Care Plan Templates in Adult Community Mental Health Teams in England and Wales: An Evaluation

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The research covers England and Wales, but the expected readers will be from different countries. I recommend that, in the introduction and discussion, refer to the articles that present the current challenges of using the "care plan" in other countries. This is especially important because many references are older than five years.

Author Response

Please find all feedback attached.

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

This is an interesting paper in which the authors used a systematic approach to evaluate care plan templates used to develop care plans for mental health settings in the UK. The results should be of interest to the Mental Health Trusts and will hopefully stimulate improvements in the templates. In this regard, this work has potential for widespread impact in the UK.

Strength

• Organized, thoughtful, systematic approach to developing the evaluation tool based on best evidence
• Methods were clearly outlined in sufficient detail
• Results are presented using the red/amber/green scheme which gives a visual overview in an easy-to-digest format
• Discussion centered on clinical versus design aspects which is very helpful to understand the impact of the deficits
• Influence of the electronic health record was useful and sufficient

Weaknesses

• I would like to see how all of the tools fell into the four quadrants shown in Figure 1. For instance, how many tools (if any) were rated High design/High quality?

Author Response

Please find reviewers feedback.

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

This is a very well-written paper, with meticulous detail on the current status of the multiple components of the community mental health care plan templates currently in use across England and Wales. It has great potential to establish consistency of care interventions with an evidence-based instrument used for the care plan. All details appear to be in order except the very basic question of why this study is not registered? Does that mean there was no ethical oversight on the process? Who did the design of the study intervention, the analysis? In my professional roles, studies that have not undergone review and received approval by an ethics committee are not permitted to proceed and cannot be disseminated. Thus, this aspect is very concerning. Had there been approval my review would have stated this a flawless manuscript, but this aspect reduces my approval. 

Author Response

Please find our feedback and amendments.

Author Response File: Author Response.pdf

Round 2

Reviewer 3 Report

Comments and Suggestions for Authors

Thank you for your revisions, which do enhance the scientific soundness of the paper. A few minor suggestions:

1. In Line 32, suggest to expand upon the statement that "this process is followed internationally". What does that mean, and where? While you provided 2 references, some text explanation would make sense, as this solo sentence seems dangling and does not provide any context.

2. Lines 96-98- the NIH Care Standards ad NHS Policy Guidelines- where is this referenced in Table 2, and which come from what source? 

3. Lines 141-142- the approval sentence should include that this study was approved. That is missing after the word "approved". Good to see the assigned number was included. 

4. While there is not a separate "Limitations" section, this should be included in the Conclusion. What are the limitations of this study? Can this be generalized, can this be adapted to other care plan procedures in other clinical settings? Will it be cumbersome, are there costs involved, etc. Anything that shows how this research is limiting or restrictive should be included here, albeit briefly.  

My recommendation is to publish this paper, after these points are addressed. Well done, overall! 

Author Response

1. In Line 32, suggest to expand upon the statement that "this process is followed internationally". What does that mean, and where? While you provided 2 references, some text explanation would make sense, as this solo sentence seems dangling and does not provide any context. The wording has changed to now say This process is followed internationally for example Ethiopia (Hailemariam et al., 2015), and Australia (Reid, Escott, & Isobel 2018; Stomski & Morrison, 2017).

2. Lines 96-98- the NIH Care Standards ad NHS Policy Guidelines- where is this referenced in Table 2, and which come from what source?  Table 2 is updated in detail.

3. Lines 141-142- the approval sentence should include that this study was approved. That is missing after the word "approved". Good to see the assigned number was included.  – lines 152/153. The wording now states The University’s School of Human and Health Research Ethics Panel reviewed the evaluation application and was approved (SREP-2019-097). 

4. While there is not a separate "Limitations" section, this should be included in the Conclusion. What are the limitations of this study? Can this be generalized, can this be adapted to other care plan procedures in other clinical settings? Will it be cumbersome, are there costs involved, etc. Anything that shows how this research is limiting or restrictive should be included here, albeit briefly.  Wording inserted in the conclusion lines 395 – 398.