Clio Berry1, Joanne Hodgekins2, Paul French3, Tim Clarke4, Lee Shepstone5, Garry Barton5, Robin Banerjee6, Rory Byrne7, Rick Fraser8, Kelly Grant5, Kathryn Greenwood9, Caitlin Notley10, Sophie Parker7, Jon Wilson4, Alison R Yung11, David Fowler9. 1. School of Psychology, University of Sussex, Brighton, UK; and Research & Development, Sussex Partnership NHS Foundation Trust, Brighton, UK; and Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK. 2. Norwich Medical School, University of East Anglia, Norwich, UK; and Research & Development, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK. 3. Manchester Metropolitan University, Faculty of Health, Psychology and Social Care, UK; and Pennine Care Mental Health NHS Foundation Trust, Ashton-under-Lyne, UK. 4. Research & Development, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK. 5. Norwich Clinical Trials Unit, University of East Anglia, Norwich, UK. 6. School of Psychology, University of Sussex, Brighton, UK. 7. Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK. 8. Research & Development, Sussex Partnership NHS Foundation Trust, Brighton, UK. 9. School of Psychology, University of Sussex, Brighton, UK; and Research & Development, Sussex Partnership NHS Foundation Trust, Brighton, UK. 10. Norwich Medical School, University of East Anglia, Norwich, UK. 11. Centre for Youth Mental Health, University of Melbourne, Australia; and School of Health Sciences, University of Manchester, UK.
Abstract
BACKGROUND: Young people with social disability and severe and complex mental health problems have poor outcomes, frequently struggling with treatment access and engagement. Outcomes may be improved by enhancing care and providing targeted psychological or psychosocial intervention. AIMS: We aimed to test the hypothesis that adding social recovery therapy (SRT) to enhanced standard care (ESC) would improve social recovery compared with ESC alone. METHOD: A pragmatic, assessor-masked, randomised controlled trial (PRODIGY: ISRCTN47998710) was conducted in three UK centres. Participants (n = 270) were aged 16-25 years, with persistent social disability, defined as under 30 hours of structured activity per week, social impairment for at least 6 months and severe and complex mental health problems. Participants were randomised to ESC alone or SRT plus ESC. SRT was an individual psychosocial therapy delivered over 9 months. The primary outcome was time spent in structured activity 15 months post-randomisation. RESULTS: We randomised 132 participants to SRT plus ESC and 138 to ESC alone. Mean weekly hours in structured activity at 15 months increased by 11.1 h for SRT plus ESC (mean 22.4, s.d. = 21.4) and 16.6 h for ESC alone (mean 27.7, s.d. = 26.5). There was no significant difference between arms; treatment effect was -4.44 (95% CI -10.19 to 1.31, P = 0.13). Missingness was consistently greater in the ESC alone arm. CONCLUSIONS: We found no evidence for the superiority of SRT as an adjunct to ESC. Participants in both arms made large, clinically significant improvements on all outcomes. When providing comprehensive evidence-based standard care, there are no additional gains by providing specialised SRT. Optimising standard care to ensure targeted delivery of existing interventions may further improve outcomes.
BACKGROUND: Young people with social disability and severe and complex mental health problems have poor outcomes, frequently struggling with treatment access and engagement. Outcomes may be improved by enhancing care and providing targeted psychological or psychosocial intervention. AIMS: We aimed to test the hypothesis that adding social recovery therapy (SRT) to enhanced standard care (ESC) would improve social recovery compared with ESC alone. METHOD: A pragmatic, assessor-masked, randomised controlled trial (PRODIGY: ISRCTN47998710) was conducted in three UK centres. Participants (n = 270) were aged 16-25 years, with persistent social disability, defined as under 30 hours of structured activity per week, social impairment for at least 6 months and severe and complex mental health problems. Participants were randomised to ESC alone or SRT plus ESC. SRT was an individual psychosocial therapy delivered over 9 months. The primary outcome was time spent in structured activity 15 months post-randomisation. RESULTS: We randomised 132 participants to SRT plus ESC and 138 to ESC alone. Mean weekly hours in structured activity at 15 months increased by 11.1 h for SRT plus ESC (mean 22.4, s.d. = 21.4) and 16.6 h for ESC alone (mean 27.7, s.d. = 26.5). There was no significant difference between arms; treatment effect was -4.44 (95% CI -10.19 to 1.31, P = 0.13). Missingness was consistently greater in the ESC alone arm. CONCLUSIONS: We found no evidence for the superiority of SRT as an adjunct to ESC. Participants in both arms made large, clinically significant improvements on all outcomes. When providing comprehensive evidence-based standard care, there are no additional gains by providing specialised SRT. Optimising standard care to ensure targeted delivery of existing interventions may further improve outcomes.
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