Transcript Detailed timetable for central input

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.
2.
3.
4.
Work in partnership
Develop activities to control alcohol misuse
Influence change through advocacy
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 lowerrisk 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