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Despite increased prevalence of domestic violence and abuse (DVA), victimization through DVA often remains undetected in mental health care. To estimate the effectiveness of a system provider level training intervention by comparing the detection and referral rates of DVA of intervention community mental health (CMH) teams with rates in control CMH teams. We also aimed to determine whether improvements in knowledge, skills and attitudes to DVA were greater in clinicians working in intervention CMH teams than those working in control teams. We conducted a cluster randomized controlled trial in two urban areas of the Netherlands. Detection and referral rates were assessed at baseline and at 6 and 12 months after the start of the intervention. DVA knowledge, skills and attitudes were assessed using a survey at baseline and at 6 and 12 months after start of the intervention. Electronic patient files were used to identify detected and referred cases of DVA. Outcomes were compared between the intervention and control teams using a generalized linear mixed model. During the 12-month follow-up, detection and referral rates did not differ between the intervention and control teams. However, improvements in knowledge, skills and attitude during that follow-up period were greater in intervention teams than in control teams: β 3.21 (95% CI 1.18-4.60). Our trial showed that a training program on DVA knowledge and skills in CMH teams can increase knowledge and attitude towards DVA. However, our intervention does not appear to increase the detection or referral rates of DVA in patients with a severe mental illness. A low detection rate of DVA remains a major problem. Interventions with more obligatory elements and a focus on improving communication between CMH teams and DVA services are recommended.

Background: The resource group method provides a structure to facilitate patients’ empowerment and recovery processes, and to systematically engage signifcant others in treatment and care. A patient chooses members of a resource group (RG) that will work together on fulflling patients’ recovery plan. By adopting shared decision-making processes and stimulating collaboration of diferent support systems, a broad and continuous support of patients’ chosen goals and wishes is preserved and problem solving and communication skills of the RG members are addressed. Objective: The objectives of this study are (1) to establish the efectiveness of the RG method in increasing empowerment in patients with severe mental illnesses (SMI) in the Netherlands; (2) to investigate the cost-efectiveness and cost utility of the RG method; and (3) to qualitatively explore its dynamics and processes. Methods/design: This multisite randomized controlled trial will compare the efects of the RG-method integrated in Flexible Assertive Community Treatment (FACT) (90 patients) with those of standard FACT (90 patients). Baseline assessments and 9-month and 18-month follow-up assessments will be conducted in face-to-face home visits. The primary outcome measure, empowerment, will be assessed using the Netherlands Empowerment List (NEL). The secondary outcomes will be quality of life (MANSA); personal, community and clinical recovery (I.ROC); general, social and community functioning (WHODAS 2.0); general psychopathological signs and symptoms (BSI-18); and societal costs (TiC-P). An economic evaluation of the cost-efectiveness and cost utility of the RG method will also be conducted. A qualitative multiple case-study will be added to collect patients’, RG members’ and professionals’ perspectives by indepth interviews, observations and focus groups. Discussion: This trial will be the frst to study the efects of the RG method on empowerment in patients with SMI. By combining clinical-efectiveness dat