During the trial, major service re-configurations happened across both study sites including disbanding of two participating teams so doing anything different was always going to be an uphill struggle. Predictors were identified at three levels: organisational stability and commitment , team effective leadership, stability and composition, and current practice and practitioner attitudes, values, motivation. Overall we showed that REFOCUS does lead to improved recovery when implemented, and that it is most likely to be implemented within systems and teams which are stable and well-led, and by practitioners who already have some positive experiences of pro-recovery practice.
Thanks Mike Slade for adding in more detail,clarification, and references. It is really helpful to see how this one paper fits into a huge scheme of work. Implementation does appear key to this study, which is clearly problematic given continued re-configuration of services.
We used a non-standardised participation scale to rank staff from each team on participation. The participation scale assessed engagement in the six implementation strategies information session, personal recovery training, coaching training, team manager reflection sessions, team reflection sessions, supervision reflection. For each team, we pooled the participation scale ratings for staff who did not move team and had baseline and follow-up data to produce a team-level score.
We then used a median split to dichotomise intervention teams into high and low implementation. We tried and abandoned several attempts to analyse this, eventually concluding that because the intervention is complex i. Mentalhealth recovery: does training staff help? Interested in mental health recovery?
Parisien, C. Emergency department visits for adverse events related to dietary supplements. El-Hage invites you to submit your publication in his special issue in Brain Sciences on Olfaction as a Marker for Psychiatric and Neurological diseases. Vascular disorders ie. Magalie Batty.
The numerous outputs from this programme overall have been enormously helpful to our work in Scotland around recovery promotion, perhaps most notably the CHIME conceptual framework Leamy et al It is of course disappointing that this trial failed to show the desired effect but in some ways not that surprising.
In addition to the clearly monumental challenges of implementation and the unfortunate timing austerity-wise there are I think other contributory elements, all of which we can learn from. For me a potential weakness was the lack of emphasis on engagement with people in receipt of services.
If recovery is at least in part characterised by hope and belief in its possibility then we need to look at new and different ways of disseminating and sharing that belief. This intervention was largely predicated on the belief that could be achieved via staff training and practices. Shifting towards recovery requires we also shift power and that requires support and negotiation both for those giving up the power practitioners and also for those taking it on people using services.
These shifts are I believe negotiated out with traditionally expert-patient settings — in peer groups, in mutual support groups in recovery learning environments. Trying to achieve recovery approaches almost entirely through practitioner interventions is missing part of the story and puts too big an onus on practitioners who may themselves feel a reduced sense of hope and agency in a sea of service change and competing demands.
That said I am hugely grateful to everyone involved in the REFOCUS study for their massive contribution to the advancement of recovery based approaches in the UK and have great respect for their work and integrity. Leamy, M.
No mention of relational security? Last chance to add to the debate. Does staff training help in mentalhealth recovery? Psychiatric Services, 60, From my prejudiced viewpoint, a much more organisational approach to helping organisations change so as to support recovery is to be found in the work of ImROC e. Shepherd, G. Implementing recovery: A methodology for organisational change. London: Centre for Mental Health.
In our experience, the main implementation problem for staff lies in their low expectations of what service users can actually achieve in their lives institutional stigma and to counteract this requires direct contact between staff and the stigmatised group service users in a safe setting where both are present and this prejudice can be explored so that staff can re-evaluate their attitudes.
Finally, the trial only involved two Trusts, both of which were really only starting on their journey of creating a more recovery-supporting culture.
We have certainly learned a lot about how to help organisations to change so as to better support recovery and there are lots of papers, films, DVDs and personal narratives on the ImROC website www. Thus, I do think this is a useful study. If nothing else it has provoked a rich discussion about how these kinds of studies could be done better.
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