Title: Co-developing Improving Access to Psychological Therapies (IAPT) services to improve the response to Family Members affected by relatives with alcohol and drug problems (IAPT-FMs)
Funder: Department of Health and Social Care

Abstract: Research Question How can Improving Access to Psychological Therapies services best meet the complex needs of help-seeking adults who also support relatives with alcohol or drug problems? Background Evidence shows that having a relative with alcohol or drug problems can cause stress, anxiety and/or depression. Improving Access to Psychological Therapies (IAPT) services work alongside General Practitioners (GPs) to provide psychological therapies to people with mild to moderate anxiety or depression. Our data show that over 20% of people using IAPT services are concerned about a relative s alcohol or drug problem (referred to as affected family members ). However, IAPT services are not currently equipped to address this issue. Proximity to alcohol/drug issues is not routinely assessed in IAPT. The therapies used in IAPT are highly structured, have not been designed for this problem, and have limited scope to help people cope with the specific additional stressors associated with having a relative with alcohol/drug problems. However, appropriate interventions are available. For example, the 5-Step Method is a flexible, brief intervention which has been shown to help family members tackle the challenges of having a relative with alcohol/drug problems. Aims and Objectives We aim to work collaboratively, with all relevant stakeholders, to co-produce an intervention pathway, which can be implemented through IAPT services, in order to meet the needs of this significant group of service-users. Methods We will take a participatory approach to intervention-pathway development, using an adapted form of Experience-Based Co-Design. Phase 1: Interviews with affected family members and service providers about their experiences of using or providing IAPT services, to identify any touchpoints which would help or hinder the delivery of an appropriate intervention. Phase 2: Feedback groups, involving affected family members, service providers, and other stakeholders, to cluster and prioritise these touchpoints from Phase 1, followed by a cross-matrix analysis to identify consensus across the groups. Phase 3: Co-design event to collaboratively solve the consensus problems identified from Phase 2, leading to a first prototype of the pathway. Phase 4: Consultation with four partner sites to produce prototype 2. Implementation-focused consultation with national stakeholders to produce the final iteration of the pathway. Timelines for delivery The study will be delivered over 24 months, starting in January 2020. Phases 1 and 2 will be completed by April 2021, Prototype 1 by August 2021 and the final pathway by October 2021. Anticipated impact and dissemination Core strengths of our approach are co-production and the speed of the pathway to patient benefit: a/ Collaboration is fundamental to our approach &ndash; we will co-develop all recommendations with affected family members and professionals. b/ The final intervention-pathway will be fully implementable within IAPT services. We have a candidate intervention which is already evidence-based. We plan to evaluate the pathway in a future trial to determine whether a combined approach (IAPT plus a specific intervention focused on coping with a family member s substance use) is cost-effective. Results will be disseminated through websites, scientific papers, and IAPT conferences.

Lay abstract: Background Research has shown that having a relative with alcohol or drug problems leads to stress, anxiety and/or depression. Improving Access to Psychological Therapies (IAPT) services work alongside General Practitioners (GPs) to provide psychological therapies to people with mild to moderate anxiety or depression. Over 20% of people using IAPT services are concerned about a relative s alcohol/drug problem. However, IAPT services are not currently equipped to address this issue. The therapies used in IAPT are highly structured, have not been designed for this problem, and have limited scope to explore the specific impacts of having a relative with an alcohol/drug problem. Service users may be reluctant to talk about this due to stigma and fear of reprisals. They may also not recognise the impact it is having on their own mental health. Aims Working with clients and staff from four IAPT services, we aim to design an improved response to service users affected by relatives with alcohol/drug problems (referred to as affected family members). We aim to make IAPT services more effective at providing help to this significant group of clients. We will use a participatory approach to intervention development called experience based co-design in which we: Collect people s experiences through interviews Identify service features which are beneficial or problematic Receive feedback and prioritise areas for action Work in close and equal collaboration with service users and providers to develop a new treatment pathway Methods We will interview affected family members and service providers to explore their experiences of IAPT services. We will share literature about what we know can help affected family members including the 5-Step Method which has been found to be effective in GP services. The 5-Step Method is a flexible, brief intervention to help family members tackle the challenges of having a relative with alcohol/drug problems. We will find out what is missing from current IAPT assessment and intervention and then generate ideas about how to address these gaps and integrate the 5-Step Method within IAPT services. To achieve this, we will hold a co-design event bringing together clients and providers to develop action plans. The research team will collate the action plans into a series of recommendations. The draft recommendations will be shared with four IAPT services and national stakeholders for feedback and refinement. Final recommendations will be disseminated through newsletters, papers, workshops and presentations. We plan to evaluate the recommendations in a future research trial. Collaboration and the lived experience of both service users and professionals is fundamental to our approach &ndash; we will co-develop all recommendations. An affected family member is a co-applicant and we will work closely with a lived experience advisory panel throughout the project.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES;7.1 INDIVIDUAL CARE NEEDS
Health categories: MENTAL HEALTH