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

Research output: Contribution to journalArticle

  • 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
Original languageEnglish
Number of pages15
JournalInternational Journal of Mental Health Nursing
Early online date30 Sep 2019
DOIs
DateAccepted/In press - 21 Aug 2019
DateE-pub ahead of print (current) - 30 Sep 2019

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, organisation, 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 anonymised 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 organisation, e.g. 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.

    Research areas

  • clinical audit, crisis intervention, cross‐sectional survey, mental health, patient participation, model fidelity, crisis resolution team

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  • Full-text PDF (accepted author manuscript)

    Rights statement: This is the author accepted manuscript (AAM). The final published version (version of record) is available online via Wiley at https://onlinelibrary.wiley.com/doi/full/10.1111/inm.12658. Please refer to any applicable terms of use of the publisher.

    Accepted author manuscript, 392 KB, PDF document

    Embargo ends: 30/09/20

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