Evaluating the implementation of a new approach to preventive care provided by community mental health services to people with a mental health condition

Services allocated to the intervention condition will implement a new approach to providing preventive care for key chronic disease risk behaviours (tobacco smoking, poor nutrition, harmful alcohol consumption, and physical inactivity) and weight. Practice change strategies, tailored to each service, will be delivered over 9-months to support the implementation of the new approach to preventive care. New approach to preventive care: A dedicated consultation will be scheduled for adult clients with a ‘healthy choices coach’ (HCC) dedicated to addressing risk behaviours. The HCC will be an experienced mental health clinician and will complete approximately a week of training in delivery of the intervention. This training will be delivered via mixed modes (online and face-to-face) by the research team. Training content and length will be developed in consultation with the participating services and be responsive to service preferences and feasibility. Intervention content will be framed around providing AAR: Assessment (asking about engagement in each of the risk behaviours), Advice (provision of brief advice to change risk behaviours) and Referral (to local available services) for risk factors; and setting relevant behaviour change goals. The consultation will incorporate behaviour change techniques, such as motivational interviewing and will be delivered in line with a manualised protocol developed collaboratively by the research team and participating services. The consultation we be approximately 40-minutes in length and we be delivered face-to-face (however, if required to respond to service demands, this mode may be adapted to be delivered via teleconference). To monitor adherence, a checklist will be used by the coach to record the aspects of the intervention that were delivered. An individualised care management plan will be initiated during the consultation; summarising the client’s current health behaviours, priority goal(s) for change, and referrals to behaviour change supports (offered and accepted). This plan will serve as a basis for ongoing behaviour change support in routine consultations (with the client's mental health clinician), to discuss client progress in achieving goals and taking up referrals. The care plan will be integrated in the electronic system (see practice change strategy 2 below), and a copy will also be provided to clients (the mode of doing so will be co-developed and tailored to participating services, and may include, for example, a printed hard copy at the time of the consultation and/or an electronic copy sent via email). Practice change strategies: Evidence based practice change strategies will be implemented by intervention services. These strategies will be co-developed with participating services to tailor them to the particular context of each service; aiming to implement the approach to preventive care as a component of standard practice. Implementation of the practice change strategies will not be sequential, and will occur simultaneously throughout the course of the intervention commencing at the beginning of the intervention period. These strategies will include: 1. Clinical leadership and consensus to reinforce and communicate the strong support for the new care initiative from service managers and clinical directors to staff. 2. Enabling systems: a template for the care management plan integrated into electronic records (available at the commencement of the intervention period). 3. Education and training for staff in the importance of preventive care, information regarding risk guidelines, strategies/skills for providing ongoing support for behaviour change and goal setting, and information about referral services. We anticipate utilising a variety of modes including online, face-to-face and written materials; with education provided throughout the intervention period. The exact content, mode of delivery, duration, frequency, and training provider will be co-developed with participating services to be tailored based on their differing needs, preferences and feasibility. 4. Audit and feedback: a working group within each service will create a brief summary of preventive care provision each month to provide to team leaders and clinicians, including recommendations for action where appropriate. Data to be included in the summary will be co-developed with participating services, and may include information regarding, for example, consultation attendance and care plans initiated. The mechanisms for how these feedback summaries will be provided to staff will also be co-developed and tailored to each service (for example, via email, in regular clinical review meetings, online presentation, etc.). 5. Client activation strategies: posters and leaflets will be placed in waiting rooms to inform clients about the extra consultation. 6. Healthy choices coach: a healthy choices coach will be embedded in the intervention services for a period of 9-months, with a dual role: (1) to provide the additional consultation to clients and (2) support all clinicians within the service to continue to provide preventive care in their routine consultations. Research staff will be in regular contact with the healthy choices coach to support them in that role. The new approach and practice change strategies will be implemented at the service level. Therefore, all clients of the intervention services will be subject to the intervention regardless of whether or not they are eligible for and/or take part in the data collection procedures. That is, participation in data collection will be independent of care provided by the mental health service. Data collection will comprise two cross-sectional surveys at baseline and 9-months of independent samples to assess practice change outcomes. Additionally, to enable assessment of client behaviour change outcomes, a random sub-sample of eligible participants who completed the baseline survey will be followed-up in a 9-month cohort follow-up (i.e. same sample).