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Step-by-step IBA (in a nutshell)

10 Jan

Sometimes IBA is seen as something complicated. But it’s not – the beauty of it is that its short, simple and effective. To the trained practitioner, brief advice is a simple conversation framed around some key parameters; don’t push someone, ask open questions, listen etc. To the unfamiliar, discussions around IBA often seem to over-complicate things. Below is something I’ve come up with to emphasise how simple IBA really is…

Nutshell

See here for a PDF version of IBA in a Nutshell. For a more detailed look at IBA see our About IBA or IBA skills pages.

IBA – who should do it and how do we convince them?

4 Dec

we not meOne of the big IBA challenges is that those who we really need to do IBA are not likely to see it as part of their job role. We need doctors, nurses, Criminal Justice roles and other front line professionals to routinely ask (screen) about alcohol – of course these are not exactly people with plently of spare time on their hands.

So the challenge facing IBA delivery is not just to equip front line roles with the knowledge, skills and resources to do IBA, but also motivate them to embrace it as a worthwhile cause – despite all the other pressures they face. Continue reading

IBA ‘mystery shopping’ experiences: the good, the bad and the…

12 Sep

Recently I posted about opportunities to ‘mystery shop’ IBA when signing up to new GP practice. Whilst there are some issues to consider, generally I think this can be a really valuable way to make a difference. As we seem to know IBA is often poorly delivered in Primary Care, so we need to take every opportunity we can to help improve it.

So here is summary of some of my three actual ‘mystery shopping’ experiences, which interestingly ranged from good to bad. And something in-between…

Continue reading

Brief advice bullets: try lower strength drinks?

12 Jul

As recently explored, highlighting the negative impact of alcohol on sleep is a winner for motivating risky drinkers to cut down. But punchy ‘brief advice’ strategies to actually help the drinker to do so are perhaps a bit harder to find. Many people may be unenthusiastic about to switching to weaker drinks or alternating with soft drinks.

So can lower-strength drinks play a role in reducing consumption? A recent report from John Moore’s University has urged caution from a policy perspective. It found that although lower strength drinks will help reduce harm where people swap them for stronger drinks, they may also create more drinking occasions where alcohol consumption is introduced. For instance, a weaker lager may make a lunchtime tipple more acceptable.

This conveniently reminds us that keeping an eye on the number of drinking occasions we have, as well as how much we drink when we do, is key for keeping as close to lower risk drinking as possible. But actually I did recently try a 2.8% ‘extra pale’ lager that was actually quite satisfactory. Not something I was expecting if I’m honest!

Brief advice bullets: alcohol disrupts sleep

9 Jul

There are some valuable bits of ‘brief advice’ that are more likely to resonate with all risky drinkers who engage. The negative effects of alcohol on sleep is surely one of those because everyone needs sleep and everyone wants to sleep well. I often speak to people who have cut down on their alcohol use, and improved sleep is probably what I hear volunteered most often as a positive outcome.

So whilst many risky drinkers might believe alcohol ‘helps’ them to sleep, they’re unaware the quality of the sleep is affected and so is less regenerating – even if they slept for as long. Alcohol reduces the capacity for deep re-energising sleep because as blood alcohol level declines, the body becomes more alert (known as the “metabolic rebound” effect). There must be something about waking up to go to the toilet too!

A recent study has found that even moderate consumption disrupts sleep. This and the fact that there seemed to be less of an impact on lost sleep time amongst heavier drinkers might negate the value of this particular benefit. Either way, alcohol isn’t good for the deep sleep we need. I know that the best shot I have of feeling fresh and well rested is to have an alcohol-free night – which is why I always aim for that on a school night!

Is IBA ‘girly’?

5 Jul

On a recent training course on IBA for lifestyle change, I was discussing the motivational style inherent in some forms of IBA with two prison officers. As officers working in the physical education department of a prison, they described their upfront approach to supporting prisoners to get fitter in words such as these:

“If they come to us and say I want to get fit, I’m overweight.  We say, yeah you are overweight and here’s what you need to do to sort it.  We’ll write you a programme but we can’t do it for you. You just need to get off your ar*e and do it.”  

Well, its certainly emphasising personal responsibility, but the ‘no nonsense’ nature of the response had the rest of us, who happened to all be women, squirming.  Where’s the rapport and empathy, the listening, the motivation matrix? And it got us talking – does all that ‘touchy-feely’ stuff make IBA a bit wimpy? Is it women’s stuff?  As a new-age feminist, I don’t even like framing the question in that way… and let’s remember motivational interviewing was invented by two men! But it is not the first time that people have questioned whether patients really want to be ‘listened to’, or whether they would prefer to be told what to do.

According to Silverman et al. (2005 p.185), it is a mistake to assume that all patients want to be actively involved in decision-making in medical consultations in general, and they cite a range of studies that explore this issue further. It is worth remembering that this kind of collaborative approach to consultation may be new to some patients; they may need some gentle encouragement to get them to engage fully with IBA or indeed other patient-centred approaches.

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.

Is the unit message getting through?

6 Jun

As an alcohol trainer one regular question I get from commissioners and public health clinicians is “do you think the unit message is getting through”.

I have been using interactive voting devices now for 4 years and I had something interesting happen the other day in an IBA session. The wonderful thing about these devices is not only the interactive properties of using voting systems but you get a feedback of real-time knowledge as a percentage results.This means you can guide your session to the participants needs.

My gut reaction over the past 4 years is that the message has been getting through. In my last session with GP’s and allied staff could 80% could work out units of alcohol and 90% knew the recommended guidelines. Yes there were 10 delegates in the room! My plan is examine the results over the past 4 years and over 4000 delegates to see if knowledge is getting better. I will let you know soon.

On reflection when I first started in alcohol services 16 years ago there was very little interest from clients or clinicians about units. We tried to talk units to service users we were met with blank faces and at least there is now some recognition of the need to talk units rather than pints or mls.

Off to analyse some data!

alcoholnurse