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Alcohol IBA ‘training app’ released

1 Jul

IBA An IBA training app was recently released on the apple store, Google play and also on the amazon app store. The free app is available to download to support front line health or social care professional roles to offer simple alcohol brief intervention.

The app contains a simple format to introducing the key fundamental knowledge and skills required to offer alcohol ‘Identification and Brief Advice’, with a focus on possible scenarios and responses. Firstly, the app offers a background to IBA and how early intervention for alcohol misuse is suitable for around a quarter of the adult population. It also offers interactive sections exploring key areas such as alcohol units and the AUDIT screening tool.

risk groupsThe main focus of the app focuses on a number of scenarios demonstrating suggested ‘brief advice’ responses as well as examples of how not to respond to ambivalent or resistant responses. The scenarios include actors playing increasing, higher risk and possibly dependent drinkers, each showing a range of possible attitudes and practitioner responses.

The app offers a shorter alternative to the 2 hour online IBA e-learning which has proven a popular resource. Nonetheless, good face to face training should still be considered the gold standard training approach. Of course many busy front line roles may not have access to face to face training so the app offers a quick and effective introduction to IBA delivery.

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IBA for alcohol… and diet…and physical activity…and smoking….and…

19 Jun

I have just had the pleasure of writing and delivering a one-day training course entitled ‘Brief Advice for Health Behaviour Change’ that aimed to enable practitioners to deliver brief interventions using a motivational approach on the four issues of alcohol, smoking, diet and physical activity. The target audience was frontline staff, not just in healthcare (hospital staff and those delivering NHS Health Checks) but also prisons and workplaces. It is not the first time we have written training on IBA for topics other than alcohol (try IBA for alcohol and drugs for youth workers, or for alcohol and sexual risk-taking) but combining four topics into one process for IBA is not easy.

Firstly, there are basic practical difficulties of how you build the knowledge and understanding of practitioners and address any prejudices or myths that may exist about not one but four issues, in a single day. This is by no means easy, but pre-course work helps.

Even more tricky is how to describe and teach the process of ‘IBA’ for such a broad range of ‘lifestyle’ issues.  Finally, the challenge is to design a process that can realistically be implemented in a 10 minute (max) conversation.

While the basic IBA skills remain the same, we designed a completely new framework or IBA process in which to present and teach them. The course included discussion not only of how and when to raise the issue of ‘lifestyle’ generally, but also how to narrow the conversation down to one or two topics which the individual is ready to discuss. We discussed stages of change in terms of just three stages to simplify thinking and decision-making. And the ‘Identification’ or ‘Screening’ process inherent in IBA was simplified to exploring the individual’s current behaviour and comparing it to national guidelines rather than using a formal screening tool.

The pilot went well, and I am confident that the challenges described can be met – but perhaps not for all of the people all of the time!  And one key question remains – are some issues harder to raise than others?  If you try to cover them all together, will practitioners avoid the issue they find most sensitive? And if so, which issue will be left out? In Scotland, I know that when Keep Well practitioners offering cardiovascular check ups (similar to NHS Health Checks in England) were trained on generic health behaviour change approaches, it was found that they avoided alcohol as an issue and separate training specifically on alcohol was provided. Was this a one-off? Or could we expect that diet and weight issues would be just as sensitive?

We will soon be training 18 people to roll out the Brief Advice for Health Behaviour Change course to others via a two-day training for trainers course… watch this space!

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

Audiovisual resources can be invaluable in IBA training

24 May

About ten slides in everyone loses the will to live and groans at the thought of role play … we’ve all been there.  Well one quick trick I’ve found is to just re-brand role play as “Skills Practice” which engages people’s egos by acknowledging them as already skilled practitioners even where they aren’t.  Alongside “skills practice,” often as a precursor to it, I always use audiovisual resources and ask trainees to critique the strengths and weaknesses of these.  You could use the Department of Health’s videos from the e-learning module which cover screening and Brief Advice or the SIPS videos of Brief Advice and Brief Lifestyle Counselling (also known as Extended Brief Interventions).  The critique of these mounted by most trainees is that they are not representative of the barriers that patients and/or service-users typically put up and the challenges faced by practitioners.  Both, for example, feature white middle-class, educated women.  The DoH videos do cover a range of potential reactions, including anger and denial, and show the GP negotiate these.  The SIPS videos are excellent examples of a relaxed and non-judgmental style and adept rapport-building.

Where you are training people in an A&E setting, you could make use of HAGA‘s IBA videos which cover use of the Paddington Alcohol Test (PAT) which feature Professor Robin Touquet introducing the background to the tool and its use in A&E, how to screen using the PAT, and PAT screening in action.  I won’t critique these as we did them!

Now all you need to do is get some good speakers and you are away!

Who needs IBA?

16 Apr

Recognising the ‘right’ group of patients or service users for delivering identification and brief advice is one of the first hurdles to be overcome by non-specialists getting to grips with delivery.  Most IBA guidance, based on reasonable evidence, suggests that those who might benefit from brief advice are drinking at increasing or higher risk levels.  We spend quite a bit of time on training talking about how you can identify these people using screening questions, and crucially, how you can’t identify them by looking, guessing or assuming!

So why is it then that when we follow-up participants some months after training courses, some still report that they have not delivered IBA because ‘my clients don’t need it’?  Some say that all their clients are drinking too much to benefit from IBA; others that their service users do not drink enough to need help, but these conclusions are not necessarily based on screening.  Why?

Well, I have a few theories…firstly I think it is worth acknowledging that this could just be an excuse, perhaps training participants just feel bad if they haven’t delivered and so they want to give us a good reason why.

Or perhaps it is true – though it seems unlikely that practitioners working with the general public, have not come across anyone at all who is drinking more than the recommended limits, but not in a dependent way!

I think the former is more likely, but it is not as simple as them making it up to satisfy us.  I think they are rationalising to themselves as well as us, why they haven’t delivered.  And I think (among other reasons) it comes down to the fact that in order to truly recognise the target groups for IBA, we need to recognise that included in the target group are folk, well, just like us.  Or if not us, like folk we know and like.  Not a stereotype ‘heavy drinker’, never mind ‘alcoholic’.  And that might mean recognising that we, or our family or friends, have a choice to make too…enjoy our drink and accept the risks, or cut the drink and cut the risk…

Delivering IBA is just about giving everybody that information, and that choice.