This randomised controlled trial explores whether debt advice provided by Citizens Advice Bureau (CAB) counsellors for patients with debt and depression, accessed through general practices, makes a difference to their recovery. This project is funded by the NIHR Health Technology Assessment Programme.
Depression and associated anxiety are common among patients seen in general practices. Many such patients also have debt and prolonged absence from work. There is increasing evidence of a relationship between indebtedness, depression and risk of self-harm and suicide. This randomised controlled trial explores whether debt advice provided by Citizens Advice Bureau (CAB) counsellors for patients with debt and depression, accessed through general practices, makes a difference to their recovery.
Set up phase (months -3 to 0)
This phase will include detailed theoretical modelling of the intervention based upon the existing systematic review literature on collaborative care and social prescribing, supported by knowledge from the evaluation of the Liverpool CAB primary pilot.
The intervention will be implemented in one practice per each site (possibly those where RB and MG currently work), focussing on use of the joint formulation. Detailed quantitative and qualitative process data will be collected using telephone and face-to-face interviews at each site and data recorded by the CAB workers in each practice with a small number (5-10) pilot participants. The model will be refined and manualised and a training programme developed for CAB workers and GPs. We will also finalise organisational agreements between CAB and practices. Fidelity assessment procedures (intervention by CAB, GP TAU and shared comprehensive assessment) will be developed during this stage.
Months 4-15, feasibility trial and review
The intervention will be implemented utilising manuals, training and organisational agreements developed above. Fidelity will be assessed and qualitative interviews will be used incorporating the Normalisation Process Theory to assess implementation problems and facilitators and resolve these to ensure the intervention is implemented as closely to the model as possible. Refinements to training and the manual may be made to help ensure fidelity to the original model. The original model itself will not be changed so as to enable the feasibility trial participants to be included in the full dataset (i.e. the feasibility trial will act an internal pilot for the main trial).
Full Trial Months 16-39
The intervention will continue to be implemented with any additional procedures developed in the feasibility trial to ensure closer fidelity to the model.
At the end of the internal pilot trial, recruitment methods, acceptability of the intervention, attendance rates at advice sessions and willingness of commissioners to continue the CAB service will be assessed.