S53: SYMPOSIUM: PULSAR: Researching recovery oriented practice in primary and secondary care.

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By September 26, 2017 No Comments

Authors: Vrinda Edan, Graham Meadows, Ellie Fossey, Lisa Brophy, Penny Weller, Michelle Kehoe

Year: 2017

Event: 2017 TheMHS Conference

Subject: Workforce,Reducing Stigma and Discrimination,Lived Experience, Recovery,Wellbeing,Change, Innovation, Reform,Advocacy,Research & Evaluation Informing Practice,Community, Culture, Society

Type of resource: Conference Presentations and Papers

Abstract: PULSAR: The Principles Unite Local Services Assisting Recovery (PULSAR) Trial – at $ 2.3 million the largest of five MIRF funded projects - is a cross-sectoral, mixed-methods research intervention involving staff training that aims to embed recovery-oriented practice in mental health care settings located in the Southern Metropolitan Region of Victoria, Australia. PULSAR involves collaboration with the British Refocus team led by Professor Mike Slade; Refocus developed and trialled a training intervention focused on supporting recovery and enabling organisational change.

This symposium will provide an overview of the design and implementation of PULSAR in Victoria. We will also explore the preliminary data from both primary and secondary care, with an in-depth examination of one primary care practice. The symposium will end with an introduction to PULSAR everyday, a consumer led recovery guide.

Paper 1: PULSAR: Overview, implementation and the intervention (GM, LB, PW, VE)
Mental health services in Victoria are working towards system-wide transformation through policy and legislation that promotes recovery-oriented practice, supporting consumers to have greater choice and control in their lives. Such transformation requires new approaches, including those which can foster cultural and attitudinal change in health professionals. This paper discusses the Principles Unite Local Services Assisting Recovery (PULSAR) project, a $2.3 million program funded through the Victorian Government’s Mental Illness Research Fund (MIRF), which aims to facilitate the reorientation of mental health services towards recovery.

PULSAR is a complex four year intervention trial involving 20 investigators in 10 organisations across both primary and secondary care services. In this paper, we will describe the stepped-wedge cluster randomised control trial designs used in the project and provide an overview of the separate recovery-oriented training interventions developed for general practitioners and for staff in community-based mental health services. We will then provide an overview of the process of implementing the large-scale multisite intervention, and discuss some of the challenges encountered during the implementation and data collection phases. Some of these challenges were specific to the area being studied, and others are commonly encountered in research projects, including engagement, recruitment and retention of participants.

Paper Two: PULSAR: Preliminary data (GM, LB, JE, EF, VE)
PULSAR data collection is nearly concluded and electronic data acquisition well advanced. Quantitative data assessing recovery is being collected in serial cross-sectional studies from over 1000 participants across multiple time points: typically baseline, end of year one and two; with variation to this structure in the primary care setting. A subset of participants is involved in up to two study interviews that include clinical, personal recovery and economic evaluation focused measures. The project also includes a series of qualitative studies with up to 60 consumers and staff participating in interviews exploring recovery-oriented practice, as well as a process evaluation. The details of this mixed-methods data analysis approach will be summarised and a set of preliminary analyses will be discussed giving an early indication of findings.

Two design frameworks can be used to drive full-study stepped-wedge analyses, characterised as ‘incomplete’ and ‘complete’ designs including Original Group Analyses as well as those based on actual exposures. Implications of different data completion rates will be described and the more exploratory nature of the primary care study explicated. Qualitative data will have considerable contributions to make to this work and the process for integrating the two strands of data will be discussed along with implications for design of similar large scale translational research exercises.

Paper Three: Implementing Recovery Oriented Practice in Primary Care – a case study. (VE, EF, WC, GM)
The PULSAR qualitative study was designed so that early data collection would guide the nature and extent of subsequent data collection. During the PULSAR primary care intervention, GP Clinics identified varied experiences, barriers and enablers to implementing recovery oriented practice. To better understand these issues from multiple perspectives, we added an in-depth case study at one of the PULSAR primary care sites. The purpose of this case study was to recruit and interview the multidisciplinary primary care staff team as well as patients attending the service, to explore recovery principles and practices in greater depth. This paper will describe this study, the outcomes and implications for primary care.

Paper Four: PULSAReveryday, a guide to consumer led recovery. (VE, MK, EF, GM)
In previous studies exploring recovery oriented practice it has been identified that a lack of focus on consumers understanding of recovery may have a potential impact on the outcomes of recovery oriented practice. During the PULSAR project there came an opportunity to support development of a consumer led project to develop materials for consumers to sustain recovery and support them in leading discussion about what's important in their interactions with health and other service providers. The project team were successful in gaining a $50,000 external grant specifically for this consumer led work.

Preliminary material was developed and used at two focus groups, conducted by the consumer researchers, to determine the final materials to be developed. During the focus groups, suggestions were made regarding the potential of a group process to deliver the material. A consumer guide was developed, as well as some supporting materials, and a four-week program to deliver and discuss the various domains of recovery as covered in the guide.

This presentation will discuss the development, implementation and evaluation of the materials for this project. The unique composition of the work team will also be discussed highlighting what it means to be a consumer working on this research project and the value of consumer-led participation in the research field.

Learning Objectives
Learning Objective 1: Participants will gain an understanding of how research for the implementation of recovery oriented practice can be developed and implemented across a complex mental health system.

Learning Objective 2: Participants will be invited to consider their learning for their practice setting from this project. Relevant areas for different participants may include directly applicable frameworks and working practices and ideas for how research, program evaluation or quality assurance projects may be constructed based on cutting-edge translational research techniques and strategies.

Enticott, J.E., Shawyer, F., Brophy, L., Russell, G., Fossey, E., Inder, B., Mazza, D., Vasi, S., Weller, P.J., Wilson-Evered, E., Edan, V., and Meadows, G. (2016) The PULSAR primary care protocol: a stepped-wedge cluster randomized controlled trial to test a training intervention for general practitioners in recovery-oriented practice to optimize personal recovery in adult patients. BMC Psychiatry 16:451
Slade, M., Bird, V., Le Boutillier, C., Williams, J., McCrone, P., & Leamy, M. (2011). REFOCUS Trial: protocol for a cluster randomised controlled trial of a pro-recovery intervention within community based mental health teams. BMC Psychiatry, 11(1), 185.

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