Alcohol Assertive Outreach Treatment (AAOT) offers a creative and flexible approach to engaging and treating patients with alcohol dependence and complex needs through regular proactive support at home or in their local neighbourhood, who might otherwise be readmitted to an acute hospital ward.
(Photo: Speakers from top row left - Kelly Davies, programme manager, Emeritus prof Colin Drummond, prof Amy O'Donnell, Amy Wolstenholme, Dr Nikos Mylonas, Stanley Matthews, Dr Tyler Mills, Dr Blossom Fernandes, Stephen Blood, Dr Stephen Kaar, Lucy Gallagher and Prof Tom Phillips.)
Around 170 mental health clinicians, practitioners, researchers, commissioners and people with lived experience of alcohol dependence co-occurring health conditions joined the webinar and discussed the challenges, outcomes, including cost savings for the local health economy, and implementation strategies for AAOT.
The webinar included:
Colin Drummond, Emeritus Prof Addiction Psychiatry, King’s College London welcomed everyone to the event explained that the event was the culmination of six years of work and an exciting opportunity to share findings about implementing alcohol assertive outreach in three regions of England. “We hope this event will encourage you to adopt and spread the AAOT approach across England.”
A study led by Amy Wolstenhome, research fellow, King’s College London evaluated the impact of AAOT on admissions to King’s College Hospital and found that following implementation of the AAOT programme there was a 23% reduction in overall alcohol admissions to the hospital. Frequent attenders at hospital were targeted to help them find better ways of managing their health in the community. Her economic evaluation found that AAOT led to saving of £10,470 per patient per year compared to care as usual.
Research in Manchester and Hull both found that alcohol assertive outreach treatment lead to reduced emergency hospital admissions.
Our study found that there was significant reduction in A&E attendances and a 50% reduction in hospital admissions in the groups supported with AAOT. There was resoundingly positive feedback on the high-quality alcohol assertive outreach facilitated by collaboration between the research team and the multi-disciplinary team
Dr Tyler Mills, University of Hull, shared findings from the qualitative evaluation at the University of Hull. He highlighted the importance of the relationship between the patient and keyworker to deliver effective AAOT.
I wanted a bottle, you know. Alcohol, alcohol, alcohol. But her [my key worker's] perseverance in a kind way, she got me out of bed. She got me downstairs and said. 'Right I’m going to make you a cup of tea.' So she made me a cup of tea and that was the start of it, that was the beginning of somebody caring enough to get me out of bed.
Dr Mills also highlighted assertive advocacy which emerged as a key feature of a positive experience of care. In AAOT, Assertive advocacy is when the key workers repeatedly and persistently advocate for better care for their service users with other services who are involved in their care. Training in advocacy is essential to support key workers facilitators the sustainability of AAOT.
Dr Blossom Fernandes, outlined the sustainability of AAOT and shared findings of research using implementation science methodology. She shared some quotes from interviews with staff delivering AAOT:
It’s a time, labour intensive model but does it get better outcomes? Does it reach more people? Does it target people who would never have come into the service? Absolutely.
Lucy Gallagher, patient and public involvement (PPI) coordinator from MHIN shared the approach to PPI in the MHIN, as a partnership between academic experts and experts by experience. Patients and the public were involved in co-facilitating workshops, co-authorship of publications, co-facilitation and presenting at commissioner events and disseminating research findings.
Alcohol support goes hand in hand with mental health but it is not always available. Being offered the role of PPIE lead was a life saver for me. I was able to access training and courses and feel welcome and part of the team.
My case worker came to me see me once a week and with her support and encouragement I got help physically and mental health support. I joined groups and met other service users in recovery. Now I do some voluntary work with a lived experience team and highlight the stigma of addiction and support needed for people with unmet needs