Implementing an online mental health toolkit for relatives– reflections from our first data day!
by Vanessa Pinfold
There is an increased focus and interest in how to implement innovations into health care settings. And there should be! Call it improvement science or knowledge transfer or implementation – this area of work is how information developed through research studies or service improvement programmes can be used to achieve practical change. Not just in one place or team or service but across entire systems and replicated to avoid post code lottery of service provision. A key question for health services researchers is how do you implement and sustain innovation when you discover something that is practically useful for people and well liked, clinically effective, feasible and cost effective?
We are part of a NIHR funded project led by Professor Lobban at Lancaster University looking at implementation of a toolkit for relatives supporting people in Early Intervention in Psychosis services. You can access the toolkit here if you are interested in helping the team develop it as this is an on-going task.
The implementation project that McPin are involved with will follow how six different NHS Trusts use the new toolkit. It will be organised in waves involving two trusts at a time, so that early intervention in psychosis teams can learn from each other and we can collectively understand how best to implement the toolkit. Do they implement it? How do they implement it? What factors impact on implementation – things that help, things that hinder? The toolkit is a digital intervention – so there are lots of potential problems with access, as well as many benefits.
A key driving factor for implementation is the requirement for early intervention in psychosis teams to support families, measured through new access and waiting time standards from April 2016.
We are particularly interested in the study because the research team are using Normalisation Process Theory (NPL). This provides a framework to ask questions about how something gets used and embedded into routine practice.
- Does the intervention make sense? Termed Coherence in NPL
- Do I want to take part? Termed Cognitive Participation in NPL
- What will the impact on my work be? Termed Collective Action in NPL
- Is it worth it? Termed reflexive monitoring in NPL.
This framework and its questions will support the research team to systematically explore what is going on within complex systems, understanding implementation factors and gain feedback from relatives. It will consider how far people engaged with the toolkit and did it extend into “routine practice”? Implementation is not the end of the line. As Professor Elizabeth Murray from UCL explained, embedding and integration of “new work”, in our case the toolkit must follow on from implementation which is another staging post on the innovation pathway.
At McPin, we have not used NPL before, but it looks like it will be a very useful approach that we could adopt in other studies as well. We would love to hear from other people with experience of this approach. Do get in touch so we can learn from each other.
Our first team data day ended with a meal organised by Professor Sonia Johnson and Puffin O’Hanlon from UCL. The team is located in Lancaster and London, communicating mostly virtually. Getting together is really important and we put the time to good use. Hopefully relatives will agree if we can get the toolkit embedded into routine practice in the next 2 years. On that note we are looking at ways for relatives to get more involved in this project. If you are a relative of someone supported in early intervention in psychosis services, and you are interested in getting involved in mental health research – please do get in touch firstname.lastname@example.org.