About FERN

This page is designed to give an outline of the FERN research proposal and what member EI services should expect from joining the network. It explains why FERN is needed, how FERN will work, ways in which your service could benefit from FERN and gives guidance on how to gain funding in order to join FERN. It also details how FERN will interface with all the members to ensure smooth running of the evaluation and component work underpinning this.

The aim of FERN

The FERN network aims to identify the illness, treatment and service factors involved in maximising outcomes in first episode psychosis through evaluation of individuals managed by member early intervention services across the U.K.

Background

Delay between onset of psychosis and first treatment is considerable (McGorry & Jackson, 1999; Birchwood, Todd & Jackson, 1998) and has been linked in research to poor outcome, lengthier hospital admission (Wiersma et al, 1998) and long-term treatment resistant symptoms (Harrow et al, 1995). The early phase of psychosis has been identified as a ‘critical period’ in the long-term trajectory of psychosis. The National Service Framework for Mental Health proposes the development of early intervention services (EIS) for early psychosis, and has ring fenced substantial funding for this purpose (DoH National Plan, 2000). In light of these developments, a number of centres with existing or developing early intervention services across the U.K. have formed a network (FERN) to:

(a) standardise research and evaluation measures conducted with this client group.
(b) to address research questions of national interest in the ‘roll out’ of these services and in improving the early outcome of this illness.

By standardising methods of evaluation across different services, FERN will provide a large cohort of participants. This will increase the statistical power of investigations into factors influencing outcome. Over a series of collaborative research meetings, the network have agreed a set of ‘core’ questions for investigation in a naturalistic, prospective study of outcomes in first episode psychosis managed by these new Early Intervention services.

Method:

Recruitment.

Clients who are referred to Mental Health NHS Early Intervention Services that are members of the FERN network, having experienced a first episode of psychosis will be approached for participation in the project. They will be given an information sheet regarding the project and a consent form to sign. Recruitment will be postponed if any individual is felt to be incapable of giving informed consent by the clinical team. There are no exclusion criteria. A similar process will exist for the recruitment of relatives and carers.

Assessments.

The assessments constituting the FERN methodology have excellent clinical applicability. Member services are strongly encouraged to adopt these tools into the standard clinical assessment procedures, undertaken by all case managers, with each client accepted by the service. As such, consent will only require the permission from the client and their carer or relative to access clinical data from the clients notes, which will be employed for the local service and national Early Intervention evaluations by FERN. All such data will be anonymised. There is a considerable advantage to this approach as services will be in the position to internally audit (I.e. a non-FERN evaluation) all clientele data

Modular Approach.

Originally, it was expected that each FERN member service would complete all the measurements relating to the core research questions. However, from collaborative research meetings, it was found that some of the developing Early Intervention services encountered various obstacles:

Problems in recruiting staff have led to a select number of assessments being employed rather than the complete battery.
Staffing capacity is not sufficient to incorporate the FERN evaluations.
Funding options such as Priority and Needs and Support for Science need to be explored further.
New staff members do not have the training to perform the assessments competently and trained team members have moved to other posts/areas.

As a result a modular approach to FERN has been established. Each participating service will only be required to undertake a ‘core module’ of assessments on each client. After collecting 6 months of data on this ‘core module’, the service then chooses optional extra modules, which are of relevance or interest to their locality or team. This ensures that issues of staffing and funding do not burden developing services as they will not have to ‘oversubscribe’ to the full FERN assessment battery. Additionally it is important to ensure data collection and input is undertaken regularly, and that services are not overburdened by opting for too many modules.

Local Arrangements.

Besides the involvement of the lead contact and lead trainer, FERN strongly encourages each member service to establish a local steering group that focuses primarily on the implementation on FERN protocols and, in addition:

Establish local innovation, e.g. user/carer involvement in aspects of FERN data collection and evaluation.
Management of evaluation data within the service.
Identification of potential problems and advantages in the implementation/running of the FERN evaluation.
Highlighting of local issues and variations specific to the EI service cohort and resource.

Steering group reports and minutes will be posted on the member-only section of the FERN server to encourage cross-fertilisation of ideas and practices.

Training.

Once a service has signed up to FERN they will be able to select one member (the lead trainer) to be extensively trained in the workings of the ‘core module’. This member will then be in a position to train the other members of their Early Intervention service. This method of training enables administrative and training costs to the network to be kept manageable. It should also counter the problems faced by new staff as services will be capable of training them rapidly and on site. FERN has developed training videos and materials to assist lead trainers and to ensure concordance is achieved for assessments within and across services. The following flow chart demonstrates the training pathway for the modular system:

Caldicott (data protection) requirements.

All data that would potentially identify a client (i.e. Demographic information) is to be stored locally. Two identical, password-protected, Microsoft Excel demographic databases will be provided on CD-RW discs, on of which is a back-up in the event of either disc being lost. Each disc will be stored, within locked cabinets, in separate buildings to ensure that instances of theft, fire etc. do not lead to a loss of data that has required a substantial amount of time and resources to collect.

The encrypted Excel database will carry all personal client data and also a unique site number and client identifier for each person consenting to the FERN study. These latter two numbers will be replicated on the FERN server when client assessment data is entered. This will allow for the merging of the demographic data and assessment data at the time of statistical analyses/service evaluation.

Clinical teams will have full access to the data of all individuals in their care. This data will be combined into a master database by the chief investigator for analysis. The primary analytical procedure will be logistic and multiple regression to evaluate outcomes in relation to categorical and continuous variables.

Collaborative Projects:

We each collect core data at baseline and follow up points as per protocol.
The core research questions as detailed in the FERN protocol
We agree about who will take the lead in writing analyzing each project.
Anyone can make a proposal for analysing data; must be put to the partners for agreement.

Special Projects:

One or more centres might want to set up a particular project in their centres (e.g. 2 centre Study). This will usually involve collecting further data…
Need to inform others and seek further collaboration if necessary.

Publications:

The lead centre for a particular piece of work chooses first author.
Co- authors include nominated individuals at collaborating centres.
‘FERN’ is acknowledged in the authorship for all publications, whether ‘collaborative’ or ‘special’.
Each centre can publish their own data as they wish, but (a) must not conflict with main publications (b) acknowledge FERN.

Intellectual Ownership:

The intellectual property rights reside with FERN (registered as a network in NHS R&D).

Data Entry:

Each centre is responsible for data entry using the common template.
Local centres are responsible for compliance with data protection etc.

Benefits

Joining FERN offers extensive benefits to all the participating Early Intervention services. These are detailed below.

Staff training and expertise.

Extensive service-wide training and support on incorporating gold standard assessments into service clinical delivery and evaluation.
Development of evidence based practice underpinned by a formulation delivered approach.
Expertise in audit service evaluation and clinical outcome mapping.

Service development.

Meeting DoH requirements for Early Intervention auditing as outlined in chapter 5 of the Policy Implementation Guide (PIG).
The opportunity to participate in future Early intervention developments e.g. Early detection, treatment of adolescent psychosis etc.
Strategic development.
Accurate assessment of DUP and development of potential innovative techniques for its reduction.
Meeting DoH targets for this clinical population, e.g. priorities and planning framework.
The option of benchmarking of individual services against a National dataset, or by specific variables, e.g. urban/rural settings.

General.

Research and data management of the FERN evaluation.
IT and statistical support where applicable.
Identification of future service needs within the context of the FERN methodology.

Communication within FERN

Please note that all communication will be addressed to the lead contact detailed in the letter of intent. Similarly all FERN training and evaluation information will be forwarded to the nominated lead trainer, in some cases this person may also be the lead contact.

It is the responsibility of the lead contact and lead trainer to ensure FERN communication is disseminated within their service and reaches all necessary stakeholders and staff.

Who Are We?

FERN (The First Episode Research Network) is a recently formed national collaboration of Early Intervention Services across the UK. It is one of the largest research networks investigating first-episode psychosis in the world.

Who Is It Run By?

The project is co-ordinated by the Universities of Birmingham and Lincoln. FERN is also a subsidiary of IRIS (The Initiative To Reduce The Impact of Schizophrenia).

Philosophy

The central tenet of the FERN partnership is that audit and evaluation, which addresses the needs of clients, carers and relatives as well as informing ongoing service development; is integral to the establishment of an effective, evidence-based local service. FERN is dedicated to the establishment of effective consumer-lead early intervention services in the UK.

Methodology

Membership of FERN will provide exhaustive evidence-based information at a local service level and also a detailed national picture of the impact of early intervention.

FERN's approach is defined by:

The employment of centralised training
The provision of extensive support to members
The utilisation of gold-standard assessments
The development of a national database and clinical tool kit

Why Be A Member?

Membership of FERN addresses a key requirement of service evaluation as stated in the Policy and Implementation Guide (DoH, 2002).

For information on how to join, click on the How To Join link, to your left for more information.

Where Are We Based?

The FERN partnership has experts within all the localities it covers. The central administration of FERN is conducted by the Universities of Birmingham and Lincoln.

Click on FERN Partners to see all the member sites.