DIALOG and DIALOG News Eoin Golden and Stefan

DIALOG and DIALOG+ News Eoin Golden and Stefan Priebe

DIALOG • “How satisfied are you with your…” mental health job situation leisure activities friendships medication meetings physical health accommodation partner/family personal safety practical help received • Rating of each domain from 1 -7 • “Do you need additional help? ”

First trial • 507 patients with schizophrenia/related disorder from 6 European countries • On average used 4 times over 12 months • After 12 months: -improved quality of life -improved treatment satisfaction -fewer unmet needs • Small effect size, higher in East London

DIALOG scale • 8 Quality of life items – high internal consistency correlation with full MANSA score 0. 94 covering the same factorial structure • 3 treatment satisfaction items good internal consistency • Each item meaningful • Efficient outcome measure

The EPOS project • Redesign of software • Extension of intervention: DIALOG+ • Randomised controlled trial to test the effectiveness of the DIALOG+ intervention

Previous software

Current software • • Tablet device (i. Pad) Touch screen Intuitive interface Easily shared between patient and clinician

4 -step approach • Based on solution focused therapy 1. Understanding: why? what is working? 2. Looking forward: best-case scenario? smallest improvement? 3. Considering options: what can the patient do? what can the clinician do? what can others do? 4. Agreeing on actions

EPOS trial: design Cluster randomised controlled trial DIALOG+ versus active control 6 -month intervention period Outcomes assessed at baseline, 3 months, 6 months and 12 months • Primary outcome: Quality of Life - MANSA • •

Inclusion criteria: patients • • Age 18 -65 years Treatment in community team for at least 1 M No planned discharge for the next six months Diagnosis ICD-10 F 20 -29 Capacity to give informed consent Mean MANSA score of <5 Sufficient command of English language 179 patients at baseline

Implementation • • 30% of patients never started DIALOG+ 2. 6 sessions (SD=1. 3) in the first 3 months 1. 5 sessions (SD=1. 1) in the second 3 months 4. 1 sessions (SD=1. 9) in total

Results • Better quality of life after 3, 6 and 12 months • Lower levels of general symptoms after 3, 6 and 12 months • Fewer unmet needs after 3 and 6 months • Better objective social situation after 12 months • Lower overall treatment costs over 12 months

Other outcomes No effect on other outcomes: • Treatment satisfaction (CSQ-8) • Self-Efficacy (GSS) • Well-being ( WEMWBS) • Positive symptoms (PANSS-positive) • Negative symptoms (PANSS-negative) • Therapeutic relationship (STAR-Patient and STAR-Clinician)

Summary of findings • Effect sizes to match costly, intensive interventions (3 m SQOL: d = 0. 34) • Effect remains even after stopping • Findings do not reflect a general appraisal across scores • Cost savings

Implications • DIALOG+ turns routine meetings into therapeutically effective interventions – identifying needs, discussing, and initiating change • Low cost, effective intervention • Generic intervention • Easily implemented - no disruption to services • Provides meaningful routine outcome data

Downloading DIALOG app • i. Pad users only (future plans to develop for Android users – watch this space) • Visit the following link on your i. Pad: https: //itunes. apple. com/us/app/dialog/id 9142 52327? ls=1&mt=8 • Or search for ‘DIALOG’ (in caps) on the App Store and look out for this icon in the results:

Customising DIALOG app • Enter ‘settings’ on your i. Pad home screen • Enter the DIALOG settings from the list of your apps on the left • Set ‘Additional Help’ and ‘DIALOG+’ to off for basic DIALOG scale • Activate ‘Additional Help’ for extra help question • Activate ‘DIALOG+’ for full solution focused intervention

Customising DIALOG app Set these buttons to ‘on’ or ‘off’ as desired

Contact details s. priebe@qmul. ac. uk e. m. golden@qmul. ac. uk