The Core Study


Underpinning principles

Too often service improvement initiatives can feel a bit "hit and run", failing to design in sustainability from the outset. With this in mind we have built in some key principles. You may notice that many of these principles chime with positive clinical practice and so will already be familiar to you if you have a clinical background or are responsible for clinical services. 

Working to local priorities, using local resources

Every CRT team and every local context is different. This resource pack is not designed to be a one size fits all service improvement tool. We hope it can be used to help address your team's priorities for developing the service, using the strengths and resources available to you. We will support you in developing positive practice in your CRT, but the plan for doing this will be made and put into practice by your team with the support of your local managers and other key people. We will seek to help you use the resources and knowledge of local management, the CRT team, and the experience of service users and carers in developing this plan, combined with our external feedback on how well your team is demonstrating that it meets current positive practice standards (your team's fidelity scale scores) and what we know from our research promotes effective CRT provision.

Starting with your strengths

No matter where you are on this journey towards improvement, you have assets that have helped you to do the best of what you currently do. We know from clinical experience that focusing disproportionately on problems, deficits and obstacles can drain energy for change. What we talk about gets bigger. So we will work with you to develop conversations about how you are when you are at your best. These are the assets that can be most trusted to take you into the future you seek, and so they need to be brought fully into everyone's awareness and then aligned to achieve maximum potential.

With no rose-tinted glasses

At the same time we will invite you to take a clear-eyed perspective on where you most need to develop as a service. Fortunately we have a fabulous resource of knowledge, skills and experience to support you on this journey. These are captured under "Resources for priority improvement" and we hope that the guidance here will continue to grow over the longer term in the light of all our experience of service improvement.   

Making the best use of evidence and positive practice

This resource pack brings together the leading edge and most recent national and international research on crisis resolution. We will support you in making best use of this resource both in continuing to build on your strengths and in helping you tackle those areas that you most want to develop. 

Working with you in context

We know that you are part of a complex local system of inter-related parts. What happens in one part of the local system has a knock on effect in another. This is particularly true of the crisis resolution response , which involves different parts of your local service working together. By focusing on the crisis response you are doing work of enormous importance to the functioning of your whole local mental health system. 

One key aspect of context that has been found to be helpful in large scale service improvement projects here and abroad is securing senior sponsorship within the organisation. We advocate that sponsorship for the work you are going to do to improve the team comes from senior trust level. The individual sponsor need not be actively involved day to day but they do need to have a watching brief and receive reports of progress for reporting at board level. Where this is not in place we will help you achieve it. 

Sometimes it might feel like all the power to make things better lies elsewhere. In our experience, pretty well everybody says that wherever and however senior they are in the local system. We will be working with you on what you have got (not what you haven't got!), including your power and influence.

Below is a helpful illustration of the difference between our circle of concern and our circle of influence.

Circle of influence

Often in team development contexts it can be temping to focus on the important things that concern us in the circle of concern such as resource shortfalls, the implications of another reorganisation, the state of the economy, cutback and state of our ailing planet. These things should concern us. At the same time by focusing too much on them, at the expense of exploring how we can make things better, we risk developing a sense of helplessness and hopelessness that does not help maintain energy for improvement. So instead we will invite you to focus on how you can expand your circle of influence to impact on the important things that concern you. 

In complex systems small actions can often have a big, sometimes unintended, effect. It is often only through taking actions that we understand how the local system actually works Such actions need personal and visible commitments made by a wide range of people, working together, and aligned to shared priorities. 

One way to achieve maximum influence is to focus on bringing  together those people who are interdependent on each other to achieve the outcome you seek. Having working groups that are as small as they can possibly by (ideally fewer than 7) comprising people who need each other to get the job done is key to effective teamwork . Including the voice of service users and their supports in such groups will greatly increase their effectiveness. 

Building local capacity for sustainable change

Support from senior management is important to achieve and sustain any service improvements the CRT team puts in place. We will seek the active involvement and support of senior managers in the improvement project. We will try to support CRT managers in seeking policy changes or additional resources from senior management.