Evaluating the effectiveness and cost-effectiveness of British Sign Language Improving Access to Psychological Therapies: an exploratory study

Abstract

BackgroundImproving Access to Psychological Therapies (IAPT) is a National Institute for Health and Care Excellence-approved approach to intervention for depression and/or anxiety. This exploratory study sets the groundwork for comparing psychological therapies for Deaf sign language users experiencing anxiety and/or depression, delivered in British Sign Language (BSL) by a Deaf therapist with usual access through an interpreter within the IAPT national programme.Objectives(1) To explore the following questions: (a) is BSL-IAPT more effective than standard IAPT for Deaf people with anxiety and/or depression? and (b) is any additional benefit from BSL-IAPT worth any additional cost to provide it? (2) To establish relevant BSL versions of assessment tools and methods to answer research questions (a) and (b). (3) To gauge the feasibility of a larger-scale definitive study and to inform its future design.DesignA mixed-methods exploratory study combing an economic model to synthesise data from multiple sources; a qualitative study of understanding and acceptability of randomisation and trial terminology; statistical determination of clinical cut-off points of standardised assessments in BSL; secondary data analysis of anonymised IAPT client records; realist inquiry incorporating interviews with service providers and survey results.SettingsIAPT service providers (NHS and private); the Deaf community.ParticipantsDeaf people who use BSL and who are clients of IAPT services (n = 502); healthy Deaf volunteers (n = 104); IAPT service providers (NHS and private) (n = 118).InterventionsIAPT at steps 2 and 3.Main outcome measuresReliable recovery and reliable improvement defined by IAPT; Deaf community views on the acceptability of randomisation; BSL terminology for trial-related language; clinical cut-off measurements for the BSL versions of the Patient Health Questionnaire-9 items (PHQ-9) and the Generalised Anxiety Disorder-7 (GAD-7); a valid BSL version of the EuroQol-5 Dimensions five-level version (EQ-5D-5L); costs, quality-adjusted life-years and incremental cost-effectiveness ratios.Data sourcesIAPT service provider anonymised records of the characteristics and clinical outcomes of Deaf BSL users of BSL-IAPT and of standard IAPT; published literature.ResultsRandomisation may be acceptable to Deaf people who use IAPT if linguistic and cultural requirements are addressed. Specifications for effective information in BSL for recruitment have been established. A valid EQ-5D-5L in BSL has been produced. The clinical cut-off point for the GAD-7 BSL is 6 and for the PHQ-9 BSL is 8. No significant difference in rates of reliable recovery and reliable improvement between Deaf users of standard IAPT or BSL-IAPT has been found. Whether or not BSL-IAPT is more cost-effective than standard IAPT is uncertain.LimitationsThe small number of participating standard IAPT services who have seen Deaf clients means that there is statistical uncertainty in the comparable clinical outcome result. Clinical cut-off scores have not been verified through gold standard clinical interview methodology. Limited data availability means that whether or not BSL-IAPT is more cost-effective than standard IAPT is uncertain.ConclusionsThere is a lack of evidence to definitively compare reliable recovery and reliable improvement between Deaf users of standard IAPT and BSL-IAPT. Instrumentation and prerequisites for a larger-scale study have been established.Future workA prospective observational study for definitive results is justified.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

Improving Access to Psychological Therapies (IAPT) in the United Kingdom: A systematic review and meta‐analysis of 10‐years of practice‐based evidence

“…There were eight studies excluded on this basis. The excluded studies focused on samples of male offenders (Adamson, Gibbs, & McLaughlin, 2015), two studies of veterans (Clarkson et al ., 2016; Giebel et al ., 2014), deaf patients (Young et al ., 2017), two studies of systemic therapy (Kuhn, 2011; DIT, Wright & Abrahams, 2015), and two studies due to both the population and treatment delivered (couples and BCT‐D, Baucom et al ., 2018; psychosis and CBT‐p, Jolley et al ., 2015). Meta‐analyses for each outcome were completed with the atypical studies excluded.…”

“…a Moderator analysis for 'primary condition' was not undertaken for the WSAS outcome measure as all studies included were deemed to be investigating mental health with none focusing purely on physical health; *Significant at p < .05 threshold; **Significant at p < .01 threshold; ***Significant at p < .0001 threshold, between subgroup differences significant at Bonferroni-adjusted p < .01 threshold for multiple testing (in bold). IAPT for deaf patients (Young et al, 2017), whilst another explored differences in outcomes based on sexual orientation (Rimes et al, 2018).…”

Psychotherapie für taube Patienten durch hörende Psychotherapeuten mittels Gebärdensprachdolmetscher – ein Systematisches Literaturreview zu Forschungsbefunden und Empfehlungen

“…Nach den Therapien zeigte die Patienten weniger Symptome der Depression bzw. Angststörungen [34,39], der PTBS [36,40] und der ADHS [37] sowie verbesserte Interaktions-und Kommunikationsfähigkeiten oder eine stärkere soziale Reaktivität [32,33,37]. Die von Munro et al [26] befragten Patientinnen fühlten sich im therapeutischen Setting wohl, empfanden die Methode des Reflecting Teams als hilfreich und bewerteten die Psychotherapie insgesamt positiv.…”

How do we know what we don’t know? Exploring Deaf people’s experiences of supporting their Deaf family member living with dementia

“…It is well evidenced that Deaf sign language users experience widespread linguistic difficulties in accessing mainstream health services, which influences health inequalities in terms of health outcomes (Alexander, Ladd, & Powell, 2012;Ringham, 2013;SignHealth, 2014;Emond et al, 2015;Young et al, 2017;Rogers, Ferguson-Coleman & Young, 2018). In part, this is because of a lack of awareness of Deaf people's language requirements for information in BSL/ISL, and in part because of a lack of interpreter provision, often despite the legal requirements to ensure it is available (NHS England, 2016).…”