IBA for children and young people: evidence, guidance and resources?

11 Jun

Although NICE advises that IBA be offered to those aged 16 and over, there is limited evidence as to the effectiveness and best delivery approaches for children and young people. However a new SIPS junior trial is getting underway focussing on younger adolescents presenting to A&E departments (but don’t expect the results anytime too soon – it’s a 5 year project!). The SIPS junior website has a good summary of the issue though, highlighting:

“advice to children under 15 years (2009) is to abstain from alcohol due to risks of harm, and 15-17 year olds are advised not to drink, but if they do drink it should be no more than 3-4 units and 2-3 units per week in males and females, respectively. In contrast, alcohol use is increasing in adolescents in the UK: the average amount consumed by 11-15 year olds doubled in the last 13 years to 2007. Adolescents in the UK are now amongst the heaviest drinkers in Europe.

Excessive drinking in adolescents is associated with increased risk of accidents, injuries, self harm, unprotected and regretted sex, violence and disorder, poisoning and accidental death. Early drinking in adolescence is associated with intellectual impairment and an increased risk of more serious alcohol problems in later life. Methods of alcohol screening and early intervention have been developed for adolescents in the USA, and show evidence of benefit, but have not been studied in the UK. Further these methods have several shortcomings including not providing screening and intervention methods appropriate to the age and developmental stage of the younger adolescent.”

In the meantime, I believe there is still a good case for IBA with younger adolescents as long as safeguarding and other risks are covered (see NICE PH24 recommendation 6). If IBA opportunities present, practitioners should be able to use a combination of common sense and good IBA skills. For instance it’s broadly accepted that children and young people are more likely to be motivated around risks to their personal safety, injuries, appearance or other more immediate harms. So highlighting things like risks to high blood pressure probably aren’t going to be the most effective approaches for framing IBA for younger groups. Nonetheless, we shouldn’t overlook that we have been seeing a trend in younger and younger adults presenting with liver disease.

Here are a few useful IBA resources aimed at practitioners working with children and young people:

One of the key things SIPS Junior will reveal will be which screening (identification) tools may be best suited for younger adolescents. For children aged 10-15 in contact with professionals, NICE suggests consent and use of the Common Assessment Framework (CAF) to obtain a detailed history of their alcohol use, including background factors such as family problems or other issues.

A comprehensive list of further guidance, resources and reports relating to children and young people is available here from the Alcohol Learning Centre.

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One Response to “IBA for children and young people: evidence, guidance and resources?”

  1. Niamh Fitzgerald August 5, 2012 at 10:12 pm #

    Some perspectives here from our work with youth workers – we find that youth workers generally are pretty clued in about the kind of techniques that are important for developing motivation in young people. Nonetheless, it is a big challenge for employers to provide adequate training/support to the many part-time and sessional youth workers to build their confidence in delivering interventions on alcohol.

    One consideration that youth workers often raise with us is a sense of discomfort with the idea of IBA sometimes being presented as a fairly short, one off intervention. They feel that it is important to build a good relationship and trust with young people and therefore that interventions like IBA are best delivered in a kind of ‘drip, drip’ approach over multiple conversations. This is contrary to the kind of IBA that is often promoted in primary care settings and the findings of the Cochrane review (http://summaries.cochrane.org/CD004148/effectiveness-of-brief-interventions-in-primary-care-populations) that longer interventions or those delivered over multiple sessions were no more effective than short one-off ones.

    One could postulate (as the NTA once did http://www.nta.nhs.uk/uploads/nta_review_of_the_effectiveness_of_treatment_for_alcohol_problems_fullreport_2006_alcohol2.pdf) that one off interventions may be less appropriate the higher the level of vulnerability/need of the person receiving the intervention. The same may apply to young people!

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