The ACCEPT Study. Developing a Complex Intervention to Improve the Process of Disclosing Adverse Childhood Experience (ACEs) for Service Users and Staff: an Experience-based Co-design Study
Trial Snapshot
- Phase
- Not Applicable
- Status
- Not yet recruiting
- Sponsor
- King's College London
- Enrollment
- 20
- Locations
- 2
- Primary Endpoint
- Therapeutic relationship
Study Overview
Brief Summary
Experiences of abuse, neglect, domestic violence, severe bullying and community violence in childhood are very common among people who use mental health services. These often have serious and long lasting impacts on people's mental health.When a person decides to disclose or talk about these traumatic experiences it can help healing. However, mental health staff often lack confidence and organisational support to ask about childhood traumatic events and struggle to know how to respond to disclosures or how best to offer follow up support.
A research method called experience-based co-design will be used to find different ways of supporting staff to safely have conversations about childhood trauma with service users. Experience-based co-design involves;
- Exploring experiences of service users' and staff through in-depth interviewing, observations and group discussions;
- Creating a short film of service users' experiences which helps staff and service users work together to identify areas for improvement and explore potential solutions;
- Staff and service users working together in teams to develop the ideas into actionable changes to service delivery
The co-designed intervention could include:
- A training package for community mental health team staff
- A toolkit for clinicians to help them to safely talk about childhood trauma with service users.
- Changes to the physical environment to make it feel safer
- A reflective practice group for staff
Anticipated impacts:
For service users: Improved experience of disclosing ACEs; improved access to trauma treatment; improved therapeutic relationships; improved mental health outcomes.
For staff: Improved confidence and competence to sensitively explore ACEs; improved compassion; greater job satisfaction
Detailed Description
Project plan
Study design and methods This study will follow the MRC framework for developing complex interventions(46), focussing on the development phases of complex intervention research.
A combination approach (47) of co-design and behaviour change theory will be used to guide the intervention development. This project will use an adapted experience-based co-design (EBCD) method to bring service user and staffs voices into the heart of the research process. This helps staff feel inspired and motivated to make and sustain changes to clinical practice.
I have consulted a range of key stakeholders including care co-ordinators, psychiatrists, psychologists and service managers working in the NHS. I have also facilitated two PPI workshops which have been instrumental in the development of this proposal (see PPI section). A Clinical Advisory Panel (CAP) and Lived Experience Advisory Group (LEAG) will be established and will meet regularly throughout the period of the PhD to give expert advice and guidance (see project management section).
Work package 1: An experience-based co-design multi-method qualitative study of the disclosure journey in a CMHT setting:
Study Design
- Study Type
- Interventional
- Allocation
- Na
- Intervention Model
- Single Group
- Primary Purpose
- Screening
- Masking
- None
Eligibility Criteria
- Ages
- 18 Years to — (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- Yes
Inclusion Criteria
- •Service users/survivors participants
- •be age 18 or over
- •have capacity to consent in research
- •self-reported lived experience of ACEs - defined by the ACE-IQ (WHO, 2018)
- •past or current service user of NHS community mental health services in England
- •Clinical staff participants:
- •NHS practitioners who currently or previously worked as a front line allied health professional in a community mental health team
- •employed by Sussex Partnership Foundation Trust
- •have capacity to consent to participate in research
- •be aged 18 or over
Exclusion Criteria
- •Service user/survivor participants
- •- People who have never received support from NHS community mental health services
- •Staff who have never worked in NHS community mental health services
Arms & Interventions
Intervention arm
Community mental health team staff will receive the intervention (training, toolkit, reflective supervision group and changes to the physical environment) over a period of six months.
Intervention: ACCEPT intervention (Behavioral)
Outcomes
Primary Outcomes
Therapeutic relationship
Time Frame: baseline, 3 months and 6 months
The STAR-C measure will be used to assess clinicians therapeutic relationships with their patients pre and post intervention (https://pubmed.ncbi.nlm.nih.gov/17094819/)
Professional Quality of Life (ProQOL)
Time Frame: baseline, 3 months and 6 months
The ProQOL will be used to measure clinicians compassion satisfaction and compassion fatigue (inc. burn out and indirect trauma)
Intervention acceptability and feasibility
Time Frame: 6 months post intervention
Interview and focus groups will be carried out with staff and service users to explore the acceptability and feasibility of the intervention
Secondary Outcomes
No secondary outcomes reported