, Jones Adam, Welsh Natalie, Ormrod Susan, Krishan Ashma, Dawber Alison, Lovell Karina
Mental Health Nursing Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.
Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.
Pilot Feasibility Stud. 2024 Aug 31;10(1):117. doi: 10.1186/s40814-024-01529-w.
Rates of disengagement from early intervention in psychosis (EIP) services are high. Care coordinators make up the largest staff group in EIP services and have the most frequent and sustained contact with service users. The quality of relationships between service users and care coordinators plays a central role in determining the effectiveness of EIP services. Care coordinators, however, are not routinely offered training in psychosocial interventions that could enhance the therapeutic impact of their role. Method of levels (MOL) is a flexible, transdiagnostic cognitive therapy with potential advantages over previously evaluated approaches. Training care coordinators in MOL could make their routine contacts with service users more helpful and improve outcomes such as recovery rates and levels of engagement.
This study aims to assess the feasibility of training care coordinators in EIP services to deliver MOL, to understand whether this approach might improve service user engagement and recovery from psychosis compared to treatment as usual, and to assess the feasibility of conducting a cluster-randomised controlled trial (C-RCT) with clustering at the level of teams. Specific feasibility outcomes relate to the recruitment and retention of participants, care coordinators' level of engagement with the MOL training and supervision programme, implementation of MOL in practice, and the acceptability of the intervention amongst participants.
A feasibility parallel group cluster-randomised controlled trial (C-RCT) designs with two arms: (1) treatment as usual (TAU) or (2) TAU plus support from a care coordinator who has received training in MOL. Randomisation will take place at the level of EIP teams with an allocation ratio of 1:2 in favour of the intervention arm. Our recruitment target is 12 EIP teams, 24 care coordinators working in participating EIP teams, and up to 96 service users working with participating care coordinators. Outcomes will be collected at baseline, 3 months, and 6 months. Qualitative methods will be used to understand participants' experiences of the study, MOL training programme, and MOL intervention.
This is the first study that aims to evaluate the feasibility of training EIP care coordinators to deliver MOL in their routine practice. Training care coordinators in MOL could enhance the quality of relationships between care coordinators and service users and improve outcomes for people experiencing early psychosis. Results will be used to determine the appropriateness of progressing to a larger evaluation trial.
This study was prospectively registered with the ISRCTN Registry (14082421).
精神病早期干预（EIP）服务的脱离率很高。护理协调员是EIP服务中最大的员工群体，与服务使用者有最频繁和持续的接触。服务使用者与护理协调员之间关系的质量在决定EIP服务的有效性方面起着核心作用。然而，护理协调员通常没有接受过心理社会干预方面的培训，而这种培训可以增强他们角色的治疗效果。层次方法（MOL）是一种灵活的跨诊断认知疗法，与之前评估的方法相比具有潜在优势。对护理协调员进行MOL培训可以使他们与服务使用者的日常接触更有帮助，并改善诸如康复率和参与度等结果。
本研究旨在评估培训EIP服务中的护理协调员以提供MOL的可行性，了解与常规治疗相比，这种方法是否可能改善服务使用者的参与度和从精神病中康复的情况，并评估在团队层面进行整群随机对照试验（C-RCT）的可行性。具体的可行性结果涉及参与者的招募和保留、护理协调员对MOL培训和监督计划的参与程度、MOL在实践中的实施情况以及参与者对干预措施的可接受性。
一项可行性平行组整群随机对照试验（C-RCT）设计，有两个组：（1）常规治疗（TAU）或（2）TAU加上接受过MOL培训的护理协调员的支持。随机分组将在EIP团队层面进行，分配比例为1:2，有利于干预组。我们的招募目标是12个EIP团队、在参与的EIP团队中工作的24名护理协调员以及与参与的护理协调员合作的多达96名服务使用者。结果将在基线、3个月和6个月时收集。将使用定性方法来了解参与者对研究、MOL培训计划和MOL干预的体验。
这是第一项旨在评估培训EIP护理协调员在其日常实践中提供MOL的可行性的研究。对护理协调员进行MOL培训可以提高护理协调员与服务使用者之间关系的质量，并改善早期精神病患者的治疗结果。结果将用于确定是否适合进行更大规模的评估试验。
本研究已在ISRCTN注册中心（14082421）进行前瞻性注册。
