Improving quality of life and behaviour that challenges in people with mild to moderate intellectual disability through person-centred solution focused communication (ICONIC)

Research question Does adapted DIALOG+ reduce behaviour that challenges in people with mild and moderate intellectual disability by improving quality of life and is it cost effective?

Background 18% of people with intellectual disability (ID) display behaviour that challenges (e.g. aggression to others/ self).

Negative consequences include exclusion from services, prescription of antipsychotic medication, breakdown in placements and admission to psychiatric hospital. The causes include poor quality of life (QoL); Improving QoL is a key target for interventions. Current psychological interventions (e.g.

Positive Behavioural Support) do not improve QoL and consequently have only short term benefits in reducing behaviour that challenges.

We propose to address this gap by adapting an existing person-centred intervention that improves QoL in people with mental illness, called DIALOG+.

DIALOG+ is delivered using an app, and uses the DIALOG scale and a solution focused approach to help individuals identify and address concerns with aspects of their life by mobilising their existing resources. It is delivered by clinicians in routine meetings. Currently DIALOG+ is inaccessible for people with ID.

Aims and Objectives To develop an adapted version of DIALOG+ (aDIALOG+) for people with mild and moderate ID; to assess the feasibility and acceptability of aDIALOG+; to evaluate the clinical and cost effectiveness of aDIALOG+ in reducing behaviour that challenges, compared to treatment as usual; to conduct a process evaluation and to assess the implementation of aDIALOG+ in routine clinical practice and make recommendations for wider use in NHS and social care settings.

Methods There will be four workstreams (WS) over 66 months.

WS1: We will conduct two systematic reviews on quality of life measures and mental health interventions using apps in people with ID to inform the adaptations. We will hold stakeholders workshops to co-produce aDIALOG+, followed by piloting in participants with ID. We will examine the psychometric properties of the DIALOG scale in 120 participants with ID.

WS2: We will conduct a single arm feasibility study of aDIALOG+ delivered by 12 clinicians to 60 participants with ID to assess recruitment and acceptability. We will explore if aDIALOG+ can be delivered in care homes and is acceptable to staff. We will undertake work to establish the minimal clinically important difference in the primary outcome measure.

WS3: We will conduct a multi-centre cluster RCT in England and Northern Ireland (n=420) with an internal pilot, to examine the clinical and cost effectiveness of aDIALOG+ compared to treatment as usual.

WS4: We will interview stakeholders about barriers and facilitators affecting implementation and develop an implementation plan to roll out aDIALOG+ at one NHS trust.

We will conduct stakeholder workshops to identify implementation issues, leading to refinement of the implementation plan.

Anticipated impact aDIALOG+ could improve QoL and reduce behaviour that challenges, thus reducing inappropriate use of psychotropic medications and hospitalisations, and reducing NHS and social care costs. aDIALOG+ and its associated app will be available for free.

Dissemination of findings will be via training workshops, conferences, social media, professional forums, and engagement with commissioners, policy makers, NHS England and NICE.