Systematic process and outcome evaluation of brief staff training in psychosocial interventions for severe mental illness

Evaluation of a novel co-designed and co-delivered training package to de-escalate violence and aggression in UK acute inpatient, PICU and forensic mental health settings

WHAT IS KNOWN ON THE SUBJECT?: Clinical guidelines and staff training recommend using de-escalation over restrictive practices, such as restraint and seclusion Evidence suggests that restrictive practices continue to be used frequently despite training This suggests a lack of impact of existing staff de-escalation training. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: The features of de-escalation training that are acceptable to staff and perceived to be impactful A co-designed and co-delivered training session on a trauma-informed approach to de-escalation on mental health wards was acceptable and perceived to be impactful Those attending training particularly valued how lived experience was incorporated into the training content and co-delivery The organizational and team context may need more consideration in adapting the training. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: De-escalation training that adopts a trauma-informed approach and considers the context of ward environments is acceptable to staff Co-delivery models of training to tackle restrictive practice can be acceptable and impactful Further research will show how clinically effective this training is in improving outcomes for service users in ward contexts.

ABSTRACT

BACKGROUND: Evidence suggests a discrepancy between recommended and routine practice in de-escalation in mental health settings, suggesting a lack of impact of existing training.

AIM

To investigate the acceptability and perceived impact of a co-designed/delivered training intervention on a trauma-informed approach to de-escalation on mental health wards.

METHODS

Trainees were invited to complete the Training Acceptability Rating Scale (TARS) post-training. Responses to the quantitative items were summarized using descriptive statistics, and open-text responses were coded using content analysis.

RESULTS

Of 214 trainees, 211 completed the TARS. The trainees rated the training favourably (median overall TARS = 55/63), as acceptable (median 33/36) and impactful (median 23/27). There were five qualitative themes: modules of interest; multiple perspectives; modes of delivery; moulding to context; and modifying other elements.

DISCUSSION

The EDITION training was found to be acceptable and impactful, with trainees particularly valuing the co-delivery model. Trainees suggested several ways in which the training could be improved, particularly around the need for further moulding of the intervention to the specific ward contexts/teams.

IMPLICATIONS FOR PRACTICE

We recommend co-designing and co-delivering staff training to mental health professionals that tackles restrictive practices.

RELEVANCE STATEMENT

This research is relevant to lived experience practitioners who want to be involved in training mental health professionals around restrictive practices, demonstrating the value and importance of their voice. It is relevant to current providers of de-escalation training, and to staff receiving training, outlining a novel, but acceptable and impactful, form of training on a key area of mental health practice. It is relevant to anyone with an interest in reducing restrictive practice via co-delivered training.

Implementing an innovative intervention to increase research capacity for enhancing early psychosis care in Indonesia

WHAT IS KNOWN ON THE TOPIC?: In low- and middle-income settings (LMICs) such as Indonesia, the burden from psychotic illness is significant due to large gaps in treatment provision Mental health workers and community nurses are a growing workforce requiring new evidence to support practice and enhanced roles and advanced competencies among UK mental health nurses also requires greater research capacity Research capacity building projects can strengthen research institutions, enhance trial capacity, improve quality standards and improve attitudes towards the importance of health research. WHAT THIS PAPER ADDS?: Delivering innovative, cross-cultural workshops to enhance research capacity to multidisciplinary, early career researchers in Indonesia and the UK are rated highly by attendees Supporting people in this way helps them to gain competitive grant funding to complete their own research which can improve the health of the population To our knowledge, there are no other studies reporting the attainment of grant income as a successful outcome of international research partnerships for mental health nursing so our finding is novel. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This method could be implemented to improve networking and collaboration between UK academics and early career researchers in other lower- and middle-income settings This strategy can also strengthen existing partnerships among early career researchers in the UK to meet the demands for greater research mentorship and leadership among mental health nurses and enhance nurses capabilities to contribute to evidence for practice.

ABSTRACT

Aim To strengthen research capacity for nurses and early career researchers in Indonesia and the UK to develop a local evidence base in Indonesia to inform policy and improve the nation's health. These strategies can strengthen research institutions, enhance trial capacity, improve quality standards and improve attitudes towards the importance of health research. Methods Four days of workshops were held in Jakarta, Indonesia developing collaborative groups of academic nurses and early career researchers from the UK and Indonesia (30 people including mentors) to produce competitive grant bids to evaluate aspects of early psychosis care. Qualitative and quantitative evaluations were conducted. Results Participants evaluated the workshops positively finding benefit in the structure, content and delivery. Research impact was shown by attaining several successful small and large grants and developing offshoot collaborative relationships. Discussion These novel findings demonstrate that collaborative workshops can strengthen research capacity by developing partnerships and instigating new collaborations and networks. No other studies of international research partnerships among mental health nurses have reported this outcome to our knowledge. Implications for Practice This method could be implemented to improve networking and collaboration between UK academics and early career researchers and also with external colleagues in other LMICs.

Evaluation of a co-delivered training package for community mental health professionals on service user- and carer-involved care planning

WHAT IS KNOWN ON THE SUBJECT?: There is consistent evidence that service users and carers feel marginalized in the process of mental health care planning. Mental health professionals have identified ongoing training needs in relation to involving service users and carers in care planning. There is limited research on the acceptability of training packages for mental health professionals which involve service users and carers as co-facilitators. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: A co-produced and co-delivered training package on service user- and carer-involved care planning was acceptable to mental health professionals. Aspects of the training that were particularly valued were the co-production model, small group discussion and the opportunity for reflective practice. The organizational context of care planning may need more consideration in future training models. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses using co-production models of delivering training to other mental health professionals can be confident that such initiatives will be warmly welcomed, acceptable and engaging. On the basis of the results reported here, we encourage mental health nurses to use co-production approaches more often. Further research will show how clinically effective this training is in improving outcomes for service users and carers.

ABSTRACT

Background There is limited evidence for the acceptability of training for mental health professionals on service user- and carer-involved care planning. Aim To investigate the acceptability of a co-delivered, two-day training intervention on service user- and carer-involved care planning. Methods Community mental health professionals were invited to complete the Training Acceptability Rating Scale post-training. Responses to the quantitative items were summarized using descriptive statistics (Miles, ), and qualitative responses were coded using content analysis (Weber, ). Results Of 350 trainees, 310 completed the questionnaire. The trainees rated the training favourably (median overall TARS scores = 56/63; median 'acceptability' score = 34/36; median 'perceived impact' score = 22/27). There were six qualitative themes: the value of the co-production model; time to reflect on practice; delivery preferences; comprehensiveness of content; need to consider organizational context; and emotional response. Discussion The training was found to be acceptable and comprehensive with participants valuing the co-production model. Individual differences were apparent in terms of delivery preferences and emotional reactions. There may be a need to further address the organizational context of care planning in future training. Implications for practice Mental health nurses should use co-production models of continuing professional development training that involve service users and carers as co-facilitators.

Interprofessional education in mental health: An opportunity to reduce mental illness stigma

Mental illness stigma is a common problem in healthcare students and professionals in addition to the general public. Stigma is associated with numerous negative outcomes and hence there is an urgent need to address it. This article explores the potential for interprofessional education (IPE) to emerge as a strategy to reduce mental illness stigma amongst healthcare students and professionals. Most anti-stigma strategies use a combination of knowledge and contact (with a person with lived experience) to change attitudes towards mental illness. Not surprisingly interprofessional educators are well acquainted with theory and learning approaches for attitude change as they are already used in IPE to address learners' attitudes and perceptions of themselves, other professions, and/or teamwork. This article, through an analysis of IPE pedagogy and learning methods, identifies opportunities to address mental illness stigma with application of the conditions that facilitate stigma reduction. The goal of this article is to raise awareness of the issue of mental illness stigma amongst healthcare students and professionals and to highlight interprofessional education as an untapped opportunity for change.

How can video recordings best contribute to clinical supervisor training?

Significant progress has been made internationally in the training of clinical supervisors, yet much remains to be done, such as refining training through the improved use of video material. A review of currently available video recordings used in supervisor training indicates that they are generally used informally, are manifestly lacking in procedural detail, are narrowly applied, and lack an educational rationale or research support. After reviewing current options, a more precise, comprehensive and educationally informed framework is proposed, broadening the video options to 10 complementary applications. Systematic links are made between these applications, the core supervision competencies, and the related workshop content (especially training objectives and learning outcomes), culminating in an educational rationale for the use of video within a supervisor training curriculum. It is concluded that application of this framework can enhance the effectiveness and efficiency of supervisor training, helping to maintain progress.

The development of a family intervention competency assessment and reflection scale (FICARS) for psychosis

Family intervention (FI) for psychosis has a robust evidence base. In recommending its use the revised NICE schizophrenia guideline states 'Healthcare professionals providing psychological interventions should have an appropriate level of competence'. Yet, no definitive instrument exists to outline what competences are required during and post FI training or help recruit staff with the appropriate knowledge and skill. This paper reports on the development of a Family Intervention competency assessment and reflection scale (FICARS). Using a systematic three-staged approach commonly used in health outcomes measurement development, a comprehensive literature review on UK-based FI training and commonly used assessment tools was undertaken. A FICARS draft was then constructed and revised in consultation with expert FI clinicians. Finally, a content validity study with FI trainers and students across three FI training programmes was undertaken to optimize FICARS aim to promote reflective assessment and professional development in FI skills and practice.

Dissemination of behavioural activation for depression to mental health nurses: training evaluation and benchmarked clinical outcomes

Depression causes significant distress, disability and cost within the UK. Behavioural activation (BA) is an effective single-strand psychological approach which may lend itself to brief training programmes for a wide range of clinical staff. No previous research has directly examined outcomes of such dissemination. A 5-day training course for 10 primary care mental health workers aiming to increase knowledge and clinical skills in BA was evaluated using the Training Acceptability Rating Scale. Depression symptom level data collected in a randomized controlled trial using trainees were then compared to results from meta-analysis of studies using experienced therapists. BA training was highly acceptable to trainees (94.4%, SD 6%). The combined effect size of BA was unchanged by the addition of the results of this evaluation to those of studies using specialist therapists. BA offers a promising psychological intervention for depression that appears suitable for delivery by mental health nurses following brief training.

Parenting training in the community: linking process to outcome

This pilot study examines the effectiveness of the Parents Together Community Course(i) (a six week preventative version of the Parents Plus Early Years Programme) in reducing parent-reported behaviour problems in pre-school and school aged children. It also investigates if there is an association between process ratings on a weekly session rating form (WSRF) and client outcome. Thirty-one parents who completed the course filled out pre and post outcome measures (namely the Strengths and Difficulties Questionnaire (SDQ) and a specially designed Client defined Problem and Goals form (CPG)), and a process measure during the course of the group. It was found that 45% of children in the community sample had behavioural problems in the borderline or clinical range, and significant reductions in these problem behaviours and gains towards parent-defined goals were observed following the course. Results also showed a number of correlations between high ratings on the WSRF and positive outcome as measured by the CPG and SDQ indicating a possible link between this process measure and outcomes. This highlights the importance of early community interventions in dealing with childhood behaviour problems and the possible utility of a process measure for identifying contributing factors to change.

Purpose and method for the evaluation of interpersonal process in health and social care

This article is concerned with the evaluation of the process of interaction between professionals and clients in health and social care. The literature is reviewed to identify examples of this kind of process evaluation and the reported studies are analysed with regard to the purposes of the evaluations and the methods employed. A novel categorisation of purpose is proposed which identifies five main purposes: confirmatory when the process is being checked to assess compliance with stated plans and intentions; causal when the intention is to link aspects of the process with outcomes; experimental when the process is being manipulated to compare outcomes for experimental and control groups; stakeholder perspectives when the process is being evaluated from the standpoint of stakeholders; formative/summative feedback when the process is being described to provide feedback to providers; and finally, exploratory when an under-researched or poorly understood process is being investigated to identify its main features. Methods for evaluating interpersonal process are described and the implications of this kind of evaluation are discussed.

Formulation and feedback: an illustration of two methods for improving access to effective therapies

It is now recognised that therapists require career-long training in order to maintain and improve their expertise. However, training will fail to improve services to clients unless the work environment supports staff in its use. Although this "training transfer" problem is widely acknowledged, to the authors' knowledge the way that the work environment influences clients' access to effective therapies has not been subjected to a detailed and systematic formulation. Therefore, this small study illustrates a suitable formulation, based on the training received by a group of National Health Service (NHS) staff in "psychosocial interventions", and proposes its use as a "feedback fascia" to managers and others. To do this, structured interviews were held with a self-selected sample of n = 20 therapists (mostly nurses) and all of their managers (n = 11) in one NHS Trust. The results indicated an impressive degree of training transfer. It is concluded that staff training can improve clients' access to effective treatments, but that significant organisational support for innovation is required. A feedback fascia can guide such support.

Is training in psychosocial interventions worthwhile? Report of a psychosocial intervention trainee follow-up study

A follow-up study of psychosocial intervention (PSI) trainees from the Sheffield and Maudsley training centres was undertaken in three stages. In Stage 1, 141 students, at two PSI training centres, were sent a simple postal questionnaire to elicit career trajectory following PSI training. A response rate of 82% was achieved. The sub-group, who had been trained and who still engaged in clinical practice were identified and followed-up in more detail (n=96). The effect of PSI training in a range of domains was investigated. The impact of training may not be to equip students with formal technical skills in CBT and family work. What is more likely is that trainees acquired proficiency in: working effectively using a case management model; conveying 'therapeutic optimism'; enabling users to meet their own goals and helping them to develop better coping strategies; using 'stress vulnerability' and formal outcome measures as means of structuring this approach. The secondary aim of the study was to identify and prioritise the barriers that impede the effective implementation of PSI skills in routine service settings. For the second phase of the survey the response rate was again 82%. This group's service managers were identified and surveyed for the same information and 59% responded. The aim was to gather information about implementation issues from both the clinical and service perspectives. The results of the survey indicate that PSI training has a positive impact on the development of services for people with serious mental health problems although there are serious organisational hurdles for managers, trainees and organisations to overcome if PSI skills are to be properly implemented. Key factors that impact upon faithful implementation are related to resource issues (caseload size), organisational factors (the existence of an implementation plan and training strategy), and the extent to which the trainee's team is supportive.

Working with sex offenders with intellectual disability: evaluation of an introductory workshop for direct care staff

BACKGROUND

Sexual aggression by men with intellectual disability (ID) is a serious problem requiring attention from the relevant agencies. Training for staff working with this problem is often not given sufficient attention and is rarely evaluated. In the present study, an introductory workshop for direct care staff that aimed to increase knowledge and improve attitudes towards work with this client group was evaluated.

METHOD

Sixty-six staff working in inpatient and community settings completed a 2.5-day workshop. Before training began, the participants completed a survey questionnaire concerning their experiences of work with this client group. An assessment of their knowledge and attitudes was carried out prior to and at the end of training in order to evaluate any changes. The participants also rated the effectiveness of the workshop and their level of satisfaction with the training at the end of the workshop.

RESULTS

The participants' knowledge and attitudes improved significantly following the workshop. Staff with greater experience over time and those who had worked with fewer sex offender clients responded to different aspects of the training. The participants' ratings indicated that they were highly satisfied with the training and found it to be effective.

CONCLUSIONS

Brief workshop training is acceptable to and can be effective in improving the knowledge, attitudes and confidence of direct care staff working with sex offenders with ID. However, because the results are based on participant self-report, caution should be exercised concerning their external validity.