The Value of Outreach (VALOR): An evaluation of the implementation of alcohol assertive outreach in Greater Manchester

Background
Alcohol misuse can lead to a wide range of harms, including chronic physical health problems, increased risk of accidents, mental health difficulties and mortality. In England, the high number of alcohol-related hospital admissions remains a significant problem. An important percentage of these admissions are attributable to a relatively small group of people who frequently attend the Accident and Emergency (A&E) departments. This cohort of service users have complex needs and a history of disengagement from standard substance misuse and mental health services. Alcohol Assertive Outreach Treatment (AAOT) is an intervention that offers creative and flexible ways of engaging the service users through small caseloads per practitioner and frequent contacts outside of clinical environments.
Methods
Funding was received from the National Institute for Health and Care Research (NIHR) Mental Health Implementation Network (MHIN) and ethical approval was obtained from Health Research Authority (HRA) and Health and Care Research Wales (HCRW) (Ref: 23/WA/0275 IRAS ID: 324498).  Semi-structured interviews were conducted with 20 service users, 20 staff members and 20 stakeholders (N=60) from AAOT teams in Bolton and Salford, Greater Manchester with the aim to derive an explanatory framework of the barriers and facilitators of the implementation of AAOT and depict the experiences of working with the core components of the intervention across different services and sites. Interview transcripts were coded using Framework Analysis and were analysed using the Consolidated Framework for Implementation Research (CFIR) and Proctor et al.’s taxonomy of Implementation Outcomes.
Results
The analysis revealed several themes pertaining to the appropriateness, sustainability, efficiency and patient-centredness of AAOT. Differences between services and fidelity to the model were found and reflected upon.  
Conclusions
The findings of this study indicate that AAOT is deemed sustainable and appropriate for service users that struggle to engage with standard alcohol misuse interventions and frequently attend A&E departments.