STrAtegies for RelaTives (START) ARC Accelerator

家庭为住在家里的痴呆症患者提供大部分护理。他们比没有照顾者的人更容易焦虑或抑郁。照顾者的心理病态预示着护理的崩溃，因此需要安置在护理之家以及虐待老人。STrAtegies for RelaTives（START）是一种针对痴呆症患者家庭护理人员的八次手动治疗，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治疗的家庭护理人员在医院焦虑和抑郁量表上的得分低于那些接受常规治疗的人，较低的得分表明心理健康状况较好。与对照组相比，干预组的患者不太可能患有病例级抑郁症，并且报告了更高的生活质量。干预组也表现出一个非显着的趋势，减少案件水平的焦虑和虐待行为对照顾对象。与对照组相比，接受START的家庭照顾者在六年后患临床显著抑郁症的可能性降低了五倍。此后，START已被改编为以英国为基地的南亚和黑人家庭。文化适应版本在这些群体中是可接受的和可行的，心理健康的变化与原始RCT中的变化一致。改编后的版本现在适用于任何背景的人，因为改编后的版本，例如，使名字在文化上中立，使图片具有种族多样性，可以使不同背景的人受益。START也适用于路易体痴呆症患者的家庭照顾者，对这一群体来说是可以接受和可行的。英格兰没有统一为痴呆症患者的家庭照顾者提供干预。对家庭照料者的支助是临时性的，有时根本不提供支助。START在疗效和成本效益方面有很强的证据基础，是痴呆症临床实践指南中提到的唯一针对家庭照顾者的干预措施，但它并不广泛使用。我们希望将START商业化为一个社会企业，以扩大其使用范围并提高其采用率。我们设想这是一个企业对政府（B2 G）的企业与潜在的客户是政府实体，如个人NHS信托和NHS专员，提供一个认可的培训计划，以培训开始从业人员的NHS，社会护理服务和/或地方当局。收入将通过卫生和保健服务部门购买我们的培训教材产生。培训包将包括START培训师的混合培训、访问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，例如直接向家庭照顾者提供START的企业对客户（B2C）模式。我们还将调查是否需要对那些提供START作为额外收入来源的人进行持续的临床监督。

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.