Optimising team functioning, preventing relapse and enhancing recovery in crisis resolution teams: the CORE programme (CRT Optimisation and RElapse prevention)
Crisis resolution teams across England are failing to keep people out of hospital or help them recover, and this programme aims to fix how those teams work. The problem is that while these teams were set up nationwide to reduce acute psychiatric admissions and improve patient experiences, recent national reports show they often fall short. Service users and carers report poor therapeutic relationships and limited recovery support, and the teams have not consistently reduced bed use as intended. The core issue is that the model itself is loosely defined—nobody knows exactly which ingredients make a crisis team effective. The research has two strands. First, it will define what best practice looks like for a crisis team, develop a way to measure whether teams achieve it, and test an implementation toolkit in 15 teams against 10 control services. Second, it will pilot a peer-facilitated self-management intervention designed to reduce relapse and help people progress toward personal recovery goals, tested in a randomised controlled trial with readmission as the primary outcome. If successful, the work could give the NHS a concrete, evidence-based model for crisis care that reduces acute bed use and improves recovery outcomes for people in mental health crisis.
View original technical description
Aims and objectivesCrisis resolution teams (CRTs) have been introduced nationwide, aiming to reduce acute psychiatric bed use and improve service user experiences. We aim to establish evidence at both team and individual patient level as to how their functioning may be optimised to reduce reliance on inpatient care and enhance recovery. Objectives are; 1. To investigate best practice in CRTs, using existing evidence and the perspectives of services users, carers, professionals and experts. 2. To formulate a model for achieving best practice in CRT organisation and operation, and a fidelity measure to assess whether this is achieved. 3. To develop an implementation resource kit for achieving high fidelity care and conduct a mixed methods investigation of its impact. 4. To develop, pilot and assess the effectiveness and cost-effectiveness of a peer-facilitated self-management intervention, designed to reduce relapse and enhance progress towards personal recovery goals among CRT service users.BackgroundCRTs are established throughout England, and pioneer services have reduced admissions and improved patient satisfaction. However, recent national reports identify significant limitations in implementation, including problems achieving continuity of care and the intended reductions in bed use, and service user and carer dissatisfaction with therapeutic relationships and the range of help available to support recovery.Resource constraints and the requirement for rapid national implementation are likely to contribute to the problems identified. However, the model is still loosely specified, and we lack evidence on the critical ingredients of effective CRT care and on specific interventions that promote recovery in this context. Research plansThe CORE programme consists of two workstreams. Workstream 1 develops the CRT model and addresses difficulties identified in recent reports at a team level. Multiple perspectives on best practice in CRTs will be investigated, informing the development and piloting of a fidelity measure to assess the extent to which CRTs achieve good practice. An implementation resource kit for achieving high fidelity care will be developed and its impact investigated in 15 CRTs with varying fidelity scores, comparing them with 10 control services. We will explore whether the resource kit enhances fidelity and whether higher team fidelity is associated with better outcomes. While Workstream 1 focuses on team-level change, Workstream 2 addresses limitations in CRT care at an individual service user level. A peer-facilitated self-management intervention, bridging the gap between the episode of acute care and continuing care, will be piloted and its effectiveness and cost-effectiveness tested in a randomised controlled trial. The primary outcome will be readmission to acute care (CRT or hospital) over a 12 month period. Secondary outcomes will include self-rated recovery, symptoms and illness management skills. Research teamThese plans originate in the Mental Health Research Network’s Acute Care Research Group, in which most applicants have participated. Several have already collaborated on a programme of work on alternatives to hosptial of which this programme is the continuation: they have thus acquired wide experience in this setting. Others bring expertise in development and testing of complex interventions, organisational research and team development, service user engagement, statistics, qualitative research and health economics.Research environmentThe main base at UCL has a long track record in policy-relevant research on complex mental health interventions, so that researchers will benefit from wide local expertise. Our programme spans several other departments with internationally recognised research in this area, and is supported by a specialist mental health Clinical Trials Unit. Anticipated outputs and impactPotential impacts include a reduction in acute bed use in the NHS mental health system, as wel
Plain English summaries and category classifications on this site are generated by AI and may not perfectly reflect the original research.
Is something wrong? Let us know