Periodic Reporting for period 3 - RECOVER-E (LaRge-scalE implementation of COmmunity based mental health care for people with seVere and Enduring mental ill health in EuRopE)
Período documentado: 2021-01-01 hasta 2021-12-31
Recovery, functioning and quality of life of persons with severe mental illness (SMI) could be improved by shifting mental health services from primarily institution-based to include a network of community-based services. Many countries in Europe are further developing or strengthening community-based mental health service delivery. Some countries in Central and Eastern Europe have piloted community-based mental health services but have not evaluated their impact on implementers (providers), service users, or service utilisation.
The overall objective of the RECOVER-E project was therefore to implement well-functioning multidisciplinary community mental health teams (CMHTs) in 5 sites in Central and Eastern Europe (Sofia, Bulgaria; Zagreb, Croatia; Kotor, Montenegro; Skopje, North Macedonia; Siret, Romania), and to contribute to the evidence base of the impact of these CMHTs delivering recovery-oriented care. This service delivery model was evaluated for its impact on functioning and quality of life for people with SMI on service utilization and the extent to which care is in line with recovery-oriented principles. A particular highlight of the project’s approach was peer workers as members of the CMHTs.
The overall objective of the RECOVER-E project was therefore to implement well-functioning multidisciplinary community mental health teams (CMHTs) in 5 sites in Central and Eastern Europe (Sofia, Bulgaria; Zagreb, Croatia; Kotor, Montenegro; Skopje, North Macedonia; Siret, Romania), and to contribute to the evidence base of the impact of these CMHTs delivering recovery-oriented care. This service delivery model was evaluated for its impact on functioning and quality of life for people with SMI on service utilization and the extent to which care is in line with recovery-oriented principles. A particular highlight of the project’s approach was peer workers as members of the CMHTs.
WP1 (MANAGEMENT AND COORDINATION) coordinated and managed project implementation.
WP2 (NEEDS ASSESSMENT AND FEASIBILITY ASSESSMENT) assessed the context and situation in mental health care in each of the 5 sites prior to implementation. This included site visits with situational analysis and needs assessments. This fed into the development of locally tailored implementation plans to guide implementation of the intervention.
WP3 (IMPLEMENTATION) focused on the implementation of the CMHTs. Prior to delivering care in a CMHT, each site completed 2 weeks of hands-on training and follow-up training sessions on specific topics identified as needs for skills or knowledge development. Additional training and peer mentoring sessions were organized for peer workers.
WP4 (RESEARCH EVALUATION) and 5 (ECONOMIC EVALUATION) evaluated the (cost-)effectiveness of the intervention compared to care as usual (CAU). Research teams received training in implementation science, clinical trials and health economic evaluation. All sites completed data collection, albeit with delays due to the COVID-19 pandemic. Qualitative interviews were carried out with CMHTs. Due to the delays, analysis for the primary outcomes has only begun towards the end of the project.
WP 6 (BRIDGING THE GAP BETWEEN POLICY AND PRACTICE) engaged with decision-makers; sites prepared a pathway for scaling-up the after the project’s life span through two policy dialogues per site, as well as through development of a stakeholder analysis and policy influencing strategy to help guide actions to engage decision-makers.
WP 7 (DISSEMINATION) focused on dissemination project information, developments, and findings. A project website was created and (social) media posts were disseminated through e.g. Linkedin and Twitter, and the project has published several website posts. It has been featured in key professional publications and has published several scientific articles. Consortium representatives delivered workshops, symposia, presentations at (inter)national (EU- and non-EU) conferences. A well-attended international webinar was organised on the role of peer worker.
Results/Dissemination: First, the teamwork and recovery-oriented approach in the multidisciplinary CMHTs delivered benefits both for CMHT members and service users. The CMHTs have been formally established as structures within the care delivery systems. Second, peer workers were an important addition to CMHTs, both from the perspective of other professionals, service users, and policymakers. Training data show that the approach to training was appreciated by CMHT professionals, as was providing continuous training and skill building opportunities through identification of needs, implementation roadmaps and meetings. Psychiatric hospital managers (where CMHTs are embedded) express continued support of the CMHTs. Third, a systematic approach to engaging with decision-makers through policy dialogues and contributed input to policy documents and regulations has been an important process to continue to show back experiences with implementation of the CMHTs and benefits of peer workers. Fourth, the project has also disseminated results through academic publications in open-access peer reviewed journals, including international English and regional journals. Study protocols and manuscripts on baseline data related to recovery-oriented care and service user outcomes have been published. Manuscripts on the formative evaluation of the CMHTs, the (cost-)effectiveness of the CMHTs compared to CAU, implementation outcomes and factors influencing implementation are under preparation. Preliminary results on the primary outcome (functioning/WHO-DAS) show significant improvements in the intervention condition compared to CAU at 12 and 18 month follow-up. These results need to be placed into the context of the COVID-19 pandemic. Measures disrupted care delivery, which might have compromised the quality of care and fewer hospitalisations may also have reduced the costs of CAU, skewing cost data in favour of CAU. The analysis of aggregated data and their publication is therefore a complex endeavour that requires further scrutiny before dissemination.
WP2 (NEEDS ASSESSMENT AND FEASIBILITY ASSESSMENT) assessed the context and situation in mental health care in each of the 5 sites prior to implementation. This included site visits with situational analysis and needs assessments. This fed into the development of locally tailored implementation plans to guide implementation of the intervention.
WP3 (IMPLEMENTATION) focused on the implementation of the CMHTs. Prior to delivering care in a CMHT, each site completed 2 weeks of hands-on training and follow-up training sessions on specific topics identified as needs for skills or knowledge development. Additional training and peer mentoring sessions were organized for peer workers.
WP4 (RESEARCH EVALUATION) and 5 (ECONOMIC EVALUATION) evaluated the (cost-)effectiveness of the intervention compared to care as usual (CAU). Research teams received training in implementation science, clinical trials and health economic evaluation. All sites completed data collection, albeit with delays due to the COVID-19 pandemic. Qualitative interviews were carried out with CMHTs. Due to the delays, analysis for the primary outcomes has only begun towards the end of the project.
WP 6 (BRIDGING THE GAP BETWEEN POLICY AND PRACTICE) engaged with decision-makers; sites prepared a pathway for scaling-up the after the project’s life span through two policy dialogues per site, as well as through development of a stakeholder analysis and policy influencing strategy to help guide actions to engage decision-makers.
WP 7 (DISSEMINATION) focused on dissemination project information, developments, and findings. A project website was created and (social) media posts were disseminated through e.g. Linkedin and Twitter, and the project has published several website posts. It has been featured in key professional publications and has published several scientific articles. Consortium representatives delivered workshops, symposia, presentations at (inter)national (EU- and non-EU) conferences. A well-attended international webinar was organised on the role of peer worker.
Results/Dissemination: First, the teamwork and recovery-oriented approach in the multidisciplinary CMHTs delivered benefits both for CMHT members and service users. The CMHTs have been formally established as structures within the care delivery systems. Second, peer workers were an important addition to CMHTs, both from the perspective of other professionals, service users, and policymakers. Training data show that the approach to training was appreciated by CMHT professionals, as was providing continuous training and skill building opportunities through identification of needs, implementation roadmaps and meetings. Psychiatric hospital managers (where CMHTs are embedded) express continued support of the CMHTs. Third, a systematic approach to engaging with decision-makers through policy dialogues and contributed input to policy documents and regulations has been an important process to continue to show back experiences with implementation of the CMHTs and benefits of peer workers. Fourth, the project has also disseminated results through academic publications in open-access peer reviewed journals, including international English and regional journals. Study protocols and manuscripts on baseline data related to recovery-oriented care and service user outcomes have been published. Manuscripts on the formative evaluation of the CMHTs, the (cost-)effectiveness of the CMHTs compared to CAU, implementation outcomes and factors influencing implementation are under preparation. Preliminary results on the primary outcome (functioning/WHO-DAS) show significant improvements in the intervention condition compared to CAU at 12 and 18 month follow-up. These results need to be placed into the context of the COVID-19 pandemic. Measures disrupted care delivery, which might have compromised the quality of care and fewer hospitalisations may also have reduced the costs of CAU, skewing cost data in favour of CAU. The analysis of aggregated data and their publication is therefore a complex endeavour that requires further scrutiny before dissemination.
The RECOVER-E project contributed to positive impacts for service users, mental health professionals, clinical practice, and mental health policy. First, end-users have been represented as members of CMHTs and have been embedded in care delivery structures. They have experienced improvements in functioning at 12 and 18 month follow-up across sites. Professionals in the CMHTs have benefited from forming new collaborations with service users, obtaining new skills in community care delivery and recovery-oriented care, and applied their new skills in practice. Input from the RECOVER-E project has informed regulations, national mental health programmes, service delivery plans for hospitals, and mental health policies. Researchers in the project have acquired new skills in implementation science and in evaluating complex service delivery interventions. Lessons learned from RECOVER-E is expected to contribute to local evidence and insights to inform further strengthening of mental health services in the community.