Improving implementation of evidence based practice for people with psychosis through training the wider workforce: Results of the GOALS feasibility randomised controlled trial
Open accessAbstract
BACKGROUND AND OBJECTIVES: There is a pressing need to improve access to evidence-based practice for people with psychosis. The primary aim of this study was to assess clinical feasibility of a manualised, evidence-based CBT intervention (GOALS) targeting a personalised recovery goal, delivered by the frontline workforce, following brief training. Secondly, we aimed to conduct preliminary statistical analyses of key outcomes and costs. METHODS: The GOALS study is a feasibility randomised controlled trial (ISRCTN 73188383). 75 participants with current psychosis were recruited and randomly allocated to receive either treatment as usual alone or with GOALS therapy. RESULTS: Brief training enabled frontline staff to deliver the therapy according to protocol and 74% of therapy participants partially or fully achieved their goals. There were significant improvements with a moderate effect size of 0.56 on goal attainment. However, preliminary statistical analyses found no significant differences between groups on our primary outcome of activity levels or other secondary outcomes Health economic analysis found that point estimates of costs, controlling for baseline costs, implied savings (even including intervention costs), but the difference was not statistically significant. LIMITATIONS: The study was designed as a feasibility RCT, and therefore the results of secondary estimates of efficacy effects should be treated with caution. CONCLUSIONS: This approach holds promise in supporting people with psychosis to reach personal recovery goals, cost effectively.
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Psychology graduates are well-positioned to undertake the role of delivering CBTp.
“Psychology graduates, however, are well-positioned to undertake such a role [18, 20]”
From Increasing access to CBT for psychosis patients: A feasibility, randomised controlled trial evaluating brief, targeted CBT for distressing voices delivered by assistant psychologists (GiVE2) (2020) · cites this paper as [18]
The GOALS study (sections 1.1 and 3.1.2) included psychology graduates in supervised clinical assistant or internship posts; 13 delivered therapy to at least one supervised case. The Discussion supports entry-level roles delivering protocolised brief therapy for people with psychosis, but does not establish that psychology graduates are generally well-positioned to deliver CBTp beyond that supervised, brief role. Page numbers were not available in our copy. (LLM, conf=0.84)
Experimental — accuracy not yet measuredPsychology graduates can be readily employed in assistant psychologist roles at lower cost than more specialist therapists.
“they can be readily employed in assistant psychologist (AP) roles at lower cost than more specialist therapists”
From Increasing access to CBT for psychosis patients: A feasibility, randomised controlled trial evaluating brief, targeted CBT for distressing voices delivered by assistant psychologists (GiVE2) (2020) · cites this paper as [18]
Section 1.1 says clinical assistant posts or internships are typically held by psychology graduates, and Section 3.1.2 reports graduate psychologists in those posts in the trial. The Introduction says therapy delivered by less-experienced staff can cost less, but it does not establish that psychology graduates can be readily employed or compare the cost of assistant psychologist roles with specialist therapists. The indexed passages provide no page numbers. (LLM, conf=0.84)
Experimental — accuracy not yet measuredCase managers cannot fulfil the role of delivering CBTp.
“Evidence to date suggests that case managers cannot fulfil this role”
From Increasing access to CBT for psychosis patients: A feasibility, randomised controlled trial evaluating brief, targeted CBT for distressing voices delivered by assistant psychologists (GiVE2) (2020) · cites this paper as [18]
The Discussion reports that many staff in case-management roles felt unable to take on a GOALS therapy participant because of time pressures and crisis work. But it also says that all frontline staff who saw a participant delivered the therapy to protocol; the Staff training section reports that four who took on supervised cases were in case-management roles. The study therefore supports a practical barrier to delivering this brief intervention, not a categorical claim that case managers cannot deliver CBTp. (LLM, conf=0.86)
Experimental — accuracy not yet measuredOutcomes from trials of case managers delivering CBTp have been inconclusive.
“outcomes from trials have been inconclusive [16–19]”
From Increasing access to CBT for psychosis patients: A feasibility, randomised controlled trial evaluating brief, targeted CBT for distressing voices delivered by assistant psychologists (GiVE2) (2020) · cites this paper as [18]
The preliminary efficacy assessment (Section 3.2.1; page unavailable) reports no effect on the primary outcome and no significant difference on most other outcomes, but a significant improvement in goal attainment. This supports describing this trial’s outcomes as mixed or inconclusive. However, the paper reports one feasibility trial of CBT delivered by frontline staff, mostly clinical assistants—not outcomes specifically for case managers or a conclusion about trials of case-manager-delivered CBTp as a group (Sections 3.1.3 and 4, pages unavailable). (LLM, conf=0.86)
Experimental — accuracy not yet measuredThere are competing demands upon case managers' time.
“there are competing demands upon their time [18, 19]”
There is a large number of psychology graduates in the UK, the USA and elsewhere.
“there is a large number of psychology graduates in the UK, the USA and elsewhere”
From Increasing access to CBT for psychosis patients: A feasibility, randomised controlled trial evaluating brief, targeted CBT for distressing voices delivered by assistant psychologists (GiVE2) (2020) · cites this paper as [18]
Section 1.1 says that many UK community teams include posts typically held by psychology graduates, and section 3.1.2 reports 13 graduate psychologists among staff who delivered therapy in this trial. Neither passage addresses how many psychology graduates there are in the UK, the USA, or elsewhere; searches for graduate numbers and availability found no such statement. (LLM, conf=0.75)
Experimental — accuracy not yet measuredPsychology graduates' degree provides them with training in psychological models of emotion and behaviour.
“their degree provides them with training in psychological models of emotion and behaviour”
From Increasing access to CBT for psychosis patients: A feasibility, randomised controlled trial evaluating brief, targeted CBT for distressing voices delivered by assistant psychologists (GiVE2) (2020) · cites this paper as [18]
The GOALS study section identifies clinical assistants and interns as typically psychology graduates, and §3.1.2 reports that graduate psychologists participated in therapy training. Neither passage says what their degrees taught them. Searches for degree training in psychological models of emotion and behaviour found no passage addressing that claim; page numbers were unavailable in our copy. (LLM, conf=0.72)
Experimental — accuracy not yet measured
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- Authors
- Waller, H., Landau, S., Fornells-Ambrojo, M., Jolley, S., McCrone, P., Halkoree, R., Basit, N., Iredale, C., Tunnard, C., Zala, D., Craig, T. J. K., & Garety, P.
- Affiliations
- King's College London (GB)
- South London and Maudsley NHS Foundation Trust (GB)
- University College London (GB)
- Corresponding author
- Waller, Helen
- ORCID
- Venue
- Journal of Behavior Therapy and Experimental Psychiatry
- Publisher
- Elsevier BV
- Published
- 2018-06
- Volume
- 59
- Pages
- 121-128
- ISSN
- 0005-7916 (ISSN-L)
- OpenAlex
- W2776620435
- Cited by
- 21
- References
- 46
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 4 · 2023: 1 · 2022: 5 · 2021: 1 · 2020: 2 · 2019: 1 · 2018: 2
- FWCI
- 1.12
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Behavior Therapy and Experimental Psychiatry (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Greenwich Academic Literature Archive (University of Greenwich) (acceptedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Research Portal (King's College London) (submittedVersion, cc-by-nc-nd)
- Funders
- National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (PB-PG-0711-25010)
- National Institute for Health Research Biomedical Research Centre at the South London
- Maudsley NHS Foundation Trust
- King's College London
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Health Sciences › Health Professions › General Health Professions › Mental Health and Patient Involvement
- Keywords
- psychosis, cognitive behavioral therapy, evidence-based practice implementation, goal achievement, activity level, health economic evaluation, cost-effectiveness, feasibility
- MeSH terms
- Adult, Aged, Community Mental Health Services, Feasibility Studies, Female, Goals, Health Workforce, Health Personnel, Humans, Male, Middle Aged, Outcome and Process Assessment, Health Care, Psychotic Disorders, Schizophrenia, Cognitive Behavioral Therapy, Health Care Costs, Evidence-Based Practice, Young Adult
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