STrAtegies for RelaTives (START) ARC Accelerator

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.