I am a Research Fellow at the Centre for Addiction and Mental Health Research, an NIHR Mental Health Research Group based at the University of Hull. My background is in Psychology, and I use mixed methods approaches to understand and improve the healthcare experiences of people with co-existing substance use and mental health conditions. My current work focuses on identifying unmet needs and optimising care pathways in the context of acute and crisis care. I am particularly interested in co-production with groups who are typically underrepresented in healthcare and addiction research.

Abstract

Evaluating the implementation of high-quality alcohol assertive outreach treatment: A mixed-methods study

Alcohol Assertive Outreach Treatment (AAOT) is a community-based model of care which supports individuals with alcohol dependence who are frequently admitted to hospital and are often not engaged with existing services. The literature identifies six features of AAOT which are essential to the provision of a high-quality service. The aim was to use Proctor’s Taxonomy of Implementation Outcomes to evaluate the implementation of high-quality AAOT. We conducted a mixed-methods evaluation involving: a) quantitative analysis of routinely collected clinical data for 40 service-users, including measures of alcohol consumption and quality of life; b) clinical case note review of 8 service-users; and c) qualitative semi-structured interviews with 9 service-users, 3 stakeholders and 1 AAOT staff member, and a focus group with 4 AAOT practitioners. Qualitative data were analysed using Framework Analysis. Quantitative analyses indicated significant improvements in psychological health (p=.02), quality-of-life (p=.01) at 6 months, and reduced alcohol consumption at 3 months (p=.02). 30% were abstinent at 6 months. The case notes indicated good fidelity to high-quality AAOT. Qualitative findings indicated that the implementation of AAOT was feasible and highly acceptable and appropriate for service-users. Challenges included stigma in healthcare, which was mitigated through multi-agency working and assertive advocacy. The AAOT service was successfully implemented with good fidelity to the high-quality model, significantly positive impacts on service-user outcomes and experiences of care, and was viewed as an appropriate and effective model of supporting vulnerable individuals with alcohol dependency. Challenges during implementation were mitigated through multidisciplinary collaborations and supporting practitioners. These findings indicate that compassionate, person-centred, assertive care is valuable for people with alcohol dependence.