Improving implementation of evidence based practice for people with psychosis through training the wider workforce: results of the GOALS feasibility randomised controlled trial

Background and objectives There is a pressing need to improve access to evidence-based practice for people with psychosis. The primary aim of this study was to assess clinical feasibility of a manualised, evidence-based CBT intervention (GOALS) targeting a personalised recovery goal, delivered by the frontline workforce, following brief training. Secondly, we aimed to conduct preliminary statistical analyses of key outcomes and costs. Methods The GOALS study is a feasibility randomised controlled trial (ISRCTN 73188383). 75 participants with current psychosis were recruited and randomly allocated to receive either treatment as usual alone or with GOALS therapy. Results Brief training enabled frontline staff to deliver the therapy according to protocol and 74% of therapy participants partially or fully achieved their goals. There were significant improvements with a moderate effect size of 0.56 on goal attainment. However, preliminary statistical analyses found no significant differences between groups on our primary outcome of activity levels or other secondary outcomes Health economic analysis found that point estimates of costs, controlling for baseline costs, implied savings (even including intervention costs), but the difference was not statistically significant. Limitations The study was designed as a feasibility RCT, and therefore the results of secondary estimates of efficacy effects should be treated with caution. Conclusions This approach holds promise in supporting people with psychosis to reach personal recovery goals, cost effectively

The Coping with Unusual Experiences for Children Study (CUES):A pilot randomized controlled evaluation of the acceptability and potential clinical utility of a cognitive behavioural intervention package for young people aged 8-14 years with unusual experiences and emotional symptoms

Objectives Health care guidelines recommend psychological interventions for childhood unusual experiences that are associated with distress or adverse functional impact (UEDs), based on adult, rather than child‐specific, evidence. We report the first randomized controlled evaluation of the acceptability and potential clinical utility of cognitive behavioural therapy for childhood UEDs (CBT‐UED). Design Pilot randomized controlled trial. Methods Participants aged 8–14 years were recruited from referrals to community services for children with emotional/behavioural problems and screened for self‐reported UEDs. Results Of around 1,000 referrals over 36 months, 304 (30%) were identified to the research team, 174 (57%) were successfully contacted, 110 (63%) consented to screening, 96 (87%) attended a screening assessment, and 51 (53%) reported UEDs. Forty‐nine (96%) consented to randomization to either CBT‐UED (9–12 weekly sessions of 40–50 min, adjunctive to usual care, n = 24) or treatment‐as‐usual/waitlist control (TAU/WL, n = 25). Childhood internalizing emotional symptoms (e.g., feeling ‘nervous’/'scared’/’tearful’/’worried’/'sick’; proposed primary outcome), UEDs, depression, anxiety, and childhood psychopathology (secondary outcomes) were measured at baseline, at 12 weeks, and, where therapy was ongoing but incomplete (Conclusions Retention, screening, and consent rates were as anticipated; recruitment took longer than planned. Trial procedures were acceptable to young people, their families, and clinicians. Therapy exceeded 12 weeks, but was well‐received, with no serious adverse events attributed to participation. Further evaluation is needed. Practitioner points Around half of 8‐ to 14‐year‐olds in Child and Adolescent Mental Health Services reported distressing unusual experiences. An age‐adapted cognitive behavioural intervention appears feasible, and safe to deliver, with the potential to augment standard care. This is a pilot study, and further evaluation is needed. Longer term outcomes should be a focus of future evaluation

Training the Frontline Workforce to Deliver Evidence-Based Therapy to People With Psychosis:Challenges in the GOALS Study

Improving access to psychotherapies in psychosis requires workforce expansion in resource-challenged systems. The GOALS feasibility randomized controlled trial assessed training and implementation of an evidence-based intervention by frontline workers, targeting recovery goals. Training uptake and therapy fidelity were good. Case managers with crisis management responsibilities were less likely than clinical assistants to deliver therapy. Participants receiving “sufficient therapy” achieved goals, but therapy was usually provided by clinical assistants. This is consistent with implementation science principles, that training must be combined with supportive organizational structures, such as by focusing on roles that already include therapy delivery or developing stronger organizational supports for case managers