Crisis resolution and home treatment in the UK: A survey of model fidelity using a novel review methodology

Danielle Lamb; Brynmor Lloyd-Evans; Kate Fullarton; Kathleen Kelly; Nicky Goater; Oliver Mason; Richard Gray; David Osborn; Fiona Nolan; Steve Pilling; Sarah A. Sullivan; Claire Henderson; Alyssa Milton; Emma Burgess; Alasdair Churchard; Mike Davidson; Johanna Frerichs; David Hindle; Beth Paterson; Ellie Brown; Jonathan Piotrowski; Claire Wheeler; Sonia Johnson

doi:10.1111/inm.12658

Crisis resolution and home treatment in the UK: A survey of model fidelity using a novel review methodology

Danielle Lamb^*, Brynmor Lloyd-Evans, Kate Fullarton, Kathleen Kelly, Nicky Goater, Oliver Mason, Richard Gray, David Osborn, Fiona Nolan, Steve Pilling, Sarah A. Sullivan, Claire Henderson, Alyssa Milton, Emma Burgess, Alasdair Churchard, Mike Davidson, Johanna Frerichs, David Hindle, Beth Paterson, Ellie BrownJonathan Piotrowski, Claire Wheeler, Sonia Johnson

^*Corresponding author for this work

Health Service & Population Research

Research output: Contribution to journal › Article › peer-review

20 Citations (Scopus)

Abstract

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.

Original language	English
Journal	International Journal Of Mental Health Nursing
DOIs	https://doi.org/10.1111/inm.12658
Publication status	Published - 1 Jan 2019

Keywords

clinical audit
crisis intervention
crisis resolution team
cross-sectional survey
mental health
model fidelity
patient participation

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10.1111/inm.12658

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Lamb, D., Lloyd-Evans, B., Fullarton, K., Kelly, K., Goater, N., Mason, O., Gray, R., Osborn, D., Nolan, F., Pilling, S., Sullivan, S. A., Henderson, C., Milton, A., Burgess, E., Churchard, A., Davidson, M., Frerichs, J., Hindle, D., Paterson, B., ... Johnson, S. (2019). Crisis resolution and home treatment in the UK: A survey of model fidelity using a novel review methodology. International Journal Of Mental Health Nursing. https://doi.org/10.1111/inm.12658

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title = "Crisis resolution and home treatment in the UK: A survey of model fidelity using a novel review methodology",

abstract = "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{\textquoteright} 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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author = "Danielle Lamb and Brynmor Lloyd-Evans and Kate Fullarton and Kathleen Kelly and Nicky Goater and Oliver Mason and Richard Gray and David Osborn and Fiona Nolan and Steve Pilling and Sullivan, {Sarah A.} and Claire Henderson and Alyssa Milton and Emma Burgess and Alasdair Churchard and Mike Davidson and Johanna Frerichs and David Hindle and Beth Paterson and Ellie Brown and Jonathan Piotrowski and Claire Wheeler and Sonia Johnson",

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Lamb, D, Lloyd-Evans, B, Fullarton, K, Kelly, K, Goater, N, Mason, O, Gray, R, Osborn, D, Nolan, F, Pilling, S, Sullivan, SA, Henderson, C, Milton, A, Burgess, E, Churchard, A, Davidson, M, Frerichs, J, Hindle, D, Paterson, B, Brown, E, Piotrowski, J, Wheeler, C & Johnson, S 2019, 'Crisis resolution and home treatment in the UK: A survey of model fidelity using a novel review methodology', International Journal Of Mental Health Nursing. https://doi.org/10.1111/inm.12658

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AU - Osborn, David

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AU - Pilling, Steve

AU - Sullivan, Sarah A.

AU - Henderson, Claire

AU - Milton, Alyssa

AU - Burgess, Emma

AU - Churchard, Alasdair

AU - Davidson, Mike

AU - Frerichs, Johanna

AU - Hindle, David

AU - Paterson, Beth

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AU - Wheeler, Claire

AU - Johnson, Sonia

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AB - 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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KW - cross-sectional survey

KW - mental health

KW - model fidelity

KW - patient participation

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JO - International Journal Of Mental Health Nursing

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ER -

Crisis resolution and home treatment in the UK: A survey of model fidelity using a novel review methodology

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