title: The CORE Service Improvement Programme for mental health crisis resolution teams: study protocol for a cluster-randomised controlled trial.
abstract: BACKGROUND
  As an alternative to hospital admission, crisis resolution teams (CRTs) provide intensive home treatment to people experiencing mental health crises. Trial evidence supports the effectiveness of the CRT model, but research suggests that the anticipated reductions in inpatient admissions and increased user satisfaction with acute care have been less than hoped for following the scaling up of CRTs nationally in England, as mandated by the National Health Service (NHS) Plan in 2000. The organisation and service delivery of the CRTs vary substantially. This may reflect the lack of a fully specified CRT model and the resources to enhance team model fidelity and to improve service quality. We will evaluate the impact of a CRT service improvement programme over a 1-year period on the service users' experiences of care, service use, staff well-being, and team model fidelity.
  
  
  METHODS
  Twenty-five CRTs from eight NHS Trusts across England will be recruited to this cluster-randomised trial: 15 CRTs will be randomised to receive the service improvement programme over a 1-year period, and ten CRTs will not receive the programme. Data will be collected from 15 service users and all clinical staff from each participating CRT at baseline and at the end of the intervention. Service use data will be collected from the services' electronic records systems for two 6-month periods: the period preceding and the period during months 7-12 of the intervention. The study's primary outcome is service user satisfaction with CRT care, measured using a client satisfaction questionnaire. Secondary outcomes include the following: perceived continuity of care, hospital admission rates and bed use, rates of readmission to acute care following CRT support, staff morale, job satisfaction, and general health. The adherence of the services to a model of best practice will be assessed at baseline and follow-up. Outcomes will be compared between the intervention and control teams, adjusting for baseline differences and participant characteristics using linear random effects modelling. Qualitative investigations with participating CRT managers and staff and programme facilitators will explore the experiences of the service improvement programme.
  
  
  CONCLUSIONS
  Our trial will show whether a theoretically underpinned and clearly defined package of resources are effective in supporting service improvement and improving outcomes for mental health crisis resolution teams.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN47185233.
authors.affiliation: Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF, UK. b.lloyd-evans@ucl.ac.uk.
authors.forename: Brynmor
authors.initials: B
authors.lastname: Lloyd-Evans
authors.affiliation: Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Fullarton
authors.affiliation: Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF, UK.
authors.forename: Danielle
authors.initials: D
authors.lastname: Lamb
authors.affiliation: Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF, UK.
authors.forename: Elaine
authors.initials: E
authors.lastname: Johnston
authors.affiliation: Onyett Entero Ltd, Care of University of the West of England, Health and Life Sciences Coldharbour Ln, Bristol, BS16 1QY, UK.
authors.forename: Steve
authors.initials: S
authors.lastname: Onyett
authors.affiliation: Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF, UK.
authors.forename: David
authors.initials: D
authors.lastname: Osborn
authors.affiliation: Department of Statistical Science, UCL, Gower Street, London, WC1E 6BT, UK.
authors.forename: Gareth
authors.initials: G
authors.lastname: Ambler
authors.affiliation: Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, UK.
authors.forename: Louise
authors.initials: L
authors.lastname: Marston
authors.affiliation: Department of Primary Care and Population Health, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, NW3 2PF, UK.
authors.forename: Rachael
authors.initials: R
authors.lastname: Hunter
authors.affiliation: Department of Clinical Education and Health Psychology, UCL, Gower Street, London, WC1E 6BT, UK.
authors.forename: Oliver
authors.initials: O
authors.lastname: Mason
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, Kings College London, 16 De Crespigny Park, London, SE5 8AF, UK.
authors.forename: Claire
authors.initials: C
authors.lastname: Henderson
authors.affiliation: West London Mental Health NHS Trust, Uxbridge Road, Southall, London, UB1 3EU, UK.
authors.forename: Nicky
authors.initials: N
authors.lastname: Goater
authors.affiliation: Epidemiology and Health Services Research, CLAHRC West, Lewins Mead, Bristol, BS1 2NT, UK.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Sullivan
authors.affiliation: Oxfordshire Healthcare NHS Foundation Trust, Barnes Unit, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Kelly
authors.affiliation: Mental Health Sciences, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Gray
authors.affiliation: Centre for Outcomes Research and Effectiveness, Division of Psychology and language Sciences, UCL, 1-19 Torrington Place, London, WC1E 7HB, UK.
authors.forename: Fiona
authors.initials: F
authors.lastname: Nolan
authors.affiliation: Centre for Outcomes Research and Effectiveness, Division of Psychology and language Sciences, UCL, 1-19 Torrington Place, London, WC1E 7HB, UK.
authors.forename: Stephen
authors.initials: S
authors.lastname: Pilling
authors.affiliation: Department of Psychiatry, Dartmouth Psychiatric Research Centre, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA.
authors.forename: Gary
authors.initials: G
authors.lastname: Bond
authors.affiliation: Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF, UK.
authors.forename: Sonia
authors.initials: S
authors.lastname: Johnson
mesh_terms: D002985:Clinical Protocols; D016000:Cluster Analysis; D003419:Crisis Intervention / Q000458:organization & administration / Q000592:standards; D003695:Delivery of Health Care; D004739:England; D006699:Home Care Services / Q000458:organization & administration / Q000592:standards; D006801:Humans; D001523:Mental Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D008603:Mental Health; D008605:Mental Health Services / Q000458:organization & administration / Q000592:standards; D010348:Patient Care Team / Q000458:organization & administration / Q000592:standards; D017060:Patient Satisfaction; D011569:Psychiatric Status Rating Scales; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D012107:Research Design; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
keywords: Acute care; Crisis resolution teams; Randomised controlled trial; Service improvement