Tag Archives: IBA

‘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.

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.

 

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.

IBA for young people: a promising picture?

12 Aug

A common question about IBA is ‘does it work for young people?’ – and a straightforward answer isn’t easy, though we are getting closer. Recently two new publications have reviewed the evidence for IBA in children and adolescents:

The good news is the reviews are broadly in agreement and make some useful points, notably that AUDIT and CRAFT screening tools are considered the most effective and should be be used with adolescents for IBA. The bad news is, as you might expect, more research is needed as many issues remain largely unanswered. Fortunately SIPS Junior is under-way and will shed some further light, especially given the absence of UK based evidence for young people’s IBA.

One of the key issues is the significant differences between young children and older adolescents. In particular, any alcohol use may be considered problematic in younger children (especially under 15), whereas ‘lower risk’ drinking in older adolescents may not be of such concern. However what is considered ‘low risk’ for adults is not considered ‘low risk’ for adolescents based on the CMO guidance, so lower scoring cut-offs on screening tools are deemed necessary – but not yet researched. And given the broad but important age range covering children and young people, it won’t be straight-forward.

The reviews do however identify a number of research trials that identified positive effects of brief interventions (as well as some null-findings, which another paper recently suggested should not be interpreted as showing IBA not to be effective). Some evidence was also found of indications that electronic forms of brief intervention (or e-BI, or e-BA if ‘IBA-ing’ it) were effective, but also one meta-analysis found traditional face-to-face approaches superior.

All in all, IBA for young people seems an important opportunity where we can make it happen effectively, even if the research, tools and guidance aren’t up to speed with that for adults. As listed in this blog’s 2012 post on this subject, here are some IBA and young people centred resources:

IBA Primary Care case study: a rare new example

29 Jul

preventionIn 2011 a ground-breaking document (in the IBA world at least) was released by a brilliant local service in Haringey. The document was a step-by-step guide to implementing the DES incentive scheme for IBA for new registrations in Primary Care. However what was arguably most impressive was the work revealing the local ‘DES picture’, which was not pretty reading.

The review found, to give just a few examples, that 75% of practices were using incorrect screening questions, and that only 50% of practices were offering face-to-face Brief Advice to identified risky drinkers. However such issues are likely to be commonplace if anecdotal reports and mystery shopping are anything to go by. The Haringey work though subsequently enabled action to significantly improve local IBA delivery.

So it seems apparent that the DES scheme itself does not result in good quality IBA – much more is needed to make that happen. Not a surprise really, but part of the problem has been a lack of available reports to identify this.  Any new pieces of work evidencing local IBA experiences and action in relation to the DES are therefore to be welcomed.

A new case study – Cruddas Park Practice

I recently came across a valuable piece of work in the North East – a report from a pilot [pdf] which aimed to assess the practicality of implementing IBA into a busy GP practice. Again, this seemed to be the result of prior some work looking at the local picture. A survey of GPs carried out by Balance found that GPs were typically only addressing alcohol in response to clinical indicators, rather than routinely as IBA is intended. Time pressures and competing priorities were the recurring reasons offered for this.

The report provides a valuable insight into a local effort to properly implement IBA and supporting pathways into a busy GP practice. It looks at the compelling local need, and evidence base, but most of all, it gives a real insight into how perceptions and practice in relation to IBA can be changed by a relatively simple project.

Some of the best insights from the report related to the feedback from the staff who delivered IBA. It is always heartening to hear a busy practitioner relay a real life positive attitude to IBA, like this example:

“One guy had a health check and his cholesterol was up, he was drinking most days, now he has cut out drinking through the week. I told him his attitude was great. He had never thought about it until he came to the GP, he is sleeping better, he feels better. He thanked me and it made me feel good.”

Of course the reality is its not straightforward. This quote really captures probably the biggest overall challenge to IBA:

“Sometimes the timing is an issue, for people who screen mid way it’s not too bad, but if people score high you need to spend more time with them. It takes a double appointment – about 20 minutes. Or I add it into an annual check it takes an extra five minutes. It’s hard to judge how long it will take until you ask the questions. You definitely need longer – especially if they need to discuss the issues more, you don’t want to hurry people if they are listening.”

There is one issue I feel I should point out with the report itself. It suggested higher risk drinkers (16-19 AUDIT scores) were offered referral for advice or extended brief interventions as the main output, rather than offering ‘brief advice’ as a starting point and only then offering referral if needed or sought. The evidence doesn’t suggest EBI is superior to IBA for higher risk drinkers in most cases – see Clarifying Brief Interventions for more.

However the report is still a highly valuable and rare example of the type of attention that’s needed to convert patchy or inadequate IBA to a standard that really makes a difference. Good, simple IBA isn’t that hard after all.. is it?

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.

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.