Implementation figures, tables, themes and quotes

Implementation figures, tables, themes and quotes - Team-based motivational engagement intervention in young people with first-episode psychosis: the EYE-2 cluster RCT with economic and process evaluation - NCBI Bookshelf An official website of the United States government Here's how you know The .gov means it's official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site. The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. 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Southampton (UK): National Institute for Health and Care Research; 2025 Sep. (Health and Social Care Delivery Research, No. 13.33.) Team-based motivational engagement intervention in young people with first-episode psychosis: the EYE-2 cluster RCT with economic and process evaluation. Show details Health and Social Care Delivery Research, No. 13.33. Greenwood K, Jones CI, Yaziji N, et al. Southampton (UK): National Institute for Health and Care Research ; 2025 Sep. Contents Search term < Prev Next > Appendix 9 Implementation figures, tables, themes and quotes FIGURE 29 Initial themes involved in the early (round 1), middle (round 2) and late (round 3) stage of intervention delivery. TABLE 45 Summary of facilitators to implementation TABLE 46 Summary of barriers to implementation TABLE 47 Normalisation process theory coding frame for phase 1 process evaluation TABLE 48 Normalisation process theory coding frame for phase 2 process evaluation TABLE 49 Normalisation process theory coding frame for phase 3 process evaluation TABLE 50 Example themes and quotes from round 3 of the EYE-2 qualitative study Notes Standardised approach : Clinicians mention the benefit of the EYE-2 collating existing practices into a standardised approach so that all employees work similarly. Clinician relates to EYE-2 approach : Clinicians relating to the EYE-2 on a personal level that is within their own set of principles. Familiarity with existing practices : The EYE-2 approaches are similar to existing EIP practices. Lack of EYE-2 understanding : Clinicians admission that they lack understanding of what the EYE-2 is or how to use the resources appropriately. Also including struggling to explain what the EYE-2 approach is. Accessibility for service users : This includes accessibility in terms of service users having appropriate technology to use resources and also challenges in the location of social groups. Language barriers is also identified within this theme. EYE-2 not a priority : Clinicians suggesting that the EYE-2 is not a priority due to COVID-19 and high workload. Clinicians noting other responsibilities are more important to complete rather than focusing on the EYE-2 . Memory as a barrier : Clinicians identifying that remembering to use the EYE-2 approaches and resources is a barrier to use. Confidence in EYE-2 approaches : Clinicians level of trust towards the EYE-2 . Workload and pressures : Clinicians identifying that high workload and pressures are a barrier to using the EYE-2 . Benefit from EYE-2 training : Clinicians mentioning that they would benefit from more training around MI and general EYE-2 training. Also includes clinicians who haven’t previously attended EYE-2 training. COVID-19 as a barrier : Clinicians suggesting that COVID-19 has been a barrier to using the EYE-2 as it posed extra strain on staff. Use resources : Using and integrating resources in daily practice with all caseload. This includes using one or more of the following: booklets, website and social groups. Use approaches: Using and implementing MI resources into daily practice with caseload. Lack of first-hand use – Clinicians who state they have a lack of personal experience using the EYE-2 approaches and resources or speak from other team members experiences of using the EYE-2 throughout the interview. Caseload increased – Clinicians identifying an increase of caseloads while implementing the EYE-2 . Staff turnover – This includes clinicians that mentioned staff turnover to be high during the time that the team was implementing the EYE-2 . Received positive feedback about resources – positive feedback received from service user, families and carers regarding any of the EYE-2 resources (booklets, website, social group). Used booklets – Clinicians identifying that they have used the booklets with service users, families, carers or independently. This is either within a session with someone or giving the booklets out for independent use. Referred patients to social group – clinicians who have mentioned actively referring patients to the social group resource. Used website – Using the website by either going through the information with a service user, families or cares within a session or giving them the information to go through it independently. This also includes clinicians who have used the website independently. Revisits resources with patient – Clinicians that revisit resources with patients at a future date. This may include clinicians who have revisited on one occasion or multiple. Resources improve clinicians' knowledge – Clinicians that identify the benefit that the EYE-2 has improve their own knowledge or other staff member knowledge. Introducing at the start of treatment – Clinicians that state introducing the resources and approaches at the beginning of treatment, they may revisit the information at a later date. Utilised treatment choices booklet – A specific mention of the treatment choices booklet being beneficial to the psychoeducation of patients. Staff conversations around EYE-2 – Discussions amount staff around the EYE-2 . Found resources helpful – Clinicians identifying that themselves or their team have found any of the EYE-2 resources helpful. Key quotes – Round 3 Standardised approach – NPT : Coherence (differentiation) P2 : ‘Do you feel that there have been any benefits to you as a clinician having worked with the EYE-2 approach over the past few years? P2: I’ve worked in EI services … forever. And you don’t want to be really egotistical and like I know everything but I think specifically for the kind of more recently qualified staff that haven’t worked in EI before there has been more of a benefit. Because like I say it’s something to refer back to, it’s a standardised resource’. P08 : ‘P08: Yeah I do think they fit in really well. I don’t think when we had the training that it was anything that was massively different to what we were already doing anyway but in addition to that it just kind of gave us an extra layer of information and maybe refreshed our mind on different ways we can interact with patients. RA : Yeah, that’s great. That sounds really positive. So erm … oh sorry. Erm how do you feel the EYE-2 approach and materials changes the way that you and your team works? P08: Erm … I think that it’s probably again just enhanced the way that we work in some ways because we can give people information in ways that we didn’t before’. Clinician related to EYE-2 approach – Cognitive participation (legitimation) and coherence (internalisation) P2 : ‘But yeah I’ve obviously found it useful but for me a lot of it makes sense and that’s why I believe in the resource, I like the resource and that’s why I recommend it to people. But I think it’s probably been kind of more useful for staff that aren’t as familiar with working with people with psychosis’. P3 : ‘So thinking about you team how do the attitudes of staff, service users or carers towards the EYE-2 approach and resources influence whether they’re used? P3: Erm … I mean as I said before, obviously if we had staff members who were unmotivated … erm either to use the resources or to work collaboratively with service users and their families kind of to inform their choice and give them information, then I would … erm suspect it would be, it would be quite tricky. But again, yeah it’s just, it just had been inline … there is already a very strong ethos of collaboration and giving information and sort of family engagement’. P4 : ‘How do the EYE-2 approaches and resources fit with the way you and other staff feel you should be working and within the standard EIP ways of working? P4: Yeah I guess I’ve already answered that in the one before. Like I do agree that it fits in well with our principles and the way we work’. Familiarity with existing EIP practice – Coherence (internalisation) P3 : In terms of the approach … I mean again I think that the EYE-2 approach is, is just from what I, I don’t remember very much about the theoretical approach other than it matched entirely with what we were already doing. So I think that kind of went in one ear and out the other ear if that makes sense … . Because I was sat there and I was like, yep yeah … that’s what we already do. So, so there certainly hasn’t been any resistance but at the same time there hasn’t been any reason to change because it’s been in line with what we’ve already been doing. P08 : ‘ RA : How do you find the use of EYE-2 approaches and resources when there are other demands and pressures? P08: Erm … I think, I suppose when you think about sort of motivational interviewing we kind of use that a bit already anyway, so I guess some of the stuff is what we should already be doing. We should be trying to engage people, we should trying to kind of build therapeutic relationships and use motivational interviewing where appropriate’. P09 : ‘P09: It’s kind of an additional pillar to support what we should be doing in the first place. It’s not anything kind of really different. Erm more so just resources to support what we are telling people’. P11 : Yeah so I think it’s always good to have extra resources in place and I think it’s always good to know you can go back to the resources with the clients and you can kind of go back to it when you need it. I think it’s kind of reinforced some of our staffs knowledge as well, especially I think it could be good for the people new to the team … but I’ve worked in EIP for like seven years so it’s kind of what I already knew but they are still really helpful for service users to use. Lack of EYE-2 understanding – Reflexive monitoring (individual appraisal) and collective action (skill set and workability) P3 : ‘Do you remember anything about the training slides, manuals or the engagement approaches used? P3: Erm, no not really. Erm, it’s been about two years since I did the initial training so no I don’t to be honest remember much about that. RA : No, that’s absolutely fine. Erm, so what do you know or remember about the EYE-2 approach and resources? P3: So, erm I mean I’m reasonably familiar with the booklets. That’s been the thing from the trial that I have used the most. Erm, I … yeah, I’ve really found in particular the … I’m just trying to think of the names of the, the the big blue one that’s all about the treatments’. P4 : ‘Do you remember anything about the training slides, manuals or engagement approaches that were spoken about in the training? P4: To be honest I can’t actually remember anything that we did. I think it was probably about two years ago that we did the training. All I remember about the EYE-2 is the stuff from actually reading the leaflets’. P5 : ‘Is there anything that could be provided to help you to know more about using the EYE-2 approach and resources? P5: Yeah I think, and I was talking to = AP = about this, erm is that we need to know … what we need to know is what the project is before we have the EYE-2 staff member in post so that they can come and talk about EYE-2 , what it is, how it benefits service users, what they need from us … erm and just go through it because I still think a lot of the team still don’t know what it is’. P09 : ‘I joined the team back in august so I missed the initial training and erm the refresher training I think as well. Erm so I just received some kind of ad hoc information. RA : Okay is there anything you can tell me about the kind of ad hoc info that you got? P09: I didn’t get much in all honesty. Erm not much at all. So erm I could probably do with some training actually haha’. P11 : We’ve had a lot of turnover and people coming back from erm … and we’ve had a lot of new starters. About four actually just starting in the last month, which is good actually but I wonder if they might need a refresher or maybe they aren’t aware of it. that would be good, I don’t know if you could come back and do another training. Accessibility for service users – Cognitive participation (initiation) P1 : ‘It’s when somebody’s expected to get somewhere. I think that’s what’s been the difficulty with the EYE-2 groups. It’s that service users, you know, still find it very difficult to motivate themselves and if they’ve got to use public transport they … tend not to. They will just stay at home rather than getting there themselves’. P2 : ‘The website has been more difficult to use because not everyone has internet access. We’ve got really rubbish mobile phones that we can’t get on the internet with to sit with someone and show it to them. It just, it feels less accessible, erm … and again with the groups. I don’t know that we’ve ever had my information about the groups, again probably due to COVID it’s not been something we’ve been able to engage with’. P2: ‘But for me personally what I would like to see is some slightly more accessible resources. Erm, so I think we have issues with kind of Autism and that type of neuro-dev, rather than capacity. We are quite a young person team, we don’t tend to get many capacity issues but you know all EI teams are I guess. But something to … kind of help autistic people. Something a bit more visual maybe, erm … we would definitely benefit from’. P2: ‘Erm you’ve got them online in a lot of different languages and we’ve spent a lot of time on there looking for erm some of the languages we wanted to find but some of them just weren’t on there. We’ve got such a diverse service user population there’s probably five or six languages that we’ve just not been able to get the resources in. But these are languages that our interpretation services can’t even provide anyone to us to interpret for us. So … it’s not, it’s not like a massive … it’s not kind of a slight on EYE-2 , it’s just we have some really obscure languages’. P2: ‘Yeah, we’ve got, we have a lot of students and stuff but internet access is surprisingly challenging for a lot of our population. We’ve got a lot of young people that don’t even have contract phones. They don’t have the internet at home. It’s probably kind of a socioeconomic thing as well. They just don’t have internet access readily. And with COVID and library’s being closed and everything else we are really struggling to get people online. We’ve got people that we are just going out to see just to bid on houses for them weekly because they can get on the internet to do it themselves. So I think internet access is not something that you think of as a problem in this day and age with the service user group but it really really is’. P07 : ‘ RA : So how well are the EYE-2 approach and materials suited to being used in a remote working approach? P07: I think it’s difficult. Erm just because you’ve got so much stuff to make sure that you’ve got with you and its more difficult to get to the patients. Erm yeah like I said some patients don’t have the appropriate technology to be able to get the resources only so that can be difficult’. P09 : ‘P09: With the groups it’s been difficult because they were originally at physical locations and now obviously with COVID they’ve had to be held over teams which has pros and cons. Pros being that obviously people that won’t come out of the house can then attend or for different reasons like they can’t get to the location I suppose it makes it easier. But erm cons being that it’s always nice to encourage people to get out and see people face to face … From conversations from my colleagues it seems people preferred it when it was face to face and more people attended’. P10 : ‘P10: We do have some families and clients that won’t or can’t use more online based resources like the social group since moving to teams because of COVID. So that kind of limits their accessibility to resources and often they’re the ones that we are working hardest to engage the most but maybe they don’t have the tech to use the online stuff or knowhow to get on these websites so it can be really difficult for those people’. EYE-2 not a priority – Process limiting factors (external and internal processes) and readiness and commitment P1 : ‘So things like EYE-2 sort of … it wasn’t a priority it was just trying keep people as well as possible and support them in a really difficult time … I think COVID, yeah COVID definitely had a role to play in this’. P5 : ‘What was your experience of implementing the EYE-2 approach and EIP more broadly during lockdown compared to before COVID? P5: I think it again was just very basic because at the beginning not many people wanted to be seen face to face, they were obviously offered it … but we were very limited in the amount of people we would see and it just wasn’t the priority. So it had reduced in somewhat but now it’s coming back again’. P09 : ‘So is there anything that gets in the way of using the resources or approaches at all? … So maybe attitudes of staff or service users, or service demands or pressures? P09: I think maybe attitudes of staff because when anything like this is introduce, you know like a study or a new approach I think people can think that it’s just another thing they’ve got to do. Another thing to add on top of their caseload. So then it might go down on the priority list so to speak. But things like the booklets and the social group and things like that they’re really very useful and it doesn’t take a lot of work to give someone a booklet to look through and then maybe when you next see them bring up a discussion about the booklet, see what they thought, just go over the content and see what they understand. It’s a good way to get people engaged as well because sometimes it can be difficult to find things to talk about’. P10 : There is so many other priorities at the moment so it’s really difficult, especially given the pandemic and the referrals have probably gone up about a third I’d say. P11 : I think erm sometimes we have so much to get through in a session with someone that it can kind of be left behind, erm you can just kind of maybe forget about mentioning it a little bit. And then once the persons gone you’ll think oh I wish I gave them the resources but sometimes there’s just not enough time. Memory as a barrier – Readiness and commitment P4 : ‘Is there anything that gets in the way of using the approach and resources? … so maybe service demands, pressures, that kind of thing? P4: Yeah that’s is basically the main thing that I was going to say is … it is the service demands, it’s that care co-ordinators don’t have enough time to remember to pick up a leaflet or have time to remember to remind their service users about the social groups, that is the main obstacle’. P5 : ‘Is there anything that gets in the way of using the approach and materials? P5: Erm … forgetfulness that they are there. Erm so again it’s about reminding each other that we do have these leaflets, we do have this website that a really good resource’. P08 : ‘ RA : Is there anything that gets in the way of using the approach and materials? So maybe service demands, pressure, maybe even attitudes of staff and service users? P08: I think again it just depends on … I think everyone’s just so busy and we’ve got lots of different paperwork to complete with patients and I think it’s just like I say keeping it fresh in people’s minds that we’ve got these resources there and they’ve been produced and a lot of work has gone into them and they’re really relevant to our service. That’s kind of how I feel about them. But erm yeah I think mainly the barriers are people time and remembering that they’re there. Erm I’m trying to think of … erm and yeah I guess the website just remembering that it’s there and giving people the information to be able to go and seek it out. But yeah I just think there’s so much for us to remember as clinicians and maybe sometimes for some people they just think it’s another thing for us to remember. But actually if you frame it differently and think actually it’s something that can really help the patient and us’. P11 : I think erm sometimes we have so much to get through in a session with someone that it can kind of be left behind, erm you can just kind of maybe forget about mentioning it a little bit. And then once the persons gone you’ll think oh I wish I gave them the resources but sometimes there’s just not enough time. Confidence in EYE-2 – Reflexive monitoring P2 : ‘People generally receive it quite well and are erm, really grateful for the information. I think people trust a professional looking book more than they trust us telling them something. I think it really helps our, really helps our impression of our team and service when we’ve got something to hand out. So, it’s been really well received’. ‘What is the value of the EYE-2 to you, your service users, families and your team? P2: Honestly it sounds proper cheesy but at this point it is like invaluable, like I’m already wondering and wanting to ask like what happens when this finishes?, do we continue getting the resources?, Is this being rolled out?. Erm, cos it would be horrible if it was taken away. You know it’s part of like, you know every care co-ordinator has got a pack of the outcome measures in their car. Like its just become part of what we do, it’s just become invaluable’. P4 : ‘How much trust or confidence do you have in the EYE-2 approach and resources? P4: Yeah, lots lots. Very confident’. P07 : ‘ RA : How do you feel that the EYE-2 approach and materials have changed the way you and your team works? P07: Well I suppose it’s kind of it, the materials are helpful in backing up what we say to the patient and it’s there for them to look as well which I think it really useful. [inaudible segment] … yeah for us it gives us a nice introduction to things. Like I said before really haha. RA : Yeah so it kind of helps you introduce things to the patients and [cross talk] P07: Yes and it also makes EIS more erm this has evidence, making it a bit more erm sort of … erm how can I say … erm it perhaps makes it sound a bit more relevant or trustworthy and helps erm show that each intervention is evidence based. RA : Okay so is what you’re saying that it gives people more confidence in what you are telling them? P07: Yeah absolutely’. Workload/pressures – Readiness and commitment (individual readiness) and process limiting factors P1 : ‘I think it’s just that, I think it’s weird cos it was like erm … it was the acuity of the number of referrals, they weren’t necessarily appropriate for us but I think it was just the number of assessments people were having to do. So we weren’t taking on the same number of people that we might have done historically … I think, I I do think that there’s a lot of people with psychosis, because they weren’t seeing family and friends and they were isolating at home. You know, there’s a lot of hidden, hidden psychosis there and that will start coming out of the woodwork over the next erm, the next few months, you know the increase of referrals will come in the next few months’. P2 : ‘How did you find the use of the EYE-2 approach and resources when there were other demands such as caseloads? P2: I think it actually assisted. Erm so it was part of the project that people were helping us, especially at the beginning we seemed to have more contact, people were helping us by contacting erm service users and completing outcome measures. Which was really really helpful when our workload was really really erm high’. P3 : ‘I think one of the things I’ve been conscious of is having the time to do some of the outcome measures that have been needed have been an absolute nightmare to be honest with you. Erm, so I guess … I’m glad of the opportunity to do this and feedback how helpful I have observed the resources to be and, but I suspect that the outcome measures don’t support that because I just don’t have the time to do them if I’m honest’. P3: ‘It’s very difficult at the moment to pick out what is Brexit and what is COVID. Yeah so there are increase pressures on the service, there are increased pressures nationally within our national culture at the moment which is putting pressure on peoples mental health, which I think is driving up referrals across the board for mental health services not just for psychosis services. So I suspect there is some degree of subtle impact but there isn’t anything that I would directly say is well that’s Brexit’. P5 : ‘How much trust or confidence do you have in the EYE-2 approach and resources? P5: Oh I do think we have a lot of confidence and trust in the research project. I just think sometimes we are lacking in knowledge of what it is and what we are doing with it. We just need that reminder. RA : Yeah I can understand how that would be a real barrier. P5: Yeah and I think that when someone hears research they just think, oh well I just haven’t got time for that right now. But when they hear that it is beneficial for service users then they will … but obviously it also depends on time’. P6 : ‘What about service demands or pressures? P6: Yeah but I think that falls in the kind of humanistic factors of when I say forgetfulness. So demands and staff feeling overwhelmed but actually when they’re feeling overwhelmed the resources are there to actually help them. RA : Yeah of course. P6: But yeah I think that falls in to kind of human factors of feeling overwhelmed, feeling busy, forgetting. And that’s why it’s always good to remind people that they are there and that they are a good resource. It’s about me introducing them to new staff as well, making sure they’re part of the introduction’. P07 : ‘ RA : Is there anything that gets in the way of using the approach and materials such as service demands or pressures? P07: It’s a lot to carry around with you all these brochures and stuff in your car so you can have it when you need it haha. So it needs a bit of co-ordination. It was particularly difficult during COVID, when you’ve got one day in the office and one day not to have the all readily there. So its organisation about the brochures that definitely something that needed good planning as a care co-ordinators’. P08 : ‘ RA : Is there anything that gets in the way of using the approach and materials? So maybe service demands, pressure, maybe even attitudes of staff and service users? P08: I think again it just depends on … I think everyone’s just so busy and we’ve got lots of different paperwork to complete with patients’. P09 : ‘ RA : So is there anything that gets in the way of using the approach and materials? Erm so maybe service demands or pressures … or maybe attitudes of staff? P09: I think maybe attitudes of staff because when anything like this is introduce, you know like a study or a new approach I think people can think that it’s just another thing they’ve got to do. Another thing to add on top of their caseload’. P11 : RA : Is there anything that gets in the way of using the EYE-2 , maybe service demands or pressures? P11: Yeah so we’ve been quite busy as a service, we have like 290 in our caseloads and I think definitely we can feel like we feel there is too much to do sometimes. So it doesn’t give as much time to go over them. Benefit from more EYE-2 training – Collective action (skill set and workability) P1 : ‘I’ve been trying to organise some additional and more in-depth motivational interviewing training as well cos I think that bit was really erm … was like was really relevant I guess to this and the other work we are doing in the EI service as well’. P2 : ‘What do you know or remember about the EYE-2 project training? P2: Oh, it was a while ago. I remember that the staff that went on it found it really useful … erm I think on reflection I should of probably asked for it to be repeated because we’ve had quite a high staff turnover and we’ve not actually got any staff left that erm completed the training’. P2: ‘Maybe the groups and the websites, like I say if it’s going to continue it would be useful to … relearn how to access those and maybe arrange some training for the staff’. P3 : ‘Okay so is there anything that you remember about the EYE-2 approach and resources? P3: Erm … EYE-2 intervention approach and resources … yeah so I guess my understanding of the EYE-2 … oh yeah and just in terms of the training by the way I think they have actually offered and provided another EYE-2 training since but I wasn’t able to attend’. P5 : ‘I think the problem is the EYE-2 project staff come in and I don’t necessarily manage them and they just come in and they, I think they expect us to have this knowledge and we don’t really so I think we would benefit from going back to basics if that makes sense’. P07 : ‘ RA : So what else could be provided to help you know more about using the EYE-2 approach and resources? P07: So for me particularly it’s the age erm range. More catering for the different age range. Erm what else would be helpful, erm … yeah so I think it’s also timing, erm you know saying this is something for life, it’s kind of something to look back on, you know. Perhaps more explaining it like that … .And it’s also like you’ve got so many different brochures which is great but maybe something to help the care co-ordinators realise when to use them. So the one that’s got all the interventions, erm and to perhaps feed them, [inaudible segment] … But for example CBT for psychosis we know there’s a delay, we know there is a waiting list. So that could have been a bit more carefully put into erm… RA : Okay so do you think maybe a bit more training for the care-co’s and when to use the different resources? P07: Yep, definitely’. P09 : ‘P09: I joined the team back in august so I missed the initial training and erm the refresher training I think as well. Erm so I just received some kind of ad hoc information. RA : Okay is there anything you can tell me about the kind of ad hoc info that you got? P09: I didn’t get much in all honesty. Erm not much at all. So erm I could probably do with some training actually haha. RA : What else could be provided to help you know more about the EYE-2? I guess training haha? P09: Yeah haha training would help. Erm so I kind of knew about the resources and the social group and the motivational interviewing so it was really just the training that was missing for me’. P11 : We’ve had a lot of turnover and people coming back from erm … and we’ve had a lot of new starters. About four actually just starting in the last month, which is good actually but I wonder if they might need a refresher or maybe they aren’t aware of it. that would be good, I don’t know if you could come back and do another training. COVID is a barrier – NPT : Process limiting factor (external processes) P1 : ‘The groups erm.. have been a bit more difficult … because we are such as dispersed and large locality is very hard to run any groups and draw in service users into those. I think COVID obviously hasn’t helped … .And … erm the EYE-2 research assistance in our area, have, have tried their hardest to, to you know, encourage service users to join and participate and you know move to online groups when COVID was its worst. But that’s, that’s definitely been more difficult … So attendance has been quite poor’. ‘Is there anything that gets in the way of using the approaches and materials? So maybe service demand or pressures, attitudes of staff and service users erm, that kind of thing?’ P1: Erm, well I think COVID, definitely. Erm … I think we would of, I think we would of really benefitted from additional training around motivational techniques. Erm the EYE-2 training was really helpful with that but you know, it just touched the surface I guess. And I think we … we didn’t have the funding to actually you know train the whole team to do that, so a couple of people have done it but not everyone. But you know, I’m still trying to fight for that, I’m still trying to get funding for that two years later’. P2 : ‘What else could be provided to help you to know more about using the EYE-2 approaches and resources? P2: I think potentially, I mean I don’t know if it’s, I guessing its largely due to COVID, I think … in line with us having such a high staff turnover and everything that’s happened in the last 18 months. I think it’s been really easy to use the written resources, they’ve been really useful and really handy but I think for the rest of it, maybe having … a link person some in … or have a bit more contact from somebody from EYE-2 just to remind us what there is. Erm and like I say kind of refresher training or kind of rerunning the training when we got new staff would have been helpful’. P3 : ‘I’m aware of in terms of the social group things now at this kind of end stage are now getting up and running again, it has been kind of unfortunate that COVID happened when it did in terms of our participation in the EYE-2 trial. Because I don’t think that, although the staff members running it have done the best that could within the circumstances, I don’t think the social group has got off the ground … erm as much as, you know it’s just finding its feet now and getting some participation but erm I imagine that could of happened much more quickly and been much more established now with a higher kind of participation had we not been in eighteen months of lockdown in the middle’. P4 : ‘Is there anything that you remember about the website or the social group resources at all? P4: I don’t really remember anything about the website to be honest. Erm … and in terms of the social group, I know initially it was really helpful but obviously it was massively impacted on by the pandemic. But yeah I know initially I think it was a peer led social group and it was really popular but I guess my impression is that perhaps it’s been harder to facilitate because of the pandemic, not that that should be an obstacle for it continuing’. P5 : ‘How does the use of the EYE-2 approach and resources fit with other demands on you time and other things you need to do when working with service users? P5: I mean again I think … you know we will endeavour to use it but if you know we are stretched with staff being off sick or with COVID it’s probably on the bottom of peoples lists’. P07 : ‘ RA : Is there anything, erm you’ve mentioned this slightly already but is there anything that gets in the way of using the approach and materials such as service demands or pressures? P07: It’s a lot to carry around with you all these brochures and stuff in your car so you can have it when you need it haha. So it needs a bit of co-ordination. It was particularly difficult during COVID, when you’ve got one day in the office and one day not to have the all readily there. So its organisation about the brochures that definitely something that needed good planning as a care co-ordinators’. P08: ‘ RA : What was your experience of using the EYE-2 resources and materials during COVID-19 and the lockdowns? Did your use increase or decrease?’ P08: Erm I suppose the booklet side of things may have decreased just because you’re not seeing as many people. Erm … but I don’t actually know. Erm I guess a lot of my, erm we still continued seeing people all throughout the lockdowns even if it might have been at a distance or kind of a lot of telephone assessments and appointments took place. For our more seriously unwell patients we were still seeing them face to face. But I’m wondering if overall it probably decreased a bit. Erm just because of the situation we are in and we were just having to do the bare minimum of contact in the service at the time’. P09 : ‘P09: With the groups it’s been difficult because they were originally at physical locations and now obviously with COVID they’ve had to be held over teams which has pros and cons. Pros being that obviously people that won’t come out of the house can then attend or for different reasons like they can’t get to the location I suppose it makes it easier. But erm cons being that it’s always nice to encourage people to get out and see people face to face … From conversations from my colleagues it seems people preferred it when it was face to face and more people attended’. Uses resources – Reflexive monitoring (Individual appraisal|) and readiness and commitment P1 : ‘The … erm I mean, I think the leaflets have been invaluable, they’ve been excellent. We’ve, you know we’ve used them regularly, erm you know I’ll be honest as well, we’ve actually used them with over 35s as well as an introduction to … psychosis, and Early Intervention for Psychosis teams and the sort of possible treatments available. And they’ve been really well received by service users and carers … yeah so they’ve been an excellent resource’. P2 : ‘I know the written resources have been really really useful. We’ve built them into our kind of initial packs. So we give them out to people when they are accepted. Some are more generic mental health problems, so we take them out on assessment because it doesn’t necessarily suggest that somebody’s got psychosis. It’s more of a useful resources for anyone with mental health problems really’. ‘How do the other elements within your day to day practice fit around using the booklets? Again I think you may have touched on that slight but if you could just … give me a bit more detail on what that might look like? P2: It feels … it definitely felt at the start like we kind of based, we kind of altered our kind of approach to new referrals based on the resources. So they’re kind of our go to resource. So it standardised it a lot for us really because everybody’s getting the same thing, everybody’s getting the same information and if another practitioner goes out they know what that persons been told because they know what’s in the booklet, if that makes sense’. P3 : ‘Is that the treatment choices one? P3: Yeah that’s the one. I mean I really do genuinely use them, I have a stash of them in my car. I give them out to patients and you know, family members that are new to the service. And I erm, I will continue to do that even post the trial. And I have found those resources erm, really really useful’. P5 : ‘How do you use the EYE-2 approach and resources, maybe thinking about anyone you are aware of using the resources more than once with the same person? P5: We have actually. I’ll tell you what I did do, when they first came out I was doing a physical health assessment and we were given the booklets and erm I gave one of the booklets, erm we went through it together because it told us about psychosis. So I used one of the booklets to explain, because it was kind of a really easy way of explain it. So we went through it together and yeah I do remember doing that. Erm so I have done a bit, a tiny bit haha’. P6 : ‘But I would like to introduce it early as possible. Erm kind of when we do that talk about why we are there, like when they’re like “well I don’t have psychosis so I don’t know why you are here” and then it’s about that psychoeducation. So it’s used at every stage of someone’s journey cos actually the resources are there at every stage and aspect of their journey because they’re there when you are considering treatment and when you’re thinking about what is psychosis to how does this impact on my family or how can I help someone. So actually the resources are helpful for every part of the patient journey and you can introduce them when appropriate. And I think it is dependent on where your service user is in their journey and where their families are in that journey as to what booklet you introduce, when you introduce the website. But we try to do that as early as possible’. Uses approaches – Reflexive monitoring and collective action (interactional workability) P3 : ‘What was your experience of using the EYE-2 approach and materials during the COVID-19 lockdown? Erm did your use increase or decrease? P3: Erm it definitely decreased in terms of the written resources during the period that we were doing fewer face-to-face contact. That being said we were tending, apart from the first couple of weeks of COVID we were still tending to see face-to-face new clients because those were often the ones were the risks were a bit more unknown and the engagement approach, a more active engagement approach was necessary. RA : How do you find the use of EYE-2 approaches and resources when there are other demands and pressures such as caseloads? P3: Erm, yeah again … I don’t think particularly … the pressures I don’t think especially impact on my use of the approaches and the resources. I suspect that yeah the only thing it impacts on is my ability to do the outcome measures. RA : Yeah. P3: Erm … because the rest of the stuff, the approach and the information giving is just such a core part of what the work is that I would be doing it whatever, you know. RA : Yeah, so those aspects … the things you’ve mention kind of come naturally? P3: It just is what the job is … it just is what care co-ordinating somebody in Early Intervention services is, it’s that engagement approach that kind of facilitating that you know the more social engagement side of things and giving the appropriate information … that’s what working in early intervention should be’. P08 : ‘ RA : How do you find the use of EYE-2 approaches and resources when there are other demands and pressures? P08: Erm … I think, I suppose when you think about sort of motivational interviewing we kind of use that a bit already anyway, so I guess some of the stuff is what we should already be doing. We should be trying to engage people, we should trying to kind of build therapeutic relationships and use motivational interviewing where appropriate’. Lack of first-hand use – Readiness and commitment and process limiting factors P1 : RA : ‘So, are you currently using anything from the EYE-2 project? P1: So, I’m not … I mean I’m not working directly with the team now. I mean I’m working across the four. But I know, I know yeah that they are still using the booklets across the team but aside from that I’m not sure to be honest’. P3 : ‘What would you say is the element that has most significant impact for the client? P3: Erm, for my, again because I don’t have any direct experience of working with people that have attended the social group, the stories that I hear coming out of the social group are fabulous and I can really imagine the impact that that’s making. Erm one of our? STR? workers who, who’s part of the social group every week comes back with these fabulous tales of different service users coming along and meeting each other and really forming, having really positive interactions any you know, really … erm positive activities. That being said none of my service users are part of that so for me … it’s been the information giving side of things’. P5 : ‘Can you think of any particular ways of how you’ve introduced anything after being advised by the EYE-2 RA? P5: No, no I wouldn’t be able to tell you that. Sorry. RA : No that’s okay. P5: Because I’m a manager and not one of the real workers, haha. I just wouldn’t be able to tell you that. RA : Haha, no that’s absolutely fine. P5: I’m sure there is but I don’t have a caseload so …’ P10 : ‘P10: So I think maybe I use it less because when I’m brought in to a patients referral or erm treatment its normally a more specialised case of someone that’s potentially quite ill or has been challenging in terms of treatment. So in that instance we are kind of looking for quite particular information that I might not get from more generic psychosis resources. So I probably haven’t used the resources as much as my other erm colleagues’. Caseload increase – Process limiting factors P1 : ‘COVID like really did put sort of different pressures. And you know, every time there was a lockdown we had a huge increase of referrals to the service, which didn’t help. And you know the sort of different demands put on the team and the sort of acuity of referrals as well. Like you know, they had a lot of referrals coming from inpatient services’. P11 : RA : Is there anything that gets in the way of using the EYE-2 , maybe service demands or pressures? P11: Yeah so we’ve been quite busy as a service, we have like 290 in our caseloads and I think definitely we can feel like we feel there is too much to do sometimes. So it doesn’t give as much time to go over them. Received positive feedback about resources – NPT : Coherence (internalisation) P02: ‘P02: … we ask for feedback on it and if we got any feedback that you know it could include something else or something could be changed then we would share that with the research assistance. But there’s been nothing, people generally receive it quite well and are erm, really grateful for the information. I think people trust a professional looking book more than they trust us telling them something. I think it really helps our, really helps our impression of our team and service when we’ve got something to hand out. So, it’s been really well received’. P03 : ‘ RA : How have you decided whether or not the EYE-2 is helpful for service users? P03: Erm.. how have I decided? … I mean for me the experience of saying to a service user to have a look at the website and in the next session seeing if they have had a look and they have. And them saying they’ve had a look and have some questions about things. That doesn’t happen all the time as you can imagine with service users so the kind of feedback that I get that service users aren’t using it all of the time but some of the time when we advise them to, yep that’s enough for me to feel like it’s useful’. P04 : ‘P04: In terms of feedback from staff, the feedback from staff has been very very positive in terms of the leaflets’. P05 : ‘ RA : How do the attitudes of staff, service users or carers towards the EYE-2 influenced whether they’re used? P05: I think there’s feedback and we have had some feedback which was positive … I don’t know if we got any negative but obviously if we had we would of looked and seen if it was something that we could look at and do differently’. P06 : ‘ RA : If you’ve given a resource to a service user, how would you know whether that has been beneficial for them? P06: It’s the feedback from them isn’t it. Like you know I’m going to leave you with this and next time we will see how you’ve gotten on. And then people come back and say well I’ve gone away and read and I can see what you’ve been saying from this point of view’ P08: ‘ RA : Have you had any feedback from service users or carers about the resources that you’ve given them? P08: Yeah I have. I think people have found them to be really helpful and comprehensive. Erm yeah really good overall I’ve had nothing negative at all’. P11 : RA : What was your experience of using EYE-2 approaches and resources during COVID-19 and the lockdowns? P11: I think that erm, I think that it probably did increase because it was an extra thing that we could offer to support people. Erm because we obviously weren’t able to see people face to face. Erm so that was really helpful to have because everything’s becoming so digital so it was accessible in that way. And I remember people being happy to have it in that way and I had a lot of positive feedback. So I think it did increase. Used booklets – NPT : Cognitive participation (activation) P01: ‘P01: I think the leaflets have been invaluable, they’ve been excellent. We’ve, you know we’ve used them regularly, erm you know I’ll be honest as well, we’ve actually used them with over 35s as well as an introduction to … psychosis, and Early Intervention for Psychosis teams and the sort of possible treatments available. And they’ve been really well received by service users and carers … yeah so they’ve been an excellent resource’. P02 : ‘ RA : Are you currently using anything from the EYE-2 project? P02: Yeah, all the booklets and the outcome measure packs. RA : … is there any booklets you use more or erm … stand out to you as being the most helpful? P02: They’re genuinely all really useful, we use all of them. We kept running out so we’ve had to order some more, haha … .It feels … it definitely felt at the start like we kind of based, we kinda altered our kind of approach to new referrals based on the resources. So they’re kind of our go to resource. So it standardised it a lot for us really because everybody’s getting the same thing, everybody’s getting the same information and if another practitioner goes out they know what that persons been told because they know what’s in the booklet, if that makes sense’. P03: ‘ RA : How do you feel the EYE-2 approach and materials have changed the way that you work and the team works? P03: Erm … I don’t think they have to be honest in terms of having to do anything new … again I do think that erm, to be honest I don’t know why we didn’t have this kind of information in booklet form and in you know leaflet form and things, erm you know … for people before. It seems ridiculous but we didn’t, erm so it just is … yeah just as I said before just to be able to give professional looking information to people I think is just really really reassuring and just sort of quite helpful to me in terms of you know it comes with a degree of gravitas and you know just … look at this resource … erm so yeah’. P04 : ‘P04: Erm … . I think the one, So there’s one for carers, one for service users and one for medications, what’s the other one? RA : Is that the treatment choice one? P04: I think that’s the one I’m thinking of for medications. I think the one we use the most is the one for service users but I think also the really big thick one is really helpful as well I think’. P05 : ‘ RA : So what has helped you to know how to use the EYE-2 approach and resources? P05: Well we had the training. Erm obviously we were given the booklets. When we were given the booklets I did actually keep them on my desk and I kept on giving them out. Erm but obviously I can’t answer that for the other care co-ordinators’. P06 : ‘ RA : Are you currently using anything from the EYE-2 project? P06: Yes, I’m using the booklets and the website resources’. P07 : ‘ RA : Are you currently using anything from the EYE-2 project? I know you’ve already touched on this a little bit but if you don’t mind elaborating. P07: Yeah so I do still refer new patients to use the overall brochure but I use it differently now. The carers one I also think it pretty good so I do use that. It’s a snapshot of things but not overloading. Erm I particularly like that one for carers. Erm, so erm yeah so I think it’s the timely kind of when you introduce things again which is important’. P08 : ‘ RA : Are you currently using anything from the EYE-2 project? P08: Yeah so I go through the leaflets a lot with people. Erm … I, it’s difficult for me because for some reason a lot of my caseload are over 35 and I know that the leaflets are, or were kind of generated for people kind of 14 to 35. But I still kind of hand them out to my patients because I think the medication one especially is excellent and to have a resource that we can give to people is really good. And I find that some of my ladies that are in their early 60s don’t really want to go online, they want to read something in a booklet or a leaflet. So I’ve kind of given them in the caveat that these were designed for people in a younger age group but the information is still exactly the same and really relevant to them as patients under our service. And we also put the booklets in as part of our drop in erm so that people can kind of help themselves. So we’ve made them really accessible to people coming into our building as well. I give them to carers as well, the carers booklets have been really helpful’. P09 : ‘ RA : So are you currently using anything from the EYE-2 project? P09: Erm a couple of leaflets. Erm … obviously I use the dialogue and QPR regularly but I know that the EYE-2 project used that as kind of a point of reference for progress. Erm the website I don’t tend to use and the social group I’ve been attending and helping’. P11 : Yeah the booklets are really valuable. Erm especially at the beginning when someone is high risk and they are getting to know the care co-ordinator and it’s kind of their triage assessment, having that kind of information in the booklets, I think the care co-ordinators have found them really helpful. Referred patients to social group – NPT : Cognitive participation (activation) P03: ‘P03: Yeah, so as I said the main ones are the website and the erm, booklets and I do bear in mind the social group and refer patients or erm service users to that. Erm … I haven’t currently got anyone that’s attending the social groups erm … but yeah, I aware to refer people but it is the written resources that I use the most’. P05 : ‘ RA : So are you currently using anything from the EYE-2 project? I know you briefly mention about the social groups. P05: All I know at the moment is the social groups … because I’m not a care co-ordinator, I mean they would know what they’re using more specifically. But I know we are definitely using the social groups’. P06: ‘ RA : what about the social groups? P06: Yeah so the social groups were introduced by the research assistants and the researchers erm as they were when we tried to run them they were very poorly attended. Erm they use a lot of resource and trying to kind of plan them and go out and stuff and they are just very very poorly attended which is a shame’. P07: ‘ RA : Do you use the website or the social group at all? P07: So I have referred people to the social group but that seems like something that it more difficult to erm engage them into. But again it was the age the age that it was addressed to that was a barrier. Younger not wanting to do it because they don’t want to be with anyone else but other younger people. Erm the group actually stood out for me more for younger people funnily enough … . I mean it’s really nice, the social groups have actually developed into a … erm now there’s a quite nice cooking activity and when it was COVID they became quite difficult. But these social groups certainly developed an interest but it seems not so much for the younger ones’. P09 : ‘Okay so moving on what do you know or remember about the EYE-2 intervention approach and the resources so the website, the booklet and the social group? P09: Erm so I was helping out with our local social group erm quite a bit. Erm and I think that that was quite a lot of fun for those involved and it was a useful resource for those who took part. Erm I’ve used a couple of the leaflets erm provided as well erm they’ve got really good information although targeted at a kind of younger audience aren’t they’ ‘ RA : Have you referred anyone to the social group out of your caseload? P09: I have but unfortunately no one’s taken me up on it haha’. P10 : ‘Erm I guess I have a slightly different role in the team from care co-ordinators. Erm … and I think from what I’ve heard from my psychotherapy colleagues, erm when they’ve undertaking a piece of work and like the peer support group they think would be kind of beneficially to their client as well, then that’s been something we’ve been able to recommend’. Used website – NPT : Cognitive participation (activation) P01: ‘P01: The EYE-2 website has been promoted by sending out posters to service users’. P03 : ‘ RA : Is there anything you remember about the website? P03: Yeah, I mean again use the website a lot. Erm … I consistently give out the website to people on my first visit with them. Erm, and often kind of, I never remember to save it but I often find myself googling Likemind and erm … when I’m in appointments with people, erm. The things I find particularly useful is the, I find … I find the ‘what is psychosis’ section you know a particularly useful resources. And I do go to that to guide that first discussion with people that have got you know first episode psychosis diagnosis or are kind of having an episode. Because I think kind of has got a nice level detail in terms of being you know informative enough without being overwhelming. So that one’s really helpful and I also certainly refer people to the … erm, the kind of relatives and loved ones kind of stories and the recovery stories’. P05: ‘P05: Yeah I mean obviously the service users have been given the website and the leaflets have gone out. I think there’s been some good use as well’. P06 : ‘ RA : Are you currently using anything from the EYE-2 project? P06: Yes, I’m using the booklets and the website resources’. P07: ‘ RA : What about the website? P07: Not many people had a look at the website funnily enough but that’s when I realised the importance of doing it together and that made a real difference to go through it together. Not right at the beginning but further down the line in session 5 or 6 to go to that’. P08 : ‘P08: And then other service users that I’ve got that are within the EYE-2 range, I’ve given out the website and I’ve found that really useful as well. RA : That sounds brilliant. That sounds really positive. So it there any kind of specific resources that you’ve started using then stopped or maybe any that you haven’t used at all? P08: Erm … no as I say I think the booklets are really great. I think plugging the booklets I should do some more definitely. Erm … I’ve got a couple of patients that are gamers so they’re online a lot and they’re used to being online erm and I know that they would maybe find looking at a booklet quite difficult, they would maybe chuck that in the corner of the room. So for them the website is really good and accessible’. P11 : Its useful to have the website and it’s easy to navigate through so I think in that sense its quite helpful. Revisits resources with patient – NPT : Cognitive participation (activation) P01: ‘P01: Giving … service users that awareness and carers that awareness of psychosis and how we can support. Erm so they’ll be used like, and revisited. I can remember errm … there’s a carer that’s really struggled to understand psychosis, what is mean to the service user, what is means for like long term erm … prognosis and erm, I guess sort of the EYE-2 booklets and other things have been used sort of various times to try and sort of support the carer in particular around her sons mental health problems. She’s really struggled with it, she’s really struggles to accept that you know although … he can sort work and move on and recover but he might need to take medication for a prolonged period of time and still need, erm ongoing support. Cos you know, her view was that … erm he could take medication for a few weeks and the stop it again then he’d be alright and be able to move on and work and be able to function really well. But he is one of the service users that probably going to have long term mental health problems and erm need medication for a long time. And you know even now he’s just recently had a hospital admission after coming off his again medication and this is probably his fourth or fifth admission, which is a a shame. But again it just about revisiting the booklets and trying to go through it and explaining that need to carry on taking his medication … and it did work for a short period, but again stopped taking medication and stopped working. It’s just that yeah, those booklets they’ll use them for, you know those reasons, just to encourage and support. It’s just a shame that for them in particular I think they’re really struggling’. P03 : ‘P03:I don’t think I’ve come back to the same like early interventions booklet or those introductory booklets more than once but I’ve certainly come back to the treatment choices booklet a couple of times when we’ve been thinking about … because you know I might spend one session talking to somebody about medication options and then a different session talking to somebody about psychological therapy options or what have you. So I certainly would come back to that one but the other I think are good introductory ones but you sort of read them once, or I read them once with the client and then I leave them with them for them to go back to when they need them. Or likewise the website … the treatment choices one I find myself with a client saying ‘do you remember that treatment booklet I gave you? Shall we get it out and have a look?’ erm so that’s, that the main one. RA : Yeah that’s really interesting. I guess if you feel that the other ones are more introductory you might not revisit them. P03: And you know some of it they might not of got the first time so you might kind of refresh it but it doesn’t, you know I would just tend people to do that for themselves really. Whereas there’s so much in the treatment one that might guide a number of different discussions’. P06 : ‘ RA : So is it something that you try and revisit at different stages it sounds like with different resources? P06: Yeah absolutely and kind of going back to it. So if we are thinking about treatment the we go back to the treatment booklet. You know if they are then going on about how they manage recovery then we will look at something else that might be helpful within the booklets or on the website that might be helpful. So yeah just keep going back to the resource, not just giving them out once and then leaving them’. P08: ‘ RA : Do you ever revisit the resources with the service users or use them in a session with somebody rather than handing them out for people to go through independently? P08: Yeah yeah, I’ve done that before as well. Again I think it depends on the patient and where they are in their recovery journey. Erm and how poorly they are as well. Sometimes it would be more appropriate to let them go away with the resource and go through it in their own time. But I have gone through it with the patients, particularly the medication one and sat and gone through it all. So it just sort of depends really’. P09 : ‘P09: … The booklets for example, it really depends on the client to how I use it. So for some clients it can be really beneficial to go through it with them but then for others they prefer to go away and have a look through it in their own time and then come back if they have any questions’. EYE-2 improves clinicians' knowledge – NPT : Coherence (internalisation) P01: ‘ RA : Do you think there has been any benefits to the, you know, different clinicians in your team using the EYE-2? P01: Yeah, I think … I think for those who were here from the beginning and sort of did that first erm … bit of training … erm, it think they’ve, I do think they’ve used the booklets regularly and that’s been the big one. You know it has, it’s just helped with guiding their practice a bit more’. P02: ‘ RA : how do you feel the EYE-2 approach and materials have changed the way you work and the team works? P02: It’s been such a long time it’s difficult to remember what it was like before. Erm … I mean they’re useful even for staff. Erm, we’ve got a lot of staff that either come to use newly qualified or you know they’ve been qualified for a while but don’t have any community experience and again instead of us trying to explain … what we do and what’s on offer to them we’ve kind of just put the EYE-2 resources into their induction packs. And it helps them as well. So it’s kind of, we use it in every … bit of the service that we offer including training staff’. P03: ‘ RA : Do you feel that there have been any benefits to you as a clinician having worked with the EYE-2 over the past couple of years? P03: Yeah, I mean again I … I feel that it has, like some of the information in the booklet … some of the treatment options I wasn’t aware of, so I was able to go away and have a look at those’. P05 : ‘ RA : Do you feel that the EYE-2 has helped you learn anything in particular? P05: Yeah definitely. Erm when I went through one of the booklets with a service user, it really made sense the way that it was worded and sometimes these things can be a bit wordy. So it’s about bringing it back to how someone will understand it’. P07 : ‘ RA : So do you think the EYE-2 has helped you learn anything in particular? P07: Erm what have I learnt? Erm so definitely about the importance of timing and when to introduce things with a patient because that could really influence whether the person engages with the materials. Erm what else have I learnt? … yeah I would say that was the main thing that timing is key’. P11 : Yeah so I think it’s always good to have extra resources in place and I think it’s always good to know you can go back to the resources with the clients and you can kind of go back to it when you need it. I think it’s kind of reinforced some of our staffs knowledge as well, especially I think it could be good for the people new to the team … but I’ve worked in EIP for like seven years so it’s kind of what I already knew but they are still really helpful for service users to use. Introducing at the start of treatment – NPT : Coherence (individual specification) P01: ‘P01: So, initially erm, when we were sending out, cos we send out an introduction letter to the service and they were sending out booklets with the introduction letter. But I think that practitioners now tend to … depending on which service user it is and depending on how responsive they are they might take out one or two at a time and actually work through them with a service user and guide. Other times they’ll just take them out and sort of let the service user go through them in their own time, and do it with the carer as well and to encourage the carer to go through it with the service user’. P02: ‘P02: Erm I know the written resources have been really really useful. We’ve built them into our kind of initial packs. So we give them out to people when they are accepted. Some are more generic mental health problems, so we take them out on assessment because it doesn’t necessarily suggest that somebody’s got psychosis’. P03 : ‘ RA : How would you decide erm when do you decide what materials to use? P03: Erm, I would usually start off … erm an interaction with a new patient or a new service user using the materials. I really, I really find it helpful thing to be able to go on the first visit and give them the, erm, early intervention the kind of what is early interventions booklet and also the carers booklet. And usually I just give those two to start with as an introduction and then within a few sessions when we start to get a bit more into the details I might give them also the treatment choices one. I may give them all at once but I don’t, I do try and stagger it as to not overwhelm people’. P04: ‘ RA : So how and when would you decide to use them with a service user? RA : Erm … so ideally it would be at the being of the persons time with the team and we’ve found it most effective when we’ve had like a little stand with all the leaflets in, in one of the main offices and then when the care co-ordinators are on their way to see someone for the first time they can just grab one to give them’. P06 : ‘ RA : So how might you introduce that to a new service user that you are working with? P06: Erm I guess it depends on the service user and where they are in their journey. Erm I suppose that is about human judgement and assessing when to introduce that. But I would like to introduce it early as possible. Erm kind of when we do that talk about why we are there, like when they’re like ‘well I don’t have psychosis so I don’t know why you are here’ and then it’s about that psychoeducation. So it’s used at every stage of someone’s journey cos actually the resources are there at every stage and aspect of their journey because they’re there when you are considering treatment and when you’re thinking about what is psychosis to how does this impact on my family or how can I help someone. So actually the resources are helpful for every part of the patient journey and you can introduce them when appropriate. And I think it is dependent on where your service user is in their journey and where their families are in that journey as to what booklet you introduce, when you introduce the website. But we try to do that as early as possible’. P09 : ‘ RA : When do you decide to introduce these resources to a client or a service user? P09: Erm I think that depends on the care co-ordinator. So I personally I like to get information out as soon as possible but it depends how you are working with a client as well. Sometimes people need a drip feed approach and by sort of shoving these booklets in their face might not be the best approach haha’. Utilised treatment choices booklet – NPT : Coherence (internalisation) P01: ‘P01: I think the leaflets have been invaluable, they’ve been excellent. We’ve, you know we’ve used them regularly, erm you know I’ll be honest as well, we’ve actually used them with over 35s as well as an introduction to … psychosis, and Early Intervention for Psychosis teams and the sort of possible treatments available. And they’ve been really well received by service users and carers … yeah so they’ve been an excellent resource’. P03 : ‘P03: Yeah sometimes I do use it with existing service users if they have a particular question or we are considering a change in treatment approach or something like that then I might whack out the erm, treatment options one’. P04 : ‘P04: Erm … . I think the one, So there’s one for carers, one for service users and one for medications, what’s the other one? RA : Is that the treatment choice one? P04: I think that’s the one I’m thinking of for medications. I think the one we use the most is the one for service users but I think also the really big thick one is really helpful as well I think’. P06 : ‘ RA : So is it something that you try and revisit at different stages it sounds like with different resources? P06: Yeah absolutely and kind of going back to it. So if we are thinking about treatment the we go back to the treatment booklet. You know if they are then going on about how they manage recovery then we will look at something else that might be helpful within the booklets or on the website that might be helpful’. P09: ‘ RA : You said that you’ve been using some of the leaflets, could you tell me which ones you’ve been using or have found most useful? P09: Erm so the treatment one I’ve been using. That’s been quite helpful to kind of educate the patients on what options and choices they have in their treatment’. P11 : Erm yeah the booklets are really valuable. Erm especially at the beginning when someone is high risk and they are getting to know the care co-ordinator and it’s kind of their triage assessment, having that kind of information in the booklets, I think the care co-ordinators have found them really helpful. Staff conversations around EYE-2 – NPT : Collective action (interactional workability) P07 : ‘ RA : So thinking about your team, how do the attitudes of staff, service users and carers towards the EYE-2 influence whether they’re used? P07: Erm … the discussions in meetings, that has really helped us reflect on that. And the training weas helpful, the booster session was helpful. I think that was a really good approach to have a booster session … erm what else was there. Erm well I think it’s just again to have the weekly section in the MDT meeting to talk about the EYE-2 . And we could definitely tell from the amount of brochures that they were going out. RA : Okay so what do you do to help others to use the approach and resources? Have you introduced any new staff at all to the approach and resources? P07: Yeah as a supervisor I do introduce people to it and that’s the first thing actually that I give to care co-ordinators to introduce them to it and ask them to familiarise themselves with it. Erm and its actually quite nice for staff that are new to EIS to actually have that. Erm, so not only for patients but also for new starters in the trust or to our services. So that was really well received’. P08 : ‘ RA : What else could be provided to help you know more about how to use the EYE-2 approach and resources? P08: Erm I think it’s just keeping it fresh in people’s minds. Just kind of talking about it in team meetings. We’ve had some really good assistants. =Team RA = the lady that’s kind of been working with us on the EYE-2 , she’s kind of been really present in team meetings which I think is really important to kind of keep it alive’. P10 : ‘P10: I mean again I’m thinking within my kind of most immediate contacts … erm you know with the pandemic I think I’ve been having kind of less contact with my colleagues. Erm and it affects us social within the team. Erm when I saw my colleagues actually within work … erm it could be sort of thought as almost corridor conversations and that’s something that I just think doesn’t having in the same way. Erm and I do sometimes try and make a point of calling people on teams to just have kind of an informal convo but I think it just ends up kind of feeling formal anyway. Rather than if you were kind of just wandering around the office. Erm I think talking about resources, I think that’s the kind of thing that just kind of comes up in more informal office conversations, in terms of work anyway’. Staff turnover – Process limiting factor P1 : ‘I think because we’ve had changes in the team, we’ve had new staff starting and that’s, it’s hard for them because they didn’t come in at the beginning’. P2 : ‘What else could be provided to help you to know more about using the EYE-2 approaches and resources? P2: I think potentially, I mean I don’t know if it’s, I guessing its largely due to COVID, I think … in line with us having such a high staff turnover and everything that’s happened in the last 18 months. I think it’s been really easy to use the written resources, they’ve been really useful and really handy but I think for the rest of it, maybe having … a link person some in … or have a bit more contact from somebody from EYE-2 just to remind us what there is. Erm and like I say kind of refresher training or kind of rerunning the training when we got new staff would have been helpful’. P3 : ‘Do you do anything to help others to use the approach and resources or have you introduced any new staff to the approach and resources? P3: Yeah certainly. I think that we have had quite a high staff turnover since we first started the trail and erm you know new members when they start the team and have their inductions, which you know is something I’m a little bit involved in, sort of mentoring new staff members’. P5 : ‘So what about the attitudes of staff towards the EYE-2? P5: Again I think it’s just down to them understanding what it is. You know the trouble with these projects is that people often come and go so sometimes you don’t get the best relationships because it’s such a small time is spent in one team and then they move on and we get somebody else. Erm so I think again it’s about introducing themselves before they arrive, rather than just the first day they arrive. And again a lot of the staff are new, you know they’re not up to speed with what EYE-2 is’. P11 : ‘We’ve had a lot of turnover and people coming back from erm … and we’ve had a lot of new starters. About four actually just starting in the last month, which is good actually but I wonder if they might need a refresher or maybe they aren’t aware of it. that would be good, I don’t know if you could come back and do another training. P11: We also have a new manager so I’m not sure they’re aware. Erm because obviously people would normally ben prompted by their manger so maybe it’s something I need to email them about’. Found resources helpful – Individual/communal appraisal P01 : ‘What do you know or remember about the EYE-2 intervention approach and resources? So the website, the leaflets and the social group resources? P01: The … erm I mean, I think the leaflets have been invaluable, they’ve been excellent. We’ve, you know we’ve used them regularly, erm you know I’ll be honest as well, we’ve actually used them with over 35s as well as an introduction to … psychosis, and Early Intervention for Psychosis teams and the sort of possible treatments available. And they’ve been really well received by service users and carers … yeah so they’ve been an excellent resource’. P02 : ‘Are you currently using anything from the EYE-2 project? P02: Yeah, all the booklets and the outcome measure packs. RA : Okay, perfect. Yeah, so is there any booklets you use more or erm … stand out to you as being the most helpful? P02: They’re genuinely all really useful, we use all of them. We kept running out so we’ve had to order some more, haha’. P03 : ‘Is there anything you remember about the website? P03: Yeah, I mean again use the website a lot. Erm … I consistently give out the website to people on my first visit with them. Erm, and often kind of, I never remember to save it but I often find myself googling Likemind and erm … when I’m in appointments with people, erm. The things I find particularly useful is the, I find … I find the ‘what is psychosis’ section you know a particularly useful resources. And I do go to that to guide that first discussion with people that have got you know first episode psychosis diagnosis or are kind of having an episode. Because I think kind of has got a nice level detail in terms of being you know informative enough without being overwhelming. So that one’s really helpful and I also certainly refer people to the … erm, the kind of relatives and loved ones kind of stories and the recovery stories’. P04: ‘ Is there anything that you remember about the website or the social group resources at all? P04: I don’t really remember anything about the website to be honest. Erm … and in terms of the social group, I know initially it was really helpful but obviously it was massively impacted on by the pandemic. But yeah I know initially I think it was a peer led social group and it was really popular but I guess my impression is that perhaps it’s been harder to facilitate because of the pandemic, not that that should be an obstacle for it continuing … I think now, I don’t even know if it's restarted to be honest or what’s happening with the current EYE-2 social group… RA : Okay great. Are you currently using anything from the EYE-2 project? P04: Erm … I think we are still using some of the leaflets, I think we still have some of the leaflets lying around. RA : Okay great, any specific ones that you use, so there’s the four different booklets or leaflets … any specific ones that you use more or less? P04: Erm … . I think the one, So there’s one for carers, one for service users and one for medications, what’s the other one? RA : Is that the treatment choice one? P04: I think that’s the one I’m thinking of for medications. I think the one we use the most is the one for service users but I think also the really big thick one is really helpful as well I think’. P05: ‘Do you feel there have been any benefits to you as a clinician having worked with the EYE-2 over the past couple of months or years? P05: Erm well I am a clinician because I’m a nurse but erm … yeah it was helpful going through the booklet and it was certainly helpful for one of the service users that I co-work with for the social groups’. P06: ‘ So you’ve kind of touched on this a little bit but what do you know or remember about the EYE-2 intervention approach and resources? P06: Erm so you’ve got the different booklets. Erm kind of booklets for carers as well which was really helpful. Erm you’ve also got the kind of outcome measures, the dialogues and the HoNOS measures to kind of look at someone’s recovery journey and whether that’s been helpful and looking at engagement and kind of seeing whether introducing resources early helps engagement. RA : Yeah that sounds brilliant. So is there anything else that could be provided to you to help you know more about using the EYE-2 approach and resources? P06: No I really like the website. It’s a really helpful tool to use and to get people to look at it in their own time because I think sometimes giving people loads of pamphlets and leaflets can kind of overwhelm people. Erm yeah so not that I can really think of’. P07: ‘What do you know or remember about the EYE-2 project training? P07: Erm yes so I suppose it focused on the intervention that we are providing and EIS and also the handouts to give us a better understanding of what is to offer. Also about motivational interviewing styles to engage people in interventions. Er yeah so it was really helpful to to use. Also kind of the the the additional things such as the carers [inaudible segment] which was really helpful. Erm what else was there? Erm erm the outcome measures to use the regularly, obviously the outcome measures help the study. It also helps us because obviously we are meant to do them anyway so it was really helpful to push ourselves to meet the deadlines of these outcome measures. We should be doing the anyway but its yeah, we also need to collect a lot of data from the management side to prove that we are delivering what we are meant to be delivering. But it’s good to push that to have the understanding, it is needed to understand how the intervention is being delivered and what outcome they have’. P08: ‘What do you know or remember about using the EYE-2 approach and resources? P08: So the leaflets, the website erm brilliant. They are really really helpful. The social groups, we never actually had any social groups and I can remember the social groups being discussed in the training and I remember we thought that would be a really good part of it and for some reason that never quite took off’. P09: ‘ You said that you’ve been using some of the leaflets, could you tell me which ones you’ve been using or have found most useful? P09: Erm so the treatment one I’ve been using. That’s been quite helpful to kind of educate the patients on what options and choices they have in their treatment’. P10: ‘ What do you know or remember about the EYE-2 intervention approach and resources? P10: Erm so I guess I kind of think about it in three ways really. Erm so you’ve got the website, which is available for people to use. Erm I think that’s very important especially in the context of a pandemic. Erm it means that information is a lot more accessible and can be updated. Erm and quite often kind of contacting a service a website is the easiest way, rather than trying to get hold of a person to actually speak to. The other aspects of it are the kind of paper resources, the information … erm I think it’s incredibly helpful I think. You know I think sort of predating the information that you’ve developed, which is more kind of colourful and well developed more so than I guess previous information we had available. So having it on paper is really helpful when we have face-to-face contacts. The thing I guess that I’m not aware of is if they’re kind of electronic as well. Erm maybe you can kind of access them through the website but it’s something I guess I haven’t used so much in my role, kind of since we started seeing people less and less face to face’. P11: ‘Erm yeah the booklets are really valuable. Erm especially at the beginning when someone is high risk and they are getting to know the care co-ordinator and it’s kind of their triage assessment, having that kind of information in the booklets, I think the care co-ordinators have found them really helpful’. Copyright © 2025 Greenwood et al . This work was produced by Greenwood et al . under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This is an Open Access publication distributed under the terms of the Creative Commons Attribution CC BY 4.0 licence, which permits unrestricted use, distribution, reproduction and adaptation in any medium and for any purpose provided that it is properly attributed. See: https://creativecommons.org/licenses/by/4.0/ . For attribution the title, original author(s), the publication source – NIHR Journals Library, and the DOI of the publication must be cited. Bookshelf ID: NBK617950 Contents < Prev Next > Share Views PubReader Print View Cite this Page Greenwood K, Jones CI, Yaziji N, et al. Team-based motivational engagement intervention in young people with first-episode psychosis: the EYE-2 cluster RCT with economic and process evaluation. Southampton (UK): National Institute for Health and Care Research; 2025 Sep. (Health and Social Care Delivery Research, No. 13.33.) Appendix 9, Implementation figures, tables, themes and quotes. PDF version of this title (5.0M) Other titles in this collection Health and Social Care Delivery Research Recent Activity Clear Turn Off Turn On Implementation figures, tables, themes and quotes - Team-based motivational enga... Implementation figures, tables, themes and quotes - Team-based motivational engagement intervention in young people with first-episode psychosis: the EYE-2 cluster RCT with economic and process evaluation Your browsing activity is empty. Activity recording is turned off. 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