The Realist Evaluation of changes to the Care Programme Approach 

The introduction of the Community Mental Health Framework for Adults and Older Adults (2019) initiated a shift away from ways of working associated with the Care Programme Approach (CPA). This shift has meant that community mental health services now work with people across a full spectrum of mental health problems and use a wider range of interventions. As an early implementer site, Somerset NHS Foundation Trust has been working to implement this framework, employing an intervention-based service necessitating the design of a new clinical model. These service changes have led to the adoption of a key working model using a cultural change approach, and removal of CPA. The University of Plymouth worked with key stakeholders across the Trust at strategic leadership, management and frontline staff level to explore the implementation of key working.  

Aims  

The aim of this project was to understand how, why, and under what circumstances the changes to key working occur. It was of particular interest to explore how, why and under what circumstances implementing key working may be more challenging, so that implementation could be optimised.    

Activity   

A Realist approach was employed to better understand key working in terms of what works, under what circumstances, for whom it works, and why.  Data were obtained using a researcher-in-residence (RiR) model enabling an in depth understanding of system changes. Interview and observational data were combined to address the aims of the project.  Data were analysed retroductively to explore the extent of change, create and refine a programme theory describing how, why, for whom and under what circumstances change was optimised, and to provide feedback on how to improve implementation.    

You can find out more about PenARC’s realist work here

You can find out more about the University of Plymouth’s researcher in residence work here

Outputs  

Findings were presented to leaders in Somerset so that they could be used to optimise further change.

A guide to undertaking key working successfully has been co-produced with Somerset NHS Foundation Trust.

Learning has been shared more widely across the South West 

Somerset NHS Foundation Trust leaders are working with experts by experience to utilise the findings to further optimise and improve key working in Somerset.