Alcohol policy: research and practice

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Alcohol Screening and Brief Intervention Research
Programmenational brief intervention research
consortium Paolo Deluca, PhDInstitute of
PsychiatryKings College London
AE St. Marys


'Scientia Vincit Timorem'
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Programme design

• 3 cluster randomised clinical trials (PHC, AED,
  CJS) to assess
• What are the barriers/facilitators to
  implementation in a typical setting
• Identify most effective screening approach/tool
• Most effective and cost effective intervention
  approach
• Common measures and design to allow comparisons

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PHC study

• 24 PHC practices, 3 regions (NE, London, SE)
• 4 screening approaches (universal vs targeted,
  M-SASQ vs FAST) Targeted New registrations,
  Injuries, Hypertension, Gastrointestinal
  problems, Mental health problems
• 3 intervention approaches
• Patient information leaflet (DH - How much is too
  much?)
• Brief advice (5 min)
• Brief Lifestyle Counselling (20 min)
• 744 patients (31 each)
• Incentives (research, clinical)
• Baseline research interview
• 6 12 month follow-up research interview
• Attitudes, barriers and facilitators

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PHC Research progress update

• Recruited 24 (8) practices
• Trained 189 staff (nurses and GPs)
• Recruiting participants since May 08
• 497 (66.8)
• 6 GPs completed recruitment, 9 about to end
• 7 under performing and 2 dropped out
• 2 agreed to carry on

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Training PHC staff

• On site training to small groups delivered by RA
  AHW
• 1 to 2 hrs for screening and BA including role
  play
• 1 to 2 sessions for BLC training with actors in
  PHC
• Overall positive feedback on training
• Research elements and Alcohol Units are usually
  the challenging parts of the training
• Most welcomed receiving training and being
  assessed
• 1 session with actor was enough for all but one
  practice
• But adequate space, staff availability, time and
  implementation issues slowed the training stage

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PHC Implementation issues

• Protocol Leaflet-eligibility-screening-informed
  consent-baseline-intervention
• Ideally delivered by same person (except BLC)
• In practice we implemented various models to fit
  local needs and resources (10 min slots)
• Strong local lead (champion)
• N of staff involved (all vs just a few)
• Low recruitment/positives in same areas (eg
  Enfield)
• After good start, patients re-attending slowed
  recruitment

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AED study

• 9 AEDs, 3 regions (NE, London, SE)
• 3 screening approaches (M-SASQ, PAT, FAST)
• 3 intervention approaches
• Patient information leaflet
• Brief advice (5 min)
• Referral to Alcohol Health Worker BLC (20 min)
• 1,179 patients (131 each)
• Baseline research interview
• 6 12 month follow-up research interview
• Attitudes, barriers and facilitators

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AE Research progress update

• Recruited 9 (2) AEs
• Trained 250 staff (nurses and consultants)
• Recruiting participants since April 08
• 717 (60.8)
• 1 AE completed recruitment, 3 about to end
• All underperforming

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Training AE staff

• On site training to small and large groups
  delivered by RA AHW
• 1 to 2 hrs for screening and BA including role
  play
• No BLC training
• Overall positive feedback on training. Research
  elements and Units are usually the challenging
  parts of the training
• Most welcomed receiving training
• Adequate space, staff availability, on call,
  turnover, time and implementation issues slowed
  training
• Booster sessions, launch events, shadowing staff
  first few weeks

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AE Implementation issues

• Protocol Leaflet-eligibility-screening-informed
  consent-baseline-intervention
• Ideally delivered by same person (except BLC) in
  practice divided by triage/nurses and doctors
• Strong local lead (champion)
• Consent and contact details put some participants
  off
• Workload
• Staff turnover (eg August)
• Easily forget training if start is delayed
• Tendency of targeting dependent drinkers
• Weekly support

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CJS study

• 96 offender managers, 18 offices
• 3 regions (NE, London, SE)
• 2 screening tools (FAST, M-SASQ)
• 3 interventions
• Leaflet
• Brief advice (5 min)
• Brief Lifestyle Counselling by Alcohol Health
  Worker
• 480 participants (5 each)
• Follow-up 6 12 months
• Attitudes, barriers and facilitators

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CJS Research progress update

• Recruited 96 (11) Offender Managers from 18
  probation offices
• Trained 131 OMs (some disappeared after training)
• Recruiting participants since June 08
• 151 (31.5)
• 17 OMs completed recruitment, 10 about to end,
  remainder underperforming-struggle to start, 24
  dropped out/left

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Training CJS staff

• On site 1 to 1 training delivered by RA AHW
• 1 to 2 hrs for screening and BA including role
  play
• No BLC training
• Overall positive feedback on training. Research
  elements (informed consent) and ulcohol units are
  usually the challenging parts of the training
• Not very enthusiastic, most drawn into it from
  line manager.
• Adequate space, staff availability (1to1),
  turnover, slowed training
• Booster sessions, shadowing staff first few weeks

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CJS Implementation issues

• Protocol Leaflet-eligibility-screening-informed
  consent-baseline-intervention
• Delivered by same person (except BLC)
• No strong local lead (champion)
• Consent and contact details put some participants
  off
• Workload
• North/South divide
• Staff not engaging with SIPS team
• Easily forget training if start is delayed
• Weekly support, further incentives?

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Training tools and methods

• List of tools
• M-SASQ
• FAST
• SIPS-PAT
• AUDIT
• Screening training
• PIL
• Brief Advice (BA)
• BA Training
• Brief Life Style Counselling (BLC)

• BLC training
• BLC Demo video
• Actors scripts
• Staff pre-training questionnaire
• Staff post-training questionnaire
• BECCI Manual
• Training manual

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Website

• www.sips.iop.kcl.ac.uk Alcohol Learning Centre

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Training and intervention tools
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Recruitment by month
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Changes to improve recruitment

• Deployment of our AHWs in AEs
• Additional GP surgeries to complement the
  underperforming ones
• Additional offender managers to complement the
  underperforming ones
• Extra support to offender managers
• Allow over-recruitment in CJS and PHC

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Conclusions

• Prevalence of AUDs reflect previous studies in
  these settings
• Patients/clients are more willing to receive an
  intervention than previous studies
• Overall staff in these settings are keen to be
  trained
• However, limited time, workload and turnover are
  limiting implementation