5 Conclusions and Recommendations
The overarching aim of the evaluation was to investigate the implementation of the DBI extended programme, the experiences of those who deliver and receive DBI, the impact that the programme has on individuals' levels of distress, and its comparison with the main evaluation.
This evaluation has provided an insight into the effectiveness of the DBI service during a global pandemic. Despite COVID-19 and associated restrictions, the DBI service adapted successfully and continued to be an effective service in supporting individuals presenting with mild to moderate distress. The provision of Level 1 service by the NHS24 Mental Health Hub has proven successful in terms of how it has integrated into existing NHS24 support provision, its ability to provide a compassionate response, and its ability to make appropriate and adequately detailed referrals to the Level 2 service. This may have been further enabled by Level 1 practitioners already being PWPs (Psychological Wellbeing Practitioners) and thus having a higher level of baseline training than Level 1 practitioners in the main pilot evaluation.
Within the limitations of the data collected, it appears that the DBI service evaluated in this report has successfully supported many of those individuals who were referred in distress, with most individuals who received the Level 2 service reporting that they received a compassionate and practical response that contributed to their ability to manage and reduce their distress in the short term.
As in the main DBI pilot evaluation, DBI does not appear to work equally well for everyone. Some individuals who received DBI had hoped that the service would provide more intensive therapeutic intervention. Feedback from Level 1 and 2 providers and individuals who received DBI suggests that DBI is less appropriate for the needs of those with severe and/or enduring mental health problems and/or other complex needs.
The evaluation findings have several implications for the ongoing roll-out and improvement of the DBI programme. Key recommendations based on the findings are set out below.
5.2.1 Roll out
1. Overall, Level 2 provider participants felt that both face-to-face and virtual/telephone interaction with individuals receiving DBI had advantages and disadvantages. When it is possible, even when COVID related restrictions are no longer in place, providing both options to individuals receiving DBI may be advantageous and enable the preferences of both individuals and DBI service providers to be met.
2. NHS24 processes meant that each call they received could only result in a choice of referring an individual to DBI Level 2 or another signposted service. Enabling NHS24 Level 1 practitioners to refer individuals to DBI in addition to another signposted service would be helpful for practitioners and valuable for individuals receiving the service.
3. The evaluation findings should be incorporated in the roll-out programme and disseminated to share learning, encourage debate and encourage further uptake of the DBI model.
5.2.2 DBI practitioner preparedness, training and development
4. Level 1 training with staff in the NHS24 Mental Health Hub should be explicitly and respectfully cognisant of practitioners' previous experience and training, acknowledging practitioners' potential existing awareness and understanding of identifying distress and the importance of compassion when individuals present to them in distress.
5. Level 1 practitioners in the NHS24 Mental Health Hub would value receiving a more detailed checklist as to what is and is not appropriate to refer to Level 2.
6. Level 1 practitioners in the NHS24 Mental Health Hub would value further information regarding the role of Level 2 providers.
7. Increased usage of anonymised case studies in Level 1 training in the NHS24 Mental Health Hub would help trainees' understanding of what is appropriate and the overall DBI journey which individuals commonly take.
5.2.3 DBI practice
8. The NHS24 Mental Health Hub should consider how to maintain the capacity for Level 1 service provision and reduce the general challenge of waiting time for NHS24 calls to be answered.
5.2.4 Future Research
9. Further research is recommended about the longer-term impact of DBI on individuals and the wider service system, particularly when the DBI intervention is conducted via telephone and other digital media when compared with face-to-face interactions.
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