Distress Brief Intervention pilot programme: evaluation

This report presents a realist evaluation of the Distress Brief Intervention (DBI) programme. DBI has been successful in offering support to those in distress, and has contributed to peoples’ ability to manage and reduce their distress in the short term, and for some in the longer term.

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15 Appendix C – Resourcing Implications and Recommendations

Drawing on results from all three elements of the evaluation, we summarise in Table 8.1, resourcing implications and recommendations for future delivery of DBI below. Using a tabular format, findings from the evaluation, considerations for the delivery of DBI and associated resourcing implications are presented vertically by stage of DBI (training, Level 1, Level 2, wider system) and horizontally by classification. Practitioners working within a specific stage of DBI will wish to read the table vertically. The columns have been shaded to help with this, for example if you are a Level 2 DBI practitioner you can see the different findings and recommendations in the shaded Level 2 column. Decision makers such as commissioners of DBI services will wish to read the table horizontally.

Table 8.1: Supporting the organisation of resources and modes of delivery in respect to the  DBI Programme pathways


Level 1  DBI

Level 2  DBI

Implications for the wider system

Findings from the evaluation

  •  Between October 2017 and December 2020, 997 staff received training in Level 1 DBI. [Sections 5.1, 5.2]
  •  Delivery of online training for Level 1 raised concerns that online lowers the effectiveness of training about compassionate response and preference was expressed, particularly by police responders, for face-to-face training. [Sections 5.1.1, 5.1.2]
  •  No impact on resources (staff time) required to respond to individuals in distress (Level 1 DBI). [Section 6.1.3]
  •  86% of staff in the Level 1 survey agreed that DBI was useful when responding to an individual in distress (Level 1 DBI). [Section 6.1.2]
  •  Manager level support was required in each locality to oversee rollout, delivery and reporting of the Level 2 service. This person was also the main point of contact with DBI Central. [Section 6.5]
  •  The high level of success in attempting (100%) and achieving (65%) a first contact within 24 hours of referral from Level 1 developed support and trust in the system. [Section 6.3.1]
  •  A quarter of cases receiving DBI Level 2 (26%) took no more than four hours, 62% took between four and seven hours, and 12% more than seven. [Section 6.3.4, Appendix 3, Table A6.3]
  •  Highest proportion of all referrals to Level 2 in all sites was from Primary Care 'in hours'. [Section 4.2, Appendix 3, Table A4.5]
  •  Approximately 27% of participants who had a successful contact at Level 2 (n=3,431) were signposted to statutory services, 73% were signposted to non-statutory services, 11% had a supported connection to statutory services and 25% had a supported connection to non-statutory services (note that the options were not mutually exclusive). [Section 6.6, Appendix 3 Tables A6.7-A6.10]
  •  Flexibility in staff appointments for the delivery of Level 2 services to ensure requirements for first contact within 24 hours. [Section 6.3.2]
  •  Limited evidence (< n=30) is available on the repeated use of front-line services where distress is reported in the three months post DBI Level 2. [Section 6.6.2, Appendix 3, Table A7.19]

Considerations for the delivery of DBI

  •  The mode of training for Level 1 is important for staff engagement and for decisions on training delivery. [Section 5.1]
  •  Developing feedback mechanisms between Level 2 and Level 1 providers can help identify cases that are not suitable for DBI and reduce inappropriate referrals. [Section 5.5]
  •  The core elements of Level 2 DBI, such as the D-MaP or contact within 24 hours, were adhered to, but flexibility was allowed in implementing Level 2 DBI and was viewed as a strength, building on the existing asset base of practitioners' skills. [Section 6.2.1]
  •  The purpose and level of support provided in Level 2 should be clearly communicated in the first session to manage expectations for individuals who may be expecting a counselling or therapeutic service or longer term support. [Section 6.2.1]
  •  Feedback from Level 1 and 2 providers and individuals suggests that DBI is less appropriate for those with severe and/or enduring mental health problems and/or addictions. [Section 6.3.3, Appendix 3, Table A67.4]
  •  This may highlight a tension or problem in accessing more appropriate supports, such as counselling or other talking therapies, quickly.

Resourcing implications

  •  Encouragement of DBI 'Champions' at all levels within and between organisations can lead to DBI training and delivery being implemented as a tool which can help to address issues identified within the service and not as an add-on.
  •  No impact on resources (staff time) required to respond to individual in distress (Level 1 DBI).
  •  Delivery of DBI Level 2 (exclusive of training and DBI Central Costs) was estimated to cost £219 per referral and £339 per successful contact that led to support being provided. (See Appendix 5, Table 4.6)
  •  The option of Level 2 DBI provides a useful referral pathway for frontline services responding to individuals in distress who are not in immediate crisis danger.
  •  Employing administrative staff allows DBI practitioners to spend their time in providing services to individuals in need rather than spending time on administrative tasks.
  •  The support from DBI Central to assist frontline services, co-ordinate Level 2 DBI providers' contracts, and to co-ordinate national government interest, was estimated to cost £328,000 in FY2020-2021 (details provided in Appendix 5).

Resourcing recommendations

  •  Delivery of Level 1 training via online platform has the potential to reduce cost compared to face-to-face if additional facilities and trainers are required.
  •  Regular review and updates to training materials will be required and refresher training arranged for all staff.
  •  Level 1 referral forms and process for submitting to Level 2 providers should capitalise on existing (online) processes and systems where possible to reduce time taken and ensure all required data is captured. [Section 6.1.3]
  •  To ensure requirements for first contact within 24 hours are met, flexibility in staff contracts for the delivery of Level 2 services may need to be considered.
  • Administrative support staff were employed in each pilot site to support the practices in delivering the DBI service. The use of administrative staff to also make the first contact with the individual increases the probability of making contact within 24 hours but may raise the risk of the client wanting more emotional support that is not provided. [Section 6.3.2]. This may have implications for administrative staff roles and responsibilities, training and support.
  •  Additional facilities may be required for the delivery of Level 2 services if providers do not have readily available and accessible private space. Rooms in GP surgeries or community facilities may need to be hired.
  •  Signposting and initiating referrals to other services following Level 2 was common and seen as an important step by DBI practitioners to support people post DBI. Consideration is needed on the availability of statutory and non-statutory services within the community and the risks of increased demand for services and the impact on waiting lists.
  •  Implication for commissioning DBI services to recognise the need for risk assessment, particularly for in person appointments (for example, may require two people to attend, additional space required etc).
  • DBI is unlikely to reduce demand on frontline services who will still be required to attend call-outs and to conduct the surgery appointments, but DBI does provide them with another referral route option and that - coupled with the enhanced compassion skills - may help to ease the emotional task of assisting an individual in distress.


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