Authors: Lisa Brophy, Michelle Kehoe, Ellie Fossey, Elisabeth Wilson-Evered, Penelope Weller, Frances Shawyer & Graham Meadows
Event: 2023 The MHS conference - Adelaide
Subject: Supporting human rights through implementing recovery oriented practice
Type of resource: Video
Implementing Recovery Oriented Practice is important in safeguarding and promoting the rights of people with mental health problems, and plays an important part in rebalancing the power differentials pervasive in mental health care. The PULSAR project showed the co-delivered REFOCUS-PULSAR training model promoted personal recovery among consumers receiving specialist care services. Published in 2019 in The Lancet Psychiatry as key learnings from a $2.4 million Victorian Government Grant, this is the first project internationally to demonstrate this impact. This symposium includes three 10-15 minute presentations drawing on differing aspects of implementing recovery-oriented practice from the PULSAR project, so as to foster a facilitated discussion about ways forward in addressing challenges to implementing change within mental health services.
Paper 1: Consumer views and experiences of services following REFOCUS-PULSAR staff training
As part of PULSAR, a qualitative study explored how consumers perceived their recovery following community mental health staff undertaking the co-delivered REFOCUS-PULSAR training in recovery-oriented practice, through one-on-one interviews with twenty-one adults receiving community mental health care. The identified themes included that connections to community and professional staff were viewed as important to support their recovery journeys; that seeking and striving towards a better life was personal and individual in how meaning around the idea of a better life was made; and that barriers to recovery primarily focused on lack of choice. Participants also expressed ‘uncertainty’ and struggled to identify not only what their recovered future might entail, but also to identify recovery focused language and aspects of recovery-oriented practice in their interactions with the service. In this presentation, we will discuss these themes, their implications for open, collaborative conversations around recovery between consumers and staff, and the development of specifically targeted recovery resources to facilitate such conversations.
Paper 2: Promoting Recovery Oriented Practice: an implementation science framework identifies which teams may benefit most.
Drawing on a healthcare-specific implementation model, ‘Promoting Action on Research Implementation in Health Services’ (PARiHS) the PULSAR project undertook a process evaluation to understand the implementation and contextual processes that contributed to impact of the REFOCUS-PULSAR staff training on personal recovery among consumers receiving specialist care services. This presentation will describe our application of a tool based on the PARiHS framework to identify those service teams and contexts most responsive to the training intervention. We generated an expectation-to-change (ETC) score to estimate the implementation of Recovery Orientated Practice training, and whether it differentiated among teams. Based on the ETC score, teams were categorised as high, medium, or low, ETC and multilevel regression models were replicated with 50 bootstrapped samples. Findings indicated that overall, medium ratings for ETC resulted in positive client recovery outcomes; however, for some functional outcomes the lower ETC group showed more change. The application of this approach can add value to team-based research work, including in trials of training interventions. These adaptations may be particularly useful where teams are already strongly aligned with the desired direction of change and may in turn guide adaptation of such interventions to team contexts.
Paper 3: PULSAR as an evidence-based approach to Recovery Oriented Practice – the challenges of implementation
The challenge of moving from research evidence to practice is a continuing one in many areas of mental health care. In the years since PULSAR, members of the PULSAR team have endeavoured to make the training accessible to a range of mental health services and students. This dissemination of new research knowledge requires skills that are very different from those of research. Clinical skills and lived experience remain crucial to effect change, but more is needed to influence people in Australia’s mental health service systems, including marketing, opportunism, lobbying and persistence in the face of challenges in fragmented, sometimes conservative and often silo-bound service contexts. One such challenge is the often-mercurial nature of leadership in health care; this may be shaped by personal career progression but also funding, restructures, policy and politics, contrasting with the desired ideal of strong, consistent, determined and committed leadership that can patiently create the system level conditions for implementation success. Nevertheless, the experiences from PULSAR have influenced design of a large stepped-wedge cluster RCT study involving 18 sites across Southern France, as well as uptake of elements in OT curricula in Australian universities and within a successful Undergraduate Certificate in Melbourne. This latter has reached occupational groups such as paramedics, fire and emergency services and the police. In this presentation, we will share our experiences of early work with the French team and with others here in Australia, illustrating the challenges in translating the research findings into widespread evidence-based practice in this critical area of concern. In facilitating discussion, we will draw on audience experiences and creativity to identify effective strategies to educate and create the conditions for change to successfully implement compassionate and rights-based practice system-wide.
Team-based training can promote Recovery Oriented Practice, but uptake is limited.
Moving from evidence to practice in mental health care may be informed by contemporary implementation frameworks. It necessitates organisational commitments across sectors that may challenge conventional power structures and require relatively new workforce elements including trainers with lived experience.
Meadows, G., Brophy, L., Shawyer, F., Enticott, J. C., Fossey, E., Thornton, C. D., Weller, P. J., Wilson-Evered, E., Edan, V., & Slade, M. (2019). REFOCUS-PULSAR recovery-oriented practice training in specialist mental health care: a stepped-wedge cluster randomised controlled trial. The Lancet Psychiatry, 6(2), 103-114.
Rycroft-Malone J. The PARiHS framework - A framework for guiding the implementation of evidence-based practice. Journal of Nursing Care Quality, 19(4), 297–304.