Exploring the High Impact Changes

1. Deryn Bishop Melvin Hartley and Alison Wheeler Regional Alcohol Managers Exploring the High Impact Changes

2. 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)

3. Local action

4. High Impact Changes • Work in partnership • Develop activities to control alcohol misuse • Influence change through advocacy • Improve the effectiveness and capacity of specialist treatment • Appoint an Alcohol Health Worker • IBA - Provide more help to encourage people to drink less • Amplify national social marketing priorities

5. 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

6. 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.

7. 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

8. 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.

9. 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

10. 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

11. 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

12. Where is the CJS is the best place to carry out a trial of SBI? Arrest Charge Sentence Prison/YOI Post Sentence Prison/YOI Conviction Sentence Community

13. 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

14. Working groups • What is my role? • What can I do back in the day job? • What opportunities exist? • Industrialisation • Sustainable • Discussion in role groups –

15. 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?

16. 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

17. For more information • www.alcohollearningcentre.org.uk