Tag Archives: EBI

Clarifying Brief Interventions: 2013 update – beware ‘IBA lite’?

16 Jan

goodIn 2010 the first Clarifying brief interventions briefing mainly aimed to shed light on the differences between ‘IBA’ as simple brief intervention and EBI as Extended Brief intervention. This was in response to an apparent lack of clarity between the two approaches, and perhaps a false assumption that EBI was ‘better’ then IBA as a general approach.

For the 2013 Clarifying Brief Interventions update the focus appeared quite different. Although the IBA agenda has clearly moved on, the focus appears to have shifted to  simpler approaches, or ‘IBA lite’ as posed in the new briefing. These minimal or ‘lite’ approaches appear to reflect the challenges of implementing IBA across front line settings. Using shorter screening tools and providing just a feedback statement + leaflet takes very little time. ‘IBA lite’ also relieves practitioners of the need to offer ‘brief advice’ which may often be perceived as lengthy or difficult. The appeal of IBA lite is therefore obvious.

The briefing however highlights the limited evidence to support ‘lite’ approaches, but accepts that it may be a good starting point. If people are being ‘identified’ and informed of their risk level they are more likely to consider their drinking. But considering one’s drinking and making a change to it are not the same. Behaviour change is often much more complex, and the opportunity to further affect the drinker’s motivation to change is lost with ‘IBA lite’.

Take for instance a drinker who after ‘IBA lite’ decides they would like to reduce their risk, but feels it will be too difficult to cut down. They are not aware of some very simple strategies that could help them, or that they can change via ‘small steps’ rather than needing to take one giant leap. Helping identify simple strategies or manage expectations are some of the obvious benefits of offering ‘brief advice’.

However, it cannot be said that IBA, as in including the offer of verbal brief advice, is the most ‘superior’ form of brief intervention. Nor can the same be said for EBI including more motivational techniques. The truth is there is still much more to be learned about the effective elements of brief intervention, and it what circumstances they might apply. In Scotland, more emphasis on empathy and motivational enhancement was placed in their national brief intervention programme, although in England ‘IBA training’ has been provided widely and to no common framework.

Future brief intervention research is increasingly focussing on not if, but how it works. This needs particular attention to the challenges faced on the ground. In the meantime, we still need to be aiming for something more than the easiest minimal approaches. ‘IBA lite’ may be a start, but my sense it is probably not close enough to what really helps most drinkers to enact a change in their drinking.

EBI: lost in the shadow of IBA?

9 Aug

Over recent years there has been a strong policy focus on IBA as a simple brief intervention: front-line roles giving simple feedback or ‘brief advice’ to risky drinkers. Big questions remain though over whether IBA is happening on the ground, or when it does, is it being done so effectively.

Another big issue though is whether Extended Brief Interventions (EBI) have been left in the shadow of simple IBA? However, since it seems most at risk drinkers will respond as well to IBA as EBI, why bother? A question perhaps strengthened by the SIPS trial which appeared to suggest even 5 minutes of brief advice is no superior to feedback and a leaflet.

v2However not everyone is content to take SIPS findings as word. Practically speaking , there are drinkers who need more than brief advice, but less than full ‘treatment’ offered by specialist services (which they are also less likely to engage with). Where someone either does not change following IBA, wants more help, is still unsure but does not need full structured treatment, EBI fills this potentially rather large gap of often ‘higher risk’ drinkers.

Another debate is of course whether EBI is actually a form of brief treatment rather than brief intervention. Semantics though are less important than identifying gaps in what’s currently being offered to all types of alcohol misusers. There are lots drinkers out there, maybe millions, who could arguably benefit from EBI or ‘brief treatment’ approaches, but very few will be offered or seek it.

How to increase access to EBI?

Of course EBI comes at a greater cost than IBA. It is part of the simple appeal of IBA that practically any front line role can do it with a quick bit of training or even e-learning. EBI however is an advanced skill based on Motivational Interviewing (MI) techniques, which are trickier than they sound. Most existing EBI services are therefore offered by alcohol roles working in community settings. However there are not many of these commissioned, although the case is there in the NICE alcohol guidance. (see 3.1 of the costing report in particular).

In some cases though other roles are stepping in, such as health trainers, ‘coaches’ or other independent practitioners working through GP practices. Certainly Primary Care settings seem the most logical arena for taking EBI to those that might benefit from it.

Avoiding ALCOHOL in the service name?

One further key consideration about EBI or ‘brief treatment’ approaches is that drinkers may often be wary of engaging in any form of ‘treatment’ or intervention. Many people view alcohol misuse as only applying to dependency, often at the more severe end, and so are unfamiliar with the concept of ‘risky’ or harmful use.

As a result, many EBI or other alcohol services have been wise to market themselves as services that are about helping people make healthier choices. This clearly fits well with the psychosocial nature of addressing alcohol misuse, but at the same time people need to understand what the service is really about.

One final plus

One further benefit of having EBI roles available is the impact on IBA delivery. EBI roles can play a crucial leadership role in ensuring routine identification is taking place by primary care roles, as well as being there as a referral resource for those otherwise left with not more than a leaflet to help them cut down.

In conclusion, the case and method for improving EBI acces is less straightforward than for IBA. Yet there is still a clear need and cost benefit to increasing access to interventions offering more than brief advice and less than structured treatment. More real world learning is needed on the best ways to achieve this.

Further reading

If you have any EBI evaluations or local case studies please let us know!