Modelling BSL-IAPT and Standard IAPT accessed by Deaf People
‘Evaluating the effectiveness and cost-effectiveness of British Sign Language Improving Access to Psychological Therapies: an exploratory study’
British Sign Language (BSL) is a fully grammatical visual language separate from English. Rates of anxiety and depression are much higher among Deaf people who use BSL than among the general population.
This study compares two kinds of service for Deaf people experiencing mental health problems. In the first, namely standard Improving Access to Psychological Therapies (IAPT), the therapist and Deaf person usually communicate using a sign language interpreter. In the second, the therapist is a Deaf person who uses the same language as the client, namely BSL. We wanted to find out which was best at helping the Deaf client to recover and which was better value for money. However, before we could do that we also needed to develop some new measurement tools. The ones usually used to assess progress in therapy and how healthy someone feels were not available in BSL. We also needed to find out about whether or not there were differences in how standard IAPT services treated Deaf BSL users. We have now developed new versions in BSL of common assessments used to measure anxiety, depression and health.
We have found out that there is little difference in the recovery levels of Deaf people who use either BSL-IAPT or standard IAPT. However, this result is not strong because most standard IAPT services had seen hardly any Deaf people. It is not certain whether or not BSL-IAPT is better value than standard IAPT using an interpreter to achieve the same outcomes for clients.
A BSL version of this summary is available
Read the full report.
Dementia is a major public health problem in the developed world; approximately 750 000 people in the UK have some form of dementia. A recent survey found that around 40% of optometrists regularly, and 58% occasionally, examine patients with dementia. The profession has a role to play in creating more dementia-friendly practices and some of the resources available to optometrists on dementia and its management are discussed in this article.
The Trust played a role in the PrOVIDe study (Prevalence of Visual Impairment in Dementia), led by the College of Optometrists, between 01/31/2012 and30/09/2014. We recruited 93 participants to the study, which investigated the prevalence of visual impairment on the attitudes and experiences of people with dementia, carers and optometrists.
One conclusion from the PrOVIDe study is that a Dementia Eye Care Pathway, by formally acknowledging the individual’s right to information and appropriate eye care services, could reduce the prevalence of visual impairment in people with dementia and the considerable impact of visual impairment on an individual’s quality of life. This article (INCLUDE LINK) introduces this proposal and outlines the areas that should be covered within a pathway.
AMyloid imaging for Phenotyping LEwy body Dementia (AMPLE) Study
The AMPLE study utilised PET imaging to look at the amount and the distribution of beta-amyloid within three groups of volunteers; those with Alzheimers Disease, Dementia with Lewy Bodies and healthy controls. The study aimed to understand and determine the relationship between amyloid levels, clinical features of the disease, other imaging changes and subsequent clinical course.
Recruitment took place from 03/06/2013 to 21/03/2016 where the Trust recruited four patients to the total of 77.
The overall results of the study indicated that there was a range of beta-amyloid levels in those with DLB, as 54% of the positive scans were found in the DLB volunteers. This was significantly greater than the controls and those with AD. Also, there was no significant difference between amyloid +ve and amyloid –ve DLB cases with regards overall cognitive impairment, level of functional impairment, or any other clinical or cognitive scale. However, there was a trend for some subtle imaging changes suggestive of Alzheimer's disease (medial temporal atrophy and hypoperfusion) to be associated with the presence of amyloid in DLB. It was also found that low Amyloid deposition was not associated with lower rates of cognitive disturbance or higher rates of other typical DLB characteristics.
Based on the findings of the study, longitudinal follow-ups will take place with the cohort to determine whether amyloid deposition is associated with differences in disease progression.
The physical health of people with severe mental ill health (SMI) is often poor with people with a diagnosis of schizophrenia reported to die 20–25 years earlier than those in the general population. One of the largest contributory factors to this early mortality is smoking. The study found that on average people with SMI who smoke die nearly 10 years earlier than those who do not smoke.
Whilst the number of people in the general population who smoke has been steadily declining over recent decades, the number of people with SMI who smoke has not been declining at the same rate. People with SMI are still more likely to smoke and to smoke more heavily. There are widely held myths about the therapeutic function of smoking and that smoking relieves anxiety when in fact nicotine can increase anxiety. In addition, smoking is perceived by some to help alleviate depression whereas a systematic review has found smoking cessation to reduce depression.
Conventional NHS approaches to smoking cessation do not take into account the additional challenges that people with SMI may face when attempting to quit smoking. In order to address these problems, the smoking cessation intervention for severe mental ill health trial (SCIMITAR) pilot study offered a bespoke smoking-cessation intervention, specifically tailored to people with SMI.
The aim of the SCIMITAR study was to assess its acceptability and uptake by people with SMI. The Trust has recruited 26 people to the SCIMITAR pilot trial (INCLUDE LINK TO DOC), which found the intervention to be acceptable to people with SMI and that it was feasible to recruit and retain participants. The clinical and cost-effectiveness of this bespoke smoking-cessation service will now be evaluated in the definitive randomised controlled SCIMITAR+ trial which is taking place currently and due to be completed in 2018.
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