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Randomized Controlled Trial
. 2020 Jun;216(6):314-322.
doi: 10.1192/bjp.2019.21.

The CORE service improvement programme for mental health crisis resolution teams: results from a cluster-randomised trial

Brynmor Lloyd-Evans  1 , David Osborn  2 , Louise Marston  3 , Danielle Lamb  4 , Gareth Ambler  5 , Rachael Hunter  6 , Oliver Mason  7 , Sarah Sullivan  8 , Claire Henderson  9 , Steve Onyett  10 , Elaine Johnston  11 , Nicola Morant  12 , Fiona Nolan  13 , Kathleen Kelly  14 , Marina Christoforou  15 , Kate Fullarton  15 , Rebecca Forsyth  15 , Mike Davidson  15 , Jonathan Piotrowski  16 , Edward Mundy  15 , Gary Bond  17 , Sonia Johnson  18
Affiliations
Randomized Controlled Trial

The CORE service improvement programme for mental health crisis resolution teams: results from a cluster-randomised trial

Brynmor Lloyd-Evans et al. Br J Psychiatry. 2020 Jun.

Abstract

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.

Keywords: Acute care; crisis resolution; mental health services; randomised controlled trial; service improvement.

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Conflict of interest statement

Declaration of interest None.

Figures

Fig. 1
Fig. 1
Crisis team Optimisation and RElapse prevention (CORE) crisis resolution team (CRT) service improvement programme cluster randomised trial – CONSORT flow diagram.
Fig. 2
Fig. 2
Implementation of the crisis resolution team (CRT) service improvement programme trial intervention.
See this image and copyright information in PMC

Comment in

  • CORE study: different interpretation of the results.
    Wong PL, Bertram R, Hubbeling D. Wong PL, et al. Br J Psychiatry. 2019 Aug;215(2):503. doi: 10.1192/bjp.2019.144. Br J Psychiatry. 2019. PMID: 31288883 No abstract available.
  • Authors' reply.
    Lloyd-Evans B, Johnson S. Lloyd-Evans B, et al. Br J Psychiatry. 2019 Aug;215(2):503-504. doi: 10.1192/bjp.2019.145. Br J Psychiatry. 2019. PMID: 31288884 No abstract available.

References

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    1. Department of Health. The NHS Plan: A Plan for Investment, a Plan for Reform. Department of Health, 2000. (http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.g...).
    1. Johnson S. Crisis resolution and home treatment teams: an evolving model. Br J Psychiatry 2013; 19: 115–23.
    1. Johnson S, Nolan F, Pilling S, Sandor A, Hoult J, McKenzie N, et al. Randomised controlled trial of acute mental health care by a crisis resolution team: the north Islington crisis study. BMJ 2005; 331: 599. - PMC - PubMed
    1. Murphy SM, Irving CB, Adams CE, Waqar M. Crisis intervention for people with severe mental illnesses. Cochrane Database Syst Rev 2015; 12: CD001087. - PMC - PubMed

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