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Programme design

Alcohol Screening and Brief Intervention Research Programme national brief intervention research consortium Paolo Deluca, PhD Institute of Psychiatry King’s College London.

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Programme design

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  1. Alcohol Screening and Brief Intervention Research Programmenational brief intervention research consortium Paolo Deluca, PhDInstitute of PsychiatryKing’s College London A&E St. Mary’s 'Scientia Vincit Timorem'

  2. Programme design • 3 cluster randomised clinical trials (PHC, AED, CJS) to assess • What are the barriers/facilitators to implementation in a “typical setting” • Identify most effective screening approach/tool • Most effective and cost effective intervention approach • Common measures and design to allow comparisons

  3. PHC study • 24 PHC practices, 3 regions (NE, London, SE) • 4 screening approaches (universal vs targeted, M-SASQ vs FAST) Targeted: New registrations, Injuries, Hypertension, Gastrointestinal problems, Mental health problems • 3 intervention approaches • Patient information leaflet (DH - How much is too much?) • Brief advice (5 min) • Brief Lifestyle Counselling (20 min) • 744 patients (31 each) • Incentives (research, clinical) • Baseline research interview • 6 & 12 month follow-up research interview • Attitudes, barriers and facilitators

  4. PHC Research progress update • Recruited 24 (+8) practices • Trained 189 staff (nurses and GPs) • Recruiting participants since May 08 • 497 (66.8%) • 6 GPs completed recruitment, 9 about to end • 7 under performing and 2 dropped out • 2 agreed to carry on

  5. Training PHC staff • On site training to small groups delivered by RA & AHW • 1 to 2 hrs for screening and BA including role play • 1 to 2 sessions for BLC training with actors in PHC • Overall positive feedback on training • Research elements and Alcohol Units are usually the challenging parts of the training • Most welcomed receiving training and being assessed • 1 session with actor was enough for all but one practice • But adequate space, staff availability, time and implementation issues slowed the training stage

  6. PHC Implementation issues • Protocol: Leaflet-eligibility-screening-informed consent-baseline-intervention • Ideally delivered by same person (except BLC) • In practice we implemented various models to fit local needs and resources (10 min slots) • Strong local lead (champion) • N of staff involved (all vs just a few) • Low recruitment/positives in same areas (eg Enfield) • After good start, patients re-attending slowed recruitment

  7. AED study • 9 AEDs, 3 regions (NE, London, SE) • 3 screening approaches (M-SASQ, PAT, FAST) • 3 intervention approaches • Patient information leaflet • Brief advice (5 min) • Referral to Alcohol Health Worker BLC (20 min) • 1,179 patients (131 each) • Baseline research interview • 6 & 12 month follow-up research interview • Attitudes, barriers and facilitators

  8. A&E Research progress update • Recruited 9 (+2) A&Es • Trained 250 staff (nurses and consultants) • Recruiting participants since April 08 • 717 (60.8%) • 1 A&E completed recruitment, 3 about to end • All underperforming

  9. Training A&E staff • On site training to small and large groups delivered by RA & AHW • 1 to 2 hrs for screening and BA including role play • No BLC training • Overall positive feedback on training. Research elements and Units are usually the challenging parts of the training • Most welcomed receiving training • Adequate space, staff availability, “on call”, turnover, time and implementation issues slowed training • Booster sessions, launch events, shadowing staff first few weeks

  10. A&E Implementation issues • Protocol: Leaflet-eligibility-screening-informed consent-baseline-intervention • Ideally delivered by same person (except BLC) in practice divided by triage/nurses and doctors • Strong local lead (champion) • Consent and contact details put some participants off • Workload • Staff turnover (eg August) • Easily forget training if start is delayed • Tendency of targeting dependent drinkers • Weekly support

  11. CJS study • 96 offender managers, 18 offices • 3 regions (NE, London, SE) • 2 screening tools (FAST, M-SASQ) • 3 interventions • Leaflet • Brief advice (5 min) • Brief Lifestyle Counselling by Alcohol Health Worker • 480 participants (5 each) • Follow-up 6 & 12 months • Attitudes, barriers and facilitators

  12. CJS Research progress update • Recruited 96 (+11) Offender Managers from 18 probation offices • Trained 131 OMs (some disappeared after training) • Recruiting participants since June 08 • 151 (31.5%) • 17 OMs completed recruitment, 10 about to end, remainder underperforming-struggle to start, 24 dropped out/left

  13. Training CJS staff • On site 1 to 1 training delivered by RA & AHW • 1 to 2 hrs for screening and BA including role play • No BLC training • Overall positive feedback on training. Research elements (informed consent) and ulcohol units are usually the challenging parts of the training • Not very enthusiastic, most drawn into it from line manager. • Adequate space, staff availability (1to1), turnover, slowed training • Booster sessions, shadowing staff first few weeks

  14. CJS Implementation issues • Protocol: Leaflet-eligibility-screening-informed consent-baseline-intervention • Delivered by same person (except BLC) • No strong local lead (champion) • Consent and contact details put some participants off • Workload • North/South divide • Staff not engaging with SIPS team • Easily forget training if start is delayed • Weekly support, further incentives?

  15. Training tools and methods • List of tools • M-SASQ • FAST • SIPS-PAT • AUDIT • Screening training • PIL • Brief Advice (BA) • BA Training • Brief Life Style Counselling (BLC) • BLC training • BLC Demo video • Actors’ scripts • Staff pre-training questionnaire • Staff post-training questionnaire • BECCI + Manual • Training manual

  16. Website www.sips.iop.kcl.ac.uk & Alcohol Learning Centre

  17. Training and intervention tools

  18. Recruitment by month

  19. Changes to improve recruitment • Deployment of our AHWs in A&Es • Additional GP surgeries to complement the underperforming ones • Additional offender managers to complement the underperforming ones • Extra support to offender managers • Allow over-recruitment in CJS and PHC

  20. Conclusions • Prevalence of AUDs reflect previous studies in these settings • Patients/clients are more willing to receive an intervention than previous studies • Overall staff in these settings are keen to be trained • However, limited time, workload and turnover are limiting implementation

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