Research into practice: The implementation and evaluation of alcohol assertive outreach treatment in England

Background: The UK’s National Institute for Health Research (NIHR) Mental Health Innovation Network (MHIN) aims to catalyse the implementation of evidence-based interventions at a supra-regional and national level in priority areas of unmet mental health need. Alcohol Assertive Outreach Treatment (AAOT) was identified by MHIN as a promising solution that could improve integrated support for co-occurring substance use, physical and mental illness. AAOT is a model of care originally developed for people with severe mental illnesses which has been used effectively to support patients with alcohol dependence and high levels of alcohol-related hospital attendance. Such patients have high levels of multimorbidity, often experience extreme socio-economic deprivation, and have poor engagement with existing health care services, including specialist treatment and primary care. As a result, their Emergency Department attendance is frequent, with high rates of emergency hospital admissions to both acute and mental health beds. 

Two sites in Hull and Manchester in Northern England were awarded research funding to evaluate the implementation of AAOT, with support from the central MHIN team in London and embedded within their respective regional NIHR Applied Research Collaboration (ARC) infrastructures.  Methods A mixed-methods study design was employed in both sites, comprising: 1) quantitative data analysis of clinical and demographic data to characterise the AAOT cohort and determine engagement with the model, unplanned healthcare utilisation and treatment outcomes; and 2) qualitative semi-structured interviews with patients, AAOT staff and key stakeholders to explore barriers and enablers to the implementation of AAOT, and analysed using framework analysis based on Proctor’s criteria. To foster collaboration and share knowledge across the two sites an AAOT Community of Practice approach was established, supported by the central MHIN team. 

Results: The session will introduce MHIN and the AAOT model with reflection on the evolution of the supra-regional collaboration and the role of MHIN in the implementation and evaluation of AAOT. Findings from the mixed-methods evaluations in Hull and Manchester showed that AAOT can be implemented in diverse geographic locations, but we observed variation in service models, with important implications. Experiences of establishing the AAOT Community of Practice will be shared. Finally, a panel discussion will offer opportunities to ask questions around the collaborations and learning from the evaluations. 

Conclusions: AAOT is an effective model of care that reduces unplanned healthcare utilisation in people with high levels of multimorbidity and alcohol dependence who are unable to access standard care. This supra-regional collaboration led by MHIN supported a successful two site evaluation of the implementation of AAOT in Manchester and Hull with important learning on its adoption, acceptability, and sustainability.