Distress Brief Intervention Pilot Programme evaluation: findings report

Key Recommendations

Roll-out

1. The national roll-out of DBI should continue, ensuring that core DBI elements (e.g. contact within 24 hours, guideline of 14-day intervention, use of Distress Management Plan) are adhered to, along with the continuation of the central leadership, coordination and management function.

2. New DBI services should be aware that DBI may be perceived as a threat to, rather than complementary to, existing services. This may need to be overcome to ensure good engagement with and uptake of the programme amongst local delivery partners.

3. The evaluation findings should be used to inform the roll-out of the DBI programme and disseminated widely to share learning, encourage debate and further uptake of the DBI model.

DBI practitioner preparedness, training and development

4. Level 1 and 2 practitioners should not commence work on DBI until they have completed the standard DBI training.

5. DBI Level 2 training should note practitioners' previous experience and training and acknowledge practitioners' potential existing awareness and understanding of identifying distress and the importance of compassion.

6. Standard DBI training updates should be communicated to all trained practitioners, and local or service-specific top-up ('buzz') sessions should be encouraged.

7. It is recommended that Level 1 practitioners spend 1 hour of their paid work time to undertake regular DBI training (we suggest every 2 years); this should include interaction with Level 2 practitioners (where possible face-to-face).

DBI practice

8. To facilitate uptake and adoption of DBI, referrals to Level 2 should be incorporated within existing frontline services' processes.

9. Review the evaluation findings that the DBI Level 1 experience is not working as well for younger people and those attending A&E - and explore whether their experience can be improved.

10. Consider how DBI Level 2 is described and delivered as a brief intervention for those using the services and practitioners. Strategies such as leaving more expansive written information for the person being supported than is currently available could be helpful in the most challenging circumstances (e.g. when individuals are highly distressed, disoriented or affected by drugs or alcohol).

11. DBI management and practitioners should continue to work to refine the appropriateness of referrals and review whether inappropriate referrals are highlighting service gaps or unmet needs.

12. DBI management and practitioners should look for opportunities to build on the finding of the importance of helping individuals to understand why they become distressed and to recognise when it starts, as this seems key to improve reduction in distress.

13. Consider whether DBI has a potential role in offering follow-up support or contact to individuals following a planned exit (i.e. because waiting for follow-up support can be a difficult time). A more tapered withdrawal may be beneficial for some and/or checking whether individuals feel able to initiate contact with follow-up services themselves.

14. Within the Level 2 services, decisions are needed on staffing composition to ensure a range of skills and experience that will meet the needs of a wide range of service users.

Research

15. Further research is recommended on the following: the level of uptake of follow-up services after DBI Level 2; the longer-term impact of DBI on individuals and the wider service system; whether and how DBI might help prevent suicide; and the factors associated with increased distress among some individuals at the end of Level 2.