The PULSAR project (specialist care trial): does providing recovery-oriented training to staff in specialist community-based mental health services improve the personal recovery of adult consumers?

The PULSAR intervention is a training intervention that is delivered by the research team to staff in participating specialist community-based mental health services. The intervention focuses on teaching and promoting recovery-based practices to staff. PULSAR stands for "Principles Unite Local Services Assisting Recovery". Recovery-oriented practice involves supporting a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential. A package of interventions, developed and trialled by the Refocus Team, Institute of Psychiatry, King's College London UK, promotes recovery-oriented practice in mental health teams. In the PULSAR project these materials are adapted for Australian specialist community-based mental health services. The content and process of training are sensitive to the needs of the Victorian mental health system and the local cultural and legal contexts. The training has been developed either as a two-day spaced program, or as four ½ day spaced sessions, or a two-day session for staff from involved services. In round two, the delivery of the intervention was modified to account for previously unknown restrictions on the ability of services to release staff for two days of training. In response to this the training was re-designed so that all material is covered in the first day of training, with more in-depth exploration and practice of the knowledge and skill on day two. The training is delivered by mental health clinicians, including experienced trainers from the study team or host organisations, with co-delivery by consumer trainers for at least half the time and carer involvement for at least one hour of training. A schedule of training is provided to trainers along with standardised training packs including use of videos to provide standardised content. Trainers are asked to keep a record of training and asked to record any deviations from the schedule and use of materials. The intervention focuses on promoting recovery-based practices to staff that are in addition to standard care, and is comprised of two core components: Recovery-Promoting Relationships and Working Practices. Recovery-Promoting Relationships: According to a recovery-oriented framework, the working relationship between staff and consumers is crucial to the process of recovery. The intervention develops and supports this relationship by: assisting teams to develop a shared understanding of personal recovery; exploring existing values held by individual workers and the team; developing skills in coaching; and raising the expectations held by consumers that their values, strengths and goals will be prioritised in their relationships with staff members. Working Practices: The intervention is centered around three main working practices that form the specific behaviours and recovery supports necessary for building positive, recovery-promoting relationships in mental health care: 1) Understanding values, treatment and support preferences; 2) Assessing and working with strengths; and 3) Supporting goal-striving. Staff are trained to ensure that care planning is based on the consumer’s values, preferences, strengths, and personally valued goals. The intervention is supported by four implementation strategies: 1) Personal recovery training; 2) Coaching and working practice training; 3) Team manager reflection group; and 4) Team reflection sessions, as well as a set of training materials and compatible working tools. After receiving the intervention, staff are invited to take part in monthly hour long PULSAR Active Learning Sessions (PALS) with an experienced PULSAR facilitator to discuss and reflect upon their experiences of delivering recovery-oriented practice in the service setting. PALS are available for 12-24 months following the intervention (depending on whether trained in the first or second year) and are delivered via face to face in a group setting. These interventions are delivered and evaluated in a stepped-wedge cluster randomised controlled trial. Seven specialist mental health services (clusters) were randomised to receive the PULSAR intervention in year 1 and seven specialist mental health services in year 2. To account for potential contamination of the intervention ‘dosage’ to be received within each cluster (i.e. the number of staff who had undergone the PULSAR training), a dosage variable will be included into the modelling. This variable will be based on estimates of staff changes, which will be collected via the site coordinator every three months including the number and EFT of 1) new staff taking up employment from outside the service 2) staff that had moved to another team but remain within the service and 3) staff leaving the service.