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. 2025 Oct 14;25(1):982.
doi: 10.1186/s12888-025-07253-w.

Evaluation of a pro-recovery training intervention (REFOCUS-RETAFORM) in specialist mental health services across France: stepped-wedge cluster randomised controlled trial protocol

Julien Dubreucq  1   2   3   4 , Nicolas Franck  5   6 , Julien Plasse  6 , Anne-Elisabeth Muller  7 , Marie-Cécile Bralet  8 , Céline Bera-Potelle  9 , Fabrice Berna  10   11 , Clara Blachère  9 , Alexandre Carpentier  8 , Isabelle Chereau  12   10 , Pauline Chillet  13 , Marine Dubreucq  14 , Isabelle Durand-Zaleski  15 , Marion Chirio-Espitalier  16   17 , Pauline Espi  18   19 , Pierre Fourneret  5   18 , Tristan Gabriel-Segard  20 , Axel Guioux  21 , Anne-Laure Grangé  22 , Amanda Green  23 , Errol Green  24 , Nathalie Guillard-Bouhet  25 , Priscille Gerardin  26 , Yves-Antoine Harscoet  16 , Yasser Khazaal  27 , Evelyne Lassere  28 , Alicia Le Bras  15 , Mary Leamy  23 , Guillaume Legrand  29 , Emilie Legros-Lafarge  22 , Pierre-Michel Llorca  12   10 , Nemat Jaafari  25 , Louis Mabille  30 , David Masson  31 , Catherine Massoubre  32 , Aurore Moisset  29 , Noushig Nahabedian  24 , Clélia Quiles  33   34 , David Reydellet  35 , Antoine Simon  6 , Aude Sibert  33 , Rémi Tresse  11 , Aurélie Tinland  35 , Graham Meadows  36   37   38   39   40 , Mike Slade  41   42 ; RETAFORM study group
Collaborators, Affiliations

Evaluation of a pro-recovery training intervention (REFOCUS-RETAFORM) in specialist mental health services across France: stepped-wedge cluster randomised controlled trial protocol

Julien Dubreucq et al. BMC Psychiatry. .

Abstract

Background: While recovery orientation is national policy in many countries, evidence remains limited for the effectiveness at a service level. This paper describes the protocol for implementing a pro-recovery training intervention (REFOCUS-RETAFORM) in specialist mental health services across France. The aim is to evaluate whether REFOCUS-RETAFORM plus usual care leads to improved outcomes for adolescent and adult mental health service users compared with usual care alone.

Methods: A two-step stepped wedge cluster randomised controlled trial will be conducted, with a nested qualitative sub-study exploring stakeholders' views on changes in staff-user relationships and implementation influences. The REFOCUS-RETAFORM intervention is a training intervention for mental health staff, to develop recovery-promoting relationships and pro-recovery working practices. Clusters are services, which transition sequentially from control to intervention condition in a randomised order. Eight clusters are randomised to deliver REFOCUS-RETAFORM in year one and eight clusters in year two. Each cluster delivers REFOCUS-RETAFORM to two teams from their organisation (32 teams in total). Participants are a) service users aged 13-65 years attending services implementing REFOCUS-RETAFORM, and b) staff receiving the intervention. The primary outcome is the Questionnaire about the Process of Recovery. Secondary outcomes include perceived stigma and coercion, self-stigma and wellbeing for service users, and recovery-orientation for staff. Data will be collected from 540 service users (180 at baseline, 180 at month 12, 180 at month 24) and 220 staff. We will use multilevel mixed-effects models, adjusting for secular trends and thematic analysis for the qualitative interview data.

Discussion: Findings will inform the continued transformation of French specialist mental health services toward a recovery orientation.

Trial registration: Clinical Trials NCT05824234, registered 21 April 2023.

Keywords: Complex intervention; Personal recovery; Recovery-oriented practices; Specialist mental health services; Training.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The relevant Ethical Review Board (CPP Sud Mediterranée III) approved the appraisal protocol on January 25th, 2023, and all participants (staff and service users) will give signed informed consent. Consent for publication: Not applicable. Competing Interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Diagram of the stepped-wedge trial design
See this image and copyright information in PMC

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