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Crisis resolution teams (CRTs) offer brief, intensive home treatment for people experiencing mental health crisis. CRT implementation is highly variable; positive trial outcomes have not been reproduced in scaled-up CRT care.
Aims
To evaluate a 1-year programme to improve CRTs’ model fidelity in a non-masked, cluster-randomised trial (part of the Crisis team Optimisation and RElapse prevention (CORE) research programme, trial registration number: ISRCTN47185233).
Method
Fifteen CRTs in England received an intervention, informed by the US Implementing Evidence-Based Practice project, involving support from a CRT facilitator, online implementation resources and regular team fidelity reviews. Ten control CRTs received no additional support. The primary outcome was patient satisfaction, measured by the Client Satisfaction Questionnaire (CSQ-8), completed by 15 patients per team at CRT discharge (n = 375). Secondary outcomes: CRT model fidelity, continuity of care, staff well-being, in-patient admissions and bed use and CRT readmissions were also evaluated.
Results
All CRTs were retained in the trial. Median follow-up CSQ-8 score was 28 in each group: the adjusted average in the intervention group was higher than in the control group by 0.97 (95% CI −1.02 to 2.97) but this was not significant (P = 0.34). There were fewer in-patient admissions, lower in-patient bed use and better staff psychological health in intervention teams. Model fidelity rose in most intervention teams and was significantly higher than in control teams at follow-up. There were no significant effects for other outcomes.
Conclusions
The CRT service improvement programme did not achieve its primary aim of improving patient satisfaction. It showed some promise in improving CRT model fidelity and reducing acute in-patient admissions.
Movement disorders associated with exposure to antipsychotic drugs are common and stigmatising but underdiagnosed.
Aims
To develop and evaluate a new clinical procedure, the ScanMove instrument, for the screening of antipsychotic-associated movement disorders for use by mental health nurses.
Method
Item selection and content validity assessment for the ScanMove instrument were conducted by a panel of neurologists, psychiatrists and a mental health nurse, who operationalised a 31-item screening procedure. Interrater reliability was measured on ratings for 30 patients with psychosis from ten mental health nurses evaluating video recordings of the procedure. Criterion and concurrent validity were tested comparing the ScanMove instrument-based rating of 13 mental health nurses for 635 community patients from mental health services with diagnostic judgement of a movement disorder neurologist based on the ScanMove instrument and a reference procedure comprising a selection of commonly used rating scales.
Results
Interreliability analysis showed no systematic difference between raters in their prediction of any antipsychotic-associated movement disorders category. On criterion validity testing, the ScanMove instrument showed good sensitivity for parkinsonism (90%) and hyperkinesia (89%), but not for akathisia (38%), whereas specificity was low for parkinsonism and hyperkinesia, and moderate for akathisia.
Conclusions
The ScanMove instrument demonstrated good feasibility and interrater reliability, and acceptable sensitivity as a mental health nurse-administered screening tool for parkinsonism and hyperkinesia.
Edited by
Fiona Jenkins, Australian National University, Canberra,Mark Nolan, Australian National University, Canberra,Kim Rubenstein, Australian National University, Canberra
Edited by
Fiona Jenkins, Australian National University, Canberra,Mark Nolan, Australian National University, Canberra,Kim Rubenstein, Australian National University, Canberra
Edited by
Fiona Jenkins, Australian National University, Canberra,Mark Nolan, Australian National University, Canberra,Kim Rubenstein, Australian National University, Canberra
Edited by
Fiona Jenkins, Australian National University, Canberra,Mark Nolan, Australian National University, Canberra,Kim Rubenstein, Australian National University, Canberra
Edited by
Fiona Jenkins, Australian National University, Canberra,Mark Nolan, Australian National University, Canberra,Kim Rubenstein, Australian National University, Canberra
Edited by
Fiona Jenkins, Australian National University, Canberra,Mark Nolan, Australian National University, Canberra,Kim Rubenstein, Australian National University, Canberra
Edited by
Fiona Jenkins, Australian National University, Canberra,Mark Nolan, Australian National University, Canberra,Kim Rubenstein, Australian National University, Canberra
Edited by
Fiona Jenkins, Australian National University, Canberra,Mark Nolan, Australian National University, Canberra,Kim Rubenstein, Australian National University, Canberra
Edited by
Fiona Jenkins, Australian National University, Canberra,Mark Nolan, Australian National University, Canberra,Kim Rubenstein, Australian National University, Canberra
Edited by
Fiona Jenkins, Australian National University, Canberra,Mark Nolan, Australian National University, Canberra,Kim Rubenstein, Australian National University, Canberra
Edited by
Fiona Jenkins, Australian National University, Canberra,Mark Nolan, Australian National University, Canberra,Kim Rubenstein, Australian National University, Canberra
Edited by
Fiona Jenkins, Australian National University, Canberra,Mark Nolan, Australian National University, Canberra,Kim Rubenstein, Australian National University, Canberra
Edited by
Fiona Jenkins, Australian National University, Canberra,Mark Nolan, Australian National University, Canberra,Kim Rubenstein, Australian National University, Canberra
Edited by
Fiona Jenkins, Australian National University, Canberra,Mark Nolan, Australian National University, Canberra,Kim Rubenstein, Australian National University, Canberra
Edited by
Fiona Jenkins, Australian National University, Canberra,Mark Nolan, Australian National University, Canberra,Kim Rubenstein, Australian National University, Canberra
Edited by
Fiona Jenkins, Australian National University, Canberra,Mark Nolan, Australian National University, Canberra,Kim Rubenstein, Australian National University, Canberra
Edited by
Fiona Jenkins, Australian National University, Canberra,Mark Nolan, Australian National University, Canberra,Kim Rubenstein, Australian National University, Canberra
Interrogating the concepts of allegiance and identity in a globalised world involves renewing our understanding of membership and participation within and beyond the nation-state. Allegiance can be used to define a singular national identity and common connection to a nation-state. In a global context, however, we need more dynamic conceptions to understand the importance of maintaining diversity and building allegiance with others outside borders. Understanding how allegiance and identity are being reconfigured today provides valuable insights into important contemporary debates around citizenship. This book reveals how public and international law understand allegiance and identity. Each involves viewing the nation-state as fundamental to concepts of allegiance and identity, but they also see the world slightly differently. With contributions from philosophers, political scientists and social psychologists, the result is a thorough appraisal of allegiance and identity in a range of socio-legal contexts.