Clair Le Boutillier

King's College London | KCL · Division of Methodologies

Background Liver disease is within the top five causes of premature death in adults. Deaths caused by complications of cirrhosis continue to rise, whilst deaths related to other non-liver disease areas are declining. Portal hypertension is the primary sequelae of cirrhosis and is associated with the development of variceal haemorrhage, ascites, hep...

Background Liver disease is within the top five causes of premature death in adults. Deaths caused by complications of cirrhosis continue to rise, while deaths related to other non-liver disease areas are declining. Portal hypertension, the primary sequalae of cirrhosis and is associated with the development of variceal haemorrhage, ascites, hepati...

People living with treatable-but-not-curable (TbnC) cancer encounter cancer-related needs. While the NHS long-term plan commits to offering a Holistic Needs Assessment (HNA) and care plan to all people diagnosed with cancer, the content, delivery and timing of this intervention differs across practice. Understanding how people make sense of their c...

Background Lung cancer is the third most common type of cancer in the UK. Treatment outcomes are poor and UK deaths from lung cancer are higher than any other cancer. Prehabilitation has shown to be an important means of preparing patients both physically and psychologically for cancer treatment. However, little is understood about the context and...

Objectives Our aim was to examine the feasibility and implementation of a complex intervention to improve the care of patients with peripheral arterial disease (the LEGS intervention) from the perspective of patients, general practitioners and secondary care clinicians. Design A qualitative study involving semistructured individual interviews with...

Background The Beta-blockers Or Placebo for Primary Prophylaxis of oesophageal varices (BOPPP) trial is a 3-year phase IV, multi-centre clinical trial of investigational medicinal product (CTIMP) that aims to determine the effectiveness of carvedilol in the prevention of variceal bleeding for small oesophageal varices in patients with cirrhosis. Ea...

Background The Community and Hospital cAre Bundle to improve the medical treatment of cLaudIcation and critical limb iSchaemia (CHABLIS) study is a prospective mixed-methods study across NHS hospitals and primary care networks, which aims to determine the feasibility of using a complex intervention in the form of a care bundle, consisting of checkl...

Objectives: Individuals with psychosis report that emotion regulation (ER) difficulties are treatment priorities, yet little is known about how targeted ER interventions may help. We evaluated a new eight-session Dialectical Behavioural Therapy (DBT)-informed skills group specifically adapted for individuals with psychosis: the Managing Emotions G...

Objective The success of pharmacological randomised controlled trials (RCTs) depends on the recruitment of the required number of participants. Recruitment to RCTs for patients with cirrhosis and small oesophageal varices raises specific additional challenges. The objectives of the study were 1) to explore patient perspectives on factors that influ...

Purpose Living with and beyond cancer is an increasingly common experience. While research is uncovering valuable individual experiences of those living with and beyond cancer, it has been argued that this idiographic approach is limited in outlook, reach and impact. This study contributes to the understanding of what it means to live with and beyo...

Background The concept of living with and beyond cancer is now emerging in policy and literature. Rather than viewing this notion simply as a linear timeline, developing an agreed understanding of the lived experience of people affected by cancer will aid the development of person‐centred models of care. Methods A systematic review was conducted....

Background: Recovery in mental health services is defined as living a satisfying, hopeful, and contributing life even with any limitations caused by illness. An evidence base for understanding and supporting recovery is needed. Objectives: To carry out a programme of linked research studies to understand how mental health services can promote recov...

Purpose: Policy is increasingly focused on implementing a recovery-orientation within mental health services, yet the subjective experience of individuals receiving a pro-recovery intervention is under-studied. The aim of this study was to explore the service user experience of receiving a complex, pro-recovery intervention (REFOCUS), which aimed t...

Background There is consensus about the importance of ‘recovery’ in mental health services, but the link between recovery orientation of mental health teams and personal recovery of individuals has been underresearched. Aims To investigate differences in team leader, clinician and service user perspectives of recovery orientation of community adult...

Little is known about the empirical relationship between clinical and personal recovery. Aims: To examine whether there are separate constructs of clinical recovery and personal recovery dimensions of outcome, how they change over time and how they can be assessed. Method: Standardised outcome measures were administered at baseline and one-year f...

Background Supporting recovery is the aim of national mental health policy in many countries. However, only one measure of recovery has been developed in England: the Questionnaire about the Process of Recovery (QPR), which measures recovery from the perspective of adult mental health service users with a psychosis diagnosis.AimsTo independently ev...

Background There is an emerging evidence base about best practice in supporting recovery. This is usually framed in relation to general principles, and specific pro-recovery interventions are lacking.AimsTo develop a theoretically based and empirically defensible new pro-recovery manualised intervention - called the REFOCUS intervention.Method Seve...

Pre-defined, researcher-selected outcomes are routinely used as the clinical end-point in randomized controlled trials (RCTs); however, individualized approaches may be an effective way to assess outcome in mental health research. The present study describes the development and evaluation of the Individualized Outcome Measure (IOM), which is a pati...

Mental health policy is for staff to transform their practice towards a recovery orientation. Staff understanding of recovery-orientated practice will influence the implementation of this policy. The aim of this study was to conduct a systematic review and narrative synthesis of empirical studies identifying clinician and manager conceptualisations...

Mental health policy in many countries is oriented around recovery. The evidence base for service-level pro-recovery interventions is lacking. Methods: Two-site cluster randomised controlled trial in England (ISRCTN02507940). REFOCUS is a one-year team-level intervention targeting staff behaviour (increasing focus on patient values, preferences, st...

Clinical guidelines for the treatment of people experiencing psychosis have existed for over a decade, but implementation of recommended interventions is limited. Identifying influences on implementation may help to reduce this translational gap. The Structured Assessment of Feasibility (SAFE) measure is a standardised assessment of implementation...

This report summarises the finding from the REFOCUS programme, which took place in England from 2009 to 2014. The document is written for the general public, and describes what the study involved and what we found. The REFOCUS programme was a 5 year research study which aimed to understand what is meant by personal recovery and to find effective wa...

No individualised standardised measure of staff support for mental health recovery exists. To develop and evaluate a measure of staff support for recovery. Development: initial draft of measure based on systematic review of recovery processes; consultation (n = 61); and piloting (n = 20). Psychometric evaluation: three rounds of data collection fro...

Recovery has come to mean living a life beyond mental illness, and recovery orientation is policy in many countries. The aims of this study were to investigate what staff say they do to support recovery and to identify what they perceive as barriers and facilitators associated with providing recovery-oriented support. Data collection included ten f...

Objective: To investigate staff and trainer perspectives on the barriers and facilitators to implementing a complex intervention to help staff support the recovery of service users with a primary diagnosis of psychosis in community mental health teams. Design: Process evaluation nested within a cluster randomised controlled trial (RCT). Partici...

Objective: Mental health services in the UK, Australia and other Anglophone countries have moved towards supporting personal recovery as a primary orientation. To provide an empirically grounded foundation to identify and evaluate recovery-oriented interventions, we previously published a conceptual framework of personal recovery based on a system...

The feasibility of implementation is insufficiently considered in clinical guideline development, leading to human and financial resource wastage. To develop (a) an empirically based standardised measure of the feasibility of complex interventions for use within mental health services and (b) reporting guidelines to facilitate feasibility assessmen...

OBJECTIVE Mental health systems internationally have adopted a goal of supporting recovery. Measurement of the experience of recovery is, therefore, a priority. The aim of this review was to identify and analyze recovery measures in relation to their fit with recovery and their psychometric adequacy. METHODS A systematic search of six data sources...

The distinction between clinical recovery and personal recovery is made, and the dominance of personal recovery as a guiding vision for mental health services is described. Two empirically based conceptualisations are presented: a recovery practice framework developed through inductive thematic analysis to identify how services can support recovery...

Strengths assessments focus on the individual's talents, abilities, resources, and strengths. No systematic review of strengths assessments for use within mental health populations has been published. The aims of this study were to describe and evaluate strengths assessments for use within mental health services. A systematic review identified 12 s...

Health Service and Population Research Department, Institute of Psychiatry, London, UKIntroductionRecovery has come of age. The recoveryapproach has gained traction in mental health policythroughout the English-speaking world, and – at least rhetorically – within mental healthsystems internationally (Slade et al., 2008). But with age comes responsi...

Aims: Mental health policy internationally varies in its support for recovery. The aims of this study were to validate an existing conceptual framework and then characterise by country the distribution, scientific foundations and emphasis in published recovery conceptualisations. Methods: Update and modification of a previously published systema...

The review aimed to (1) identify measures that assess the recovery orientation of services; (2) discuss how these measures have conceptualised recovery, and (3) characterise their psychometric properties. A systematic review was undertaken using seven sources. The conceptualisation of recovery within each measure was investigated by rating items ag...

No systematic review and narrative synthesis on personal recovery in mental illness has been undertaken. To synthesise published descriptions and models of personal recovery into an empirically based conceptual framework. Systematic review and modified narrative synthesis. Out of 5208 papers that were identified and 366 that were reviewed, a total...

Recovery is a multifaceted concept, and the need for operationalization in practice has been identified. Although guidance on recovery-oriented practice exists, it is from disparate sources and is difficult to apply. The aims of the study were to identify the key characteristics of recovery-oriented practice guidance on the basis of current interna...

There is a consensus about the importance of 'recovery' in mental health services, but the evidence base is limited. A two centre, cluster randomised controlled trial. Participants are community-based mental health teams, and service users aged 18-65 years with a primary clinical diagnosis of psychosis. In relation to the REFOCUS Manual researchint...

Background/Objectives: This paper will describe the REFOCUS RCT, which is currently underway in two mental health trusts in the UK. It has been designed to evaluate whether service users in the intervention arm will experience significantly greater increases in measures of personal recovery, as measured by the Processes of Recovery Questionnaire (Q...

Background/Objectives: Despite an increased emphasis on personal recovery within both mental health services and the literature, there is little empirical research regarding the perspectives on recovery of individuals from black communities. Furthermore, the recovery literature has been described as ‘monocultural', with authors noting a lack of emp...

Background/Objectives: The concept of recovery is being increasingly promoted in mental health research and policy, and mental health services are encouraged to consider their role in supporting the recovery of individuals who experience severe mental illness. Although guidance on recovery orientated practice exists, a lack of clarity around what c...

Background/Objectives: One of the aims for mental health services is to promote recovery for service users. A challenge for services is how to assess their progress in doing this. One method to assess recovery is to use standardised outcome measures. A new measure (INSPIRE) has been developed as part of the REFOCUS project which assesses the recove...

Although there is now increasing evidence as to the role played by social factors in contributing to the onset of mental health difficulties, there has been little systematic examination of the role that social factors can play in enabling (or impeding) recovery. This paper provides a review of the emerging international literature in this area, an...

Social inclusion is a leading concept in mental health practice. Multiple definitions exist and it is often assumed that full participation is required to achieve full inclusion. Challenging this assumption is the notion of ‘middle-ground’, a personally defined position where an individual feels socially included regardless of his or her physical i...