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Briefing on IBA & LGBT people – a key group to ‘target’?

9 Oct

LGBT IBAA short briefing highlights the potential for IBA to reduce alcohol related harm amongst lesbian, gay, bisexual and transgender (LGB&T) people. It describes LGBT groups as a ‘high-risk group’ for alcohol misuse given research that shows higher prevalence.

The briefing provides a short background of IBA as a short alcohol intervention, and considerations for ensuring IBA can reach LGBT people. For those already seeking IBA implementation, it may highlight another setting or area to consider engaging front line roles with training and support, or opportunity to build IBA into service commissioning.

Of course the debate about which wider settings should IBA be sought in goes on, and the challenges may not be wholly different from many other settings where IBA is sought. At the same time, it urges all staff delivering IBA to ‘ensure their approach is culturally sensitive and LGB & T-inclusive’, given discrimination that LGB&T service users often report when using mainstream services.

The briefing though may be of most use in encouraging LGBT specific services to incorporate IBA as something to potentially benefit their service users. As the briefing advises, ‘IBAs can readily be incorporated into initial screening and triage for new service users; into case or care plan reviews with existing service users; or into outreach interventions in LGBT social settings.’

Of course any practitioner delivering IBA should show key skills that both underpin brief intervention and non-judgmental person-centred approaches relevant for ensuring people of any sexual orientation feel well treated . The reality though is that more training, support and resources are needed for quality IBA to be adopted more widely. And with LGBT people likely to make up between 1.5 – 7% of the adult population, as a ‘high risk’ group for alohol misuse it makes sense to support LGBT services specifically in IBA delivery.

 

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IBA and the wider ‘workforce’ – will it happen?

2 Oct

Wider workforce RSPHEarlier this year the Royal Society for Public Health (RSPH) generated headlines following a report saying  ‘15 million workers including firemen, hairdressers and postal workers could form part of “wider public health workforce”.’

With the ‘core’ public health workforce totalling only 40,000 people, they are unlikely to be able to deliver widespread health behaviour interventions to much of the population. As such, the report calls for anyone who has “the opportunity or ability to positively impact health and wellbeing through their work” to join the wider public health workforce.

Whilst the media focused on the idea of bar maids and hairdressers giving out health ‘tips’, it’s certainly true that many areas have sought to extend well beyond healthcare for IBA delivery. A recent review into IBA in non-health settings found settings like schools, criminal justice, pharmacies and universities have shown promise in terms of the feasibility of IBA delivery, although most of these wider settings including the workplace still lacked evidence.

Healthy conversations

“Healthy conversations”

Another report from the RSPH, ‘Healthy Conversations and the Allied Health Professionals’, highlights Allied Health Professionals (AHPs) as an auxiliary Public Health workforce of around 170,000, made up of 12 professions including Physiotherapists, Occupational Therapists, paramedics and dietitians.

The AHP workforce certainly seem a realistic workforce for delivering brief interventions than perhaps hairdressers or posties, and indeed some areas have already been seeking to engage AHP roles in IBA. The report itself specifically gives some examples of AHPs delivering alcohol IBA or other support, and also some insights into AHP’s attitudes and experiences.

Of particular note may be the findings on AHP’s confidence to discuss different ‘health conversations’ by topic. This may be of relevance given that barriers to delivering alcohol IBA are often related to patient or practitioner beliefs about alcohol. In some areas ‘Making Every Contact Count’ (MECC) approaches have been adopted to try to facilitate widespread health conversations, but the level of alcohol IBA activity specifically is unclear.

Indeed it seems that when compared to smoking, diet, exercise and weight, AHP’s felt more confident to discuss these than alcohol. However AHPs did feel more confident to discuss alcohol than areas such as dementia, domestic violence or sexual health, though perhaps unsurprising.

Wider workforce RSPH

What does this mean for IBA? We know alcohol brief intervention is effective, and possibly more so than for other health topics. But it may also be that quality alcohol brief interventions may be at risk of getting lost or diluted within the wider ‘healthy conversations’ agenda.

 

‘IBA Direct’ – new opportunities for brief intervention?

20 May

IBA directIn London a piece of work has been underway seeking to design and deliver interventions to ‘at-risk’ drinkers who are unlikely to come into contact with a health care professional. Young ‘twenty-somethings’ are less likely to visit their GP, but more likely to drink heavily when they do drink. So how else can these drinkers be reached?

We know ‘responsible drinking’ messages alone are unlikely to be effective, particularly when we consider the environment and all those alcohol cues. We also know IBA is effective, particularly in Primary Care, but serious questions remain over actual delivery, even for the minority that do receive it. But what about cutting out the middle man and taking IBA straight to the target group?

This was the idea behind ‘IBA direct’. Resonant, an agency who specialise in behaviour change, went out and found local twenty-somethings drinking at risky levels and worked with them to co-create how they could be reached in an effective way. Young risky drinkers said they were more than happy, in fact actually liked doing the ‘alcohol quiz’ – i.e the AUDIT. They found it interesting and it made them think, especially when they knew it was credible rather than just a magazine style quiz.  Perhaps surprisingly they actually liked a person offering them ‘feedback’ and ‘advice’, rather than a less personalised web approach.

The real challenge is how to reach significant numbers of these drinkers with ‘IBA direct’, and whether it can be done cost-effectively. The drinkers themselves identified that it needed to be engaging, part of something that would grab their attention and hook them in. As you would also expect, it also need to avoid being presented as something that would make them feel judged or lectured.

chuggerPerhaps one way of delivering ‘IBA direct’ can akin to ‘chugging’ – aka those ‘charity muggers’, except not going after anyone’s money. In fact they are offering a person something that might them make a healthier, informed choice about something they didn’t realise carried so many risks (or benefits from cutting down). Perhaps there are many opportunities where we can engage the public directly through IBA, rather than relying on busy practitioners.

In some ways ‘IBA direct’ is also not entirely new. If you’ve invited someone to do IBA at a community event, for instance during Alcohol Awareness Week, that’s IBA direct. Apps or web-based approaches could also be argued to be, but IBA in its true form is delivered by a person. The question is, how cost-effective is it going to be, and what’s the best way to really hook people in? Work is under-way to test this out, so watch this space!

IBA direct summary

You can read more about Resonant’s work with Lambeth 20-somethings via IBA direct (pdf) or get in touch here.

Delivering alcohol IBA in non-health settings?

29 Sep

IBA questionsIn this guest post Dr Fizz Annand takes a quick look at recent research she was involved in exploring alcohol brief intervention as ‘IBA’ in non-health settings.

A team of researchers from the Drug and Alcohol Research Centre based at Middlesex University have completed a literature review as part of a larger research project funded by an Alcohol Research UK grant. A short ‘insight report’ of the research can be found here.

The evidence base for the effectiveness of IBA in health settings particularly primary care and to a smaller extent A&E, is well documented and because of the proven effectiveness in these settings there is a push to extend the delivery of alcohol IBA into other, non-health settings. This is despite there not being anywhere near the same weight of evidence to do so.

Some studies in schools, criminal justice, pharmacies and universities have shown promise in terms of the feasibility of IBA delivery, however in order to deliver, staff in these settings have needed extra support in order to be able to embed it into their everyday practice. Some studies on computerised or web-based versions if IBA show potential with students or people not in touch with services but more evidence is needed.

In most other settings evidence is weak or non-existent. The workplace has been proposed as an obvious context where benefits could be felt by both workers and employers given the impact of alcohol on productivity. Occupational Health teams could provide a structure in which IBA could be delivered as part of wider health screening and support. In order to convince employers of the benefit a business case would have to be demonstrated.

The researchers highlight the potential for financial rewards to operate as incentives to implementation however it is unclear how much the incentives should be.

A number of barriers to implementation were documented in the studies which included:

  • Lack of buy-in from organisations
  • Staff not feeling it’s their job, or that they have sufficient skills
  • Workload pressure
  • Reluctance to engage on part of staff and/or clients and concerns about confidentiality

Whilst IBA training was rolled out in many organisations, this alone did not necessarily result in widespread implementation of IBA. Very little monitoring or evaluation of the implementation was undertaken.

The researchers concluded that there’s good reason to feel optimistic that IBA in non-health settings can be delivered. Thought does however need to be given to how to adapt the implementation to take account of organisational, professional and context- specific issues that hamper implementation and, in particular, the sustainability of initiatives in the long term. Financial incentives may generate interest in delivery, and monitoring/evaluation will allow measurement of implementation, activity and ultimately help to justify the use of resources.

A full version of the report ‘Delivering Alcohol IBA Broadening the base from health to non-health contexts: Review of the literature and scoping’ can be found here.

Follow Fizz on Twitter @FizzAnnand or see here for contacts.

#UKalcohol – Twitter discussion on IBA/brief interventions

30 Jul

A planned Twitter discussion on addressing alcohol harms will take place on Wednesday the 13th August at 8pm (= 20.00 BST = 19.00 GMT = 3pm/15.00 EDT) on the theme of alcohol brief advice and brief interventions.  This follows on from an initial discussion on alcohol-related hospital admissions which you can read here.

Who can take part?

The aim of the #UKalcohol discussions is to identify and discuss key issues facing those working in the alcohol field – either as commissioners, researchers, service providers or policy roles. It is hoped a different ‘theme’ will be addressed each month, reflecting key areas of interest.

#UKalcohol discussion 13th August: alcohol brief advice, brief interventions

The 2nd planned discussion is intended to cover the broad theme of design, delivery, support and monitoring of alcohol brief advice in addressing alcohol-related risks and harm.

The following issues may be used as needed as prompts/themes for discussion:

  1. What is brief advice, what is a brief intervention, does it matter?
  2. How widely should we implement brief advice/interventions on the basis of current evidence?
  3. What is needed to support brief advice/interventions in practice? How do the needs of different settings differ?
  4. How should brief advice/interventions on alcohol fit with attempts to address other lifestyle issues?
  5. What monitoring and evaluation of these interventions is needed and is it feasible?

Partnership

This 2nd discussion is being brought to you by the UK Centre for Tobacco and Alcohol Studies with the support from a range of partners and stakeholders who will be jointly supporting the alcohol Twitter discussion, and may initiate further themed discussions in future.

Next steps

If you are interested in participating in the proposed Twitter discussion either as an individual or on behalf of your organisation simply sign in via Twitter on Wednesday the 13th August at 8pm and use the #UKalcohol. Discussion may be subsequently captured and shared via Storify.  You can also follow @ukctas to see tweets about this in advance.

If you’d like to ask any questions or help with Twitter please do get in touch via niamh.fitzgerald@stir.ac.uk or james@alcoholacademy.net.

IBA – are all settings equal? Presentations and experiences

27 Oct

Two recent events explored evidence, experience and views on delivering IBA across different settings. The first – ‘IBA: are all settings equal?’ – was held in partnership between the Alcohol Academy and DrinkWise NorthWest in July. More recently the Academy teamed up with the Nottingham Recovery Partnership to deliver ‘IBA: Making Every Contact Count?’.

Both events aimed to bring together alcohol leads and practitioners to assess how IBA implementation is going – and how and whether it should be extended across further settings. Of course, ‘all settings are not equal’ because the evidence base and policy focus is on IBA in Primary Care. Yet there is clearly both an enthusiasm and investment in delivering IBA across a wide range of settings.

A few of the key presentations and discussion points are outlined below, but all presentations can be accessed here and here. Continue reading

How to decide what to do, whatever the evidence.

7 Jun

At the recent Cyrenian’s conference on the potential for delivery of alcohol brief interventions in untested or unproven community settings, Dr. Andrew Tannahill’s presentation with the above title, may be of interest. Rather than an ‘evidence rules’ approach decision-making, his thesis (part of his work for NHS Health Scotland) advocates 10 principles to underpin an ethics-based approach to deciding how to improve population health and reduce health inequalities. The alternative motto of this approach, he claims is ‘ethics rule: evidence serves’.

Importantly, evidence remains an important part of the decision-making framework, but so does logic and theory about the probable and possible impact of any decision or intervention made. The 10 principles can be organised into 3 categories:

1. Four principles fundamental to main health outcomes and how the organisation goes about its
business: Do good, Do not harm, Fairness, Sustainability
2. Five principles to do with other outcomes and/or how the organisation goes about its business:
Respect, Empowerment, Social responsibility, Participation, Openness
3. Principle of Accountability – for consequences of decisions and actions, use of resources, value for
money, etc

Dr. Tannahill’s presentation goes through each of the principles and considers how it might be applied to the rollout of IBA in new or untested settings and is well worth a look.  You can also read his journal paper on the framework.

Personally, I find it offers an answer to concerns I have had about how to balance the need for evidence with the great need to do something effective about alcohol consumption.  A solely evidence based approach is not always possible – many, many aspects of what we do are not evidence-based, and it seems to me unlikely that we will ever have really robust, hard evidence for many ‘interventions’ by many practitioners.  Dr. Tannahil’s approach offers part of the answer.  A shorter answer may be that – if we choose to do new things – we have a responsibility to contribute to knowledge about them – by clearly describing why and how and what happened – and to be honest with ourselves and others about exactly what the level of evidence is.

INEBRIA Conference 2012

28 May

9th Conference of INEBRIA: International Network on Brief Interventions for Alcohol and Other Drugs

Conference theme: From Clinical practice to Public Health: The two dimensions of brief interventions.

Dates: 27th – 28th September 2012

Location: Barcelona, Spain

View conference flyer

The conference aims to:

  • Enhance research on EIBI/SBI implementation as a public health tool
  • Expand EIBI/SBI in emerging economies.
  • Promote expansion of EIBI/SBI to other drugs
  • Continue promoting the use of new technologies on the implementation of EIBI/SBI
  • Review the major achievements on EIBI/SBI research in the last 9 years since INEBRIA was launched and the INEBRIA contribution to them.