Service user experiences of support and intervention from crisis resolution home treatment teams, and the implementation of Method of Levels therapy for people presenting to crisis resolution home treatment teams in the community.

  • Sara Goodier

Student thesis: Doctor of Clinical Psychology

Abstract

Abstract The aim of this thesis was to gain a better understanding of service user experiences of support and intervention from crisis resolution home treatment teams (CRHTTs), and explore of Method of Levels therapy for people who require acute care in the community. The implementation of CRHTTs facilitates individuals experiencing mental health crises being supported in the community, thereby reducing the likelihood of a potentially disruptive hospital admission. Currently, clinical practice in crisis services varies considerably and there is no commonly agreed theoretical framework to inform practice. As such, understanding service user experiences of crisis services is imperative to the delivery of service user-relevant and meaningful care. Paper one aimed to synthesise qualitative research that explored service user views and experiences of the intervention and support received from CRHTTs, to inform practice and service provision. As CRHTTs are commissioned to offer brief psychological interventions, a secondary aim exploring psychological interventions and processes with crisis team support was also included. Sixteen qualitative studies were identified. Using a reflexive approach to thematic synthesis, three superordinate themes which represented the implications of CRHTT care at different systemic levels were identified. Nine sub- themes were indicated to explore the relevant nuances of this: at the systemic level home access, implications of the practitioner-service user power balance, and continuation of care between services were highlighted. In terms of the service itself, participants discussed access, timing, and how the idea of 24-hour support could feel containing. Finally, individual experience of treatment being led by the person or by the service was reported and is discussed in relation to psychological safety. Recommendations for practice were indicated, particularly around practice that advocates for working towards a system that scaffolds compassionate, collaborative support around service users. Paper two presents the first study to evaluate the use of a client-led, transdiagnostic, cognitive therapy called Method of Levels (MOL) for people using CRHTTs. The study aimed to explore whether MOL could be feasibly delivered to people accessing CRHTTs and what their experiences of MOL as a therapy were. The secondary aim was to collect descriptive outcome data, to inform the design and specific hypotheses of future research. A case series design was used to deliver MOL to five participants who were successfully recruited into the study. All participants provided a post therapy qualitative interview which allowed the exploration of their experiences of MOL as an intervention. Outcome measures were administered at baseline, during intervention, post intervention and at one month follow-up. Recruitment and retention rates showed that it is feasible to recruit participants from CRHTTs and deliver MOL as an intervention alongside current care plans. Data collection indicated that it is possible to evaluate the intervention with this client group. Although there was a range of outcomes across study measures, the results suggest further investigation into the effectiveness of MOL as an intervention for people using CRHTTs would be worthwhile. Paper Three presents critical reflections of the research process. This paper provides further detail on the methodology and decision-making processes which took place during the project. The strengths and limitations of the work are considered and suggestions for future research and personal reflections are included. This paper concludes with dissemination plans.
Date of Award31 Dec 2023
Original languageEnglish
Awarding Institution
  • The University of Manchester
SupervisorSara Tai (Supervisor) & Warren Mansell (Supervisor)

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