1. Looking beyond the literature to identify and develop promising approaches to reducing alcohol related harm Rachel Herring and Mariana Bayley Drug and Alcohol Research Centre, School of Health and Education, Middlesex University SSA Symposium, York, 8-9th Nov 2012

2. Background • ARUK/JRF jointly funded study • Since 1990s emphasis on Evidence Based Policy - ‘what counts is what works’ • How do we decide ‘what works’? • How do we build the evidence base? • How do we support the development of new/innovative approaches & initiatives?

3. Alcohol policy and practice needs to be evidence based - who would argue with that? But how do we decide ‘what works’? ‘HARD’ Formal, explicit, ‘superior?’ ‘SOFT’ Informal, tacit, ‘inferior?’ • Published international research literature – RCTs, systematic reviews, regarded as ‘gold’ standard • Grey literature (e.g. reports, unpublished papers) • Knowledge of stakeholders and practitioners who develop and deliver local alcohol policy and interventions E V I D E N C E

4. Type V EVIDENCE – SOFT Informal, tacit, Knowledge of practitioners, service users and stakeholders

5. Types of evidence used for decision-making • Theoretical evidence: • Ideas, concepts and models used to describe and explain how an intervention works • Empirical evidence: • Information about how the intervention is implemented, its effectives and outcomes. • Experiential: • Tacit knowledge and ‘practical wisdom’ of frontline practitioners • Lived experience of people using services Williams, I. and Glasby, J. (2010) Making ‘what works’ work: the use of knowledge in the UK health and social care decision-making, Policy and Society, 29: 95-102.

6. Methods • Comprehensive narrative review of international research literature (MCP, published since 2000) • Review of UK grey literaturePrimary source: ‘Local Initiatives’ (England & Wales) a web based resource (Alcohol Learning Centre) • Scoping exercise: • email questionnaire to key informants (e.g. alcohol leads, alcohol co-ordinators) to identify examples of what they regarded as promising initiatives (72 identified) • follow up telephone interviews (26 projects) • Practitioner Workshop: drew together expertise and knowledge to think about what ‘works’, how to identify ‘promise’ & develop initiatives

7. Implementation frameworks Multi-component programmes Partnerships Innovation

8. Working together to reduce alcohol related harm • Partnership as a key mechanism • Innovation approach provides risk-free platform for piloting new initiatives • ‘Tacit’ knowledge • Evaluation regarded as valuable tool

9. Working with ‘Frequent Flyers’* • Example of an initiative grounded in practitioner knowledge/evidence base • Portsmouth Frequent Flyer Pilot project (Jan – April 2010) awarded £15,000 ‘High Impact Change’ grant from South East Alcohol Innovation Programme(SEAIP) • Original pilot set out to engage 20 most prolific FFs. Actually engaged 5 • Service spec drawn up for next phase (used for Hastings etc) included provision for specialist community nurse to work with 10 most prolific FFs * clients with highest level of repeat alcohol related hospital admissions

10. Learning from the pilot • Best to engage patient while inpatient • Treatment on it own not enough – group has complex health and social needs • Requires intensive back up support from outreach and treatment services • Intensive supervision of worker required • Perseverance – not taking ‘no’ for an answer

11. Frequent flyer project development • Project adapted – pilot extended • Stakeholders in SE invited to bid to replicate project model • Another 3 FF projects funded for 3 months – Brighton and Hove, Chichester, Hastings • By Feb 2011, pilot work is being mainstreamed

12. Use of evidence in Frequent Flyer project development Practitioner and ‘stakeholder’ observations and hospital admissions data Project ‘success’ measured in terms of: Alcohol related admissions, Outcomes, Budget, Sustainability, Diffusion, Performance Learning Adaptations Project evaluation

13. Finally...... • Value of initiatives needs to be understood not just in terms of financial savings • Need flexibility in responding to changes in problems, policy and society • Ensure mechanisms in place to support value of ‘tacit’ practitioner/user knowledge • Encourage generation of new ideas/improvements in practice • Provide ‘risk free’ opportunities to test ideas and provide pathways for further testing of promising initiatives • Enable learning to be shared