Introduction
EQUIP intervention and trial
Length of training | 2 days (starting at 9.30 and finishing at 16.30) |
Format of training | Face-to-face |
Location of training | Held at community mental health team bases or other NHS training venues or on university premises |
Day 1 training content | Explanation of the EQUIP cluster randomised controlled trial (RCT) Understanding the policy drivers relating to care planning and the experiences of service users and carers in receipt of mental health services Update on current evidence on service user and carer involved care planning What does good care planning look like from multiple perspectives Interactive exercises developing engagement and communication skills Understanding care planning terms and processes |
Day 2 training content | User-centred assessment Exploring issues around ‘risk’ and ‘safety’ Co-producing summary and formulation statements Developing aspirational goals What does shared decision-making look like Thinking about user-involved implementation and reviewing of care planning |
Delivery | Role plays, interactive presentations, small group work, live examples of good practice |
Follow-up | After the training, participants were emailed additional resources to complement learning and offered 6 h of clinical supervision. Available here: http://research.bmh.manchester.ac.uk/equip |
Trainers | Each training was run collaboratively by one of two academic researchers with a clinical background and one or two service users and, where possible a carer |
Service user and carer trainer roles | Group facilitators, sharing personal experiences of care planning and contribution to group discussions over the course of the 2-day training |
Methods
Ethical approval
Participants
Service users | |
Male | 13 |
Female | 16 |
Trust 1: northwest of England | 12 |
Trust 2: East Midlands | 5 |
Trust 3: Northern England | 3 |
Trust 5: northwest of England | 7 |
Trust 4: Midlands | 2 |
Intervention | 18 |
Control | 11 |
Total | 29 |
Carers | |
Male | 2 |
Female | 2 |
Trust 1: northwest of England | 1 |
Trust 2: East Midlands | 1 |
Trust 3: Northern England | 1 |
Trust 4: Midlands | 1 |
Intervention | 3 |
Control | 1 |
Total | 4 |
Professionals | |
Male | 3 |
Female | 18 |
Trust 1: northwest of England | 9 |
Trust 3: Northern England | 2 |
Trust 6: Northwest England | 1 |
Trust 7: Northern England | 9 |
Intervention | 19 |
Control | 2 |
Total | 21 |
Trust | Number of professionals in participating CMHTs | Number of service users within participating CMHTs |
---|---|---|
Trust 1: northwest of England | 60 | 1355 |
Trust 2: East Midlands | 26 | 310 |
Trust 3: Northern England | 6 | 77 |
Trust 4: Midlands | 25 | 638 |
Trust 5: northwest of England | 16 | 424 |
Trust 6: northwest of England | 18 | 278 |
Trust 7: Northern England | 104 | 2318 |
Participant type | Initial expression of interest submitted | Recruited at baseline | % (n) of those recruited at baseline followed up at 6 months | % (n) of those recruited at baseline followed up at 12 months |
---|---|---|---|---|
Service user | 47 | 29 | 90 (26) | 83 (24) |
Carer | 9 | 4 | 50 (2) | 25 (1) |
Professional | 31 | 21 | 76 (16) | 52 (11) |
Procedure
Data analysis
Findings
The sense and sense making of care planning training
We haven’t really progressed very far in terms of being more person centred. We’re still quite stuck in the medical model.5022, professional, intervention
I’m not best pleased with it, because obviously I’m stuck on a CTO, but the care planning should involve me more. I’ve been subjected to a care plan, rather than being involved in it.6014, service user, control
I mean I did say too on the course that I felt...cos some of the examples they were giving we were horrified at, so I do think in a way you’re working with a team here that is better than that.5002, professional, intervention
I can’t do it with every service user because some people, you know, they just, erm, they’re either unwell or they’ve…they’ve, you know, they’ve got other issues. They don’t want to do that. They’re suspicious. I went to one yesterday, she’s always got ongoing psychotic symptoms. She’s very suspicious.5008, professional, intervention
There’s been times when I didn’t really want any input from the support workers, just wanted to go me own way. Sometimes I’ve been so ill I just, it’s been enough just to get through the day and I, I didn’t really want a care plan. And I didn’t want to be involved in it. Because I was so ill I just, I was just surviving really.6002, service user, intervention
I didn’t find the EQUIP training at all helpful because I didn’t learn anything in it that we hadn’t already been taught and that we didn’t know.5027, professional, intervention
I think we all thought it was a pain in the arse to be honest because……I think we all, have far too much work to do and the thought of giving up two full days, I think we all thought that, sort of, care management was our bread and butter.5002, professional, intervention
It just makes it more pertinent. It just makes you think, I think about the person you’re writing about really and that, you know, that these two people were saying, you know, that they’d had these care plans that, erm, they couldn’t relate to at all and it……it did make you think, gosh, have I…have I written care plans like that, you know?5002, professional, intervention
I think any change is really hard, and I think with all the pressures that we’ve got it’s really hard to, to get it changed when…you’re trying to catch up all the time anyway.5009, professional, intervention
I mean I’m not trying to be rude but I don’t think it sort of ever radically changes ones practice. It’s not going to make a vast impact in terms of what the service users will experience day to day.5019, professional, intervention
It [involving service users] should be part of what I do. And it’s maybe been…just slipped away.5003, professional, intervention
Because we don’t have two days to think about practice, you know, you’re literally firefighting and going from one job to another. So, like I say, even the sense of taking that time out was amazing and having the whole team there all feeling quite positive was just…was inspirational, it was really positive.5022, professional, intervention
I don’t think it is more a dramatic change, maybe, you know, some of the, like, using terms like aspirational goals and working around them and maybe they might, you know, pick that out, I’m not too sure, so maybe some of the language, but I don’t know if they [service users] would [notice any difference in practice], you know, really, because I think I’ve always, looked at…5006, professional, intervention
So has anything changed in terms of your contact with mental health services over the last six months?No, no, nothing at all.No. Have you had any, um, care planning meetings or any care planning reviews?No.6015, service user, intervention
The absence of the required relational work to enact the principles of SDM
We had the dis…such discontinuity with the medics…over the years. We’ve had no consistent medic for years and years and years. We’ve just had one part-time, erm, female consultant who left…to go to a different service. We’ve had nobody really else that’s been that consistent and good.5003, professional, intervention
…I have particularly noticed the last few weeks is how traumatic it can be for people to review their care plans. Particularly with a guy I met last week… And to look back at stuff that was written, you know, a few months ago and how much he has progressed from then, it brings back quite horrible memories for him. Yeah, it can be quite upsetting for service users to have to have a listen to that….. I don’t know what the answer is to that.5030 professional, intervention
I’ve had CPNs in the past but they’ve been a bit of a waste of space, if you ask me. They didn’t really offer that much support. They just sat there telling me what I should and shouldn’t do. So when I’ve been offered them in the past, I’ve gone, no, you’re alright. But because I have to have one because of the medication I’m on, I have to have a CPN so I don’t really get a say in the matter.5015, service user, intervention
I think it’s hard really when you haven’t had mental illness to know what the actual experience is for someone who has had the experience. So it’s hard really. There’s like a chasm, deep chasm between us - a growing canyon. They’re on one side of it and we’re on the other side of it.6002, service user, intervention
I think when carers maybe have their own conflicts with the person they care for in terms of what they need and how unwell they are, or, you know, what their care plan should be, we then have to sort of manage that tension listening to what the service user wants and the carer not being happy, you know, because they feel that there are other needs or something should be done differently, but it’s not in line with what the service user wants.5019, professional, intervention
The failure of organisational readiness to support the workability of the intervention
I don’t know, it’s hard to say that [if practice has changed] really, because it’s the same pressures, I mean I haven’t done a care plan since if that means anything. I hope it’s made us all think a little bit more, which I think it does do, I think training does do that. It’s just that it’s still all the same pressures as to why our care plans maybe aren’t as rich as they should be.5019, professional, intervention
It’s very difficult seeing a different person every single time that doesn’t know me from Adam, reads the last page of my notes because they haven’t got time to sort of get a handle on me in the appointment process. So they only know a very little about me and go on sort of the last bit of data that’s been put in the notes, and some of them are better than others, obviously.4027, service user, intervention
We do all have tablets now. We’ve got Internet access on the tablets and we can do some work with with clients while we’re out. But…and hopefully it’s coming in but it’s not there yet, so our computerised notes system isn’t on that tablet. So if that could be on it, then we can do the care plans and do things live and as we’re there. Whereas at the moment, it’s you’d have to type up, come back to the office, and then, you know, copy and paste and redo things.5006, professional, intervention
The thing I remember is around aspirational statements and…and goals, but obviously there’s a lot more to it that because I haven’t been able to use it as part of, you know, habit…it hasn’t become habit forming and part of my practice, so, sort of, it’s forgotten, sort of.5006, professional, intervention
Workability in context
It’s the firefighting, you are literally moving from one thing to another and stealing bits of time from something else and you don’t actually have that time to sit and think; time is the biggest barrier, so it’s about making sure that it gets prioritised in terms of everything else that we have to do and that’s always going to be a problem. My motivation to…to change things might slip.5022, professional, intervention
I feel they’re too hard pressed really. Coz, coz the senior support worker left, retired. And another support worker’s left and they never replaced them. So there’s more work for them to do. They are rushing, they’ve got too much to do in a day and there’s too few support workers in my view.6002, service user, intervention
They’ve [support workers] got loads more time than you and they can actually get in and know people as well… I mean a lot of us had the skills to be able to come up with, with a [care] plan but we don’t have the time. We don’t have the time to go round somebody’s house every two or three days and say, just walk to the end of the path with me. Let’s stand here for ten minutes, let’s…we don’t. But support workers would be able to do that.5003, professional, intervention.
My support workers that come round to the house, I think they’re the ones. I mean they helped me when I had my last bad do. So they came in and, er, they were much better than the crisis team.What was it, do you think about the support workers that made them good at - made them good at involving people?Well I think they did rely on their own experiences of life, the support workers. Um, and they come in every day and, er, you know, I think they came in for as long as was necessary.6002, service user.