A new briefing paper warns the current position on alcohol brief intervention could be at a 'turning point', and makes a number of recommendations to improve delivery.
Brief intervention - known as 'Identification and Brief Advice' (IBA) in England - has been a central component of national and local alcohol strategies across the UK in recent years. However despite its growing profile, IBA has proved difficult to implement effectively, with a number of key questions raised over whether 'success' will be achieved. Challenges include concerns over delivery in key Primary Care settings, whilst important questions around specific approaches and wider settings are yet to be fully answered.
The briefing was produced by the Alcohol Academy following a conference earlier in the year, and aims to capture and build on the lessons, views and ideas from the event.
Key messages include:
- Despite significant attention to the issue in recent years, the current national position of IBA delivery still requires significant investment to achieve ‘success’
- Some basic level issues still remain, including understanding of what brief intervention actually involves, and the role or not of specialist services
- Issues still exist over Primary Care as the key setting, particularly in identifying both the quantity and quality of IBA reportedly taking place, and the impact of the recent removal of the ‘DES’ incentive
- Indications that ‘minimal’ or ‘lite’ approaches to IBA delivery may be becoming the norm need careful consideration given the limited evidence for these
- Other key questions include which further settings IBA should be undertaken in, and the precise role of innovative and digital ‘IBA’ approaches
- The current IBA agenda may be considered at a ‘turning point’ – if further efforts to embed IBA are not continued, longer term implementation may ‘fail’
- Policy makers, commissioners, academics and potential deliverers of IBA all have crucial roles to play – and must do so in a coordinated way
Where next?
The briefing also summarises content from expert presentations and workshop on the day and highlights a number of 'key ideas' to advance implementation:
- Create a ‘national centre’ for IBA delivery
- No IBA without ‘quality assurance’
- MECC Matters
- Focus on the front line
- Avoid the ‘one in eight’
- Take IBA ‘direct’ to the public
The briefing suggest further central coordination and leadership is required to improve IBA delivery, as the smoking agenda appears to have benefited from the NCSCT. It also raises questions over how much of claimed IBA delivery actually meets the 'minimum standard' - as such calls for 'quality assurance' to be routine.
The 'Making Every Contact Count' (MECC) agenda is identified as offering opportunities and threats - alcohol behaviours are of course linked with others, but practitioners may feel less inclined to raise the subject compared to say smoking or diet.
'Focusing on the frontline' is called for since quality IBA ultimately comes down to the motivations and beliefs of the practitioners delivering it. For instance language that may be overly 'academic', such as 'Numbers Needed to Treat' (NNT) may be counter-productive or be cited in ways that underplay the potential for IBA to reduce drinking.
The briefing also urges further exploration of novel and innovative ways to reach the public, such as 'IBA direct' in public places and digital approaches, albeit with further research necessary.
IBA in England - matching up to Scotland & Wales?
Although focused on 'IBA' in England, the briefing identifies potential lessons from Scotland and Wales who have both invested in Alcohol Brief Intervention (ABI) implementation. In Scotland, a national target has reportedly delivered around half a million ABIs in conjunction with a national training programme. The Welsh ABI programme has also seen a popular 'Have a Word' identity.
Whilst Public Health England may highlight alcohol activity is ultimately up to local areas, a widespread intention to implement IBA still appears evident. The agenda has arguably benefited from online resources and training roll-out, and some areas are piloting 'Have a Word' or continuing to develop the 'MECC' agenda. As the briefing warns though, the agenda will need further support and development for IBA to be seen as a truly successful in the longer term.
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