Affiliation:
1. University College London
2. The University of Sydney
Abstract
Abstract
Background
Crisis Resolution Teams (CRTs) offer home-based care for people in mental health crisis, as an alternative to hospital admission. The success of CRTs in England has been variable. In response to this, the CRT Optimization and RElapse prevention (CORE) study developed and trialled a 12-month Service Improvement Programme (SIP) based on a fidelity model. This paper describes a qualitative evaluation of the perspectives of CRT staff, managers, and programme facilitators. We identify barriers and facilitators to implementation, and mechanisms by which service improvements took place.
Methods
Managers and staff from six purposively sampled CRTs were interviewed, as well as six facilitators who were employed to support the implementation of service improvement plans. Semi-structured focus groups and individual interviews were conducted and analysed using thematic analysis.
Results
A majority of participants viewed all components of the SIP as helpful in improving practice, although online resources were under-used. Perceived barriers to implementation centred principally around lack of staff time and ownership. Support from both senior staff and facilitators was essential in enabling teams to undertake the work associated with the SIP. All stakeholder groups reported that using the fidelity model to benchmark their CRT work to best practice and feel part of a ‘bigger whole’ was valuable.
Conclusion
CRT staff, managers and programme facilitators thought that a structured service improvement programme helped to increase fidelity to a best practice model. Flexibility (from all stakeholders) was key to enable service improvement actions to be manageable within time- and resource-poor teams.
Publisher
Research Square Platform LLC
Reference32 articles.
1. Johnson S. Crisis resolution and home treatment teams: an evolving model. Adv Psychiatr Treat [Internet]. 2013 Jan 3 [cited 2014 Dec 11];19(2):115–23. Available from: http://apt.rcpsych.org/content/19/2/115.
2. Wheeler C, Lloyd-Evans B, Churchard A, Fitzgerald C, Fullarton K, Mosse L et al. Implementation of the Crisis Resolution Team model in adult mental health settings: a systematic review. BMC Psychiatry [Internet]. 2015;15:74. http://dx.doi.org/10.1186/s12888-015-0441-x.
3. Department of Health. The Mental Health Policy Implementation Guide [Internet]. 2001 [cited 2015 Nov 24]. Available from: http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/publicationsandstatistics/publications/publicationspolicyandguidance/dh_4009350.
4. Dalton-Locke C, Johnson S, Harju-Seppänen J, Lyons N, Sheridan Rains L, Stuart R et al. Emerging models and trends in mental health crisis care in England: a national investigation of crisis care systems. BMC Health Serv Res [Internet]. 2021 Oct 29 [cited 2023 Mar 16];21(1):1174. https://doi.org/10.1186/s12913-021-07181-x.
5. Lloyd-Evans B, Lamb D, Barnby J, Eskinazi M, Turner A, Johnson S. Mental health crisis resolution teams and crisis care systems in England: a national survey. BJPsych Bull [Internet]. 2018 Aug [cited 2020 Feb 12];42(4):146–51. Available from: https://www.cambridge.org/core/journals/bjpsych-bulletin/article/mental-health-crisis-resolution-teams-and-crisis-care-systems-in-england-a-national-survey/11E05E81FE3748703875FC92BEF1F0E0.