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)

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 – 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.