Article Text
Abstract
Introduction Crisis resolution teams (CRTs) provide assessment and intensive home treatment in a crisis, aiming to offer an alternative for people who would otherwise require a psychiatric inpatient admission. They are available in most areas in England. Despite some evidence for their clinical and cost-effectiveness, recurrent concerns are expressed regarding discontinuity with other services and lack of focus on preventing future relapse and readmission to acute care. Currently evidence on how to prevent readmissions to acute care is limited. Self-management interventions, involving supporting service users in recognising and managing signs of their own illness and in actively planning their recovery, have some supporting evidence, but have not been tested as a means of preventing readmission to acute care in people leaving community crisis care. We thus proposed the current study to test the effectiveness of such an intervention. We selected peer support workers as the preferred staff to deliver such an intervention, as they are well-placed to model and encourage active and autonomous recovery from mental health problems.
Methods and analysis The CORE (CRT Optimisation and Relapse Prevention) self-management trial compares the effectiveness of a peer-provided self-management intervention for people leaving CRT care, with treatment as usual supplemented by a booklet on self-management. The planned sample is 440 participants, including 40 participants in an internal pilot. The primary outcome measure is whether participants are readmitted to acute care over 1 year of follow-up following entry to the trial. Secondary outcomes include self-rated recovery at 4 and at 18 months following trial entry, measured using the Questionnaire on the Process of Recovery. Analysis will follow an intention to treatment principle. Random effects logistic regression modelling with adjustment for clustering by peer support worker will be used to test the primary hypothesis.
Ethics and dissemination The CORE self-management trial was approved by the London Camden and Islington Research Ethics Committee (REC ref: 12/LO/0988). A Trial Steering Committee and Data Monitoring Committee oversee the progress of the study. We will report on the results of the clinical trial, as well as on the characteristics of the participants and their associations with relapse.
Trial registration number ISRCTN01027104; pre-results stage.
- Peer support
- self-management
- crisis resolution teams
- home treatment
- relapse prevention
- randomised controlled trial
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Footnotes
Contributors The trial design was developed by SJ, BLE, SP, OM, RG, FN, TW, CH and NM. LM and GA developed the statistical analysis plans and RH the economic analysis plan. AM has led on the development of the intervention. SJ is the Chief Investigator, based at University College London and BLE the project manager. DO provided oversight as a triallist in the Priment Clinical Trials Unit. All authors have contributed and approved this manuscript.
Funding This paper presents independent research undertaken as part of the CORE Study and funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research programme (Reference Number: RP-PG-0109-10,078). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. The funding body did not have any role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript. SJ, DO and BLE were in part supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North Thames at Bart’s Health NHS Trust. The views expressed in this paper are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.
Competing interests None declared.
Ethics approval The trial received a favourable opinion from the London Camden and Islington Research Ethics Committee (REC ref: 12/LO/0988F). Consent forms are in online supplementary files 1 and 2. The following sites have approved the trial: Camden and Islington NHS Foundation Trust; Surrey and Borders Partnership NHS Foundation Trust; North East London NHS Foundation Trust; South London and Maudsley NHS Foundation Trust; West London Mental Health NHS Trust; and Avon and Wiltshire Mental Health Partnership NHS Trust.
Provenance and peer review Not commissioned; externally peer reviewed.