How intense an intervention is IBA? And competencies needed?

5 Aug

I have recently been reminding myself of the content of the NHS Health Scotland document ‘Health Behaviour Change Competency Framework, which is a forensic analysis of knowledge, skills and techniques for all forms of health behaviour change effort.

The framework outlines three different levels of intervention – low, medium and high intensity which raise interesting questions about where IBA fits.  The intensity levels are described as follows:

1. Low intensity interventions
Interventions delivered per protocol (i.e. following an agreed ‘script’) with restricted flexibility for change by the practitioner. Interventions will primarily be brief and will include opportunistic delivery. Clients may present with few or mild (but not moderate or severe) physical co-morbidities (i.e. few of those additional illnesses which often occur together).
2. Medium intensity
Interventions for which there is a manual but which offer the practitioner some flexibility in delivery. Interventions might be of longer duration, either in the form of a longer single session or multiple sessions. Interventions could be delivered opportunistically or via self-referral or referral from other services. Clients may present with mild to moderate (but not severe) physical co-morbidities.
3. High intensity
Flexible interventions delivered to match the assessed needs of the client. Typically interventions will be of longer duration on referral from other services. Clients may present with moderate or complex physical co-morbidities and may present with moderate mental health co-morbidities.

So the question is – can IBA fit into all of these categories?  Or is it only one?  Is an intervention following an ‘agreed script’ in keeping with the theory of IBA?  And can high intensity interventions still be considered as IBA?  In the research literature, interventions described as ‘brief interventions’ vary widely in  terms of length, number and depth of sessions, but in England, the term IBA is usually intended to describe shorter, one off interventions.  What works best may vary in different settings or for different target groups as discussed in my comment on another thread.

If you’re interested in competencies – it is worth noting that the framework outlines three different competence types – foundation competences (which apply to generic interactions with the public), health behaviour change competences (which relate to interactions discussing health behaviour change) and health behaviour change techniques (which are evidence-based approaches specific to interactions seeking to change health behaviour).

The (89) health behaviour change techniques are organised into three categories: those related to building Motivation for change; those related to supporting skills for Action for change; and those related to Prompts for change such as environmental prompts/nudges.

The three levels of intervention outlined in the framework (low, medium and high) each require competency across the three competency types (foundation, HBC competencies and HBC techniques).  Each also requires competency in a selection of the three categories of HBC technique (Motivation, Action and Prompts).

Finally, worth noting that NHS Health Scotland have also produced a competency framework specific to alcohol brief interventions (or IBA).

One Response to “How intense an intervention is IBA? And competencies needed?”

  1. James Morris August 23, 2012 at 9:46 am #

    One very interesting point you raise is can IBA fit into all three categories of of low, medium and high intensity. As you rightly identify, whilst ‘brief interventions’ can describe at least medium intensity (‘extended brief interventions’/brief motivational interviewing/lifestyle counselling), IBA I do not believe can.

    There are critics of the term ‘Identification and Brief Advice’ (IBA) and they have valid points. The main argument for ‘IBA’ terminology though in my view is that it has given a catchy label for the ‘simple brief advice’ that is all that is needed in most opportunistic cases. The best chance we have to achieve widespread delivery of brief interventions is to ensure as many health and social care roles can delvier simple IBA as routinely as possible. We are facing lots of challenges to this depsite investment in time and resources. Longer interventions require more intensive training and longer time expectations on practitioners so seems to me unrealistic in many settings at this stage.

    It is also arguable that any ‘high intensity’ interventions are more likely to be ‘brief treatment’ rather than ‘brief intervention’ approaches, especially if not opportunistic (i.e a refferal for that issue) or care planned. This is fully explored in the Academy paper ‘Clarifying brief interventions’.

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