Implications for policy and practice
- Those developing and delivering the new Enhanced Reconnect services for high risk prison leavers – the Engager model has many similarities in that is designed to provide personalised wrap around care. The depth Engager process evaluation provides insights for practice and support to those delivering care.
- Those voluntary, community or social enterprise (VCSE) services looking after individuals with complex needs in the community in the housing, substance misuse and criminal justice sectors – we propose a new model adapted from engager where an experienced specialist mental health worker provides supervision to the many support workers already providing mental health support outside of specialist services.
- A realist review of psycho-social care for individuals with complex needs;
- Case studies within services demonstrating promising intervention features;
- Focus groups with individuals from underrepresented groups;
- A rapid realist review of the intervention implementation literature;
- A formative process evaluation of the prototype intervention.
- Selection of outcome measures through review of the literature, piloting of measures and a consensus process with stakeholders;
- Development of ways to quantify treatment as usual and intervention receipt;
- Piloting of trial procedures;
- Modelling economic outcomes.
- An individually-randomised superiority trial of the Engager intervention;
- A cost-effectiveness and cost-consequence analysis;
- An in-depth mixed methods process evaluation.
- Weston L, Rybczynska-Bunt S, Quinn C, Lennox C, Maguire M, Pearson M, et al. Interrogating intervention delivery and participants’ emotional states to improve engagement and implementation: a realist informed multiple case study evaluation of Engager. PLOS ONE 2022;17:e0270691. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0270691
- Byng R, Kirkpatrick T, Lennox C, Warren FC, Anderson R, Brand SL, et al. Evaluation of a complex intervention for prisoners with common mental health problems, near to and after release: The Engager randomised controlled trial [published online ahead of print August 18 2022]. Br J Psych 2022. https://pubmed.ncbi.nlm.nih.gov/35978272/
- Hunter RM, Anderson R, Kirkpatrick T, Lennox C, Warren F, Taylor R, et al. Economic evaluation of a complex intervention (Engager) for prisoners with common mental health problems, near to and after release: a cost-utility and cost-consequences analysis. Eur J Health Econ 2022;22:193–210. https://doi.org/10.1007/s10198-021-01360-7
- Rybczynska-Bunt S, Weston L, Byng R, Stirzaker A, Lennox C, Pearson M, et al. Clarifying realist analytic and interdisciplinary consensus processes in a complex health intervention: a worked example of judgemental rationality in action. Evaluation 2021;27. https://doi.org/10.1177/13563890211037699
- Lennox C, Stevenson R, Owens C, Byng R, Brand SL, Maguire M, et al. Using multiple case studies of health and justice services to inform the development of a new complex intervention for prison-leavers with common mental health problems (Engager). Health Justice 2021;9:6. https://doi.org/10.1186/s40352-021-00131-z
- Brand SL, Quinn C, Pearson M, Lennox C, Owens C, Kirkpatrick T, et al. Building programme theory to develop more adaptable and scalable complex interventions: realist formative process evaluation prior to full trial. Evaluation 2019;25:149–70. https://doi.org/10.1177/1356389018802134
- Taylor C, Gill L, Gibson A, Byng R, Quinn C. Engaging ‘seldom heard’ groups in research and intervention development: offender mental health. Health Expect 2018;21:1104–10. https://doi.org/10.1111/hex.12807
- Owens C, Carter M, Shenton D, Byng R, Quinn C. Engaging without exposing: use of a fictional character to facilitate mental health talk in focus groups with men who have been subject to the criminal justice system. Qual Health Res 2018;28:2102–14. https://doi.org/10.1177/1049732318785359
- Lennox C, Kirkpatrick T, Taylor RS, Todd R, Greenwood C, Haddad M, et al. Pilot randomised controlled trial of the ENGAGER collaborative care intervention for prisoners with common mental health problems, near to and after release. Pilot Feasibility Stud 2018;4:15. https://doi.org/10.1186/s40814-017-0163-6
- Kirkpatrick T, Lennox C, Taylor R, Anderson R, Maguire M, Haddad M, et al. Evaluation of a complex intervention (Engager) for prisoners with common mental health problems, near to and after release: study protocol for a randomised controlled trial. BMJ Open 2018;8:e017931. https://doi.org/10.1136/bmjopen-2017-017931
- Owens, C., Carter, M., Shenton, D., Byng, R. & Quinn, C. (2018). Engaging Without Exposing: Use of a Fictional Character to Facilitate Mental Health Talk in Focus Groups With Men Who Have Been Subject to the Criminal Justice System. Qualitative Health Research, 28(13).
- Brand, S.L., Quinn, C., Pearson, M., Lennox, C., Owens, C., Kirkpatrick, T., Callaghan, L., Stirzaker, A., Miche, S., Maguire, M., Shaw, J. & Byng, R. (2019). Building programme theory to develop more adaptable and scalable complex interventions: Realist formative process evaluation prior to full trial. Evaluation, 25(22):149-170.
- Lennox, C., Kirkpatrick, T., Taylor, R.S., Todd, R., Greenwood, C., Haddad, M., Stevenson, C., Stewart, A., Shenton, D., Carroll, L., Brand, S.L., Quinn, C., Anderson, R., Maguire, M., Harris, T., Shaw, J. & Byng, R. (2018). Pilot randomised controlled trial of the ENGAGER collaborative care intervention for prisoners with common mental health problems, near to and after release. Pilot and Feasibility Studies, 7(4):15.
- Kirkpatrick, T., Lennox, C., Taylor, R., Anderson, R., Maguire, M., Haddad, M., Michie, S., Owens, C., Durcan, G., Stirzaker, A., Henley, W., Stevenson, C., Carroll, L., Quinn, C., Brand, S.L., Harris, T., Stewart, A., Todd, R., Rybczynska-Bunt, S., Greer, R., Pearson, M., Shaw, J. & Byng, R. (2018). Evaluation of a complex intervention (Engager) for Prisoners with Common Mental Health Problems, Near to and After Release: Study Protocol for a Randomised Controlled Trial. BMJ Open, 8(20):e017931.
- Taylor, C., Gill, L., Gibson, A., Byng, R. & Quinn, C. (2018). Engaging “seldom heard” groups in research and intervention development: Offender mental health. Health Expectations, 21(6):1104-1110.
- Pearson, M., Brand, S.L., Quinn, C., Shaw, J., Maguire, M., Michie, S., Briscoe, S., Lennox, C., Stirzaker, A., Kirkpatrick, T. & Byng, R. (2015). Using realist review to inform intervention development: methodological illustration and conceptual platform for collaborative care in offender mental health. Implementation Science, 10:134.
- Pearson M, Brand SL, Quinn C, Shaw J, Maguire M, Michie S, et al. Using realist review to inform intervention development: methodological illustration and conceptual platform for collaborative care in offender mental health. Implement Sci 2015;10:134. https://doi.org/10.1186/s13012-015-0321-2
Strengths and limitations
Patient and Public Involvement (PPI)
- Trial science; including refining study documents such as invitation letters, consent forms, interview schedules and deciding on outcome measures, and explaining randomisation;
- Qualitative data capture (co-facilitating focus groups allowing participants to feel more comfortable to contribute) and analysis (reviewing focus groups transcripts ‘line-by-line with an academic researcher);
- Training new academic researchers in delivering interview schedules;
- Intervention theory development;
Engager Peer Researcher film
A video telling the story of what it meant to the Peer Researchers to be involved in Engager, and the advice they would give to someone else considering being involved in a research project.
Summary of the Engager intervention
Meet the team
This research was a collaboration between the Faculty of Health and The University of Manchester, along with several other institutions and individuals.
It was led by Professor Richard Byng at Plymouth and Professor Jenny Shaw at Manchester.
The Northwest team:
Professor Jenny Shaw, University of Manchester
Principal Investigator – Northwest Site
Dr Charlotte Lennox, University of Manchester
Senior Research Fellow; Project Manager for Northwest site
Collaborators: Exeter University
- Professor Rob Anderson, Associate Professor of Health Economics and Evaluation
- Professor Rod Taylor, Professor of Health Services Research
- Professor William Henley, Professor of Medical Statistics
- Dr Mark Pearson, Senior Research Fellow
- Dr Christabel Owens, Senior Research Fellow.
Collaborators: other institutions
Professor Susan Michie
Director, UCL Centre for Behaviour Change
Dr Nat Wright
Associate Medical Director Specialist Services and Vulnerable Groups
Leeds Community Healthcare
Professor Mike Maguire
Professor in Criminology
University of South Wales
Dr Alex Stirzaker
IAPT Advisor and Specialist in PD and SMI
Avon & Wiltshire Mental Health Partnership NHS Trust
Dr Mark Haddad
Senior Lecturer in Mental Health
City University London
Dr Graham Durcan
Associate Director, Criminal Justice
Centre for Mental Health
Senior Research Associate
Dr Christine Brown
Consultant Forensic Psychiatrist
Devon Partnership Trust
Dr Tirril Harris
Former Senior Research Fellow
King’s College London.