Service User Participation Research Articles

Implementation of child mental health service improvement plans in four low- and middle-income countries: stakeholders’ perspectives

ABSTRACT Children in low- and middle-income countries (LMIC) have high levels of unmet mental health needs, especially in disadvantaged communities. To address this gap, we developed a child mental health service improvement programme. This was co-facilitated using interprofessional principles and values in four countries, South Africa, Kenya, Turkey and Brazil. Eighteen stakeholders from different professions were interviewed after six months on their perspectives on enabling factors and challenges they faced in implementing service plans. Participants valued the holistic case management approach and scaled service model that underpinned the service plans. Emerging themes on participants’ priorities related to service user participation, integrated care, and different levels of capacity-building. We propose that an integrated care model in LMIC contexts can maximize available resources, engage families and mobilize communities. Implementation requires concurrent actions at micro-, meso- and macro-level.

Participation: Add‐on or core component of public service delivery?

AbstractDrawing on a systematic review of the literature, this paper explores the factors which have enabled and/or constrained the transformative potential of public service user participation within the five most influential recent narratives of public service reform. It argues that these narratives have failed either to offer a holistic conceptualisation of such participation in theory or to achieve its enactment in practice for four main reasons: participation is framed as polemic, with limited evidence of efficacy; public service delivery has been conceptualised as a linear process, with participation at its margins; structural changes have been insufficient in embedding participation; and power asymmetries have been reinforced through successive reforms. To combat these long‐standing challenges, a value‐creation approach is presented, which starts from an assumption of participation as a defining feature of public service delivery and considered how its import can be maximised to create value for individuals and society.

Mindfulness and the Wisdom of Advocates - Journeys in the Landscape of Health Care

Service-user volunteers in a National Health Service (NHS) Mental Health Trust in the UK have made an unusual contribution to mindfulness teaching, training, research and governance as ‘advocates’ of mindfulness-based therapy interventions. We explore the nature of what has been named internally as the ‘wisdom’ of the ‘advocate’ group in this NHS Trust, and its impact on mental health provision. A clinician (clinical psychologist) and an advocate (anthropologist) conduct an investigative conversational journey using a grounded theory framework in an institutional-personal landscape. They look for roots of the ‘wisdom’ in the mindfulness-based therapy, in the practices of the Trust, and in the tradition out of which the therapy has emerged. The investigators find themselves focusing on matters of institutionalisation and professionalism (as forms of exclusion), on journeying and arriving (as expectations - in life, and in embarking on therapy) and on the advocates’ ‘wisdom’ as a deepening recognition of the intrinsic inclusiveness of mindfulness as a practice. The paper stands at a distance from typical healthcare presumptions of professionalism and delivery of treatment. This particular (mindfulness-based) therapy is presented as an intrinsically inclusive life-practice within a community of deepening capability, rather than a medicalised treatment. The method of writing the paper parallels the fluidity of professional/patient role and mutual contribution and journeying that the mindfulness-based approach itself embodies, and this offers an alternative model of ‘service-user participation’.

Factors Influencing Attendees’ Engagement with Group Psychoeducation: A Multi-stakeholder Perspective

Few studies have explored the problem of engagement in relation to group psychoeducation from a multi-site and multi-stakeholder perspective. The aim of the study was to explore the factors influencing service user and family engagement with group psychoeducation programmes. The study design was qualitative descriptive. Data were collected through individual and focus group interviews with key stakeholders (n = 75) involved with the programme within 14 mental health sites in the Republic of Ireland. Enablers and barriers to engagement were identified at participant, provider, programme and organization level. Motivated participants and engaged clinicians, peer co-facilitation and support, and skilled and responsive facilitators were some of the factors which enhanced engagement. Barriers to engagement included readiness among participants, concerns related to stigma and confidentiality, desire to distance oneself from mental health services, a lack of support for programme participation within families, group discomfort, the time and length of the programme, issues with transport, visibility of the programme, and structural supports for clinicians. Findings from the study illustrate the multifaceted nature of engagement as well as provide a greater understanding of the multifactorial influences on engagement. Strategies to enhance engagement should therefore reflect a multipronged approach. At the outset of programme implementation, organizations should address their readiness to engage, conduct local needs assessments to anticipate individuals’ needs and plan accordingly in order to maximize engagement, and bolster facilitators’ engagement skills through the provision of training and mentoring opportunities.

Patient and public involvement in oesophageal cancer survivorship research

Background Good clinical research is often conducted in close collaboration between patients, the public, and researchers. Few studies have reported the development of patient and public involvement (PPI) in research outside the United States and the United Kingdom, and for patients with more aggressive cancers. The study aimed to describe and evaluate the development of PPI in oesophageal cancer survivorship research in Sweden by the use of a framework to support the process. Methods Oesophageal cancer survivors were recruited to a PPI research collaboration at Karolinska Institutet, Sweden. The development process was supported by the use of a framework for PPI, ‘Patient and service user engagement in research’. Insights, benefits, and challenges of the process were described and discussed among the collaborators. Results The collaboration resulted in joint publications with a more patient- and family-focussed perspective. It also contributed to the development of information folders about survivorship after oesophageal cancer surgery and national conference arrangements for patients, their families, healthcare workers, and researchers. Since the PPI contributors were represented in patient organisations and care programmes, the dissemination of research results increased. Their contributions were highly valued by the researchers, but also revealed some challenges. The use of a structured framework contributed to support and facilitated the process of establishing PPI in research collaboration. Conclusions A genuine interest in establishing PPI in research and an understanding and respect for the patients’ expertise in providing a unique inside perspective was imperative for a successful collaboration. Research focus should not only be on mortality and reductions in daily life, but also on positive outcomes. Using a framework supports development and avoids pitfalls of PPI collaboration. Patient and public contribution Patient partners were equal collaborators in all aspects of the study.

Youth and family members make meaningful contributions to a randomized-controlled trial: YouthCan IMPACT.

BackgroundThere are growing calls to engage service users in research about issues relevant to them. Youth and family members can make meaningful contributions to research projects, improving quality and relevance. However, more information is needed on the contributions that youth and family members can make to various study designs.ObjectiveThis paper describes the contributions that youth and family members have made to a multi‐site pragmatic randomized‐controlled trial, YouthCan IMPACT, and the way project‐based engagement learnings accelerated change at the institutional level and beyond.ResultsYouth and family members were full members of the project team, including the project's core governance and working groups. They contributed to project leadership, as funding co‐applicants and as equal members of the governance team. They were also engaged in study design. Youth defined the primary outcome measure and contributed to decisions on all secondary measures. The service pathway was co‐designed with youth and family members; for example, they guided the inclusion of peer support and a family member intervention as core service components. Study implementation contributions included ensuring a youth‐ and family‐friendly research process and training research staff on working with youth and family members. Knowledge translation activities have included youth and family members as co‐presenters and manuscript co‐authors. The learnings from this trial have been leveraged to expand youth and family engagement at the institution and beyond.ConclusionsYouth and family members make substantial contributions to complex research projects, including randomized‐controlled trials, thereby improving project design, study implementation, associated interventions, and knowledge translation.

Introducing intersex wellbeing and rights and the INIA programme

Abstract Background Intersex people are exposed to human rights violations all over the world. Ongoing practices of sex-normalising surgery and other medical interventions on minors too young to give informed consent encroach on their bodily autonomy. Little is known about the public health implications of bodies with variations of sex characteristics (VSC). What key issues do VSCs raise? Methods In 2020 the INIA international consortium began work on a large research programme to address intersex people's wellbeing and human rights from a variety of new and innovative perspectives. The programme will train a cohort of 10 early-stage researchers working collaboratively to develop knowledge that will inform policy making and practice across a range of key sectors. Drawing on critical intersex studies, the research projects are relevant to stakeholders who are concerned with supporting the wellbeing and rights of intersex people through knowledge sharing and development. The project received funding from the European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No. 859869. Please see https://www.intersexnew.co.uk/. Results Indicative findings show that VSC could be an important area of public health work concerning diversity and equality. Early-stage results show a dearth of intersex visibility in key areas including social policy, education, and elder care. Intersex people and those with VSC face major health challenges and discrimination. There is a pressing need for appropriate healthcare. Conclusions The interdisciplinary INIA programme surfaces multiple discourses about intersex people and those with variations of sex characteristics. Projects of particular interest to public health practitioners and policy makers include those concerning multi-disciplinary healthcare, ethics, social policy, education, aging, and service user participation.

‘My Contributions Made a Significant Difference’: Young Carers’ Reflections on Their Participation in Social Work Admissions

Abstract Whilst the participation of service users and carers (SUCs) in Social Work admissions (SWAs) has significantly developed over the past decades, concerns have been raised about the tokenistic nature of SUC involvement (Barnes, D., Carpenter, J. and Bailey, D. (2000) ‘Partnerships with service users in interprofessinal education for community mental health: A case study’, Journal of Interprofessional Care, 14(2), pp. 189–200) particularly in relation to young people (YP). Liverpool John Moores University (LJMU) in partnership with Barnardo’s Action with Young Carers Liverpool have (BAWYC) worked to develop meaningful participation for YP in SWA. In this article, we discuss our approach to YPs’ participation, exploring their experiences of involvement. Using a co-production approach, drawing on participatory action research methodology, we utilise in-depth interviews from a purposive sample of young carers (YCs) to ask questions about the nature of YPs’ participation including: How meaningful they consider their involvement; what are the outcomes and benefits and what are the continuing barriers? Adopting a reflective thematic analysis, research findings indicate that YCs feel valued and respected in their SWA role, and surprised at the level of involvement and decision making ascribed to them. They report personal development and feelings of self-worth and increased confidence, helping them to consider their own futures in a more aspirational way.

A qualitative study of the label of personality disorder from the perspectives of people with lived experience and occupational experience

PurposeThe label “Personality Disorder” continues to divide opinion. Challenges to the terminology of personality disorder led by people with lived experience and supported by critical practitioners and academics are tempered by acknowledgement of certain positive social consequences of obtaining a diagnosis. This study aims to engage service users and staff in a process of inquiry to better understand the complexities of views on the terminology of Personality Disorder.Design/methodology/approachThis study set out to qualitatively explore the views of a range of people with lived, occupational and dual lived experience/occupational expertise, relating to the diagnostic label of Personality Disorder, via participatory and critical group debate. The World Café approach is an innovative methodology for participatory inquiry into subjective views suited to exploring the contested subject matter.FindingsThis study identified contrasting opinions towards the label of Personality Disorder and provides insight into the concerns described for both keeping and losing the label. Although many felt the words “personality” and “disorder” are not in themselves helpful, certain positive views were also revealed. Perspectives towards the label were influenced by the way in which diagnosis was explained and understood by patients and practitioners, alongside the extent to which service provision and evidence-based interventions were offered.Research limitations/implicationsThe findings have the potential to contribute to the ongoing critical debate regarding the value of the Personality Disorder construct in the provision of care and support. Specific emphasis upon the relational framing of care provision offers a means to ameliorate some of the negative impacts of terminology. Perspectives are influenced in the way the label is understood, hence, attention is required to enhance these processes in clinical practice. There is much more study required to overcome stigmatisation, prejudice, and lack of knowledge and understanding. Further research identifying means for challenging stigma and the factors contributing to positive clinical interactions are required.Originality/valueThis study brings together a wide range of views and experiences of mental health professionals, individuals lived experiences and those who align to both lived and occupational expertise. A safe space was provided via the uniquely co-produced World Café research event to bring together discussion and debates from mixed perspectives makes this a novel study. The focus being on perspectives towards contested language, labelling and social impact adds to scholarship in this field.

Home‐ and Community‐Based Work at the Margins of Welfare: Balancing between Disciplinary, Participatory and Caring Approaches

By the end of the 20th century, deinstitutionalisation had become a pervasive trend in the Western world. This thematic issue discusses how successful deinstitutionalisation has been in enabling dignified and safe living with necessary services in local communities. It contributes to an understanding of the history and phases of deinstitutionalisation and ‘home turn’ policies, and sheds light on the grassroots‐level of home‐ and community‐based work at the margins of welfare, hitherto little researched. The latter includes grassroots work to implement the Housing First approach to homelessness, commonly portrayed as a means of social inclusion, worker–client interactions during home visits and in the local community, as well as close inspections of what ‘housing support’ may actually entail in terms of care, discipline and service user participation.

Advancing recovery education for people experiencing housing instability: A qualitative analysis of service user and provider perspectives in Canada.

The recovery paradigm is increasingly being adopted within mental health services internationally, to support a process of personal change for affected individuals, with the aim of living a satisfying, hopeful, contributing life within the limitations of mental illness. In efforts to assist the process of recovery, Recovery Education Centres (REC), offering recovery supports through education rather than traditional service models, have been widely implemented; there is limited evidence to date with respect to the experiences and outcomes of disadvantaged populations, such as people experiencing homelessness, with recovery education. This study used qualitative methods to explore the perspectives and experiences of service users and providers of the Supporting Transitions and Recovery (STAR) Learning Centre in Toronto, Canada, focused on supporting the process of recovery for individuals with histories of homelessness. Between July 2017 and June 2018, semistructured interviews with 20 service users, one key informant, and a focus group comprising eight current and former REC staff and volunteers were conducted to explore opportunities to better tailor the curriculum, and key programmatic features, to the needs of the population. Interviews were analysed using inductive thematic analysis. Most participants described favourable experiences with the REC and suggested adding more challenging course content (n=10) and increasing delivery options (n=8), highlighting the diversity of participant needs. Others described the importance of improving accessibility through geographic expansion, offering transit subsidies, and using innovative media. In addition, the importance of delivering more courses in partnership with community partners, to maximise reach and impact, was also highlighted (n=15). This study underscores the importance of engaging service users and providers, including peers, in ongoing adaptations to best serve the target populations. The expertise and lived experience of these key stakeholders offer a unique lens, supporting the process of recovery, through co-production of curriculum content and joint program planning and improvements. Findings can inform REC development for disadvantaged populations and potentially enhance recovery outcomes for those experiencing multiple barriers to recovery.

Engagement of mental health service users and carers in care planning - Is it meaningful and adding value?

Consider whether mental health service users and carers meaningfully engage in care planning and whether care planning adds value to patient care. A review of the meta-analyses and systematic reviews of service users and carers identified many barriers to their meaningful engagement in care planning. No research has demonstrated any measurable benefits or positive outcomes linked to mental health care planning.

International audit of simulation use in pre-registration medical radiation science training

IntroductionSimulation-based education (SBE) can replicate the challenging aspects of real-world clinical environments, while providing a safe and less intimidating setting. Literature supports its use within medical radiation science (MRS) training for safe practice of psychomotor skills, development of problem solving, team working, interpersonal and decision-making skills and embedding awareness of patient safety. This project aimed to quantify usage of SBE resources and activities internationally and to evaluate how this changed during COVID-19 restrictions. MethodsAn anonymous online survey tool gathered data relating to programme demographics, simulation resources, simulation activities and future plans. A link to the survey was distributed to programme leads via social media, professional bodies and national networks. ResultsA total of 72 responses were received from a range of countries and representing a range of programme structures. Most respondents reported up to 100 h of SBE per student per year with low fidelity resources and image viewing software featuring most prominently. There was low reported engagement of service users within simulation activities. Respondents also indicated that COVID-19 had been a trigger for rapid uptake of simulation resources. ConclusionSBE forms an important aspect of MRS training internationally with low-fidelity resources being widely deployed. Where available, high fidelity virtual reality and specialised profession-specific resources were used heavily. There was a low level of reported engagement with service users or expert patients in simulation activities. Future research will identify whether the rapid uptake of SBE during COVID-19 continues and clarify the role of service users in SBE provision. Implications for practiceIncreased collaboration between MRS education providers may help to improve parity of SBE provision and identify additional opportunities to engage service users within SBE.

Which criteria characterize a health literate health care organization? \u2013 a scoping review on organizational health literacy

BackgroundOrganizational health literacy (OHL) aims to respond to the health literacy needs of patients by improving health information and services and making them easier to understand, access, and apply. This scoping review primarily maps criteria characterizing health literate health care organizations. Secondary outcomes are the concepts and terminologies underlying these criteria as well as instruments to measure them.MethodsThe review was carried out following the JBI Manual on scoping reviews. The databases CINAHL, Cochrane Library, JSTOR, PsycINFO, PubMed, Web of Science Core Collection, and Wiley Online Library were searched in July 2020. Three researchers screened the records and extracted the data. The results were synthesized systematically and descriptively.ResultsThe literature search resulted in 639 records. After removing duplicates, screening by title and abstract, and assessing full-texts for eligibility, the scoping review included 60 publications. Criteria for OHL were extracted and assigned to six main categories (with 25 subcategories). The most prevalent topic of organizational health literacy refers to communication with service users. Exemplary criteria regarding this main category are the education and information of service users, work on easy-to-understand written materials as well as oral exchange, and verifying understanding. The six main categories were defined as 1) communication with service users; 2) easy access & navigation; 3) integration & prioritization of OHL; 4) assessments & organizational development; 5) engagement & support of service users, and 6) information & qualification of staff. The criteria were based on various concepts and terminologies. Terminologies were categorized into four conceptual clusters: 1) health literacy in various social contexts; 2) health literate health care organization; 3) organizational behavior, and 4) communication in health care. 17 different assessment tools and instruments were identified. Only some of the toolkits and instruments were validated or tested in feasibility studies.ConclusionsOrganizational health literacy includes a significant number of distinct organizational criteria. The terminologies used in the OHL literature are heterogeneous based on a variety of concepts. A comprehensive, consensus-based conceptual framework on OHL is missing.

Service Users in Social Work Student Supervision: A Scoping Review

ABSTRACT While the participation of service users in social work education and practice has gained momentum recently, little attention has been paid to the implications for student supervision in field education or practice learning. This scoping review examines the nature of, and extent to which, international literature recognises service users in social work student supervision. Sixty-seven relevant abstracts that potentially linked service users to social work student supervision were identified from five databases. After review, 25 full-text articles were examined. Of these, none were found to identify practices that integrate service user perspectives into social work student supervision, although some identified participation of service users in other components of field education in areas such as the provision of mentoring or feedback. The results suggest that the ways in which service users are constructed and positioned in field education supervision require further development in order to align with contemporary policy and practice. IMPLICATIONS Service users are not overtly acknowledged as central stakeholders in social work student supervision and this omission needs exploration. The positioning of service users through the use of social workers’ language and professional power requires examination in the context of Australian social work field education. In relation to the participation of service users, a cultural shift is required so that students are provided with consistency between education and practice standards.

Can a formalised model of co-production contribute to empowering indigenous communities in decisions about land use?

PurposeCo-production has been used in public services in the UK areas such as mental health to improve the participation of service users in decisions made about the services traditionally provided for them and done to them. It has also been used in areas such as mental health and to address concerns about the quality of services provided to members of minority communities. Western Australia is currently passing legislation to address the issue of aboriginal cultural heritage management in the context of recent adverse incidents such as the incident where Rio Tinto was responsible for the destruction of the site. This paper aims to show how a formalised model of co-production can assist in the implementation of this legislation.Design/methodology/approachThis paper considers how effective co-production has been within the domain of mental health services in the UK and then considers whether they are lessons that may be learnt in other contexts. It considers whether concepts from co-production have a role to play in ensuring that the legislation and its implementation are not seen as actions done to or on behalf of the aboriginal communities and if a more structured approach to coproduction can produce a model, which facilitates genuinely collaborative aboriginal heritage management.FindingsThe approach has facilitated the development of a model to monitor and improve collaboration within aboriginal cultural heritage management, which complements existing participatory approaches and enables businesses to demonstrate their legislatory compliance.Social implicationsThe study offers an approach, which may be used globally to empower indigenous communities in decision-making in other contexts, such as deforestation in South America and oil and gas exploitation on Inuit and First Nations land in Canada.Originality/valueThe use of co-production concepts and capability modelling is novel in this space.

We've got what the NHS ultimately intended for us: Experiences of community engagement in rural primary care services change

Policy promotes service user engagement in health services design and delivery. Various tools exist to support the engagement of citizens within health services design. We consider community engagement within the context of primary care delivery in remote and rural areas of Scotland. We present findings from three years of qualitative work with community members and healthcare professionals within five different remote and rural areas, undergoing primary care service changes. 364 interviews were carried out with community members and healthcare professionals on their experiences of, and feelings towards, the services changes. A key theme to emerge from our thematic analysis of the qualitative data is experiences of community engagement. In this paper we present our analysis of this theme. We identify different types of community engagement discourse within community and healthcare professional interviews. We illustrate these themes and, through consideration of five case study areas, demonstrate how these discourses can co-exist within the same service change process. The paper presents our sub-themes on community engagement relating to discourses of inclusion and exclusion; the role of the General Practitioner (GP); conceptualisations of the organisational role of the NHS; discourses of fear and, finally, community members understandings of what it means to be active “agents of change” (or not) within health services redesign. We argue that context is as important as method when it comes to facilitating a positive community engagement experience for citizens. Our findings have relevance to the emerging social science literature on citizen experience of public sector community engagement activities.

Perspectives on mental health recovery from Egyptian mental health professionals: A qualitative study.

WHAT IS KNOWN ON THE SUBJECT?: Personal recovery concept is dominant in mental health systems when service user involvement is emphasized; however, service user involvement in mental health research and practice does not exist in Egypt. Definitions of recovery from high-income and English-speaking countries should be carefully adapted to other settings. Nurses providing mental health care in Egypt generally do not have specialized mental health nursing qualifications. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Both cultural and contextual uniqueness of Egypt as a Middle Eastern, low-middle-income country were clear in the findings of this paper. There are differences in the definition of family and service user engagement in the current study and in high-income countries. Seeking faith healers as a barrier to mental health recovery is culturally unique. Functional recovery prevails as a model in Egypt as there is limited service user involvement. Nursing values and code of ethics are consistent with enablers of mental health recovery. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Changing the pre-registration nursing education to prepare specialized graduates in mental health nursing. Training of mental health professionals on recovery approaches which involve service users is needed in Egypt. Mental health nurses in Egypt can use the current findings to implement national campaigns to raise public awareness of mental health problems. ABSTRACT: Introduction Recovery-oriented mental health practice is an emerging approach that aims to empower individuals to define their goals and take responsibility for their own recovery. However, mental health practice in Egypt is still custodial. Aim To explore perspectives of Egyptian mental health professionals on recovery. Method Semi-structured interviews were conducted with 15 mental health professionals identified through snowball sampling. Results The current study identified that functional recovery outweighed other definitions. Four facilitators of mental health recovery were identified: therapeutic relationship; family engagement; cultural sensitivity; and professionals' self-awareness. Six barriers to recovery were found, comprising mental health stigma and lack of awareness, seeking traditional healers, shortage of psychiatrists, cost of treatment, lack of training and effective rehabilitation programs. Discussion The concept of functional recovery predominates among nurses and other mental health professionals, which may be due to limited training and the historical lack of service user involvement in Egypt. Lack of support from family and society, inadequate training MHPs and perceived system inefficiencies are also major impeding factors for recovery. Implications for Practice There is a need for nurses to be involved in designing intervention programs targeting the general public and to support increased involvement of people with mental health issues.

A Systematic Review to Examine the Evidence in Developing Social Prescribing Interventions That Apply a Co-Productive, Co-Designed Approach to Improve Well-Being Outcomes in a Community Setting.

This systematic review aims to investigate the evidence in applying a co-design, co-productive approach to develop social prescribing interventions. A growing body of evidence suggests that co-production and co-design are methods that can be applied to engage service users as knowledgeable assets who can contribute to developing sustainable health services. Applying the Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic literature search was conducted. Peer-reviewed articles were sought using electronic databases, experts and grey literature. The review search concluded with eight observational studies. Quality appraisal methods were influenced by the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) Framework approach. A narrative thematic synthesis of the results was conducted. The evidence suggests that a co-design and co-productive social prescribing can lead to positive well-being outcomes among communities. Barriers and facilitators of co-production and co-design approach were also highlighted within the evidence. The evidence within this review confirms that a co-production and co-design would be an effective approach to engage stakeholders in the development and implementation of a SP intervention within a community setting. The evidence also implies that SP initiatives can be enhanced from the outset, by drawing on stakeholder knowledge to design a service that improves health and well-being outcomes for community members.

The experiences of therapists providing psychological treatment for adults with depression and intellectual disabilities as part of a randomised controlled trial.

Health professionals were trained to deliver adapted psychological interventions for depression to people with learning disabilities and depression alongside a supporter. Exploring the delivery of psychological interventions can help increase access to therapy. Twenty-seven participants took part in six focus groups, and the data were subject to a Framework Analysis. The structure and focus of the manualised therapies, and the use of specific techniques were perceived as key to service-user engagement. Supporters' involvement was valued by therapists if they had a good relationship and regular contact with the individual they supported. Regular clinical supervision was regarded as vital in understanding their role, assessing progress and delivering the interventions. The findings highlight that health professionals can embrace a focussed therapeutic role and increase access to psychological therapies for people with intellectual disabilities.