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Karina Lovell - One of the best experts on this subject based on the ideXlab platform.
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training to enhance user and Carer involvement in mental Health Care Planning the equip research programme including a cluster rct
Programme Grants for Applied Research, 2019Co-Authors: Karina Lovell, Helen Brooks, Penny Bee, Patrick Callaghan, Peter Bower, Patrick Cahoon, Lesleyanne Carter, Lindsey Cree, Linda Davies, Richard DrakeAbstract:Background Service users and Carers using mental Health services want more involvement in their Care and the aim of this research programme was to enhance service user and Carer involvement in Care Planning in mental Health services. Objectives Co-develop and co-deliver a training intervention for Health professionals in community mental Health teams, which aimed to enhance service user and Carer involvement in Care Planning. Develop a patient-reported outcome measure of service user involvement in Care Planning, design an audit tool and assess individual preferences for key aspects of Care Planning involvement. Evaluate the clinical effectiveness and the cost-effectiveness of the training. Understand the barriers to and facilitators of implementing service user- and Carer-involved Care Planning. Disseminate resources to stakeholders. Methods A systematic review, focus groups and interviews with service users/Carers/Health professionals informed the training and determined the priorities underpinning involvement in Care Planning. Data from focus groups and interviews were combined and analysed using framework analysis. The results of the systematic review, focus groups/interviews and a review of the training interventions were synthesised to develop the final training intervention. To develop and validate the patient-reported outcome measure, items were generated from focus groups and interviews, and a psychometric analysis was conducted. Patient-reported outcome measure items and a three-round consensus exercise were used to develop an audit tool, and a stated preference survey was undertaken to assess individual preferences for key aspects of Care Planning. The clinical effectiveness and cost-effectiveness of the training were evaluated using a pragmatic cluster trial with cohort and cross-sectional samples. A nested longitudinal qualitative process evaluation using multiple methods, including semistructured interviews with key informants involved locally and nationally in mental Health policy, practice and research, was undertaken. A mapping exercise was used to determine current practice, and semistructured interviews were undertaken with service users and mental Health professionals from both the usual-Care and the intervention arms of the trial at three time points (i.e. baseline and 6 months and 12 months post intervention). Results The results from focus groups (n = 56) and interviews (n = 74) highlighted a need to deliver training to increase the quality of Care Planning and a training intervention was developed. We recruited 402 participants to develop the final 14-item patient-reported outcome measure and a six-item audit tool. We recruited 232 participants for the stated preference survey and found that preferences were strongest for the attribute ‘my preferences for Care are included in the Care plan’. The training was delivered to 304 Care co-ordinators working in community mental Health teams across 10 NHS trusts. The cluster trial and cross-sectional survey recruited 1286 service users and 90 Carers, and the primary outcome was the Health Care Climate Questionnaire. Training was positively evaluated. The results showed no statistically significant difference on the primary outcome (the Health Care Climate Questionnaire) (adjusted mean difference –0.064, 95% confidence interval –0.343 to 0.215; p = 0.654) or secondary outcomes at the 6-month follow-up. Overall, the training intervention was associated with a net saving of –£54.00 (95% confidence interval –£193.00 to £84.00), with a net quality-adjusted life-year loss of –0.014 (95% confidence interval –0.034 to 0.005). The longitudinal process evaluation recruited 54 service users, professionals and Carers, finding a failure of training to become embedded in routine Care. Limitations Our pragmatic study was designed to improve service user and Care involvement in Care Planning among routine community mental Health services. We intervened in 18 sites with > 300 Care co-ordinators. However, our volunteer sites may not be fully representative of the wider population, and we lacked data with which to compare our participants with the eligible population. Conclusions We co-developed and co-delivered a training intervention and developed a unidimensional measure of service user and Carer involvement in Care Planning and an audit tool. Despite a high level of satisfaction with the training, no significant effect was found; therefore, the intervention was ineffective. There was a failure of training to become embedded and normalised because of a lack of organisational readiness to accept change. Working with NHS trusts in our ‘Willing Adopters’ programme with enhanced organisational buy-in yielded some promising results. Future work Research should focus on developing and evaluating new organisational initiatives in addition to training Health-Care professionals to address contextual barriers to service and Carer involvement in Care Planning, and explore co-designing and delivering new ways of enhancing service users’ and Carers’ capabilities to engage in Care Planning. Trial registration Current Controlled Trials ISRCTN16488358. Funding This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 7, No. 9. See the NIHR Journals Library website for further project information.
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training to enhance user and Carer involvement in mental Health Care Planning the equip research programme including a cluster rct
Programme Grants for Applied Research, 2019Co-Authors: Karina Lovell, Helen Brooks, Patrick Callaghan, Peter Bower, Patrick Cahoon, Lesleyanne Carter, Lindsey Cree, Linda Davies, Richard Drake, Claire M. FraserAbstract:Background: Service users and Carers using mental Health services want more involvement in their Care and the aim of this research programme was to enhance service user and Carer involvement in Care Planning in mental Health services. Objectives: Co-develop and co-deliver a training intervention for Health professionals in community mental Health teams, which aimed to enhance service user and Carer involvement in Care Planning. Develop a patient-reported outcome measure of service user involvement in Care Planning, design an audit tool and assess individual preferences for key aspects of Care Planning involvement. Evaluate the clinical effectiveness and the cost-effectiveness of the training. Understand the barriers to and facilitators of implementing service user- and Carer-involved Care Planning. Disseminate resources to stakeholders. Methods: A systematic review, focus groups and interviews with service users/Carers/Health professionals informed the training and determined the priorities underpinning involvement in Care Planning. Data from focus groups and interviews were combined and analysed using framework analysis. The results of the systematic review, focus groups/interviews and a review of the training interventions were synthesised to develop the final training intervention. To develop and validate the patient-reported outcome measure, items were generated from focus groups and interviews, and a psychometric analysis was conducted. Patient-reported outcome measure items and a three-round consensus exercise were used to develop an audit tool, and a stated preference survey was undertaken to assess individual preferences for key aspects of Care Planning. The clinical effectiveness and cost-effectiveness of the training were evaluated using a pragmatic cluster trial with cohort and cross-sectional samples. A nested longitudinal qualitative process evaluation using multiple methods, including semistructured interviews with key informants involved locally and nationally in mental Health policy, practice and research, was undertaken. A mapping exercise was used to determine current practice, and semistructured interviews were undertaken with service users and mental Health professionals from both the usual-Care and the intervention arms of the trial at three time points (i.e. baseline and 6 months and 12 months post intervention). Results: The results from focus groups (n = 56) and interviews (n = 74) highlighted a need to deliver training to increase the quality of Care Planning and a training intervention was developed. We recruited 402 participants to develop the final 14-item patient-reported outcome measure and a six-item audit tool. We recruited 232 participants for the stated preference survey and found that preferences were strongest for the attribute ‘my preferences for Care are included in the Care plan’. The training was delivered to 304 Care co-ordinators working in community mental Health teams across 10 NHS trusts. The cluster trial and cross-sectional survey recruited 1286 service users and 90 Carers, and the primary outcome was the Health Care Climate Questionnaire. Training was positively evaluated. The results showed no statistically significant difference on the primary outcome (the Health Care Climate Questionnaire) (adjusted mean difference –0.064, 95% confidence interval –0.343 to 0.215; p = 0.654) or secondary outcomes at the 6-month follow-up. Overall, the training intervention was associated with a net saving of –£54.00 (95% confidence interval –£193.00 to £84.00), with a net quality-adjusted life-year loss of –0.014 (95% confidence interval –0.034 to 0.005). The longitudinal process evaluation recruited 54 service users, professionals and Carers, finding a failure of training to become embedded in routine Care. Limitations: Our pragmatic study was designed to improve service user and Care involvement in Care Planning among routine community mental Health services. We intervened in 18 sites with > 300 Care co-ordinators. However, our volunteer sites may not be fully representative of the wider population, and we lacked data with which to compare our participants with the eligible population. Conclusions: We co-developed and co-delivered a training intervention and developed a unidimensional measure of service user and Carer involvement in Care Planning and an audit tool. Despite a high level of satisfaction with the training, no significant effect was found; therefore, the intervention was ineffective. There was a failure of training to become embedded and normalised because of a lack of organisational readiness to accept change. Working with NHS trusts in our ‘Willing Adopters’ programme with enhanced organisational buy-in yielded some promising results. Future work: Research should focus on developing and evaluating new organisational initiatives in addition to training Health-Care professionals to address contextual barriers to service and Carer involvement in Care Planning, and explore co-designing and delivering new ways of enhancing service users’ and Carers’ capabilities to engage in Care Planning. Trial registration: Current Controlled Trials ISRCTN16488358.
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assessing mental Health service user and Carer involvement in physical Health Care Planning the development and validation of a new patient reported experience measure
PLOS ONE, 2019Co-Authors: Nicola Small, Helen Brooks, Chris J Sideygibbons, Judith Gellatly, Karina LovellAbstract:Background People living with serious mental Health conditions experience increased morbidity due to physical Health issues driven by medication side-effects and lifestyle factors. Coordinated mental and physical HealthCare delivered in accordance with a Care plan could help to reduce morbidity and mortality in this population. Efforts to develop new models of Care are hampered by a lack of validated instruments to accurately assess the extent to which mental Health services users and Carers are involved in Care Planning for physical Health. Objective To develop a brief and accurate patient-reported experience measure (PREM) capable of assessing involvement in physical Health Care Planning for mental Health service users and their Carers. Methods We employed psychometric and statistical techniques to refine a bank of candidate questionnaire items, derived from qualitative interviews, into a valid and reliable measure involvement in physical Health Care Planning. We assessed the psychometric performance of the item bank using modern psychometric analyses. We assessed unidimensionality, scalability, fit to the partial credit Rasch model, category threshold ordering, local dependency, differential item functioning, and test-retest reliability. Once purified of poorly performing and erroneous items, we simulated computerized adaptive testing (CAT) with 15, 10 and 5 items using the calibrated item bank. Results Issues with category threshold ordering, local dependency and differential item functioning were evident for a number of items in the nascent item bank and were resolved by removing problematic items. The final 19 item PREM had excellent fit to the Rasch model fit (x2 = 192.94, df = 1515, P = .02, RMSEA = .03 (95% CI = .01-.04). The 19-item bank had excellent reliability (marginal r = 0.87). The correlation between questionnaire scores at baseline and 2-week follow-up was high (r = .70, P < .01) and 94.9% of assessment pairs were within the Bland Altman limits of agreement. Simulated CAT demonstrated that assessments could be made using as few as 10 items (mean SE = .43). Discussion We developed a flexible patient reported outcome measure to quantify service user and Carer involvement in physical Health Care Planning. We demonstrate the potential to substantially reduce assessment length whilst maintaining reliability by utilizing CAT.
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implementing an intervention designed to enhance service user involvement in mental Health Care Planning a qualitative process evaluation
Social Psychiatry and Psychiatric Epidemiology, 2019Co-Authors: Helen Brooks, Karina Lovell, Penny Bee, Claire M. Fraser, Christine Molloy, Anne RogersAbstract:Purpose Shared decision-making (SDM) and the wider elements of intersecting professional and lay practices are seen as necessary components in the implementation of mental Health interventions. A randomised controlled trial of a user- and Carer-informed training package in the United Kingdom to enhance SDM in Care Planning in secondary mental Health Care settings showed no effect on patient-level outcomes. This paper reports on the parallel process evaluation to establish the influences on implementation at service user, Carer, mental Health professional and organisational levels. Methods A longitudinal, qualitative process evaluation incorporating 134 semi-structured interviews with 54 mental Health service users, Carers and professionals was conducted. Interviews were undertaken at baseline and repeated at 6 and 12 months post-intervention. Interviews were digitally audio-recorded, transcribed verbatim and analysed thematically. Results The process evaluation demonstrated that despite buy-in from those delivering Care Planning in mental Health services, there was a failure of training to become embedded and normalised in local provision. This was due to a lack of organisational readiness to accept change combined with an underestimation and lack of investment in the amount and range of relational work required to successfully enact the intervention. Conclusions Future aspirations of SDM enactment need to place the circumstances and everyday practices of stakeholders at the centre of implementation. Such studies should consider the historical and current context of Health Care relationships and include elements which seek to address these directly.
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Understanding experiences of and preferences for service user and Carer involvement in physical Health Care discussions within mental Health Care Planning
BMC Psychiatry, 2017Co-Authors: Nicola Small, Helen Brooks, Andrew Grundy, Rebecca Pedley, Chris Gibbons, Karina Lovell, Penny BeeAbstract:People with severe mental illness suffer more physical comorbidity than the general population, which can require a tailored approach to physical Health Care discussions within mental Health Care Planning. Although evidence pertaining to service user and Carer involvement in mental Health Care Planning is accumulating, current understanding of how physical Health is prioritised within this framework is limited. Understanding stakeholder experiences of physical Health discussions within mental Health Care Planning, and the key domains that underpin this phenomena is essential to improve quality of Care. Our study aimed to explore service user, Carer and professional experiences of and preferences for service user and Carer involvement in physical Health discussions within mental Health Care Planning, and develop a conceptual framework of effective user-led involvement in this aspect of service provision. Six focus groups and four telephone interviews were carried out with twelve service users, nine Carers, three service users with a dual service user and Carer role, and ten mental Health professionals recruited from one mental Health Trust in the United Kingdom. Data was analysed utilising a thematic approach, analysed separately for each stakeholder group, and combined to aid comparisons. No service users or Carers recalled being explicitly involved in physical Health discussions within mental Health Care Planning. Six prerequisites for effective service user and Carer involvement in physical Care Planning were identified. Three themes confirmed general mental Health Care Planning requirements: tailoring a collaborative working relationship, maintaining a trusting relationship with a professional, and having access to and being able to edit a living document. Three themes were novel to feeling involved in physical Health Care Planning discussions: valuing physical Health equally with mental Health; experiencing coordination of Care between physical-mental Health professionals, and having a physical Health discussion that is personalised. High quality physical Health Care discussions within the Care Planning process demands action at multiple levels. A conceptual framework is presented which provides an evidence-based foundation for service level improvement. Further work is necessary to develop a new patient reported outcome measure to enable meaningful quantification of Health Care quality and patient experience.
Alan Simpson - One of the best experts on this subject based on the ideXlab platform.
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recovery focused mental Health Care Planning and co ordination in acute inpatient mental Health settings a cross national comparative mixed methods study
BMC Psychiatry, 2019Co-Authors: Michael Coffey, Rachel Cohen, Alison Faulkner, Ben Hannigan, Alan Simpson, Sally Barlow, Aled Jones, Martin CartwrightAbstract:Involving mental Health service users in Planning and reviewing their Care can help personalised Care focused on recovery, with the aim of developing goals specific to the individual and designed to maximise achievements and social integration. We aimed to ascertain the views of service users, Carers and staff in acute inpatient wards on factors that facilitated or acted as barriers to collaborative, recovery-focused Care. A cross-national comparative mixed-methods study involving 19 mental Health wards in six service provider sites in England and Wales. This included a survey using established standardised measures of service users (n = 301) and staff (n = 290) and embedded case studies involving interviews with staff, service users and Carers (n = 76). Quantitative and qualitative data were analysed within and across sites using descriptive and inferential statistics, and framework method. For service users, when recovery-oriented focus was high, the quality of Care was rated highly, as was the quality of therapeutic relationships. For staff, there was a moderate correlation between recovery orientation and quality of therapeutic relationships, with considerable variability. Staff members rated the quality of therapeutic relationships higher than service users did. Staff accounts of routine collaboration contrasted with a more mixed picture in service user accounts. Definitions and understandings of recovery varied, as did views of hospital Care in promoting recovery. Managing risk was a central issue for staff, and service users were aware of measures taken to keep them safe, although their involvement in discussions was less apparent. There is positive practice within acute inpatient wards, with evidence of commitment to safe, respectful, compassionate Care. Recovery ideas were evident but there remained ambivalence on their relevance to inpatient Care. Service users were aware of efforts taken to keep them safe, but despite measures described by staff, they did not feel routinely involved in Care Planning or risk management decisions. Research on increasing therapeutic contact time, shared decision making in risk assessment and using recovery focused tools could further promote personalised and recovery-focused Care Planning. This paper arises from a larger study published by National Institute for Health Research (Simpson A, et al, Health Serv Deliv Res 5(26), 2017).
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ordinary risks and accepted fictions how contrasting and competing priorities work in risk assessment and mental Health Care Planning
Health Expectations, 2017Co-Authors: Michael Coffey, Rachel Cohen, Alison Faulkner, Ben Hannigan, Alan Simpson, Sally BarlowAbstract:Background Communication and information sharing are considered crucial to recovery-focused mental Health services. Effective mental Health Care Planning and coordination includes assessment and management of risk and safety. Objective Using data from our cross-national mixed-method study of Care Planning and coordination, we examined what patients, family members and workers say about risk assessment and management and explored the contents of Care plans. Design Thematic analysis of qualitative research interviews (n = 117) with patients, family members and workers, across four English and two Welsh National Health Service sites. Care plans were reviewed (n = 33) using a structured template. Findings Participants have contrasting priorities in relation to risk. Patients see benefit in discussions about risk, but cast the process as a worker priority that may lead to loss of liberty. Relationships with workers are key to family members and patients; however, worker claims of involving people in the Care Planning process do not extend to risk assessment and management procedures for fear of causing upset. Workers locate risk as coming from the person rather than social or environmental factors, are risk averse and appear to prioritize the procedural aspects of assessment. Conclusions Despite limitations, risk assessment is treated as legitimate work by professionals. Risk assessment practice operates as a type of fiction in which poor predictive ability and fear of consequences are accepted in the interests of normative certainty by all parties. As a consequence, risk adverse options are encouraged by workers and patients steered away from opportunities for ordinary risks thereby hindering the mobilization of their strengths and abilities.
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cross national comparative mixed methods case study of recovery focused mental Health Care Planning and co ordination collaborative Care Planning project cocapp
Health Services and Delivery Research, 2016Co-Authors: Alan Simpson, Michael Coffey, Rachel Cohen, Ben Hannigan, Sally Barlow, Aled Jones, Jitka Vseteckova, Alison FaulknerAbstract:The Care programme approach in England and Care and treatment Planning in Wales are systems designed to provide mental Health service users with a named Care co-ordinator who meets regularly with the service user, oversees their Care and develops a written plan to guide the Care that they receive. These approaches are meant to help people towards recovery. In this study, we investigated whether Care is organised to help people’s recovery and whether this is done in a personalised way. We identified six NHS trust/Health board sites in England and Wales, and surveyed staff and service users to measure views on recovery, empowerment and therapeutic relationships. At each site we also interviewed managers, clinical staff Care co-ordinators, service users and Carers about their experiences of Care Planning. We found that good relationships are important for service users, Carers and Care co-ordinators in Care Planning and supporting recovery. Experiences of Care Planning and co-ordination varied within all sites. People do not always feel involved in their own Care. The understanding of recovery and personalisation varied among the service users and staff interviewed. Workers say that there is too much paperwork and, like service users, they rarely look at Care plans once written. Staff focus on risk but this does not often appear to be discussed with people using services, which may be problematic. We recommend research to investigate new ways of working and training to increase staff contact time with service users and Carers and to improve a focus on recovery.
Helen Brooks - One of the best experts on this subject based on the ideXlab platform.
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training to enhance user and Carer involvement in mental Health Care Planning the equip research programme including a cluster rct
Programme Grants for Applied Research, 2019Co-Authors: Karina Lovell, Helen Brooks, Penny Bee, Patrick Callaghan, Peter Bower, Patrick Cahoon, Lesleyanne Carter, Lindsey Cree, Linda Davies, Richard DrakeAbstract:Background Service users and Carers using mental Health services want more involvement in their Care and the aim of this research programme was to enhance service user and Carer involvement in Care Planning in mental Health services. Objectives Co-develop and co-deliver a training intervention for Health professionals in community mental Health teams, which aimed to enhance service user and Carer involvement in Care Planning. Develop a patient-reported outcome measure of service user involvement in Care Planning, design an audit tool and assess individual preferences for key aspects of Care Planning involvement. Evaluate the clinical effectiveness and the cost-effectiveness of the training. Understand the barriers to and facilitators of implementing service user- and Carer-involved Care Planning. Disseminate resources to stakeholders. Methods A systematic review, focus groups and interviews with service users/Carers/Health professionals informed the training and determined the priorities underpinning involvement in Care Planning. Data from focus groups and interviews were combined and analysed using framework analysis. The results of the systematic review, focus groups/interviews and a review of the training interventions were synthesised to develop the final training intervention. To develop and validate the patient-reported outcome measure, items were generated from focus groups and interviews, and a psychometric analysis was conducted. Patient-reported outcome measure items and a three-round consensus exercise were used to develop an audit tool, and a stated preference survey was undertaken to assess individual preferences for key aspects of Care Planning. The clinical effectiveness and cost-effectiveness of the training were evaluated using a pragmatic cluster trial with cohort and cross-sectional samples. A nested longitudinal qualitative process evaluation using multiple methods, including semistructured interviews with key informants involved locally and nationally in mental Health policy, practice and research, was undertaken. A mapping exercise was used to determine current practice, and semistructured interviews were undertaken with service users and mental Health professionals from both the usual-Care and the intervention arms of the trial at three time points (i.e. baseline and 6 months and 12 months post intervention). Results The results from focus groups (n = 56) and interviews (n = 74) highlighted a need to deliver training to increase the quality of Care Planning and a training intervention was developed. We recruited 402 participants to develop the final 14-item patient-reported outcome measure and a six-item audit tool. We recruited 232 participants for the stated preference survey and found that preferences were strongest for the attribute ‘my preferences for Care are included in the Care plan’. The training was delivered to 304 Care co-ordinators working in community mental Health teams across 10 NHS trusts. The cluster trial and cross-sectional survey recruited 1286 service users and 90 Carers, and the primary outcome was the Health Care Climate Questionnaire. Training was positively evaluated. The results showed no statistically significant difference on the primary outcome (the Health Care Climate Questionnaire) (adjusted mean difference –0.064, 95% confidence interval –0.343 to 0.215; p = 0.654) or secondary outcomes at the 6-month follow-up. Overall, the training intervention was associated with a net saving of –£54.00 (95% confidence interval –£193.00 to £84.00), with a net quality-adjusted life-year loss of –0.014 (95% confidence interval –0.034 to 0.005). The longitudinal process evaluation recruited 54 service users, professionals and Carers, finding a failure of training to become embedded in routine Care. Limitations Our pragmatic study was designed to improve service user and Care involvement in Care Planning among routine community mental Health services. We intervened in 18 sites with > 300 Care co-ordinators. However, our volunteer sites may not be fully representative of the wider population, and we lacked data with which to compare our participants with the eligible population. Conclusions We co-developed and co-delivered a training intervention and developed a unidimensional measure of service user and Carer involvement in Care Planning and an audit tool. Despite a high level of satisfaction with the training, no significant effect was found; therefore, the intervention was ineffective. There was a failure of training to become embedded and normalised because of a lack of organisational readiness to accept change. Working with NHS trusts in our ‘Willing Adopters’ programme with enhanced organisational buy-in yielded some promising results. Future work Research should focus on developing and evaluating new organisational initiatives in addition to training Health-Care professionals to address contextual barriers to service and Carer involvement in Care Planning, and explore co-designing and delivering new ways of enhancing service users’ and Carers’ capabilities to engage in Care Planning. Trial registration Current Controlled Trials ISRCTN16488358. Funding This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 7, No. 9. See the NIHR Journals Library website for further project information.
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training to enhance user and Carer involvement in mental Health Care Planning the equip research programme including a cluster rct
Programme Grants for Applied Research, 2019Co-Authors: Karina Lovell, Helen Brooks, Patrick Callaghan, Peter Bower, Patrick Cahoon, Lesleyanne Carter, Lindsey Cree, Linda Davies, Richard Drake, Claire M. FraserAbstract:Background: Service users and Carers using mental Health services want more involvement in their Care and the aim of this research programme was to enhance service user and Carer involvement in Care Planning in mental Health services. Objectives: Co-develop and co-deliver a training intervention for Health professionals in community mental Health teams, which aimed to enhance service user and Carer involvement in Care Planning. Develop a patient-reported outcome measure of service user involvement in Care Planning, design an audit tool and assess individual preferences for key aspects of Care Planning involvement. Evaluate the clinical effectiveness and the cost-effectiveness of the training. Understand the barriers to and facilitators of implementing service user- and Carer-involved Care Planning. Disseminate resources to stakeholders. Methods: A systematic review, focus groups and interviews with service users/Carers/Health professionals informed the training and determined the priorities underpinning involvement in Care Planning. Data from focus groups and interviews were combined and analysed using framework analysis. The results of the systematic review, focus groups/interviews and a review of the training interventions were synthesised to develop the final training intervention. To develop and validate the patient-reported outcome measure, items were generated from focus groups and interviews, and a psychometric analysis was conducted. Patient-reported outcome measure items and a three-round consensus exercise were used to develop an audit tool, and a stated preference survey was undertaken to assess individual preferences for key aspects of Care Planning. The clinical effectiveness and cost-effectiveness of the training were evaluated using a pragmatic cluster trial with cohort and cross-sectional samples. A nested longitudinal qualitative process evaluation using multiple methods, including semistructured interviews with key informants involved locally and nationally in mental Health policy, practice and research, was undertaken. A mapping exercise was used to determine current practice, and semistructured interviews were undertaken with service users and mental Health professionals from both the usual-Care and the intervention arms of the trial at three time points (i.e. baseline and 6 months and 12 months post intervention). Results: The results from focus groups (n = 56) and interviews (n = 74) highlighted a need to deliver training to increase the quality of Care Planning and a training intervention was developed. We recruited 402 participants to develop the final 14-item patient-reported outcome measure and a six-item audit tool. We recruited 232 participants for the stated preference survey and found that preferences were strongest for the attribute ‘my preferences for Care are included in the Care plan’. The training was delivered to 304 Care co-ordinators working in community mental Health teams across 10 NHS trusts. The cluster trial and cross-sectional survey recruited 1286 service users and 90 Carers, and the primary outcome was the Health Care Climate Questionnaire. Training was positively evaluated. The results showed no statistically significant difference on the primary outcome (the Health Care Climate Questionnaire) (adjusted mean difference –0.064, 95% confidence interval –0.343 to 0.215; p = 0.654) or secondary outcomes at the 6-month follow-up. Overall, the training intervention was associated with a net saving of –£54.00 (95% confidence interval –£193.00 to £84.00), with a net quality-adjusted life-year loss of –0.014 (95% confidence interval –0.034 to 0.005). The longitudinal process evaluation recruited 54 service users, professionals and Carers, finding a failure of training to become embedded in routine Care. Limitations: Our pragmatic study was designed to improve service user and Care involvement in Care Planning among routine community mental Health services. We intervened in 18 sites with > 300 Care co-ordinators. However, our volunteer sites may not be fully representative of the wider population, and we lacked data with which to compare our participants with the eligible population. Conclusions: We co-developed and co-delivered a training intervention and developed a unidimensional measure of service user and Carer involvement in Care Planning and an audit tool. Despite a high level of satisfaction with the training, no significant effect was found; therefore, the intervention was ineffective. There was a failure of training to become embedded and normalised because of a lack of organisational readiness to accept change. Working with NHS trusts in our ‘Willing Adopters’ programme with enhanced organisational buy-in yielded some promising results. Future work: Research should focus on developing and evaluating new organisational initiatives in addition to training Health-Care professionals to address contextual barriers to service and Carer involvement in Care Planning, and explore co-designing and delivering new ways of enhancing service users’ and Carers’ capabilities to engage in Care Planning. Trial registration: Current Controlled Trials ISRCTN16488358.
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assessing mental Health service user and Carer involvement in physical Health Care Planning the development and validation of a new patient reported experience measure
PLOS ONE, 2019Co-Authors: Nicola Small, Helen Brooks, Chris J Sideygibbons, Judith Gellatly, Karina LovellAbstract:Background People living with serious mental Health conditions experience increased morbidity due to physical Health issues driven by medication side-effects and lifestyle factors. Coordinated mental and physical HealthCare delivered in accordance with a Care plan could help to reduce morbidity and mortality in this population. Efforts to develop new models of Care are hampered by a lack of validated instruments to accurately assess the extent to which mental Health services users and Carers are involved in Care Planning for physical Health. Objective To develop a brief and accurate patient-reported experience measure (PREM) capable of assessing involvement in physical Health Care Planning for mental Health service users and their Carers. Methods We employed psychometric and statistical techniques to refine a bank of candidate questionnaire items, derived from qualitative interviews, into a valid and reliable measure involvement in physical Health Care Planning. We assessed the psychometric performance of the item bank using modern psychometric analyses. We assessed unidimensionality, scalability, fit to the partial credit Rasch model, category threshold ordering, local dependency, differential item functioning, and test-retest reliability. Once purified of poorly performing and erroneous items, we simulated computerized adaptive testing (CAT) with 15, 10 and 5 items using the calibrated item bank. Results Issues with category threshold ordering, local dependency and differential item functioning were evident for a number of items in the nascent item bank and were resolved by removing problematic items. The final 19 item PREM had excellent fit to the Rasch model fit (x2 = 192.94, df = 1515, P = .02, RMSEA = .03 (95% CI = .01-.04). The 19-item bank had excellent reliability (marginal r = 0.87). The correlation between questionnaire scores at baseline and 2-week follow-up was high (r = .70, P < .01) and 94.9% of assessment pairs were within the Bland Altman limits of agreement. Simulated CAT demonstrated that assessments could be made using as few as 10 items (mean SE = .43). Discussion We developed a flexible patient reported outcome measure to quantify service user and Carer involvement in physical Health Care Planning. We demonstrate the potential to substantially reduce assessment length whilst maintaining reliability by utilizing CAT.
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implementing an intervention designed to enhance service user involvement in mental Health Care Planning a qualitative process evaluation
Social Psychiatry and Psychiatric Epidemiology, 2019Co-Authors: Helen Brooks, Karina Lovell, Penny Bee, Claire M. Fraser, Christine Molloy, Anne RogersAbstract:Purpose Shared decision-making (SDM) and the wider elements of intersecting professional and lay practices are seen as necessary components in the implementation of mental Health interventions. A randomised controlled trial of a user- and Carer-informed training package in the United Kingdom to enhance SDM in Care Planning in secondary mental Health Care settings showed no effect on patient-level outcomes. This paper reports on the parallel process evaluation to establish the influences on implementation at service user, Carer, mental Health professional and organisational levels. Methods A longitudinal, qualitative process evaluation incorporating 134 semi-structured interviews with 54 mental Health service users, Carers and professionals was conducted. Interviews were undertaken at baseline and repeated at 6 and 12 months post-intervention. Interviews were digitally audio-recorded, transcribed verbatim and analysed thematically. Results The process evaluation demonstrated that despite buy-in from those delivering Care Planning in mental Health services, there was a failure of training to become embedded and normalised in local provision. This was due to a lack of organisational readiness to accept change combined with an underestimation and lack of investment in the amount and range of relational work required to successfully enact the intervention. Conclusions Future aspirations of SDM enactment need to place the circumstances and everyday practices of stakeholders at the centre of implementation. Such studies should consider the historical and current context of Health Care relationships and include elements which seek to address these directly.
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Understanding experiences of and preferences for service user and Carer involvement in physical Health Care discussions within mental Health Care Planning
BMC Psychiatry, 2017Co-Authors: Nicola Small, Helen Brooks, Andrew Grundy, Rebecca Pedley, Chris Gibbons, Karina Lovell, Penny BeeAbstract:People with severe mental illness suffer more physical comorbidity than the general population, which can require a tailored approach to physical Health Care discussions within mental Health Care Planning. Although evidence pertaining to service user and Carer involvement in mental Health Care Planning is accumulating, current understanding of how physical Health is prioritised within this framework is limited. Understanding stakeholder experiences of physical Health discussions within mental Health Care Planning, and the key domains that underpin this phenomena is essential to improve quality of Care. Our study aimed to explore service user, Carer and professional experiences of and preferences for service user and Carer involvement in physical Health discussions within mental Health Care Planning, and develop a conceptual framework of effective user-led involvement in this aspect of service provision. Six focus groups and four telephone interviews were carried out with twelve service users, nine Carers, three service users with a dual service user and Carer role, and ten mental Health professionals recruited from one mental Health Trust in the United Kingdom. Data was analysed utilising a thematic approach, analysed separately for each stakeholder group, and combined to aid comparisons. No service users or Carers recalled being explicitly involved in physical Health discussions within mental Health Care Planning. Six prerequisites for effective service user and Carer involvement in physical Care Planning were identified. Three themes confirmed general mental Health Care Planning requirements: tailoring a collaborative working relationship, maintaining a trusting relationship with a professional, and having access to and being able to edit a living document. Three themes were novel to feeling involved in physical Health Care Planning discussions: valuing physical Health equally with mental Health; experiencing coordination of Care between physical-mental Health professionals, and having a physical Health discussion that is personalised. High quality physical Health Care discussions within the Care Planning process demands action at multiple levels. A conceptual framework is presented which provides an evidence-based foundation for service level improvement. Further work is necessary to develop a new patient reported outcome measure to enable meaningful quantification of Health Care quality and patient experience.
Denis Breuille - One of the best experts on this subject based on the ideXlab platform.
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sarcopenia an undiagnosed condition in older adults current consensus definition prevalence etiology and consequences international working group on sarcopenia
Journal of the American Medical Directors Association, 2011Co-Authors: Roger A Fielding, Bruno Vellas, William J Evans, Shalender Bhasin, John E Morley, Anne B Newman, Gabor Abellan Van Kan, Sandrine Andrieu, J M Bauer, Denis BreuilleAbstract:Sarcopenia, the age-associated loss of skeletal muscle mass and function, has considerable societal consequences for the development of frailty, disability, and Health Care Planning. A group of geriatricians and scientists from academia and industry met in Rome, Italy, on November 18, 2009, to arrive at a consensus definition of sarcopenia. The current consensus definition was approved unanimously by the meeting participants and is as follows: Sarcopenia is defined as the age-associated loss of skeletal muscle mass and function. The causes of sarcopenia are multifactorial and can include disuse, altered endocrine function, chronic diseases, inflammation, insulin resistance, and nutritional deficiencies. Although cachexia may be a component of sarcopenia, the 2 conditions are not the same. The diagnosis of sarcopenia should be considered in all older patients who present with observed declines in physical function, strength, or overall Health. Sarcopenia should specifically be considered in patients who are bedridden, cannot independently rise from a chair, or who have a measured gait speed less that 1 m/s –1 . Patients who meet these criteria should further undergo body composition assessment using dual energy x-ray absorptiometry with sarcopenia being defined using currently validated definitions. A diagnosis of sarcopenia is consistent with a gait speed of less than 1 m·s −1 and an objectively measured low muscle mass (eg, appendicular mass relative to ht 2 that is ≤ 7.23 kg/m 2 in men and ≤ 5.67 kg/m 2 in women). Sarcopenia is a highly prevalent condition in older persons that leads to disability, hospitalization, and death.
Claire M. Fraser - One of the best experts on this subject based on the ideXlab platform.
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training to enhance user and Carer involvement in mental Health Care Planning the equip research programme including a cluster rct
Programme Grants for Applied Research, 2019Co-Authors: Karina Lovell, Helen Brooks, Patrick Callaghan, Peter Bower, Patrick Cahoon, Lesleyanne Carter, Lindsey Cree, Linda Davies, Richard Drake, Claire M. FraserAbstract:Background: Service users and Carers using mental Health services want more involvement in their Care and the aim of this research programme was to enhance service user and Carer involvement in Care Planning in mental Health services. Objectives: Co-develop and co-deliver a training intervention for Health professionals in community mental Health teams, which aimed to enhance service user and Carer involvement in Care Planning. Develop a patient-reported outcome measure of service user involvement in Care Planning, design an audit tool and assess individual preferences for key aspects of Care Planning involvement. Evaluate the clinical effectiveness and the cost-effectiveness of the training. Understand the barriers to and facilitators of implementing service user- and Carer-involved Care Planning. Disseminate resources to stakeholders. Methods: A systematic review, focus groups and interviews with service users/Carers/Health professionals informed the training and determined the priorities underpinning involvement in Care Planning. Data from focus groups and interviews were combined and analysed using framework analysis. The results of the systematic review, focus groups/interviews and a review of the training interventions were synthesised to develop the final training intervention. To develop and validate the patient-reported outcome measure, items were generated from focus groups and interviews, and a psychometric analysis was conducted. Patient-reported outcome measure items and a three-round consensus exercise were used to develop an audit tool, and a stated preference survey was undertaken to assess individual preferences for key aspects of Care Planning. The clinical effectiveness and cost-effectiveness of the training were evaluated using a pragmatic cluster trial with cohort and cross-sectional samples. A nested longitudinal qualitative process evaluation using multiple methods, including semistructured interviews with key informants involved locally and nationally in mental Health policy, practice and research, was undertaken. A mapping exercise was used to determine current practice, and semistructured interviews were undertaken with service users and mental Health professionals from both the usual-Care and the intervention arms of the trial at three time points (i.e. baseline and 6 months and 12 months post intervention). Results: The results from focus groups (n = 56) and interviews (n = 74) highlighted a need to deliver training to increase the quality of Care Planning and a training intervention was developed. We recruited 402 participants to develop the final 14-item patient-reported outcome measure and a six-item audit tool. We recruited 232 participants for the stated preference survey and found that preferences were strongest for the attribute ‘my preferences for Care are included in the Care plan’. The training was delivered to 304 Care co-ordinators working in community mental Health teams across 10 NHS trusts. The cluster trial and cross-sectional survey recruited 1286 service users and 90 Carers, and the primary outcome was the Health Care Climate Questionnaire. Training was positively evaluated. The results showed no statistically significant difference on the primary outcome (the Health Care Climate Questionnaire) (adjusted mean difference –0.064, 95% confidence interval –0.343 to 0.215; p = 0.654) or secondary outcomes at the 6-month follow-up. Overall, the training intervention was associated with a net saving of –£54.00 (95% confidence interval –£193.00 to £84.00), with a net quality-adjusted life-year loss of –0.014 (95% confidence interval –0.034 to 0.005). The longitudinal process evaluation recruited 54 service users, professionals and Carers, finding a failure of training to become embedded in routine Care. Limitations: Our pragmatic study was designed to improve service user and Care involvement in Care Planning among routine community mental Health services. We intervened in 18 sites with > 300 Care co-ordinators. However, our volunteer sites may not be fully representative of the wider population, and we lacked data with which to compare our participants with the eligible population. Conclusions: We co-developed and co-delivered a training intervention and developed a unidimensional measure of service user and Carer involvement in Care Planning and an audit tool. Despite a high level of satisfaction with the training, no significant effect was found; therefore, the intervention was ineffective. There was a failure of training to become embedded and normalised because of a lack of organisational readiness to accept change. Working with NHS trusts in our ‘Willing Adopters’ programme with enhanced organisational buy-in yielded some promising results. Future work: Research should focus on developing and evaluating new organisational initiatives in addition to training Health-Care professionals to address contextual barriers to service and Carer involvement in Care Planning, and explore co-designing and delivering new ways of enhancing service users’ and Carers’ capabilities to engage in Care Planning. Trial registration: Current Controlled Trials ISRCTN16488358.
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implementing an intervention designed to enhance service user involvement in mental Health Care Planning a qualitative process evaluation
Social Psychiatry and Psychiatric Epidemiology, 2019Co-Authors: Helen Brooks, Karina Lovell, Penny Bee, Claire M. Fraser, Christine Molloy, Anne RogersAbstract:Purpose Shared decision-making (SDM) and the wider elements of intersecting professional and lay practices are seen as necessary components in the implementation of mental Health interventions. A randomised controlled trial of a user- and Carer-informed training package in the United Kingdom to enhance SDM in Care Planning in secondary mental Health Care settings showed no effect on patient-level outcomes. This paper reports on the parallel process evaluation to establish the influences on implementation at service user, Carer, mental Health professional and organisational levels. Methods A longitudinal, qualitative process evaluation incorporating 134 semi-structured interviews with 54 mental Health service users, Carers and professionals was conducted. Interviews were undertaken at baseline and repeated at 6 and 12 months post-intervention. Interviews were digitally audio-recorded, transcribed verbatim and analysed thematically. Results The process evaluation demonstrated that despite buy-in from those delivering Care Planning in mental Health services, there was a failure of training to become embedded and normalised in local provision. This was due to a lack of organisational readiness to accept change combined with an underestimation and lack of investment in the amount and range of relational work required to successfully enact the intervention. Conclusions Future aspirations of SDM enactment need to place the circumstances and everyday practices of stakeholders at the centre of implementation. Such studies should consider the historical and current context of Health Care relationships and include elements which seek to address these directly.
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evaluating and quantifying user and Carer involvement in mental Health Care Planning equip co development of a new patient reported outcome measure
PLOS ONE, 2016Co-Authors: Chris Gibbons, Claire M. Fraser, Patrick Callaghan, Karina LovellAbstract:International and national Health policy seeks to increase service user and Carer involvement in mental Health Care Planning, but suitable user-centred tools to assess the success of these initiatives are not yet available. The current study describes the development of a new reliable and valid, interval-scaled service-user and Carer reported outcome measure for quantifying user/Carer involvement in mental Health Care Planning. Psychometric development reduced a 70-item item bank to a short form questionnaire using a combination of Classical Test, Mokken and Rasch Analyses. Test-retest reliability was calculated using t-tests of interval level scores between baseline and 2–4 week follow-up. Items were worded to be relevant to both service users and Carers. Nine items were removed following cognitive debriefing with a service user and Carer advisory group. An iterative process of item removal reduced the remaining 61 items to a final 14-item scale. The final scale has acceptable scalability (Ho = .69), reliability (alpha = .92), fit to the Rasch model (χ2(70) = 97.25, p = .02), and no differential item functioning or locally dependent items. Scores remained stable over the 4 week follow-up period, indicating good test-retest reliability. The ‘Evaluating the Quality of User and Carer Involvement in Care Planning (EQUIP)’ scale displays excellent psychometric properties and is capable of unidimensional linear measurement. The scale is short, user and Carer-centred and will be of direct benefit to clinicians, services, auditors and researchers wishing to quantify levels of user and Carer involvement in Care Planning.
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re inventing Care Planning in mental Health stakeholder accounts of the imagined implementation of a user Carer involved intervention
BMC Health Services Research, 2015Co-Authors: Helen Brooks, Karina Lovell, Claire M. Fraser, Caroline Sanders, Anne RogersAbstract:Background Despite an increase in mental Health innovations designed to increase service user and Carer involvement in services, there is evidence that service users and Carers are still relatively marginalised. This study aimed to identify key informants operating with knowledge of both policy and practice related to future models of mental Health management in order to explore the potential de-implementation of existing Care Planning and possibilities for the introduction of a training programme designed to implement a new user and Carer involved and focussed process of mental Health Care Planning.
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Professional perspectives on service user and Carer involvement in mental Health Care Planning: A qualitative study
International Journal of Nursing Studies, 2015Co-Authors: Penny Bee, Helen Brooks, Claire M. Fraser, Karina LovellAbstract:Abstract Background Involving users/Carers in mental Health Care-Planning is central to international policy initiatives yet users frequently report feeling excluded from the Care Planning process. Rigorous explorations of mental Health professionals' experiences of Care Planning are lacking, limiting our understanding of this important translational gap. Objectives To explore professional perceptions of delivering collaborative mental Health Care-Planning and involving service users and Carers in their Care. Design Qualitative interviews and focus groups with data combined and subjected to framework analysis. Setting UK secondary Care mental Health services. Participants 51 multi-disciplinary professionals involved in Care Planning and recruited via study advertisements. Results Emergent themes identified Care-Planning as a meaningful platform for user/Carer involvement but revealed philosophical tensions between user involvement and professional accountability. Professionals emphasised their individual, relational skills as a core facilitator of involvement, highlighting some important deficiencies in conventional staff training programmes. Conclusions Although internationally accepted on philosophical grounds, user-involved Care-Planning is poorly defined and lacks effective implementation support. Its full realisation demands greater recognition of both the historical and contemporary contexts in which statutory mental HealthCare occurs.
