ALCOHOL BRIEF INTERVENTIONS IN OTHER HEALTH CARE SETTINGS
There are other healthcare settings which can be appropriate for screening and delivery of Alcohol Brief Interventions (ABIs).
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NHS Dumfries and Galloway
For information about the overall approach to delivery of ABI in NHS Dumfries and Galloway email: lhyland@nhs.net
NHS workplace - staff base
Summary: Following an exercise where a manned information board was set up outside the Health Improvement Office which generated staff enquiries about alcohol consumption, it was decided to continue to disseminate information in an opportunistic fashion to inform, raise awareness and undertake screening and ABI delivery as appropriate.
General feedback has been positive with people reporting that they have become more aware regarding units in drinks, calories and safe drinking limits.
Delivery model: Opportunistic screening and delivery of ABIs.
Supporting factors: These sessions were delivered opportunistically. Use of a display stand and unit demos, in addition to the provision of free up to date information helped to get people involved, and ensuring forms were all anonymous was also important.
Challenges: Getting people to engage when they think they are already alcohol aware.
Contact details:
Tina Gibson
Public Health Practitioner
NHS Health Improvement, Dumfries and Galloway
Tina.gibson@nhs.net
NHS Forth Valley
For information about the overall approach to delivery of ABI in NHS Forth Valley email: theresa.martinus@nhs.net
Occupational health service
Summary: It is planned that as part of a programme to extend the range of settings of alcohol screening and ABI delivery on an opportunistic basis, occupational health nurses will address alcohol issues while in consultation with NHS staff who have been referred or have self referred. The intention is to raise awareness of alcohol when assessing the overall health and wellbeing of NHS staff, incorporating it into support plans.
Delivery model: One-to-one assessment appointments.
Supporting factors: Senior management support.
Challenges: None noted.
Contact details:
Theresa Martinus
FVADP Coordinator
theresa.martinus@nhs.net
Head and neck cancer service
Summary: Research evidence shows an increased link between alcohol consumption and oral cancer. This has led us to include alcohol consumption in an individual’s assessment, to raise awareness of the links, screen and deliver ABIs where appropriate.
Delivery model: Opportunistic screening as part of assessment.
Supporting factors: Initially supported by a clinical nurse specialist.
Challenges: Staffing continuity.
Contact details:
Theresa Martinus
FVADP Coordinator
theresa.martinus@nhs.net
NHS Greater Glasgow and Clyde
For information about the overall approach to delivery of ABI in NHS Greater Glasgow and Clyde, email: paul.rimmer@glasgow.gov.uk
South Glasgow CHP: Health Professionals
Summary: Dieticians working with patients with diabetes requested to be part of a network of trained staff that could deliver screening and brief interventions. Greater Glasgow and Clyde Alcohol Action Team also identified the following staff groups to be part of a trained network of CH(C)P staff which could identify and address the role of alcohol in health issues: Occupational Therapists; Physiotherapists; Podiatrists; District Nurses; Health Visitors; Cognitive Behavioural Therapists; Crisis Practitioners; Community Psychiatric Nurses, and Health Improvement professionals. This service development was undertaken as part of an action plan to deliver comprehensive strategic training across the board area to 40 per cent of our NHS workforce in a large range of staff groupings.
Delivery model: Opportunistic screening and delivery of ABI
Supporting factors: Good quality training was delivered at an appropriate level based on feedback from pre-course questionnaires. Sufficient resources were provided for delivery, along with ongoing trainer support to deliver ABIs. Clear contact details, instructions and pathways for possible referral were also provided.
Challenges: No ABI monitoring forms have been returned and there has been a lack of feedback from staff in addition to organisational challenges.
Contact details:
Lee Craig
Senior Health Improvement Practitioner
Health Improvement team, Glasgow CHP South Sector
Lee.Craig@ggc.scot.nhs.uk
North East Glasgow CHP staff
Summary: Greater Glasgow and Clyde Alcohol Action Team offered ABI training to all CH(C)P staff with client contact, whether working in social work or health, to address issues of alcohol misuse confidently, using ABIs opportunistically or as part of a planned baseline for services.
Delivery model: ABIs are delivered using several paths:
-opportunistic screening and delivery of ABI
-opportunistic screening, delivery of ABI and follow-up
-opportunistic screening and onward referral for delivery of ABI
-planned screening and delivery of ABI
-planned screening, delivery of ABI and follow-up
-planned screening and onward referral for delivery of ABI.
Supporting factors: NHS Greater Glasgow and Clyde chose to support HEAT 4 by making ABI training a priority for communities of staff, giving each sector a target of training 40 per cent of staff in ABI with training mandatory for staff with patient contact. Each sector employed a health improvement senior to lead on ABI work allowing the programme to be managed at a local level, promoting and delivering training.
Pens, leaflets and posters promoting ABI to patients are currently being produced and should also act as prompts for staff to encourage embedding of ABI delivery.
Challenges: Training uptake has been good, but reporting of delivery has been poor, despite staff telling us alcohol is a big issue in their practices and that they regularly talk to patients and service users about their alcohol use. We developed a reporting booklet which trainees were asked to complete and return after doing an ABI. Returns have been poor, despite continuing prompts. We surmise that ABIs are being delivered, but not being reported to us. Having a more robust, universal system of reporting would help.
Contact details:
Rowan Anderson
Health Improvement Senior
rowan.anderson@ggc.scot.nhs.uk
North West Glasgow CHP Staff
Summary: We wanted to strengthen and compliment the HEAT work, and provide an opportunity for all staff within the CH(C)P setting to discuss the use of alcohol with other workers, to embed discussions on alcohol into the daily practice of the workforce.
Delivery model:
Opportunistic screening and delivery of ABI
Opportunistic screening and onward referral for delivery of ABI
Planned screening and onward referral for delivery of ABI.
Supporting factors: Support from the senior management team and the team leaders was helpful, and certain work areas made the training mandatory. Development of our own ABI training packs and monitoring pads was useful, as were the resources from NHS Health Scotland.
Challenges: Getting onto the agenda was difficult in some areas as was finding time for staff to attend the training. The monitoring pad was deemed to be very time consuming, and feedback indicated that electronic collection would be preferred.
Contact details:
Ian Quigley
Health Improvement Senior
ian.quigley@ggc.scot.nhs.uk
East Renfrewshire CHCP: frontline staff
Summary: Guidance was established through Glasgow Addiction Services to improve early identification of problematic alcohol use, to increase general knowledge of alcohol and to consider attitudes to alcohol and drinking behaviour. Health Improvement Workers, Social Workers and Mental Health Practitioners were trained to screen and deliver ABIs. The work also sought to develop knowledge of alcohol units and to gain information about local supports and services.
Delivery model: Opportunistic screening and delivery of ABI.
Supporting factors: We have taken a multi agency approach and support the delivery of ABIs through the ‘Prevention and education framework’. There is a dedicated coordinator post and initially there was also admin support for the project. A planning group and an alcohol and drugs training calendar supported the wider message around alcohol.
Challenges: We have carried out an evaluation of the effectiveness of our implementation. Main challenges include the considerable development work required to gain support from the managers, and to embed into current practice, restrictions posed by the current IT systems and difficulties with monitoring.
Contact details:
Heather Molloy
Addiction Implementation Officer
heather.molloy@eastrenfrewshire.gov.uk
NHS Lothian
For information about the overall approach to delivery of ABI in NHS Lothian, email: jamie.megaw@nhslothian.scot.nhs.uk
Mental Health Services
Summary: Links between inappropriate behaviour and intoxication in acute mental health settings, led to training nursing staff in acute mental health settings to receive training to enable them to screen and deliver ABIs when appropriate.
The aim of this work is to embed the delivery of ABIs into the core practice of staff in mental health acute settings with further work undertaken to include staff in rehabilitation and elderly care settings to be developed.
Delivery model: Opportunistic screening and delivery of ABI.
Supporting factors: Support from Clinical Nurse Specialist in acute mental health.
Challenges: None yet identified as it is very early in the project.
Contact details:
Eleanor McWhirter
ABI Lead
NHS Lothian
Eleanor.McWhirter@nhslothian.scot.nhs.uk
NHS Shetland
For information about the overall approach to delivery of ABI in NHS Shetland email: karenk.smith2@nhs.net
Mental health
Summary: Shetland’s Substance misuse service delivers a home alcohol detox service which sits within the Mental Health Department (MHD), as does the Dual diagnosis service. The substance misuse nurses from the MHD undertake the screening and delivery of the ABIs.
Delivery model: Planned screening, delivery of ABIs and follow-up.
Supporting factors: The commitment of the staff is the main supporting factor.
Challenges: None noted.
Contact details:
Karen Smith
Alcohol and Drug Development Officer
karenk.smith2@nhs.net
Podiatry
Summary: Many of Shetland’s older residents attend podiatry and it was felt this is a group that may not attend other health related services. Therefore we could capture a different target group within this setting.
A research project is being conducted in Shetland in partnership with Stirling University, looking at older people and dementia. There is anecdotal evidence that alcohol related brain injury is a cause for some of the dementia cases in Shetland. This research will feed into a wider follow-up of our older population, in which data from podiatry will also be used.
This service started in April 2011 with four podiatrists screening and delivering ABIs, and is due to be evaluated at the end of the first year.
Delivery model: Opportunistic screening and delivery of ABIs.
Supporting factors: Podiatry is keen to take this forward. It will be interesting to follow their progress as they begin to deliver.
Challenges: Podiatrists were trained initially in 2010, but haven’t taken it forward until now as they didn’t feel confident in delivering ABIs. They have since had a refresher training session and also have new staff members who are much more confident in delivering.
Contact details:
Karen Smith
Alcohol and Drug Development Officer
karenk.smith2@nhs.net