Table 3 Summary of programme specifications and recovery plan adaptations resulting from modelling and feasibility testing (Stages 3 and 4)
Area | Decision | Rationale |
|---|---|---|
Self-management resource | Personal Recovery Plan (Repper and Perkins 2008) selected | (i) Covers elements of effective self-management programmes (literature reviews) (ii) Specific focus on recovery mental health crisis (iii) Co-produced with service users—suitable for delivery by a PSW (iv) Has been tested in NHS settings |
Programme abbreviated | To fit within a 10-week programme of support | |
Section on developing a crisis plan omitted | Acknowledging that not all participants in the CORE trial will have ongoing support from mental health services in place, or meetings with the PSW and mental health services may be difficult, so agreeing service responses in a crisis may not be possible | |
Section on “moving on after a crisis” brought to the front of the plan | All participants in the CORE trial will have experienced a recent mental health crisis, so this is likely to be an immediate concern | |
“Recovery means” page left for individual to complete | Feedback from PSWs and service user reference group: more individualised to encourage people to provide their own definition of personal recovery | |
Redesign with green leaf motif | Feedback from service user reference group: calming and symbolic of growth and renewal | |
More white space incorporated into the plan | To allow free text writing, drawing or adding photos etc. for those with literacy difficulties or who prefer a less structured approach | |
Structure of the programme | 10 session programme | To maintain the focus of the programme on brief, bridging support with recovery following a mental health crisis (rather than longer term support) |
Programme to begin immediately following CRT discharge, and be completed within 3 months | ||
1:1 support | Likely to be acceptable and feasible for more participants than a group programme | |
Values of the programme | Recovery focused: promoting hope and valuing participants’ strengths | Consistent feedback from service users and other stakeholders about what help is wanted and needed following CRT support and advocated by peer support literature and training programmes |
Peer-delivered: appropriate self-disclosure and story-sharing is encouraged; modelling recovery and coping | ||
Person-centred: the recovery plan to be used flexibly, in an individualised way with each participant | ||
Complementary to mental health services care (integrated within CRT services, but offering additional, distinct support) | ||
Peer Support Worker (PSW) recruitment | Essential requirements for PSW roles defined as: having lived experience of mental health problems, previous experience in a support role, good interpersonal and support skills, has developed a personal recovery plan/relapse prevention plan, has a recovery-oriented approach, ability to problem solve and work collaboratively with mental health staff and service users | Lived experience and having own recovery plan to ensure positive story-sharing and modelling of recovery strategies is possible; no requirement for clinical qualifications and broad range of previous experience in a support role accepted, recognising the non-clinical recovery focus of this role |
Open market NHS employment, competitive recruitment | To recognise the demands of the role and support integration with CRT teams | |
PSW training and supervision | Adapted Nottingham IMH training covering: the meaning of peer support, self-management and recovery; core skills: listening, valuing diversity, strengths-based; peer support skills including story sharing; boundaries and disclosure; referring and linking in; working with distress and addressing safety concerns | Drawing on an established, accredited training course used to support peer workers in using the personal recovery plan |
Additional NHS Trust training and induction (including safeguarding and personal safety training; orientation to NHS policies and procedures) | To support safe working and integration with participating NHS mental health services | |
Regular group supervision delivered by participating NHS Trusts | As above; Group supervision was chosen to maximise the PSWs’ opportunities to learn from and support each other | |
Access to 1:1 supervision too | Reinforced as important by PSWs following preliminary testing. Access to additional support from an experienced PSW to ensure PSWs’ distinct role is retained and supported | |
PSW access to immediate support and advice from CRT staff following meetings | ||
Access to support from experienced peer support worker |