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David Osborn - One of the best experts on this subject based on the ideXlab platform.
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the core service improvement programme for mental health crisis resolution teams results from a cluster randomised trial
British Journal of Psychiatry, 2020Co-Authors: Brynmor Lloydevans, David Osborn, Louise Marston, Danielle Lamb, Gareth Ambler, Rachael Hunter, Oliver Mason, Sarah A Sullivan, Claire Henderson, Steve OnyettAbstract:BACKGROUND Crisis resolution teams (CRTs) offer brief, intensive home treatment for people experiencing mental health crisis. CRT implementation is highly variable; positive trial outcomes have not been reproduced in scaled-up CRT care. AIMS To evaluate a 1-year programme to improve CRTs' Model Fidelity in a non-masked, cluster-randomised trial (part of the Crisis team Optimisation and RElapse prevention (CORE) research programme, trial registration number: ISRCTN47185233). METHOD Fifteen CRTs in England received an intervention, informed by the US Implementing Evidence-Based Practice project, involving support from a CRT facilitator, online implementation resources and regular team Fidelity reviews. Ten control CRTs received no additional support. The primary outcome was patient satisfaction, measured by the Client Satisfaction Questionnaire (CSQ-8), completed by 15 patients per team at CRT discharge (n = 375). Secondary outcomes: CRT Model Fidelity, continuity of care, staff well-being, in-patient admissions and bed use and CRT readmissions were also evaluated. RESULTS All CRTs were retained in the trial. Median follow-up CSQ-8 score was 28 in each group: the adjusted average in the intervention group was higher than in the control group by 0.97 (95% CI -1.02 to 2.97) but this was not significant (P = 0.34). There were fewer in-patient admissions, lower in-patient bed use and better staff psychological health in intervention teams. Model Fidelity rose in most intervention teams and was significantly higher than in control teams at follow-up. There were no significant effects for other outcomes. CONCLUSIONS The CRT service improvement programme did not achieve its primary aim of improving patient satisfaction. It showed some promise in improving CRT Model Fidelity and reducing acute in-patient admissions.
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crisis resolution and home treatment in the uk a survey of Model Fidelity using a novel review methodology
International Journal of Mental Health Nursing, 2020Co-Authors: Danielle Lamb, Brynmor Lloydevans, David Osborn, Oliver Mason, Richard Gray, Kate Fullarton, Kathleen Kelly, Nicky GoaterAbstract:Crisis resolution teams (CRTs) provide treatment at home to people experiencing mental health crises, as an alternative to hospital admission. Previous UK research, based on self-report surveys, suggests that a loosely specified Model has resulted in wide variations in CRTs' service delivery, organization and outcomes. A Fidelity scale (developed through evidence review and stakeholder consensus) provided a means of objectively measuring adherence to a Model of good practice for CRTs, via one-day Fidelity reviews of UK crisis teams. Reviews included interviews with service users, carers, staff and managers, and examination of data, policies, protocols and anonymized case notes. Of the 75 teams reviewed, 49 (65%) were assessed as being moderate Fidelity and the rest as low Fidelity, with no team achieving high Fidelity. The median score was 122 (range: 73-151; inter-quartile range: 111-132). Teams achieved higher scores on items about structure and organization, for example ease of referral, medication and safety systems, but scored poorly on items about the content of care and interventions. Despite a national mandate to implement the CRT Model, there are wide variations in implementation in the UK and no teams in our sample achieved overall high Fidelity. This suggests that a mandatory national policy is not in itself sufficient to achieve good quality implementation of a service Model. The CRT Fidelity Scale provides a feasible and acceptable means to objectively assess Model Fidelity in CRTs. There is a need for development and testing of interventions to enhance Model Fidelity and facilitate improvements to these services.
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Crisis resolution teams for people experiencing mental health crises: the CORE mixed-methods research programme including two RCTs
'National Institute for Health Research', 2019Co-Authors: Brynmor Lloyd-evans, David Osborn, Louise Marston, Danielle Lamb, Gareth Ambler, Oliver Mason, Marina Christoforou, Nicola Morant, Sarah Sullivan, Claire HendersonAbstract:Background: Crisis resolution teams (CRTs) seek to avert hospital admissions by providing intensive home treatment for people experiencing a mental health crisis. The CRT Model has not been highly specified. CRT care is often experienced as ending abruptly and relapse rates following CRT discharge are high. Aims: The aims of CORE (Crisis resolution team Optimisation and RElapse prevention) workstream 1 were to specify a Model of best practice for CRTs, develop a measure to assess adherence to this Model and evaluate service improvement resources to help CRTs implement the Model with high Fidelity. The aim of CORE workstream 2 was to evaluate a peer-provided self-management programme aimed at reducing relapse following CRT support. Methods: Workstream 1 was based on a systematic review, national CRT manager survey and stakeholder qualitative interviews to develop a CRT Fidelity scale through a concept mapping process with stakeholders (n = 68). This was piloted in CRTs nationwide (n = 75). A CRT service improvement programme (SIP) was then developed and evaluated in a cluster randomised trial: 15 CRTs received the SIP over 1 year; 10 teams acted as controls. The primary outcome was service user satisfaction. Secondary outcomes included CRT Model Fidelity, catchment area inpatient admission rates and staff well-being. Workstream 2 was a peer-provided self-management programme that was developed through an iterative process of systematic literature reviewing, stakeholder consultation and preliminary testing. This intervention was evaluated in a randomised controlled trial: 221 participants recruited from CRTs received the intervention and 220 did not. The primary outcome was re-admission to acute care at 1 year of follow-up. Secondary outcomes included time to re-admission and number of days in acute care over 1 year of follow-up and symptoms and personal recovery measured at 4 and 18 months’ follow-up. Results: Workstream 1 – a 39-item CRT Fidelity scale demonstrated acceptability, face validity and promising inter-rater reliability. CRT implementation in England was highly variable. The SIP trial did not produce a positive result for patient satisfaction [median Client Satisfaction Questionnaire score of 28 in both groups at follow-up; coefficient 0.97, 95% confidence interval (CI) –1.02 to 2.97]. The programme achieved modest increases in Model Fidelity. Intervention teams achieved lower inpatient admission rates and less inpatient bed use. Qualitative evaluation suggested that the programme was generally well received. Workstream 2 – the trial yielded a statistically significant result for the primary outcome, in which rates of re-admission to acute care over 1 year of follow-up were lower in the intervention group than in the control group (odds ratio 0.66, 95% CI 0.43 to 0.99; p = 0.044). Time to re-admission was lower and satisfaction with care was greater in the intervention group at 4 months’ follow-up. There were no other significant differences between groups in the secondary outcomes. Limitations: Limitations in workstream 1 included uncertainty regarding the representativeness of the sample for the primary outcome and lack of blinding for assessment. In workstream 2, the limitations included the complexity of the intervention, preventing clarity about which were effective elements. Conclusions: The CRT SIP did not achieve all its aims but showed potential promise as a means to increase CRT Model Fidelity and reduce inpatient service use. The peer-provided self-management intervention is an effective means to reduce relapse rates for people leaving CRT care. Study registration: The randomised controlled trials were registered as Current Controlled Trials ISRCTN47185233 and ISRCTN01027104. The systematic reviews were registered as PROSPERO CRD42013006415 and CRD42017043048. Funding: The National Institute for Health Research Programme Grants for Applied Research programme
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development of a measure of Model Fidelity for mental health crisis resolution teams
BMC Psychiatry, 2016Co-Authors: Brynmor Lloydevans, Torleif Ruud, David Osborn, Claire Henderson, Gary R Bond, Ada Ivanecka, Richard Gray, Fiona Nolan, Oliver MasonAbstract:Crisis Resolution Teams (CRTs) provide short-term intensive home treatment to people experiencing mental health crisis. Trial evidence suggests CRTs can be effective at reducing hospital admissions and increasing satisfaction with acute care. When scaled up to national level however, CRT implementation and outcomes have been variable. We aimed to develop and test a Fidelity scale to assess adherence to a Model of best practice for CRTs, based on best available evidence. A concept mapping process was used to develop a CRT Fidelity scale. Participants (n = 68) from a range of stakeholder groups prioritised and grouped statements (n = 72) about important components of the CRT Model, generated from a literature review, national survey and qualitative interviews. These data were analysed using Ariadne software and the resultant cluster solution informed item selection for a CRT Fidelity scale. Operational criteria and scoring anchor points were developed for each item. The CORE CRT Fidelity scale was then piloted in 75 CRTs in the UK to assess the range of scores achieved and feasibility for use in a 1-day Fidelity review process. Trained reviewers (n = 16) rated CRT service Fidelity in a vignette exercise to test the scale’s inter-rater reliability. There were high levels of agreement within and between stakeholder groups regarding the most important components of the CRT Model. A 39-item measure of CRT Model Fidelity was developed. Piloting indicated that the scale was feasible for use to assess CRT Model Fidelity and had good face validity. The wide range of item scores and total scores across CRT services in the pilot demonstrate the measure can distinguish lower and higher Fidelity services. Moderately good inter-rater reliability was found, with an estimated correlation between individual ratings of 0.65 (95% CI: 0.54 to 0.76). The CORE CRT Fidelity Scale has been developed through a rigorous and systematic process. Promising initial testing indicates its value in assessing adherence to a Model of CRT best practice and to support service improvement monitoring and planning. Further research is required to establish its psychometric properties and international applicability.
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development of a measure of Model Fidelity for mental health crisis resolution teams
BMC Psychiatry, 2016Co-Authors: Brynmor Lloydevans, Torleif Ruud, David Osborn, Claire Henderson, Gary R Bond, Ada Ivanecka, Richard Gray, Fiona Nolan, Oliver MasonAbstract:Abstract Background Crisis Resolution Teams (CRTs) provide short-term intensive home treatment to people experiencing mental health crisis. Trial evidence suggests CRTs can be effective at reducing hospital admissions and increasing satisfaction with acute care. When scaled up to national level however, CRT implementation and outcomes have been variable. We aimed to develop and test a Fidelity scale to assess adherence to a Model of best practice for CRTs, based on best available evidence. Methods A concept mapping process was used to develop a CRT Fidelity scale. Participants ( n = 68) from a range of stakeholder groups prioritised and grouped statements ( n = 72) about important components of the CRT Model, generated from a literature review, national survey and qualitative interviews. These data were analysed using Ariadne software and the resultant cluster solution informed item selection for a CRT Fidelity scale. Operational criteria and scoring anchor points were developed for each item. The CORE CRT Fidelity scale was then piloted in 75 CRTs in the UK to assess the range of scores achieved and feasibility for use in a 1-day Fidelity review process. Trained reviewers ( n = 16) rated CRT service Fidelity in a vignette exercise to test the scale’s inter-rater reliability. Results There were high levels of agreement within and between stakeholder groups regarding the most important components of the CRT Model. A 39-item measure of CRT Model Fidelity was developed. Piloting indicated that the scale was feasible for use to assess CRT Model Fidelity and had good face validity. The wide range of item scores and total scores across CRT services in the pilot demonstrate the measure can distinguish lower and higher Fidelity services. Moderately good inter-rater reliability was found, with an estimated correlation between individual ratings of 0.65 (95% CI: 0.54 to 0.76). Conclusions The CORE CRT Fidelity Scale has been developed through a rigorous and systematic process. Promising initial testing indicates its value in assessing adherence to a Model of CRT best practice and to support service improvement monitoring and planning. Further research is required to establish its psychometric properties and international applicability.
Subbarao Varigonda - One of the best experts on this subject based on the ideXlab platform.
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Physically-based reduced-order capacity loss Model: SEI layer growth and active material loss for graphite anode
2017 American Control Conference (ACC), 2017Co-Authors: Xing Jin, Tridib Saha, Vaidehi Hoshing, Oleg Wasynczuk, Ashish P. Vora, Gregory M. Shaver, Edwin R. García, Subbarao VarigondaAbstract:Physically-based Li-ion electrochemical cell Models have been shown capable of predicting cell performance and degradation, but are computationally expensive for optimization-oriented design applications. Faster empirical Models have been developed from experimental data, but are not generalizable to operating conditions outside of the range established by the calibration data. In this paper, a reduced-order capacity-loss Model for graphite anodes is derived based upon the salient physical loss mechanisms to improve computational efficiency without sacrificing Model Fidelity. This Model captures the two primary degradation mechanisms that occur in the graphite anode of a typical lithium ion cell: a) capacity loss due to Solid Electrolyte Interface (SEI) layer growth, and b) capacity loss due to isolation of active material. The Model is calibrated and validated for a commercial 2.3-Ah cell with a Lithium Iron Phosphate (LFP) cathode and graphite anode. One data set is used for calibration, another two data sets are used for validation. The Model matches experimental capacity degradation results within 10% error. Moreover, the reported Model is 2400× faster than currently existing more complex physically-based electrochemical Models that are only slightly more accurate (less than 8% error).
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Physically-based reduced-order capacity loss Model for graphite anodes in Li-ion battery cells
Journal of Power Sources, 2017Co-Authors: Xing Jin, Ashish Vora, Gregory Shaver, R. Edwin Garc�a, Tridib Saha, Vaidehi Hoshing, Oleg Wasynczuk, Subbarao VarigondaAbstract:Physically-based Li-ion electrochemical cell Models have been shown capable of predicting cell performance and degradation, but are computationally expensive for optimization-oriented design applications. Faster empirical Models have been developed from experimental data, but are not generalizable to operating conditions outside of the range established by the calibration data. In this paper, a reduced-order capacity-loss Model for graphite anodes is derived based upon the salient physical loss mechanisms to improve computational efficiency without sacrificing Model Fidelity. This Model captures the two primary degradation mechanisms that occur in the graphite anode of a typical lithium ion cell: a) capacity loss due to Solid Electrolyte Interface (SEI) layer growth, and b) capacity loss due to isolation of active material. The Model is calibrated and validated for a commercial 2.3-Ah cell with a Lithium Iron Phosphate (LFP) cathode and graphite anode. One data set is used for calibration, another four experimental data sets are used for validation. The Model matches experimental capacity degradation results within a 20% error. Moreover, the reported Model is 2400� faster than currently existing more complex physically-based electrochemical Models that are only slightly more accurate (in some cases).
Oliver Mason - One of the best experts on this subject based on the ideXlab platform.
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the core service improvement programme for mental health crisis resolution teams results from a cluster randomised trial
British Journal of Psychiatry, 2020Co-Authors: Brynmor Lloydevans, David Osborn, Louise Marston, Danielle Lamb, Gareth Ambler, Rachael Hunter, Oliver Mason, Sarah A Sullivan, Claire Henderson, Steve OnyettAbstract:BACKGROUND Crisis resolution teams (CRTs) offer brief, intensive home treatment for people experiencing mental health crisis. CRT implementation is highly variable; positive trial outcomes have not been reproduced in scaled-up CRT care. AIMS To evaluate a 1-year programme to improve CRTs' Model Fidelity in a non-masked, cluster-randomised trial (part of the Crisis team Optimisation and RElapse prevention (CORE) research programme, trial registration number: ISRCTN47185233). METHOD Fifteen CRTs in England received an intervention, informed by the US Implementing Evidence-Based Practice project, involving support from a CRT facilitator, online implementation resources and regular team Fidelity reviews. Ten control CRTs received no additional support. The primary outcome was patient satisfaction, measured by the Client Satisfaction Questionnaire (CSQ-8), completed by 15 patients per team at CRT discharge (n = 375). Secondary outcomes: CRT Model Fidelity, continuity of care, staff well-being, in-patient admissions and bed use and CRT readmissions were also evaluated. RESULTS All CRTs were retained in the trial. Median follow-up CSQ-8 score was 28 in each group: the adjusted average in the intervention group was higher than in the control group by 0.97 (95% CI -1.02 to 2.97) but this was not significant (P = 0.34). There were fewer in-patient admissions, lower in-patient bed use and better staff psychological health in intervention teams. Model Fidelity rose in most intervention teams and was significantly higher than in control teams at follow-up. There were no significant effects for other outcomes. CONCLUSIONS The CRT service improvement programme did not achieve its primary aim of improving patient satisfaction. It showed some promise in improving CRT Model Fidelity and reducing acute in-patient admissions.
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crisis resolution and home treatment in the uk a survey of Model Fidelity using a novel review methodology
International Journal of Mental Health Nursing, 2020Co-Authors: Danielle Lamb, Brynmor Lloydevans, David Osborn, Oliver Mason, Richard Gray, Kate Fullarton, Kathleen Kelly, Nicky GoaterAbstract:Crisis resolution teams (CRTs) provide treatment at home to people experiencing mental health crises, as an alternative to hospital admission. Previous UK research, based on self-report surveys, suggests that a loosely specified Model has resulted in wide variations in CRTs' service delivery, organization and outcomes. A Fidelity scale (developed through evidence review and stakeholder consensus) provided a means of objectively measuring adherence to a Model of good practice for CRTs, via one-day Fidelity reviews of UK crisis teams. Reviews included interviews with service users, carers, staff and managers, and examination of data, policies, protocols and anonymized case notes. Of the 75 teams reviewed, 49 (65%) were assessed as being moderate Fidelity and the rest as low Fidelity, with no team achieving high Fidelity. The median score was 122 (range: 73-151; inter-quartile range: 111-132). Teams achieved higher scores on items about structure and organization, for example ease of referral, medication and safety systems, but scored poorly on items about the content of care and interventions. Despite a national mandate to implement the CRT Model, there are wide variations in implementation in the UK and no teams in our sample achieved overall high Fidelity. This suggests that a mandatory national policy is not in itself sufficient to achieve good quality implementation of a service Model. The CRT Fidelity Scale provides a feasible and acceptable means to objectively assess Model Fidelity in CRTs. There is a need for development and testing of interventions to enhance Model Fidelity and facilitate improvements to these services.
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Crisis resolution teams for people experiencing mental health crises: the CORE mixed-methods research programme including two RCTs
'National Institute for Health Research', 2019Co-Authors: Brynmor Lloyd-evans, David Osborn, Louise Marston, Danielle Lamb, Gareth Ambler, Oliver Mason, Marina Christoforou, Nicola Morant, Sarah Sullivan, Claire HendersonAbstract:Background: Crisis resolution teams (CRTs) seek to avert hospital admissions by providing intensive home treatment for people experiencing a mental health crisis. The CRT Model has not been highly specified. CRT care is often experienced as ending abruptly and relapse rates following CRT discharge are high. Aims: The aims of CORE (Crisis resolution team Optimisation and RElapse prevention) workstream 1 were to specify a Model of best practice for CRTs, develop a measure to assess adherence to this Model and evaluate service improvement resources to help CRTs implement the Model with high Fidelity. The aim of CORE workstream 2 was to evaluate a peer-provided self-management programme aimed at reducing relapse following CRT support. Methods: Workstream 1 was based on a systematic review, national CRT manager survey and stakeholder qualitative interviews to develop a CRT Fidelity scale through a concept mapping process with stakeholders (n = 68). This was piloted in CRTs nationwide (n = 75). A CRT service improvement programme (SIP) was then developed and evaluated in a cluster randomised trial: 15 CRTs received the SIP over 1 year; 10 teams acted as controls. The primary outcome was service user satisfaction. Secondary outcomes included CRT Model Fidelity, catchment area inpatient admission rates and staff well-being. Workstream 2 was a peer-provided self-management programme that was developed through an iterative process of systematic literature reviewing, stakeholder consultation and preliminary testing. This intervention was evaluated in a randomised controlled trial: 221 participants recruited from CRTs received the intervention and 220 did not. The primary outcome was re-admission to acute care at 1 year of follow-up. Secondary outcomes included time to re-admission and number of days in acute care over 1 year of follow-up and symptoms and personal recovery measured at 4 and 18 months’ follow-up. Results: Workstream 1 – a 39-item CRT Fidelity scale demonstrated acceptability, face validity and promising inter-rater reliability. CRT implementation in England was highly variable. The SIP trial did not produce a positive result for patient satisfaction [median Client Satisfaction Questionnaire score of 28 in both groups at follow-up; coefficient 0.97, 95% confidence interval (CI) –1.02 to 2.97]. The programme achieved modest increases in Model Fidelity. Intervention teams achieved lower inpatient admission rates and less inpatient bed use. Qualitative evaluation suggested that the programme was generally well received. Workstream 2 – the trial yielded a statistically significant result for the primary outcome, in which rates of re-admission to acute care over 1 year of follow-up were lower in the intervention group than in the control group (odds ratio 0.66, 95% CI 0.43 to 0.99; p = 0.044). Time to re-admission was lower and satisfaction with care was greater in the intervention group at 4 months’ follow-up. There were no other significant differences between groups in the secondary outcomes. Limitations: Limitations in workstream 1 included uncertainty regarding the representativeness of the sample for the primary outcome and lack of blinding for assessment. In workstream 2, the limitations included the complexity of the intervention, preventing clarity about which were effective elements. Conclusions: The CRT SIP did not achieve all its aims but showed potential promise as a means to increase CRT Model Fidelity and reduce inpatient service use. The peer-provided self-management intervention is an effective means to reduce relapse rates for people leaving CRT care. Study registration: The randomised controlled trials were registered as Current Controlled Trials ISRCTN47185233 and ISRCTN01027104. The systematic reviews were registered as PROSPERO CRD42013006415 and CRD42017043048. Funding: The National Institute for Health Research Programme Grants for Applied Research programme
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development of a measure of Model Fidelity for mental health crisis resolution teams
BMC Psychiatry, 2016Co-Authors: Brynmor Lloydevans, Torleif Ruud, David Osborn, Claire Henderson, Gary R Bond, Ada Ivanecka, Richard Gray, Fiona Nolan, Oliver MasonAbstract:Crisis Resolution Teams (CRTs) provide short-term intensive home treatment to people experiencing mental health crisis. Trial evidence suggests CRTs can be effective at reducing hospital admissions and increasing satisfaction with acute care. When scaled up to national level however, CRT implementation and outcomes have been variable. We aimed to develop and test a Fidelity scale to assess adherence to a Model of best practice for CRTs, based on best available evidence. A concept mapping process was used to develop a CRT Fidelity scale. Participants (n = 68) from a range of stakeholder groups prioritised and grouped statements (n = 72) about important components of the CRT Model, generated from a literature review, national survey and qualitative interviews. These data were analysed using Ariadne software and the resultant cluster solution informed item selection for a CRT Fidelity scale. Operational criteria and scoring anchor points were developed for each item. The CORE CRT Fidelity scale was then piloted in 75 CRTs in the UK to assess the range of scores achieved and feasibility for use in a 1-day Fidelity review process. Trained reviewers (n = 16) rated CRT service Fidelity in a vignette exercise to test the scale’s inter-rater reliability. There were high levels of agreement within and between stakeholder groups regarding the most important components of the CRT Model. A 39-item measure of CRT Model Fidelity was developed. Piloting indicated that the scale was feasible for use to assess CRT Model Fidelity and had good face validity. The wide range of item scores and total scores across CRT services in the pilot demonstrate the measure can distinguish lower and higher Fidelity services. Moderately good inter-rater reliability was found, with an estimated correlation between individual ratings of 0.65 (95% CI: 0.54 to 0.76). The CORE CRT Fidelity Scale has been developed through a rigorous and systematic process. Promising initial testing indicates its value in assessing adherence to a Model of CRT best practice and to support service improvement monitoring and planning. Further research is required to establish its psychometric properties and international applicability.
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development of a measure of Model Fidelity for mental health crisis resolution teams
BMC Psychiatry, 2016Co-Authors: Brynmor Lloydevans, Torleif Ruud, David Osborn, Claire Henderson, Gary R Bond, Ada Ivanecka, Richard Gray, Fiona Nolan, Oliver MasonAbstract:Abstract Background Crisis Resolution Teams (CRTs) provide short-term intensive home treatment to people experiencing mental health crisis. Trial evidence suggests CRTs can be effective at reducing hospital admissions and increasing satisfaction with acute care. When scaled up to national level however, CRT implementation and outcomes have been variable. We aimed to develop and test a Fidelity scale to assess adherence to a Model of best practice for CRTs, based on best available evidence. Methods A concept mapping process was used to develop a CRT Fidelity scale. Participants ( n = 68) from a range of stakeholder groups prioritised and grouped statements ( n = 72) about important components of the CRT Model, generated from a literature review, national survey and qualitative interviews. These data were analysed using Ariadne software and the resultant cluster solution informed item selection for a CRT Fidelity scale. Operational criteria and scoring anchor points were developed for each item. The CORE CRT Fidelity scale was then piloted in 75 CRTs in the UK to assess the range of scores achieved and feasibility for use in a 1-day Fidelity review process. Trained reviewers ( n = 16) rated CRT service Fidelity in a vignette exercise to test the scale’s inter-rater reliability. Results There were high levels of agreement within and between stakeholder groups regarding the most important components of the CRT Model. A 39-item measure of CRT Model Fidelity was developed. Piloting indicated that the scale was feasible for use to assess CRT Model Fidelity and had good face validity. The wide range of item scores and total scores across CRT services in the pilot demonstrate the measure can distinguish lower and higher Fidelity services. Moderately good inter-rater reliability was found, with an estimated correlation between individual ratings of 0.65 (95% CI: 0.54 to 0.76). Conclusions The CORE CRT Fidelity Scale has been developed through a rigorous and systematic process. Promising initial testing indicates its value in assessing adherence to a Model of CRT best practice and to support service improvement monitoring and planning. Further research is required to establish its psychometric properties and international applicability.
Brynmor Lloydevans - One of the best experts on this subject based on the ideXlab platform.
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the core service improvement programme for mental health crisis resolution teams results from a cluster randomised trial
British Journal of Psychiatry, 2020Co-Authors: Brynmor Lloydevans, David Osborn, Louise Marston, Danielle Lamb, Gareth Ambler, Rachael Hunter, Oliver Mason, Sarah A Sullivan, Claire Henderson, Steve OnyettAbstract:BACKGROUND Crisis resolution teams (CRTs) offer brief, intensive home treatment for people experiencing mental health crisis. CRT implementation is highly variable; positive trial outcomes have not been reproduced in scaled-up CRT care. AIMS To evaluate a 1-year programme to improve CRTs' Model Fidelity in a non-masked, cluster-randomised trial (part of the Crisis team Optimisation and RElapse prevention (CORE) research programme, trial registration number: ISRCTN47185233). METHOD Fifteen CRTs in England received an intervention, informed by the US Implementing Evidence-Based Practice project, involving support from a CRT facilitator, online implementation resources and regular team Fidelity reviews. Ten control CRTs received no additional support. The primary outcome was patient satisfaction, measured by the Client Satisfaction Questionnaire (CSQ-8), completed by 15 patients per team at CRT discharge (n = 375). Secondary outcomes: CRT Model Fidelity, continuity of care, staff well-being, in-patient admissions and bed use and CRT readmissions were also evaluated. RESULTS All CRTs were retained in the trial. Median follow-up CSQ-8 score was 28 in each group: the adjusted average in the intervention group was higher than in the control group by 0.97 (95% CI -1.02 to 2.97) but this was not significant (P = 0.34). There were fewer in-patient admissions, lower in-patient bed use and better staff psychological health in intervention teams. Model Fidelity rose in most intervention teams and was significantly higher than in control teams at follow-up. There were no significant effects for other outcomes. CONCLUSIONS The CRT service improvement programme did not achieve its primary aim of improving patient satisfaction. It showed some promise in improving CRT Model Fidelity and reducing acute in-patient admissions.
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crisis resolution and home treatment in the uk a survey of Model Fidelity using a novel review methodology
International Journal of Mental Health Nursing, 2020Co-Authors: Danielle Lamb, Brynmor Lloydevans, David Osborn, Oliver Mason, Richard Gray, Kate Fullarton, Kathleen Kelly, Nicky GoaterAbstract:Crisis resolution teams (CRTs) provide treatment at home to people experiencing mental health crises, as an alternative to hospital admission. Previous UK research, based on self-report surveys, suggests that a loosely specified Model has resulted in wide variations in CRTs' service delivery, organization and outcomes. A Fidelity scale (developed through evidence review and stakeholder consensus) provided a means of objectively measuring adherence to a Model of good practice for CRTs, via one-day Fidelity reviews of UK crisis teams. Reviews included interviews with service users, carers, staff and managers, and examination of data, policies, protocols and anonymized case notes. Of the 75 teams reviewed, 49 (65%) were assessed as being moderate Fidelity and the rest as low Fidelity, with no team achieving high Fidelity. The median score was 122 (range: 73-151; inter-quartile range: 111-132). Teams achieved higher scores on items about structure and organization, for example ease of referral, medication and safety systems, but scored poorly on items about the content of care and interventions. Despite a national mandate to implement the CRT Model, there are wide variations in implementation in the UK and no teams in our sample achieved overall high Fidelity. This suggests that a mandatory national policy is not in itself sufficient to achieve good quality implementation of a service Model. The CRT Fidelity Scale provides a feasible and acceptable means to objectively assess Model Fidelity in CRTs. There is a need for development and testing of interventions to enhance Model Fidelity and facilitate improvements to these services.
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development of a measure of Model Fidelity for mental health crisis resolution teams
BMC Psychiatry, 2016Co-Authors: Brynmor Lloydevans, Torleif Ruud, David Osborn, Claire Henderson, Gary R Bond, Ada Ivanecka, Richard Gray, Fiona Nolan, Oliver MasonAbstract:Crisis Resolution Teams (CRTs) provide short-term intensive home treatment to people experiencing mental health crisis. Trial evidence suggests CRTs can be effective at reducing hospital admissions and increasing satisfaction with acute care. When scaled up to national level however, CRT implementation and outcomes have been variable. We aimed to develop and test a Fidelity scale to assess adherence to a Model of best practice for CRTs, based on best available evidence. A concept mapping process was used to develop a CRT Fidelity scale. Participants (n = 68) from a range of stakeholder groups prioritised and grouped statements (n = 72) about important components of the CRT Model, generated from a literature review, national survey and qualitative interviews. These data were analysed using Ariadne software and the resultant cluster solution informed item selection for a CRT Fidelity scale. Operational criteria and scoring anchor points were developed for each item. The CORE CRT Fidelity scale was then piloted in 75 CRTs in the UK to assess the range of scores achieved and feasibility for use in a 1-day Fidelity review process. Trained reviewers (n = 16) rated CRT service Fidelity in a vignette exercise to test the scale’s inter-rater reliability. There were high levels of agreement within and between stakeholder groups regarding the most important components of the CRT Model. A 39-item measure of CRT Model Fidelity was developed. Piloting indicated that the scale was feasible for use to assess CRT Model Fidelity and had good face validity. The wide range of item scores and total scores across CRT services in the pilot demonstrate the measure can distinguish lower and higher Fidelity services. Moderately good inter-rater reliability was found, with an estimated correlation between individual ratings of 0.65 (95% CI: 0.54 to 0.76). The CORE CRT Fidelity Scale has been developed through a rigorous and systematic process. Promising initial testing indicates its value in assessing adherence to a Model of CRT best practice and to support service improvement monitoring and planning. Further research is required to establish its psychometric properties and international applicability.
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development of a measure of Model Fidelity for mental health crisis resolution teams
BMC Psychiatry, 2016Co-Authors: Brynmor Lloydevans, Torleif Ruud, David Osborn, Claire Henderson, Gary R Bond, Ada Ivanecka, Richard Gray, Fiona Nolan, Oliver MasonAbstract:Abstract Background Crisis Resolution Teams (CRTs) provide short-term intensive home treatment to people experiencing mental health crisis. Trial evidence suggests CRTs can be effective at reducing hospital admissions and increasing satisfaction with acute care. When scaled up to national level however, CRT implementation and outcomes have been variable. We aimed to develop and test a Fidelity scale to assess adherence to a Model of best practice for CRTs, based on best available evidence. Methods A concept mapping process was used to develop a CRT Fidelity scale. Participants ( n = 68) from a range of stakeholder groups prioritised and grouped statements ( n = 72) about important components of the CRT Model, generated from a literature review, national survey and qualitative interviews. These data were analysed using Ariadne software and the resultant cluster solution informed item selection for a CRT Fidelity scale. Operational criteria and scoring anchor points were developed for each item. The CORE CRT Fidelity scale was then piloted in 75 CRTs in the UK to assess the range of scores achieved and feasibility for use in a 1-day Fidelity review process. Trained reviewers ( n = 16) rated CRT service Fidelity in a vignette exercise to test the scale’s inter-rater reliability. Results There were high levels of agreement within and between stakeholder groups regarding the most important components of the CRT Model. A 39-item measure of CRT Model Fidelity was developed. Piloting indicated that the scale was feasible for use to assess CRT Model Fidelity and had good face validity. The wide range of item scores and total scores across CRT services in the pilot demonstrate the measure can distinguish lower and higher Fidelity services. Moderately good inter-rater reliability was found, with an estimated correlation between individual ratings of 0.65 (95% CI: 0.54 to 0.76). Conclusions The CORE CRT Fidelity Scale has been developed through a rigorous and systematic process. Promising initial testing indicates its value in assessing adherence to a Model of CRT best practice and to support service improvement monitoring and planning. Further research is required to establish its psychometric properties and international applicability.
Xing Jin - One of the best experts on this subject based on the ideXlab platform.
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Physically-based reduced-order capacity loss Model: SEI layer growth and active material loss for graphite anode
2017 American Control Conference (ACC), 2017Co-Authors: Xing Jin, Tridib Saha, Vaidehi Hoshing, Oleg Wasynczuk, Ashish P. Vora, Gregory M. Shaver, Edwin R. García, Subbarao VarigondaAbstract:Physically-based Li-ion electrochemical cell Models have been shown capable of predicting cell performance and degradation, but are computationally expensive for optimization-oriented design applications. Faster empirical Models have been developed from experimental data, but are not generalizable to operating conditions outside of the range established by the calibration data. In this paper, a reduced-order capacity-loss Model for graphite anodes is derived based upon the salient physical loss mechanisms to improve computational efficiency without sacrificing Model Fidelity. This Model captures the two primary degradation mechanisms that occur in the graphite anode of a typical lithium ion cell: a) capacity loss due to Solid Electrolyte Interface (SEI) layer growth, and b) capacity loss due to isolation of active material. The Model is calibrated and validated for a commercial 2.3-Ah cell with a Lithium Iron Phosphate (LFP) cathode and graphite anode. One data set is used for calibration, another two data sets are used for validation. The Model matches experimental capacity degradation results within 10% error. Moreover, the reported Model is 2400× faster than currently existing more complex physically-based electrochemical Models that are only slightly more accurate (less than 8% error).
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Physically-based reduced-order capacity loss Model for graphite anodes in Li-ion battery cells
Journal of Power Sources, 2017Co-Authors: Xing Jin, Ashish Vora, Gregory Shaver, R. Edwin Garc�a, Tridib Saha, Vaidehi Hoshing, Oleg Wasynczuk, Subbarao VarigondaAbstract:Physically-based Li-ion electrochemical cell Models have been shown capable of predicting cell performance and degradation, but are computationally expensive for optimization-oriented design applications. Faster empirical Models have been developed from experimental data, but are not generalizable to operating conditions outside of the range established by the calibration data. In this paper, a reduced-order capacity-loss Model for graphite anodes is derived based upon the salient physical loss mechanisms to improve computational efficiency without sacrificing Model Fidelity. This Model captures the two primary degradation mechanisms that occur in the graphite anode of a typical lithium ion cell: a) capacity loss due to Solid Electrolyte Interface (SEI) layer growth, and b) capacity loss due to isolation of active material. The Model is calibrated and validated for a commercial 2.3-Ah cell with a Lithium Iron Phosphate (LFP) cathode and graphite anode. One data set is used for calibration, another four experimental data sets are used for validation. The Model matches experimental capacity degradation results within a 20% error. Moreover, the reported Model is 2400� faster than currently existing more complex physically-based electrochemical Models that are only slightly more accurate (in some cases).