MHIN 3: Integrated care protocols for co-occurring mental and physical health problems and substance use issues (aka VALOR study - Value of Assertive Outreach)
What are we trying to do?
Alcohol Assertive Outreach Treatment (AAOT) is a community, or ‘place-based’ service aimed at a group of people with alcohol dependence who have high levels of unplanned alcohol-related hospital attendance and who struggle to engage with traditional health and other services. Typically, people in this group have multiple long-term conditions and experience high levels of socioeconomic deprivation, so AAOT offers a way to reduce the high levels of morbidity and mortality they experience, through increasing engagement in treatment.
The overall aim of this study is to evaluate the implementation of the AAOT model to create a framework explaining the barriers and enablers to both its implementation, but also its sustainability and potential for wider use. This will be done by:
- A mixed-methods study using routinely collected clinical AAOT data and semi-structured interviews.
- Co-producing expert-by-experience outcome measures to evaluate the assertive outreach model.
- Exploring the longer-term clinical- and cost-effectiveness of AAOT.
- Developing best practice and sharing the findings with service-users, practitioners and policymakers.
Why is this important?
Worldwide, alcohol misuse is the biggest factor for death, ill-health and disability among 15-49 year olds. In 2021 in the UK, there were 9,641 alcohol-specific deaths, which was an increase of almost 20% from 2019. Alcohol-related harm costs the NHS £3.5 billion each year, so both decreasing harm for patients and reducing costs to the NHS are key aims in government policy.
How are we doing it?
We are doing an evaluation of how and when AAOT services are used and the outcomes before and after AAOT involvement, as well as exploring the barriers and facilitators of AAOT implementation. This will take place over two studies:
- Study 1: Analysis of Routine Clinical Data (this is a quantitative, or data-based study)
- Study 2: Analysis of barriers and facilitators to the implementation of AAOT in clinical services (this is a qualitative, or interview-based, study)
We are assessing the engagement and incorporation of AAOT services into routine care by examining the services currently in use, which include:
- Assertive outreach services (BigLife in Bolton, and the High Intensity Substance Misuse Team in Salford)
- NHS general hospital sites (Salford and Bolton Royal Hospital)
- Structured community alcohol care teams (GMMH Achieve in Salford and Bolton)
A PPI advisory panel has been set up to generate outcomes and co-develop the interview schedules that will be used to gather information about service-user experience. Patient and Public Involvement (PPI) members are integrated into the study team and meet with researchers regularly to give feedback on recruitment and research materials, to help generate a list of outcomes that will inform study 2, and to provide feedback on the analysis and interpretation of the data that’s gathered.
Who are we working with?
Dr Stephen Kaar, Consultant Addictions Psychiatrist in Greater Manchester Mental Health NHS Foundation Trust is the Principal Investigator (PI) of this project.
We are working with:
- GMMH Achieve (Salford and Bolton)
- Biglife (Salford and Bolton)
- Salford Royal Hospital
- Royal Bolton Hospital
Funding information
This work was funded by the NIHR Mental Health Implementation Network.
