Baseline and post-intervention ‘diary snapshot’ results for phase 1

1. INTEGRATING EVIDENCE-BASED FAMILY-INTERVENTION INTO ROUTINE ADDICTION SERVICES: BRIDGING THE GAP BETWEEN RESEARCH AND PRACTICE Claire Hampson, Alex Copello & Jim OrfordAlcohol, Drugs and Addiction Research Group • School of Psychology • University of Birmingham email CLH803@bham.ac.uk • phone 0121 414 7209 IntroductionDespite the recognition that family members of people with alcohol or drug problems have considerable needs in their own right, addiction treatment services are set up to predominantly focus on the individual drinker or drug user (Orford et al, 2008). One possible reason for this lack of response to the underlying needs of family members is that addiction services do not have available to them the theoretical and practical tools with which to respond to these needs (Copello et al, 2000). This project is providing an alcohol treatment organisation, Aquarius, an opportunity to receive training and ongoing supervision in two family-orientated brief-interventions, aiming to promote a shift towards family-focused practice and to further advance implementation of family work into routine addiction services. Methods Managers and frontline staff will be trained in two family-orientated interventions: the ‘5-step approach’ and Social Behaviour and Network Therapy (SBNT) (see Copello et al, 2000). Two teams were allocated to be part of a pilot phase. Following the pilot phase the remaining four teams were randomly assigned to receive either the immediate or delayed (control group) training and supervision support package. The support package includes: a two-day training event; 8 monthly supervision meetings with the research team and a one-day refresher training event at the end of the intervention. The quasi-experimental method will be made up of two phases over a two-year period. The study design will allow comparisons of the immediate and delayed training on the implementation of family-focused service at various time points. • Evaluation measures • The impact of the training on the brief interventions on family-focused practice will be evaluated combining qualitative and quantitative methods: • Two questionnaires at baseline and 9 months after post- training: the AAFPQ** and a questionnaire developed for the study (see further attitude measurement) • Baseline and 3-monthly post-training ‘diary snapshot’: taking a weekly snapshot of focal client / family member activity from staff diaries • Detailed process notes from monthly supervision meetings (conducted qualitatively with staff at various points) • Documentary evidence - monitoring any changes to process documents, e.g. invitation letter sent to clients / family member; confidentiality form etc. • Results • So far, as part of the pilot, total AAFPQ scores for Knowledge, Confidence, Support, Legitimacy, Motivation and Self-belief increased over time, suggesting improved attitudes. The only significant change was in total score (t= -3.741, p<0.5). Impact decreased very slightly over time. Baseline and post-intervention ‘diary snapshot’ results for phase 1 Using the differences in proportions test, the proportion of both family activity in their own right and focal clients being accompanied by a family member significantly increased (p<0.01). The proportion of individual focal client work decreased post-intervention. Further attitude measurement Based on the feedback from the AAFPQ results, we decided to develop a more sensitive family-specific measure, aiming to tap into attitudes specific to working with family members, in addition to using the previously adapted AAFPQ. The ‘Attitudes to Involving Family Members in Treatment Questionnaire’ (AIFMTQ) was piloted and developed. 141 staff working in addiction services (statutory and non-statutory) completed the pilot measure. Statistical analyses of the original 32 items using principal components analysis (PCA) resulted in the identification of a reduced 22-item measure with four factors (sub-scales) described as General Orientation (α=.93), Confidence in Managing Interpersonal Issues (α=.66), Concern About Involving Family Members (α=.69), and Perceived Compatibility (α=.69). Cronbach’s alpha coefficient for the measure was 0.89indicating high reliability. The criterion group method was also used to establish construct validity. Phase I: Pilot teams post-intervention activity Phase I: Pilot teams baseline activity * Total scores for AAFPQ measure – Pilot Teams Discussion Initial outcomes for the pilot teams are promising. So far, an overall increase in positive attitude towards involving family members in treatment sessions has been shown post-intervention, as well as an increase in the proportion of family-focused activity within the teams. This project in the long run will allow comparisons between all teams at different time periods in order to evaluate the impact of the training on family-focused service. This project continues to promote further implementation of family-focused practice within routine addiction services. Figure 1: Timeline showing phases of quasi-experimental method Key: TW=Initial training event; MM=Monthly Supervision Meeting; DS= Diary snapshot; BM=Baseline attitude measure (pre-training); FUAM= post-intervention attitude measure; FUW=Follow-up workshop References 1. Copello A, Templeton L, Krishnan M, Orford J, Velleman R. (2000a). A treatment package to improve primary care services for the relatives of people with alcohol and drug problems. Addiction Research, 8, 471 – 84. 2. Copello, A. & Orford, J. (2002) Addiction and the family: is it time for services to take notice of the evidence? Addiction, 97, 361–1363. 3. Copello, A., Orford, J., Velleman, R., Templeton, L., & Krishnan, M. (2000b). Methods for reducing alcohol and drug related family harm in non-specialist settings. Journal of Mental Health, 9, 319-333. 4. Copello, A., Velleman, R., Templeton, L., (2005) Family interventions in the treatment of alcohol and drug problems. Drug and Alcohol Review 24, (4), 369-85. 5. Orford J., Natera, G., Copello, A., Atkinson, C., Mora, J., Velleman, R., el al. (2005a). Coping with alcohol and drug problems: The experiences of family members in three contrasting cultures. London: Brunner-Routledge. **The Alcohol and Alcohol Problems Perception Questionnaire (AAPPQ) was originally developed by Cartwright (1980) to measure the overall therapeutic commitment to professionals working with people with alcohol problems. The AAFPQ has since been adapted (see Templeton et al., 2004). Acknowledgment: Study funded by Aquarius, University of Birmingham and BSMHT (NHS) 6. Orford, J., Natera, G., Davies, J., Nava, A., Mora, J., Rigby, K., et al. (1998). Social Support in coping with alcohol and drug problems at home: Findings from Mexican and English families. Addiction Research, 6, 395-420. 7. Orford, J., Templeton, L., Velleman, R. & Copello, A. (2005b). Family members of relatives with alcohol, drug and gambling problems: a set of standardised questionnaires for assessing stress, coping and strain. Addiction, 100, 1611-1624. 8. Roberts, M., Klein., A. & Trace, M. (2004). Towards a Review of Global Policies on Illegal Drugs. Drugscope – Report 1, 1 – 8. 9. UKATT Research Team (2005). Effectiveness of treatment for alcohol problems: findings of the randomised UK Alcohol Treatment Trial. British Medical Journal; 331, 541–544. 10. Velleman, R., Templeton, L., Group, U. K. A. D. a. t. F. R., (2003). Alcohol, Drugs and the Family: Results from a long-running research programme within the U.K. European Addiction Research, 9 (3), 103-112.