STrAtegies for RelaTives (START) ARC Accelerator

家庭为居住在家中的痴呆症患者提供大部分护理。他们比不照看孩子的人更容易焦虑或抑郁。护理者的心理发病率预示着护理的崩溃，因此需要被安置在养老院以及虐待老年人。亲属策略(START)是一种针对痴呆症患者的家庭护理人员的八个疗程的手动疗法，已在短期和长期随机对照试验(RCT)中进行了测试。在最初的随机对照试验中，接受START治疗的家庭照顾者在医院焦虑和抑郁量表上的得分低于那些通常接受治疗的家庭照顾者，后者得分较低表明心理健康状况较好。与对照组相比，干预组患者患抑郁症的可能性较小，生活质量较高。干预组也显示出一个不明显的趋势，即减少病例水平的焦虑和减少对护理接受者的虐待行为。与对照组相比，接受Start治疗的家庭照顾者六年后患上临床上严重抑郁症的可能性降低了五倍。自那以后，Start被改编成适用于英国的南亚和黑人家庭。文化适应版在这些群体中是可以接受和可行的，精神健康方面的变化与最初的随机对照试验中的变化是一致的。改编后的版本现在适用于任何背景的人，因为改编版本，例如使名字具有文化中性，使图片具有种族多样性，可以使来自不同背景的人受益。START也适用于路易体痴呆症患者的家庭护理人员，对这一群体来说是可以接受和可行的。英国没有统一为痴呆症患者的家庭护理人员提供干预。对家庭照顾者的支持是临时提供的，有时根本不提供。START的有效性和成本效益有很强的证据基础，是痴呆症临床实践指南中提到的对家庭照顾者的唯一干预措施，但它并不广泛可用。我们希望将Start作为一家社会企业进行商业化，以扩大准入范围并增加其采用率。我们设想这是一家企业对政府(B2G)企业，潜在客户是政府实体，如个人NHS信托和NHS专员，提供经认可的培训计划，为NHS、社会护理服务和/或地方当局培训Start从业者。收入将通过健康和护理服务购买我们的培训包来产生。培训方案将包括从入门培训师开始的混合培训、使用我们的培训平台和材料以及认证和认证。作为这项工作的一部分，我们将探索START的其他收入来源，例如企业对客户(B2C)模式，直接向家庭照顾者提供START。我们还将调查是否有对那些提供START作为额外收入来源的人进行持续临床监督的需求。

Families provide most of the care to people with dementia living at home. They are more likely to be anxious or have depression than non-carers. The psychological morbidity of carers predicts breakdowns in care and therefore the need for placement in a care home as well as elder abuse. STrAtegies for RelaTives (START) is an eight-session manualised therapy for family carers of people living with dementia, which has been tested in short- and long-term randomised controlled trials (RCT). In the original RCT, family carers receiving START reported lower scores on the hospital anxiety and depression scale than those receiving treatment as usual, where lower scores indicate better mental health. Those in the intervention group were less likely to have case level depression, and reported higher quality-of-life compared to the control group. The intervention group also showed a non-significant trend towards reduced case level anxiety and less abusive behaviour towards the care recipient. Family carers who received START were five times less likely to have clinically significant depression six years later compared to the control group. START has since been adapted for UK-based South Asian and Black families. The culturally adapted version was acceptable and feasible within these groups, and changes in mental health were in line with those in the original RCT. The adapted version is now used with people from any background as the adaptations e.g. making names culturally neutral and pictures ethnically diverse can benefit people from different backgrounds. START has also been adapted for family carers of people with Lewy Body Dementia and was acceptable and feasible for this group.No intervention for family carers of people living with dementia is uniformly offered in England. Support for family carers is offered ad-hoc and sometimes not at all. START has a strong evidence base for its efficacy and cost effectiveness and is the only intervention for family carers mentioned in clinical practice guidelines for dementia, but it is not widely available. We want to commercialise START as a social enterprise to widen access and increase its adoption. We envision this to be a Business to Government (B2G) enterprise with the potential customers being government entities such as individual NHS trusts and NHS commissioners, providing an accredited training programme to train up START practitioners for the NHS, social care services and/or local authorities. Revenue will be generated through the purchase of our training package by health and care services. The training package will include hybrid training from a START trainer, access to our training platform and materials, and accreditation and certification. As part of this work, we will explore additional sources of revenue for START such as a Business to Customer (B2C) model with the provision of START directly to family carers. We will also investigate whether there is demand for ongoing clinical supervision of those who deliver START as an additional source of income.