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Alcohol Screening and Brief Intervention Research Program

This research program focuses on assessing the effectiveness and barriers to implementing alcohol screening and intervention in various settings. It includes cluster randomized clinical trials and explores different approaches and tools. The progress updates and implementation issues are highlighted for Primary Health Care, Accident and Emergency, and Criminal Justice System studies.

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Alcohol Screening and Brief Intervention Research Program

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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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