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The CORE Service Improvement Programme for mental health crisis resolution teams: study protocol for a cluster-randomised controlled trial

Lloyd-Evans, Brynmor, Fullarton, Kate, Lamb, Danielle, Johnston, Elaine, Onyett, Steve, Osborn, David, Ambler, Gareth, Marston, Louise, Hunter, Rachael, Mason, Oliver , Henderson, Claire, Goater, Nicky, Sullivan, Sarah A., Kelly, Kathleen, Gray, Richard, Nolan, Fiona, Pilling, Stephen, Bond, Gary and Johnson, Sonia (2016) The CORE Service Improvement Programme for mental health crisis resolution teams: study protocol for a cluster-randomised controlled trial Trials, 17, 158. pp. 1-12.

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As an alternative to hospital admission, crisis resolution teams (CRTs) provide intensive home treatment to people experiencing mental health crises. Trial evidence supports the effectiveness of the CRT model, but research suggests that the anticipated reductions in inpatient admissions and increased user satisfaction with acute care have been less than hoped for following the scaling up of CRTs nationally in England, as mandated by the National Health Service (NHS) Plan in 2000. The organisation and service delivery of the CRTs vary substantially. This may reflect the lack of a fully specified CRT model and the resources to enhance team model fidelity and to improve service quality. We will evaluate the impact of a CRT service improvement programme over a 1-year period on the service users’ experiences of care, service use, staff well-being, and team model fidelity.


Twenty-five CRTs from eight NHS Trusts across England will be recruited to this cluster-randomised trial: 15 CRTs will be randomised to receive the service improvement programme over a 1-year period, and ten CRTs will not receive the programme. Data will be collected from 15 service users and all clinical staff from each participating CRT at baseline and at the end of the intervention. Service use data will be collected from the services’ electronic records systems for two 6-month periods: the period preceding and the period during months 7-12 of the intervention. The study’s primary outcome is service user satisfaction with CRT care, measured using a client satisfaction questionnaire. Secondary outcomes include the following: perceived continuity of care, hospital admission rates and bed use, rates of readmission to acute care following CRT support, staff morale, job satisfaction, and general health. The adherence of the services to a model of best practice will be assessed at baseline and follow-up. Outcomes will be compared between the intervention and control teams, adjusting for baseline differences and participant characteristics using linear random effects modelling. Qualitative investigations with participating CRT managers and staff and programme facilitators will explore the experiences of the service improvement programme.


Our trial will show whether a theoretically underpinned and clearly defined package of resources are effective in supporting service improvement and improving outcomes for mental health crisis resolution teams.

Item Type: Article
Divisions : Faculty of Health and Medical Sciences > School of Psychology
Authors :
Lloyd-Evans, Brynmor
Fullarton, Kate
Lamb, Danielle
Johnston, Elaine
Onyett, Steve
Osborn, David
Ambler, Gareth
Marston, Louise
Hunter, Rachael
Henderson, Claire
Goater, Nicky
Sullivan, Sarah A.
Kelly, Kathleen
Gray, Richard
Nolan, Fiona
Pilling, Stephen
Bond, Gary
Johnson, Sonia
Date : 22 March 2016
DOI : 10.1186/s13063-016-1283-7
Copyright Disclaimer : © Lloyd-Evans et al. 2016. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.
Uncontrolled Keywords : Crisis resolution teams; Acute care; Service improvement; Randomised controlled trial
Depositing User : Clive Harris
Date Deposited : 19 Feb 2019 09:55
Last Modified : 19 Feb 2019 10:00

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