Dual diagnoses of psychosis/schizophrenia spectrum diagnosis and drugs/alcohol problems Mental and Behavioural Disorders
Conditions
Interventions
We will conduct a small trial to test the feasibility of procedures for a planned larger scale trial.
Six community mental health teams (CMHTs) will be randomised in a 1:1 ratio to add Contingency Ma
Sponsors
South London and Maudsley NHS Foundation Trust
Eligibility
Sex/Gender
All
Age
18 Years to 100 Years
Inclusion criteria
Inclusion criteria: 1. Are aged 18 years and over at enrolment 2. Are receiving care from a participating CMHT 3. Have a dual diagnosis of symptoms of both psychosis/schizophrenia spectrum diagnosis and drugs/alcohol problems (both ascertained according to the treating team's working diagnoses, which will be recorded on the clinical record) 4. Are able to give informed consent and safely participate (i.e. severity of psychosis, drug/alcohol problems, and/or other problems does not, in the clinical judgement of the treating team, preclude consenting and safely participating)
Exclusion criteria
Exclusion criteria: All participants receiving care from participating teams, with the target difficulties, judged by the team able to give informed consent and participate safely will be included. We will exclude only those participants whose care team deems their participation in the study unsafe, or considers them unable to give informed consent. This is likely to be because of the severity of their difficulties with psychosis or drug/alcohol problems.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Feasibility outcome measures Screening, consent and enrolment (at baseline) 1. Number of PSWs approached (measured by screening instruments, at baseline) 2. Percentage PSWs recruited to take part in the study (measured by screening instruments at baseline) 3. Number and percentage of screened service users eligible for inclusion over the 12-month recruitment period and reasons for ineligibility (measured by screening instruments at baseline). 4. Number and percentage of eligible service users who consent to participate in the trial and reasons for no consent (measured by screening instruments at baseline). 5. Number of participants enrolled per week over the 12-month recruitment period (measured by screening instruments at baseline). Data completeness at baseline and follow-up assessments (at 12- and 24-weeks). 6. Number and percentage of PSW appointments at which attendance is recorded (measured by Peer Support Worker Session Summary at weeks 1 to 12). 7. Number and percentage of engagement questionnaires completed at each assessment point (0,12, 24 weeks) (measured by completion of the brief observer-rated engagement measure by both Peer Support Workers and participants at baseline and weeks 12 and 24). 8. Number and percentage of service users providing 12-week outcomes (measured by routine clinical data collection of ASSIST-LITE , the AUDIT, and DIALOG12 at baseline and 12 and 24 weeks and extracted from clinical records. Also, measured by the EQ5D at baseline and week 12 and 24). 9. Number and percentage of completed baseline assessments. As above. Adherence 10. Adherence to CM and TAU protocols by PSWs (measured by CM Adherence Scale at weeks 1 to 12). | — |
Secondary
| Measure | Time frame |
|---|---|
| Primary outcome for consideration in a future confirmatory trial 1. Attendance at weekly appointments with PSWs during treatment period (0-12 weeks). Number of appointments offered, number and percentage attended (measured by Peer Support Worker session summary at weeks 1 to 12). Secondary outcomes for consideration in a future trial 2. Attendance at PSW appointments during the tapering period (13-24 weeks). Number of appointments offered, number and percentage attended (measured by Peer Support Worker Session Summary at weeks 13 to 24). 3. Attendance at treatment as usual appointments during the treatment period (0-12 weeks), including monthly meetings with the Care Coordinator and other treatments provided as set out in participants’ Individualised Care Plan (measured by Peer Support Worker session summary at weeks 1 to 12). 4. Attendance at treatment as usual appointments (as above) during weeks 13-24 weeks (assessed by routine clinical data collection at 13 to 24 weeks and extracted from clinical records) 5. Engagement assessed using patient-reported ratings of engagement in peer support and the wider care plan, combined with PSW and Care Coordinator/CMHT worker ratings of engagement (measured by completion of the brief observer-rated engagement measure by both Peer Support Workers and participants at baseline and weeks 12 and 24). 6. Clinical outcomes assessed from clinical records: number of inpatient and crisis team episodes, episode length (days), patient-reported drug/alcohol use, patient-reported quality of life/satisfaction as assessed by routine clinical data collection at 1 to 24 weeks and extracted from clinical records). 7. Estimated mean treatment costs per participant and quality-adjusted life years per service user (assessed by clinical records and the EQ5D as above between 1-24 weeks). | — |
Countries
England, United Kingdom
Outcome results
None listed