A&E St. Mary’s 'Scientia Vincit Timorem' Implementation of screening and brief intervention in accident and emergency departments: challenges and solutions Paolo Deluca, PhD Institute of Psychiatry, King’s College London

AED study design 9 AEDs, 3 regions (NE, London, SE) 3 screening approaches (M-SASQ, SIPS-PAT, FAST) 3 intervention approaches – Patient information leaflet – Brief advice (5 min) – Referral to Alcohol Health Worker BLC (20 min) 1,179 patients (131 each) Baseline research interview 6 & 12 month follow-up research interview Attitudes, barriers and facilitators factors

The Shortened Alcohol and Alcohol Problems Questionnaire (SAAPPQ) Training and experience in dealing with AUDs Multiple choice assessment Feedback questions Implementation questionnaire T1 vs T2 vs T3

How do we assess implementation? Number screened, positives, received intervention Factors supporting implementation Factors impeding implementation Impact: individual, service, costs and benefits Acceptability: patient, practitioner, commissioner Sustainability

Overview recruitment Recruited 9 A&Es – Royal Ham., St Thomas, King’s, North Mid, Central Mid, Newcastle Gen, Darlington Mem., Hexham, South Tyneside. Trained 250 (range 5-84) staff (nurses and consultants) Recruiting participants from April 08 to April (102%)

Participants Recruitment ApproachedEligibleScreenedPositiveRecruited All A&EsN % ApproachedEligibleScreenedPositiveRecruited All PHCsN % ApproachedEligibleScreenedPositiveRecruited All CJSsN %

A&EApproachedEligibleScreenedPositiveRecruited St Thomas’N % King’sN % C. MiddxN % N. MiddxN % Royal HamN % Participants Recruitment

A&EApproachedEligibleScreenedPositiveRecruited DarlingtonN % S. TynesideN % NewcastleN % HexhamN % Participants Recruitment

Recruitment by month

Recruitment by month for each A&E

Training A&E staff On site training to small and large groups delivered by RA & AHW 1 to 2 hrs for screening and BA including role play No BLC training Overall positive feedback on training. Research elements and Units are usually the challenging parts of the training Most welcomed receiving training Adequate space, staff availability, “on call”, turnover, time and implementation issues slowed training Booster sessions, launch events, shadowing staff first few weeks

SAAPPQ Staff’s attitude and motivation SAAPPQ assesses differences in five areas: – Role adequacy – Role legitimacy – Motivation – Task-specific self-esteem – Work satisfaction

SAAPPQ between groups (preliminary findings) – Overall A&E staff score significantly better than PHC and CJS staff respectively (p =.000) – Role security Staff in A&Es score significantly better that PHC and CJS respectively – Therapeutic commitment Staff in A&Es score significantly better that PHC and CJS respectively

SAAPPQ within group (T1 vs T2) (preliminary findings) – Overall A&E staff score significantly better than before the training (p =.000). In particular: – Role security Staff in A&Es score significantly better after training (p =.02) – Therapeutic commitment Staff in A&Es score significantly better after training (p =.000)

A&E Implementation issues Protocol: Leaflet-eligibility-screening-informed consent-baseline-intervention Ideally delivered by same person (except BLC) in practice divided by triage/nurses and doctors Strong local lead (champion) Consent and contact details put some participants off Workload/time Staff turnover (eg August) Easily forget training if start is delayed Tendency of targeting dependent drinkers Weekly support

Implementation issues for screening and BI Workload/time Language/communication barriers Too intoxicated patients Patients not wanting to engage Time/staffing/resources Unwillingness of patients to engage Space/privacy to deliver intervention No dedicated alcohol health worker/internal A&E service to refer to. Dealing with presenting problem

Changes to improve recruitment Extra support to staff Incentives (MHRN) Deployment of Alcohol Health Workers to conduct also screening, BA and research assistants to support baseline activities 19

Conclusions Prevalence of AUDs reflect previous studies in these settings Patients are more willing to receive an intervention than previous studies Overall staff in these settings are keen to be trained, have positive attitude and motivation However, limited time, workload, lack of privacy and turnover are limiting implementation Need for support or dedicated AHWs