Making Every Contact Count for alcohol… not always IBA

17 Mar

MECCIn this guest post, Deryn Bishop, Health Behaviour Specialist, explores why the Making Every Contact Count is important, and doesn’t always mean doing IBA.

Much has been written regarding the effectiveness of alcohol interventions, brief or otherwise. Recently some of the concerns about the delivery of what has come to be known as “IBA-Lite” have been highlighted, particularly following the publication of PH49 Behaviour Change: Individual Approaches, which states:

Recommendation 9:  Encourage health, wellbeing and social care staff in direct contact with the general public to use a very brief intervention to motivate people to change behaviours that may damage their health. The interventions should also be used to inform people about services or interventions that can help them improve their general health and wellbeing. Encourage staff who regularly come into contact with people whose health and wellbeing could be at risk to provide them with a brief intervention. (The risk could be due to current behaviours, sociodemographic characteristics or family history.)

The use of the term “very brief intervention” may at first glance seem to be a deviation away from the recommendation of “Clarifying alcohol brief interventions 2013 update” which discussed concerns about diluting alcohol brief advice (IBA).

As a member of the Development Group for the  above NICE Guidance, I can assure readers that much discussion was had regarding the evidence supporting behaviour change techniques, and we upheld the view that workforce staff should be properly trained and supported to deliver interventions appropriate to their role or to the environment within which they work. The existence of very brief interventions in no way assumes that it is only the minimal intervention that should be offered, where there is the opportunity to offer a more in-depth intervention.

One concern I have about the Clarifying Brief Interventions briefing is it’s continuance to use the word “patient”, even within the case study chart at the end of the document. My viewpoint would be that in any situation where staff are having a conversation with a “patient”, there surely must be the opportunity to deliver IBA as the minimum.

Making Every Contact Count (MECC) is about developing the larger public health workforce to look for opportunities to empower the people whom they meet, whatever health behaviour it is concerning.

MECC brief advice describes a short intervention, which may last from one to 3 minutes, delivered opportunistically.

It may differ from “IBA Lite” however. “IBA lite” is comprised of a screening process but is “lite” because of the absence of Brief Advice or a full AUDIT.

A “MECC” conversation, as delivered by a Community Police Officer, or a Trading Standards Officer, or as part of a conversation from one colleague to another, where an opportunity to raise awareness about alcohol has proffered itself, may not include a screen, even one as short as SASQ. One can easily see that in these circumstances it is inappropriate to whip out a screening tool. That is not to say, however, that the understanding of how to assess risk has not been part of the MECC training, and that an assessment of risk is not implicit.

In MECC training, frontline staff gain the capability and confidence to assess risk, to deliver feedback that it pertinent and salient to the person with whom they are conversing, and to encourage the person to consider the benefits of making a change. Staff working in situations where a conversation may open a door to a more in-depth intervention, should also feel confident and capable to move into a brief intervention (as say a worker engaged in a home assessment, for fire risk, for health and safety concerns or whatever, who has the time and skills to go a little further with the conversation).

There is an excellent MECC Competency Framework that sets out in detail the knowledge and skills base required to deliver MECC effectively (Y and H MECC competency framework), whatever the level of intervention.

As a MECC trainer I strongly believe that the quality of the intervention is paramount, whatever the length.

MECC is one way in which we can  “shape the way citizens are involved in their own health and well-being” (What Local Authorities Need to Know about Public Health: South et al Feb 2014);  we should encourage all staff to consider how and when they can best be advocates of healthier lifestyles.

Deryn Bishop is a trainer for The Training Tree, specialising in health behaviour change. You can contact Deryn at

One Response to “Making Every Contact Count for alcohol… not always IBA”

  1. James Morris March 18, 2014 at 9:09 pm #

    Thanks Deryn, important post because firstly I believe MECC is an important opportunity for IBA, but which also raises some issues you identify.

    I think the key bit is “where there is the opportunity to offer a more in-depth intervention” full IBA should be given. The pressures of the real world understandably exert a strong force on doing the shortest approach available, so there will always be a pull towards ‘IBA lite’ or one minute MECC conversations. .

    Doing IBA is often about making the time to do it. Front line staff often don’t see IBA as important (not their fault ) so will tend to argue not having the time to do it. So if they have an option, they will opt for less by default. I’m not saying we shouldn’t support lite or very brief approaches, just that we need to be careful of creating a norm where shorter less evidenced approaches will be done, when IBA could have been.

    It seems that aiming for IBA in many places has resulted in IBA lite. We need to set our ambitions high as I think in truth interventions will always be cut down in practice.

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