Exploring the High Impact Changes

Deryn Bishop

Melvin Hartley

and Alison Wheeler

Regional Alcohol

Managers

Introduction

• Who’s who?– Criminal justice– Health– Young people– Licensing– Local authority

• Commissioning Guidance• Local action• The High Impact Changes• Focus on Identification and Brief Advice (IBA)

Local action

High Impact Changes

1. Work in partnership

2. Develop activities to control alcohol misuse

3. Influence change through advocacy

4. Improve the effectiveness and capacity of specialist treatment

5. Appoint an Alcohol Health Worker

6. IBA - Provide more help to encourage people to drink less

7. Amplify national social marketing priorities

Identification & Brief Advice

• What does this mean?

– Identification and Brief Advice (IBA) is opportunistic case finding followed by the delivery of simple alcohol advice. These are effective interventions directed at patients drinking at increasing or higher-risk levels who are not typically complaining about or seeking help for an alcohol problem.

– It is what we call “The teachable moment”– IBA can be effectively implemented in a number of settings

including: • Primary Care• A&E Departments • Specialist settings• Criminal Justice settings

Identification & Brief Advice

• What is the evidence that this works? – There is a very large body of research evidence

supporting IBA in Primary Care including 56 controlled trials (Moyer et al., 2002) and a Cochrane Collaboration Review (Kaner et al., 2007).

– For every eight people who receive simple alcohol advice, one will reduce their drinking to within lower-risk levels (Moyer et al., 2002). This compares favourably with smoking where only one in twenty will act on the advice given (Silagy & Stead, 2003). This improves to one in ten with nicotine replacement therapy.

Benefits of IBA• IBA would result in the reduction from higher-risk to lower-risk

drinking in 250,000 men and 67,500 women each year (Wallace et al, 1988).

• Higher risk and increasing risk drinkers who receive brief advice are twice as likely to moderate their drinking 6 to 12 months after an intervention when compared to drinkers receiving no intervention (Wilk et al, 1997).

• Brief advice can reduce weekly drinking by between 13% and 34%, resulting in 2.9 to 8.7 fewer mean drinks per week with a significant effect on recommended or safe alcohol use (Whitlock et al, 2004).

• The SIPS trials on going : (Screening and Intervention Programme for Sensible drinking)

– Criminal Justice (probation) – Primary Care– Accident and Emergency Departments

IBA in Primary Care

• Early opportunity to identify alcohol related issues - E.g./GP surgery, Pharmacies, Health Trainers,

• The less obvious - Police Section 27 notices, fire home assessments

• Training Needs Analysis - identify ideal setting, person, opportunity

• Workplace Policies - return to work interviews/occupational health

• IMPORTANT - treatment pathways identified and have capacity.

IBA in Hospital settings

• Acute Care Impacts: Identifying the Hazardous and Harmful (increasing risk drinkers)

• Focuses on the non dependent drinker in hospital setting• Delivers brief advice and signposts to further support

• IBA in A and E, MAU, maxillofacial clinics, fracture clinics, sexual health clinics

• Gastroenterology outpatients, TB outpatients, • Cardiac wards, gastro wards, general medical wards etc

IBA in A&E

• A study at St Mary’s Paddington showed that patients who received an intervention (Crawford et al, 2004):– Were drinking at significantly lower levels– Made ½ fewer visits to A&E– Saved 40 admissions per year

• Use the Top Ten conditions• Validated screening tools such as PAT or FAST• SIPs is refining the tool for A and E

IBA in Acute care

• How to effectively deliver:

• Do it in partnership with Acute Care staff• Raise general awareness of acute care staff about

alcohol issues, for themselves and their patients• Train acute care staff, then refresh and monitor variance• Target patient cohorts• Have an agreed, simple, care pathway in place• Link in to local Tier 2 /3 treatment agencies• Record activity and data...and feed it back

Where is the CJS is the best place to carry out a trial of SBI?

Arrest

Charge

Conviction Sentence Community

Sentence Prison/YOI

Post Sentence Prison/YOI

IBA in Criminal Justice

• Area wide offender health group• Police

– Custody areas– Arrest referrals & FPNs

• Court– alcohol treatment requirements

• Prison– Offender health trainers– Physical health– Ex offenders– Prison officers and Carat teams

• Probation / YOT– Use of ASSET and OASYS to identify– Approved premises– Health trainers– Probation officers

Working groups

• What is my role?• What can I do back in the day job?• What opportunities exist?• Industrialisation• Sustainable

– Discussion in role groups –

Next steps for action

• Pledge cards

– One thing I am going to do

• Drinks diary

– My personal challenge

– My challenge to my colleagues

• Any questions?

Your regional alcohol manager

• East of England – Melvin Hartley• East Midlands - Liz Ambler• London – Matthew Andrews• North East - Colin Shevills• North West - Alison Wheeler• South East - David Sheehan• South West - Laura Juett• West Midlands – Deryn Bishop• Yorkshire and Humber - Dianne Draper

For more information

• www.alcohollearningcentre.org.uk