New drinking guidelines – IBA implications?

7 Mar

0005623507Y-1440x1920Earlier this year the new adult weekly recommended drinking guidelines sparked a bit of a media frenzy. On the plus side, this raised awareness (in the short term at least), and perhaps got some people talking about them. On the other hand, awareness of the guidelines alone doesn’t tend to lead to behaviour change. Much of the media also pandered to the distraction of the ‘nanny state’, arguably failing to recognise the basic principle of a ‘guideline’ to support informed decision making – one of the reasons why it should not be described as a ‘limit’.

Yet to be answered though is what the implications are for alcohol interventions and other policy areas. Obviously most recent alcohol literature (and alcoholic drinks packaging) will now be ‘outdated’ if displaying the old daily guidelines – although you can find an updated tool here [ppt]. Certainly there will be further work underway about how we calculate and define ‘at risk’ drinkers, but overall we must not get too caught up in trying to pin point exact ‘cut-offs’.

As such the important point is that alcohol misuse is a spectrum, and people are often unknowingly changing their consumption and the actual or potential effects on their health and wellbeing. IBA is about helping people understand where they sit and helping facilitate change where relevant.

So whether we use the alcohol guidelines as a general indicator of our risk level, or something more sophistaced like the AUDIT, it is important not to get too literal about things. A person drinking near 14 units a week (or say a person scoring AUDIT 7 or less) should not consider themselves to be risk free, just as a person drinking 15 units (or scoring AUDIT 8+) should not assume they will certainly suffer alcohol problems. The basic principle of the dose effect applies – the more of a drug one consumes, or the more frequently, the greater the risks – generally speaking.

So in practice, a little common sense applies. When we offer ‘brief advice’ to people, we automatically take into account a wide range of factors – what the person is there for, how motivated they are, how much time we have etc. etc. A change in the guidelines may be just another ‘common sense’ consideration to take into account. For instance we might inform or ask people if they knew that the guidelines have recently reduced a bit, and although any level of drinking carries some risk, sticking to them means a person is unlikely to develop serious negative effects in the long run. running

Drinking is of course just one of many ‘health behaviours’. If someone is getting overly focused on debating specific cut-offs, it could be worth pointing out the many other factors that will influence their likely health outcomes; especially those that they may be able to change.

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‘IBA direct’ evaluation shows people welcome IBA in public

21 Dec

An evaluation has shown that taking ‘IBA direct’ to people on the streets of South London was found to be highly effective in engaging people and delivering brief intervention.

The project, branded ‘The London Challenge: are you healthier than your mates?’, took place over three days in August and tested a number of methods to engage passersby and deliver IBA.

Resonant, a specialist behaviour change agency, had been commissioned by NHS Lambeth to deliver the activity in a way which would engage at-risk drinkers in their 20’s as an identified target group. Within the borough, this age range were found to be less likely to access services where they might receive IBA, but many were found to be drinking at risky levels.

As part of the ‘The London Challenge’, four ‘brand ambassadors’ were trained to engage passersby and offer IBA. Free ‘mocktails’ were offered as an incentive to ‘hook’ the public into completing the AUDIT.

Resonant developed the approach based on research and ‘co-creation’ with the target group who identified that answering alcohol questions and receiving ‘brief advice’ was acceptable as long as it was engaging and non-judgemental.

The evaluation was independently conducted by the South London Health Innovation Network (HIN) Alcohol team.

Rod Watson, Senior Project Manager (Alcohol) for the Health Innovation Network highlights some key observations on the evaluation findings:

  • The service evaluation found IBA Direct is feasible and acceptable at being delivered in a public setting by non-health professionals.
  • Over the course of the three days of the project, 402 people received IBA.
  • The brand ambassadors engaged people with professionalism and their approach was central to the large number of people taking part.
  • A small follow up sample of the 402 people who received IBA direct showed a reduction in AUDIT scores six weeks following the intervention. (Note: caution should be exercised here as no control group was used).
  • A participant feedback form was completed by 61 people. Participants rated both the ‘London Challenge’ and the service they received from a brand ambassador highly.
  • All respondents found the setting to be suitable and 90% stated they would take part in this service in a public setting again. There was nothing reported back that indicated any concerns from people about the public setting of the project.

As such the project shows significant potential for delivering IBA ‘direct’ to people in public spaces. Given the challenges facing IBA in other settings, this approach could offer a promising channel to reach new groups of at-risk drinkers.

The full report can be downloaded here:

‘The London Challenge: are you healthier than your mates?’ Service Evaluation of Alcohol Identification and Brief Advice Direct to the Public [pdf]

To find out more about IBA direct please get in touch.

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Substance use and sight loss guide

4 Dec

A new practice guide has been produced to help practitioners support people with overlapping sight loss and drug and alcohol issues.

Download Substance Use and Sight Loss: A guide for substance use and sight loss professionals [pdf]

The guide follows research identifying that neither sight loss or substance abuse services feel adequately equipped to deal with these overlapping issues, and as such aims to help support better identification and responses in this area.

The issue highlights how many professionals with the chance to offer alcohol brief interventions will be working with a range of different issues that may be closely interlinked. As such ensuring practitioners feel able to respond appropriately is essential, and often why often IBA itself is overlooked as an important early intervention.

Sight loss is of course one of a large number of issues that may be contributing or linked to drug and alcohol problems. Professor Sarah Galvani, one of the authors of the guide said: “Substance abuse can sometimes be used as a coping mechanism for sight loss but the combination of both issues can create a complex challenge for support professionals.”

IBA is about offering a person an opportunity to make an informed decision about their alcohol use. Sometimes it will be straightforward, and discussions around motivations and strategies for change will be along more common lines. At other times, discussion may need to reflect and support other issues – for some people sight loss will be one of them.

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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.

 

The Evidence of Effectiveness & Standards for IBA: Hospital & Criminal Justice settings

16 Jul

Further guidance for IBA delivery has been released, outlining the evidence for IBA and minimum standards for delivery in Hospital and Criminal Justice settings.

Download: IBA hospital settings

Guidance for community health settings was also released earlier this year – full report here [pdf].

Although the documents share many of the same sections in terms of explaining IBA and the evidence base, setting specific implications and invest to save rationale are included.

  • Alcohol misuse costs the NHS £3.5 billion per annum; much of this burden is from hospital care.
  • In 2010/2011 there were 1.2 million alcohol-related hospital admissions. This equated to 7% of all hospital admissions and offers a substantial opportunity to intervene.
  • Over 14 million people are treated in ED in England each year. The Department of Health estimates that 35% of ED attendances in the UK are attributable to alcohol, increasing to 70% between midnight and 5am.
  • Almost one third of London fire deaths are alcohol related.
  • 11% of male high blood pressure is alcohol related.
  • Over 4,000 people die each year as a result of alcoholic liver disease.51
  • A National Statistics study found that 27% of people with severe and enduring mental health problems had an AUDIT score of 8 or more in the year before interview, including 14% who were classified as alcohol dependent.IBA Criminal Justice

For Criminal Justice Settings, the rationale for IBA is also convincing:

  • The prevalence of individuals with an alcohol use disorder in the criminal justice setting
    is three times greater than in the general population.
  • As many as 75% of arrestees may be risky drinkers and therefore appropriate for brief advice.
  • In 2010/2011 1.4 million people were arrested in England and Wales highlighting police custody as an effective setting to reach around 3% of the adult population annually.
  • Self-reported associations between drinking alcohol and the offence were identified in two fifths of respondents and for 50% of violent crimes.
  • 47 % of violent crime is believed to be alcohol related.
  • 45% of victims of domestic violence say their attacker had been drinking.
  • The national cost of domestic violence to criminal justice, health, social, housing and legal services as well as the economy amounts to more than £5.7 billion a year.
  • A study of arrestees and offenders who had been given brief advice and treatment in police custody or referred elsewhere identified that 40% of respondents found the advice useful.
  • 74% of probation clients in a study in South London were AUDIT-C positive

The guidance was commissioned by the Safe Sociable London Partnership, a regional body aiming to supports alcohol improvement work in London.

‘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.

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The Evidence of Effectiveness & Minimum Standards for IBA in Community Health Settings

31 Mar

A new document outlining the evidence for IBA and standards for delivery in a range of settings has been released. Commissioned by the Safe Sociable London Partnership, the document provides an overview of the evidence base for IBA as a short ‘brief intervention’, and suggests how it should be delivered in key community health settings.IBA evidence and standards_community health

The Evidence of Effectiveness & Minimum Standards for the Provision of Alcohol Identification and Brief Advice in Community Health Settings [pdf]

‘Identification and Brief Advice’ has been central to England’s alcohol policy, particularly given its effectiveness in comparison to other individual level interventions. Brief intervention is most likely to ‘work’ because a combination of ‘identifying’ a level of risk – and ‘feedback’ to the drinker to inform them of this – may trigger a process of change.

In contrast, just handing someone a booklet means even if it is read, a risky drinker may not realise the information is relevant to them and assume they are fine. Brief advice may also give added benefits, such as helping build a person’s motivation or belief in their ability to change.

As such, the guides summarises the evidence base behind IBA, for example it states:

“On average, following intervention, individuals reduced their drinking by 15%. While this may not be enough to bring the individual’s drinking down to lower risk levels, it will reduce their alcohol-related hospital admissions by 20% and “absolute risk of lifetime alcohol-related death by some 20%” as well as have a significant impact on alcohol–related morbidity.”

As well as setting out an interpretation of how IBA should be delivered, it provides specific suggestions and statements for key community health roles including:nurse IBA

  • Primary Care Staff
  • Community Pharmacists
  • Midwives and Health Visitors
  • Mental Health Service Staff
  • Drug Service Staff
  • Delivery by Sexual Health Workers

The report also addresses the crucial issue of ‘making it happen’ through what it describes as ensuring ‘organisational ownership’, as well as the need for training, materials and inter-linking IBA with related issues and policy.

Some of the statements within the report will still be subject to debate. In particular, exactly what ‘brief advice’ consists of, and whether IBA should be implemented in all community health settings without more setting specific evidence.

Exactly what ‘IBA’ is as a form of brief intervention has been explored in the ‘Clarifying brief interventions’ briefing [pdf], and IBA in non-health settings has been explored in recent research report.

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