National Institute of Health Research

HS&DR - 11/2004/12: Cross-national comparative mixed-methods case study of recovery-focused mental health care planning and co-ordination: Collaborative Care Planning Project (COCAPP)

Project title Cross-national comparative mixed-methods case study of recovery-focused mental health care planning and co-ordination: Collaborative Care Planning Project (COCAPP)
Research type Primary Research
Status Project complete
Start date October 2012
Publication date

April 2015

Link to journal publication
Cost £ 388,437.33
Chief Investigator Professor Alan Simpson
Co-investigators Dr Michael Coffey (Swansea University), Dr Ben Hannigan (Cardiff University), Dr Aled Jones (Cardiff University)
Contractor City University London
Plain English summary In this study we plan to find out how care is planned and organised in mental health services. We are interested to know whether and how care planning and coordination may focus on people's recovery and be conducted in a personlaised way. We will do this by looking at how care coordinators assess, plan and coordinate care on a day-to-day basis. We will investigate whether staff work in partnership with users and carers, how they plan service users care, and how they work to address that care plan. To do this we will carry out the study in six different NHS Trust/Health Board sites in England and Wales and we will use a range of methods. Interviews: We plan to interview 12 senior managers, 30 senior practitioners (e.g. Consultant Psychiatrists, Lead Nurses), 36 service user, 24 carers and 36 care co-ordinators. Questionnaires: We will ask about 400 service users to complete three questionnaires about recovery, empowerment and therapeutic relationships We will ask about 200 care coordinators to complete the same questionnaire about recovery. We will also review local policies and audits about care planning and review 36 service users' care plans. We hope to reveal the kinds of things that work best when helping people who have difficulties with their mental health. There is already a system in place to plan and organise care for individuals with mental health difficulties. This system, called the care programme approach (CPA), is seen as best practice in England and is now law in Wales. All people under this system are meant to have a named worker (called a care coordinator) and a written plan to guide the care and treatment they get. These care plans should be specific to the person and help them to get better. We also know that people receiving help should be part of any decisions made about their care. However, even though the CPA is part and parcel of how care is organised and delivered to people with mental health problems in England and Wales it is surprising how very little research has been done on how this system works, and why it sometimes doesn't. The evidence for similar systems of care shows that they help people stay in contact with services but also increase admissions to hospital and have little effect on the symptoms people have. We also know that if workers focus more closely on getting to know the person and agreeing plans with them they tend to do better. However, people may need to be helped to become better involved in their own care and how workers do this seems to be important. The system of care that currently exists has some faults. These faults include too much paperwork, and too much time for care coordinators away from service users. What happens within care teams also seems to be important in deciding the quality of care received. Even when the CPA is used many people say they are still uncertain who their care coordinator is, have not been offered a copy of their care plan or don't understand what is in them. Some also say that their plans don't take into account their views of what is needed. We also know that for the minority of people with mental health problems who go on to harm others this care system has not been properly used in most cases. Our plan is to get close to day-to-day work in typical mental health teams in order to find out what is really going on in care planning and care coordination, and to share the information we find with people in a position to improve the planning and delivery of care to people with mental health problems.
Scientific summary Design: We propose to undertake a two-phase cross-national comparative study of recovery-focused mental health care planning and coordination. We will conduct a detailed comparative analysis of ostensibly similar approaches to recovery-focused CPA care planning and coordination within different government, legislative, policy and provider contexts. Phase 1: a) review of international literature on care planning and coordination processes and their relationships to recovery and personalisation; and b) comparative analysis of mental health policy and service frameworks in England and Wales. We will adopt Greenhalgh et al s (2004) meta-narrative mapping technique (MNM) to provide a review of evidence that is most useful, rigorous and relevant for service providers and decision-makers. Comparative analysis of policy and service frameworks will identify all key national-level policy and guidance documents relating to mental health care planning and coordination, recovery and personalisation across the two countries. We will identify major themes and areas of policy convergence and divergence to describe macro-level national policy contexts to inform our case study research interviews. Phase 2: We are employing a concurrent transformative mixed methods approach with embedded case studies (Creswell 2009: 215). We will conduct six in-depth meso-level case study investigations across contrasting case study sites in England (n=4) and Wales (n=2). Four NHS Trusts in England and two Local Health Boards in Wales are selected to reflect variety in geography and population and include a mix of rural, urban and inner city settings in which routine community care is provided. Across the Trust/Board sites a large sample of service users (total n=400) and care coordinators (n=200) will be surveyed about recovery oriented practices, therapeutic relationships and empowerment to develop a Recovery profile of the organisation. Measures include the Recovery Self Assessment Scale (RSA) (O Connell et al 2005); the Scale To Assess the Therapeutic Relationship (STAR) (McGuire-Snieckus et al 2007); and the Empowerment Scale (ES) (Rogers et al, 1997). Documents and interviews with senior managers/practitioners will also be generated relating to local contexts, policies and practices. In each site we will also select a single CMHT and invite a sample of service users (total n=36) to become the starting point for a series of embedded case studies nested within each meso-level organisational case study. Each service user, their informal carers where possible (n=24), and their care coordinator (n=36) will be interviewed and CPA care plans will be reviewed. Analysis and interpretation of the case study data will be informed by a conceptual framework that emphasises the connections between different (macro/meso/micro) levels of policy and service organisation and that draws on the findings of the literature and policy review.
  1. Ordinary risks and accepted fictions: how contrasting and competing priorities work in risk assessment and mental health care planning.

    Authors: Coffey M, Cohen R, Faulkner A, Hannigan B, Simpson A, Barlow S.

    Reference: Health Expectations ;doi: 10.1111/hex.12474. [Epub ahead of print]

  2. Recovery-focused care planning and coordination in England and Wales: a cross-national mixed methods comparative case study

    Authors: Simpson A, Hannigan B, Coffey M, Barlow S, et al

    Reference: BMC Psychiatry 2016;16:147


Specification Document (PDF File - 136.2 KB)

Protocol (PDF File - 517.9 KB)


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