Examining outcomes for service users accessing the Breaking Free Online computer-assisted therapy program for substance use disorders via a 'telehealth' approach: protocol for a two arm, parallel group randomized controlled trial.

BACKGROUND: Breaking Free Online (BFO), a computer-assisted therapy (CAT) program for substance use disorders (SUD), has been available across UK treatment services for the past decade and has demonstrated efficacy. The Covid-19 pandemic has contributed to digital and 'telehealth' approaches to healthcare delivery becoming more common and accepted, and has in parallel, increased numbers of referrals to SUD services because of the impact pandemic-related stress has had on substance using habits in the general population. Digital and telehealth approaches, such as BFO, have the potential to support the treatment system to meet this increased demand for SUD services. METHODS: Parallel-group randomized controlled trial of eight-week BFO as an adjunct to standard treatment for SUD, in comparison to standard treatment only, at a National Health Service (NHS) Mental Health Trust in North-West England. Participants will be service users aged 18 years and over with demonstrable SUD for at least 12-months. Interventional and control groups will be compared on multiple measures from baseline to post-treatment assessment at eight-weeks, and then three and six-months follow-up. Primary outcome will be self-reported substance use, with secondary outcomes being standardized assessments of substance dependence, mental health, biopsychosocial functioning and quality of life. DISCUSSION: This study will examine whether BFO and telehealth support, when delivered as an adjunct to standard SUD interventions, improves outcomes for services users receiving NHS SUD treatment. Findings from the study will be used to inform both developments to the BFO program and guidance around augmenting the delivery of CAT programs via telehealth. Trial registration registered with ISRCTN on 25th May 2021-registration number: 13694016. PROTOCOL VERSION: 3.0 05th April 2022. TRIAL STATUS: This trial is currently open to recruitment-estimated to be completed in May 2023.

The impact of participation in research for speech and language therapy departments and their patients: A case example of the Big CACTUS multicentre trial of self-managed computerized aphasia therapy.

BACKGROUND: In order to conduct research that is meaningful to speech and language therapy services and their patients, it is often desirable to conduct the research within routine clinical services. This can require considerable time and commitment from speech and language therapists (SLTs). It is therefore important to understand the impact that such participation in research can have. AIMS: To explore the impact of research participation in the Big CACTUS study of self-managed computerized aphasia therapy conducted in 21 UK NHS speech and language therapy departments. METHODS & PROCEDURES: An online survey was sent to SLTs who took the lead role for the study at their NHS Trust to evaluate the impact of study participation in three domains: capacity-building, research development and health services. The questionnaire, based on the VICTOR framework for evaluating research impact, included Likert scale statements and closed and open-ended questions. The results from open-ended questions were coded and analysed using framework analysis in NVivo 12 and the data from closed questions were analysed descriptively. OUTCOMES & RESULTS: A total of 12 SLTs returned the survey. Nine codes were identified from open-ended questions and 20 predefined from the literature. Analysis of the responses demonstrated the perceived impact including improvements in practices and access to therapy, investments in infrastructure, increased SLT profile, and impact on research culture among SLTs. The usefulness of the intervention during the COVID-19 pandemic was also highlighted. CONCLUSIONS & IMPLICATIONS: The results suggest participation in Big CACTUS has resulted in improvements in patient care and SLT research capacity and culture in speech and language therapy departments. WHAT THIS PAPER ADDS: What is already known on the subject Practice-based research is encouraged to assist with the clinical relevance of the research findings. Participation in research can be seen as an activity that is additional to the core business of patient care and it can be difficult to secure time to participate or conduct research in clinical settings. Impact evaluation initiatives of individual trials facilitate early identification of benefits beyond the trial. What this paper adds to existing knowledge This study describes specific examples of the impact on services, staff and patients from SLT participation and leadership in the Big CACTUS speech and language therapy trial in clinical settings. What are the potential or actual clinical implications of this study? Clinical services participating in research may benefit from improved clinical care for patients both during and after the study, an improved professional reputation, and increased research capacity and culture within the clinical settings.

A remote cognitive behavioural therapy approach to treating hoarding disorder in an older adult

Hoarding disorder (HD) is characterised by excessive acquisition and distress associated with discarding objects, resulting in significant clutter. At present, cognitive behavioural therapy (CBT) represents the strongest evidence base for treating HD, although some limitations exist. Little research has examined the effectiveness of remote-CBT interventions for HD in older adults. This case study focuses on Mary, an older female adult presenting with clinically significant hoarding behaviours which severely impact her daily functioning and quality of life. Assessment and intervention followed a structured CBT approach. Despite the complicating factor of COVID-19, Mary responded well to a remote-CBT intervention, with progress indicators suggesting modest improvements in personal, social and occupational functioning. These findings support the use of remote-CBT for HD in both reducing frequency and intensity of hoarding behaviours and improving wellbeing. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Domestic abuse and intimate partner violence: The role of digital by design

Purpose: Domestic abuse or intimate partner violence is a term that describes a pattern of abusive behaviours, often experienced concurrently and linked to gender-based violence. This study aims to explore through the literature the potential to design effective digital services that work for victims, survivors and those who provide domestic abuse support services. Design/methodology/approach: This study is based on a systems or service design thinking methodology which was adopted during a Scottish Government-funded Technology Enabled Care (TEC) pathfinder project on domestic abuse. This methodology is the basis for the Scottish Approach to Service Design which is based on the Design Council Double Diamond. During the first phase, known as the discovery phase, desk-based research is conducted by the service design team to inform their approach to the later phases (the second half of the first diamond is define whilst design and deliver form the second diamond). Time is spent during discovery to unpack the complexity whilst the approach takes a pragmatic worldview. Findings: Technology has yet to be shown to provide an effective solution to any aspect of the victim or survivors' experience or support services albeit these are often over-stretched and under-funded even without the Covid-19 pandemic. Digital abuse is increasing with perpetrators adapting new technologies. Digital developments should be grounded on ethical design principles. Research limitations/implications: This study is the result of the desk-based research during a TEC project considering the potential role of technology in tackling domestic abuse. Limitations include only including evidence from the literature;interviews were conducted but are not reported here. Another limitation is the pragmatic rather than academic nature of the approach;it was to be a foundation for service re-design. So hopefully useful for new practitioners to immerse themselves in the topic area but with no claims to be reproducible as would be the case in a formal review. Practical implications: All the evidence shows the authors need to keep trying different approaches, different forms of engagement and ways to empower survivors. Could technology support health-care practitioners to consistently use sensitive routine enquiry? Perhaps enable independent domestic violence advisors to attend more multidisciplinary team meetings in local community settings? Meanwhile, digital abuse is increasing with perpetrators adapting new technologies. Technology has not yet provided a digital solution which is practical and meets the needs of the broad intersectional population affected by domestic abuse nor those who provide support. If the future is to be based on digital developments it must be grounded on ethical design principles. Originality/value: This desk-based review collates the current national and international policy and research literature whilst focusing on digital developments which support those affected by domestic abuse. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Digital Health Interventions for Delivery of Mental Health Care: Systematic and Comprehensive Meta-Review.

BACKGROUND: The COVID-19 pandemic has shifted mental health care delivery to digital platforms, videoconferencing, and other mobile communications. However, existing reviews of digital health interventions are narrow in scope and focus on a limited number of mental health conditions. OBJECTIVE: To address this gap, we conducted a comprehensive systematic meta-review of the literature to assess the state of digital health interventions for the treatment of mental health conditions. METHODS: We searched MEDLINE for secondary literature published between 2010 and 2021 on the use, efficacy, and appropriateness of digital health interventions for the delivery of mental health care. RESULTS: Of the 3022 records identified, 466 proceeded to full-text review and 304 met the criteria for inclusion in this study. A majority (52%) of research involved the treatment of substance use disorders, 29% focused on mood, anxiety, and traumatic stress disorders, and >5% for each remaining mental health conditions. Synchronous and asynchronous communication, computerized therapy, and cognitive training appear to be effective but require further examination in understudied mental health conditions. Similarly, virtual reality, mobile apps, social media platforms, and web-based forums are novel technologies that have the potential to improve mental health but require higher quality evidence. CONCLUSIONS: Digital health interventions offer promise in the treatment of mental health conditions. In the context of the COVID-19 pandemic, digital health interventions provide a safer alternative to face-to-face treatment. However, further research on the applications of digital interventions in understudied mental health conditions is needed. Additionally, evidence is needed on the effectiveness and appropriateness of digital health tools for patients who are marginalized and may lack access to digital health interventions.

Effectiveness of a structured intervention to make routine clinical meetings therapeutically effective (DIALOG+) for patients with depressive and anxiety disorders in Bosnia and Herzegovina: A cluster randomised controlled trial.

BACKGROUND: DIALOG+ is a patient-centred, solution-focused intervention, which aims to make routine patient-clinician meetings therapeutically effective. Existing evidence suggests that it is effective for patients with psychotic disorders in high-income countries. We tested the effectiveness of DIALOG â€‹+ â€‹for patients with depressive and anxiety disorders in Bosnia and Herzegovina, a middle-income country. METHODS: We conducted a parallel-group, cluster randomised controlled trial of DIALOG+ in an outpatient clinic in Sarajevo. Patients inclusion criteria were: 18 years and older, a diagnosis of depressive or anxiety disorders, and low quality of life. Clinicians and their patients were randomly allocated to either the DIALOG â€‹+ â€‹intervention or routine care in a 1:1 ratio. The primary outcome, quality of life, and secondary outcomes, psychiatric symptoms and objective social outcomes, were measured at 6- and 12-months by blinded assessors. RESULTS: Fifteen clinicians and 72 patients were randomised. Loss to follow-up was 12% at 6-months and 19% at 12-months. Quality of life did not significantly differ between intervention and control group after six months, but patients receiving DIALOG â€‹+ â€‹had significantly better quality of life after 12 months, with a medium effect size (Cohen's d â€‹= â€‹0.632, p â€‹= â€‹0.007). General symptoms as well as specifically anxiety and depression symptoms were significantly lower after six and 12 months, and the objective social situation showed a statistical trend after 12 months, all in favour of the intervention group. No adverse events were reported. LIMITATIONS: Delivery of the intervention was variable and COVID-19 affected 12-month follow-up assessments in both groups. CONCLUSION: The findings suggest DIALOG â€‹+ â€‹could be an effective treatment option for improving quality of life and reducing psychiatric symptoms in patients with depressive and anxiety disorders in a low-resource setting.