Osservatorio Nazionale Alcol - World Health Organization Collaborating Centre for RESEARCH and HEALTH PROMOTION on ALCOHOL and ALCOHOL- RELATED HEALTH PROBLEMS 1 The experience and activities related to Early Identification and Brief Intervention on alcohol in Italy. Gandin C, Scafato E, Ghirini S, Galluzzo L and the IPIB working group Claudia Gandin, MD Researcher Istituto Superiore di Sanità-ISS, Rome (Italy) National Center on Epidemiology, Surveillance and Health Promotion - CNESPS Inebria 2009, Newcastle (UK), 8/10 October 2009

Osservatorio Nazionale Alcol - World Health Organization Collaborating Centre for RESEARCH and HEALTH PROMOTION on ALCOHOL and ALCOHOL- RELATED HEALTH PROBLEMS 2

Osservatorio Nazionale Alcol - World Health Organization Collaborating Centre for RESEARCH and HEALTH PROMOTION on ALCOHOL and ALCOHOL- RELATED HEALTH PROBLEMS 3 SUMMARY A.The ongoing strategies on alcohol in Italy aimed at developing and enduring implementation of alcohol EPIB in PHC settings. 1.The Frame Law on Alcohol (125/2001) 2.The National Health Plan (PSN) 3.The National Alcohol and Health Plan (PNAS) 4.The National Committee on Alcohol B.The experience and activities related to IPIB, the Italian EIBI programme at the National Institute of Health – ISS, Rome, Italy.

Osservatorio Nazionale Alcol - World Health Organization Collaborating Centre for RESEARCH and HEALTH PROMOTION on ALCOHOL and ALCOHOL- RELATED HEALTH PROBLEMS 4 1. The Frame Law on Alcohol (125/2001) All over Europe, the 125/2001 Italian law is the only one example of a full endorsement of the WHO European Alcohol Action Plan and of the European Charter on Alcohol principles reported as the aims of the law at the art 2. This is to show how a WHO principle introduced by mean the Charter on Alcohol has been transformed into a RIGHT for the Italian population……………….in principle but not really enforced

Osservatorio Nazionale Alcol - World Health Organization Collaborating Centre for RESEARCH and HEALTH PROMOTION on ALCOHOL and ALCOHOL- RELATED HEALTH PROBLEMS 5 Art. 2 - Aims ensures all people’s rights, especially children and adolescents, to a family, community and working life protected from the consequences of alcoholic beverages abuse; fosters access to health and social treatment services for heavy drinkers and their families; promotes information and education on the negative consequences of alcohol consumption and abuse; promotes research and ensures adequate standards of training and updating for professionals dealing with alcohol related problems; supports non profit non-governmental and voluntary organisations which aim is to prevent or reduce alcohol-related problems. 1. The Frame Law on Alcohol (125/2001)

Osservatorio Nazionale Alcol - World Health Organization Collaborating Centre for RESEARCH and HEALTH PROMOTION on ALCOHOL and ALCOHOL- RELATED HEALTH PROBLEMS 6 2. The National Health Plan The last NHP renewed the need to implement actions and strategies that can help in: Promoting healthier lifestyles and habits (life skills); Tackling misleading risk-taking cultures; Improving settings (family, schools, communities); Strengthening health protection of the vulnerable groups; Decreasing “gradients” within and between groups (inequalities in health) and reduce harm; Ensuring a wider range of initiatives devoted at the early detection of alcohol abuse. Source: Ministry of Health, “ National Health Plan ” available online at: A National Prevention Plan is agreed by the STATE-REGIONS Conference mostly leaving to the regional autonomies the setting and the implementation of strategies and programs that are ONLY oriented by the National Health Plan.

Osservatorio Nazionale Alcol - World Health Organization Collaborating Centre for RESEARCH and HEALTH PROMOTION on ALCOHOL and ALCOHOL- RELATED HEALTH PROBLEMS 7 The need for the specific training standard and consequent activities outlined by the PHEPA/EIBI Country strategy found a relevant inclusion among the activities of the National Alcohol and Health Plan (Piano Nazionale Alcol e Salute – PNAS) 3. National Alcohol and Health Plan (PNAS) endorsed in April 2007 by the State-Regions Conference Source: Ministry of Health, “ National Alcohol and Health Plan ” at:

Osservatorio Nazionale Alcol - World Health Organization Collaborating Centre for RESEARCH and HEALTH PROMOTION on ALCOHOL and ALCOHOL- RELATED HEALTH PROBLEMS 8 3. National Alcohol and Health Plan Strategic areas of intervention 1. 1.Information and education 2. 2.Drinking and driving 3. 3.Alcohol and work 4. 4.Treatment of harmful/hazardous alcohol consumption and alcohol dependence 5. 5.Production and distribution’s responsibility 6. 6.Social network to face risk factors alcohol related 7. 7.Strengthening NGOs, voluntary organizations, self-help and mutual aid groups 8. 8.Monitoring harm done by alcohol and strengthening alcohol policy

Osservatorio Nazionale Alcol - World Health Organization Collaborating Centre for RESEARCH and HEALTH PROMOTION on ALCOHOL and ALCOHOL- RELATED HEALTH PROBLEMS 9 Actions: To engage in and train on EIBI of alcohol-related risk people all the PHC professionals (particularly GPs, pediatricians, prevention department’s physicians). To strength an integrated approach including health services, GPs, voluntary organizations, self-help and mutual aid groups, educational institutions, work, justice and other institutions. To disseminate standardized tools and methodologies for EIBI to be used for harmful and hazardous alcohol consumption and alcohol dependence evidence- and also need’s evaluations- based.

Osservatorio Nazionale Alcol - World Health Organization Collaborating Centre for RESEARCH and HEALTH PROMOTION on ALCOHOL and ALCOHOL- RELATED HEALTH PROBLEMS 10 In line with the European Charter on Alcohol (December 2005) principles the law 125/2001 set up a National Committee on Alcohol including as designated members representatives from several ministries as well as experts from scientific societies, alcohol industry, advocacy groups and from the Istituto Superiore di Sanità.

Osservatorio Nazionale Alcol - World Health Organization Collaborating Centre for RESEARCH and HEALTH PROMOTION on ALCOHOL and ALCOHOL- RELATED HEALTH PROBLEMS National Committee on Alcohol Working group on: “Training and updating for professionals dealing with alcohol related problems” “At the National and Regional level it’s recommendable the implementation of specific training of GPs and health professionals aimed at the prevention of alcohol-related problems. A standard for training and continuous professional education has been already provided by the European Project PHEPA - Primary Health care European Project on Alcohol and the Istituto Superiore di Sanità is prepared and candidated to promote together with the Regions the specific activities in tight coordination with the professional and scientific societies (SIMG, SIA).” 9E22395E862F/0/Formazionedelpersonale.doc

Osservatorio Nazionale Alcol - World Health Organization Collaborating Centre for RESEARCH and HEALTH PROMOTION on ALCOHOL and ALCOHOL- RELATED HEALTH PROBLEMS 12 Gaining Health Strategic area 5 “Strengthening primary and secondary prevention on alcohol consumption in primary health care” Strategic area 8 “Training the health care provider on alcohol consumption and alcohol related problems”.

Osservatorio Nazionale Alcol - World Health Organization Collaborating Centre for RESEARCH and HEALTH PROMOTION on ALCOHOL and ALCOHOL- RELATED HEALTH PROBLEMS 13 SUMMARY A.The ongoing strategies on alcohol in Italy aimed at developing and enduring implementation of alcohol EIBI in PHC settings. 1.The Frame Law on Alcohol (125/2001) 2.The National Health Plan (PSN) 3.The National Alcohol and Health Plan (PNAS) 4.The National Committee on Alcohol B.The experience and activities related to IPIB, the Italian EIBI programme at the National Institute of Health – ISS, Rome, Italy.

Osservatorio Nazionale Alcol - World Health Organization Collaborating Centre for RESEARCH and HEALTH PROMOTION on ALCOHOL and ALCOHOL- RELATED HEALTH PROBLEMS 14 IPIB working group E.Scafato (Coordinator), V.Patussi, T.Codenotti, C.Gandin, L.Mezzani, I.Londi, S.Ghirini, L.Galluzzo, M.Di Rosa, S.Bruni, E.Vanni, S.Martire, L.Di Pasquale, A.Scafato, N.Parisi, R.Scipione, R.Russo, R.Travaglini, T.Fanucchi ISS, National Centre on Epidemiology, Surveillance and Health Promotion (CNESPS) National Observatory on Alcohol Centro Alcologico Regionale (CAR) Tuscany Region Working Group CSDA Centro Servizi Documentazione Alcol EUROCARE Italy WHO CC for Research and Health Promotion on Alcohol and alcohol- related problems IPIB working group (Identificazione Precoce Intervento Breve)

Osservatorio Nazionale Alcol - World Health Organization Collaborating Centre for RESEARCH and HEALTH PROMOTION on ALCOHOL and ALCOHOL- RELATED HEALTH PROBLEMS 15 The ISS has been indicated by the National Committee on Alcohol as the national provider of the training activities in tight connection with the SIA (Italian Society of Alcohology) and the Regions. It is a concrete example of implementation of EU PHEPA project and integration into the National Alcohol policy. Until now training in IPIB on alcohol is not yet compulsory for the professionals of the National Health System, but an example of implementation at the Regional level has been the central funding to the Tuscany Region of a specific training programme for all the Regions devoted to IPIB in the workplaces funded by the Centre for Controls of Diseases (CCM). Training on IPIB in PHC in Italy

Osservatorio Nazionale Alcol - World Health Organization Collaborating Centre for RESEARCH and HEALTH PROMOTION on ALCOHOL and ALCOHOL- RELATED HEALTH PROBLEMS 16 IPIB-PHEPA activities The IPIB working team started its activities in April 2006 to deliver a communication strategy and to organise conferences to announce, promote and disseminate the EIBI- PHEPA programme. English version Italian version

Osservatorio Nazionale Alcol - World Health Organization Collaborating Centre for RESEARCH and HEALTH PROMOTION on ALCOHOL and ALCOHOL- RELATED HEALTH PROBLEMS 17 The editorial team of the Italian PHEPA training manual Il testo del volume, la traduzione e l’adattamento dei materiali sono stati curati dall’Istituto Superiore di Sanità che ha elaborato il progetto editoriale finale del prodotto finale e coordinato il Gruppo di Lavoro IPIB che comprende: - Osservatorio Nazionale Alcol - Centro Collaboratore dell’Organizzazione Mondiale della Sanità per la Ricerca e la Promozione della Salute su Alcol e Problemi Alcolcorrelati, Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute dell’Istituto Superiore di Sanità (coordinamento) - Società Italiana di Alcologia - Centro Alcologico Regionale della Toscana - Regione Toscana - Eurocare Italia - Gruppo di Lavoro CSDA Centro Servizi Documentazione Alcol dell’Osservatorio Nazionale Alcol: Emanuele Scafato (Coordinatore), Valentino Patussi, Laura Mezzani, Ilaria Londi, Claudia Gandin, Lucia Galluzzo, Sonia Martire, Egidio Chessa, Riccardo Scipione, Nicola Parisi, Silvia Ghirini, Monica Di Rosa, Tiziana Codenotti, Silvia Bruni, Antonietta Scafato, Elena Vanni, Lucilla Di Pasquale. Si ringrazia la Dottoressa Rosaria Russo per il supporto tecnico, la revisione dei testi, la verifica dei formati di stampa ed i contatti interistituzionali nazionali ed europei. La stampa del volume, la predisposizione del corso di formazione e la sua attuazione sono resi possibili grazie al finanziamento del Ministero della Salute nell’ambito delle iniziative di comunicazione ai sensi della Legge 125/2001.

Osservatorio Nazionale Alcol - World Health Organization Collaborating Centre for RESEARCH and HEALTH PROMOTION on ALCOHOL and ALCOHOL- RELATED HEALTH PROBLEMS 18 IPIB is actually the formal institutional standard of training in Italy allowing to participants to be trained themselves and to train other professionals. The training course has been opened to GPs and to physicians involved in the PHC. In order to reach subgroups of population at risk but otherwise not reachable by GPs, as a novelty for the Italian landscape we open the course also to professionals (physicians and psychologists) from:  Services for the treatment of dependences (SERT),  Consultories,  Workplace prevention setting. The definition of professionals working in the wide area of the Primary Health Care settings to be involved in the train course is still open. IPIB training courses at the ISS

Osservatorio Nazionale Alcol - World Health Organization Collaborating Centre for RESEARCH and HEALTH PROMOTION on ALCOHOL and ALCOHOL- RELATED HEALTH PROBLEMS 19 The implementation of IPIB training courses at the ISS The implementation started on 2007 with the first formal training course, for the duration of two days, and other courses have been carried out at the ISS and at territorial level. The calls for selection of candidate (24 participants for each) are available at the web page of the Istituto Superiore di Sanità. The training course received funding from the Ministry of Health (until September 2009) and it received a good evaluation in terms of credits to be earned through the Continuous National Training Programme (ECM), compulsory for the professionals of the National Health System.

Osservatorio Nazionale Alcol - World Health Organization Collaborating Centre for RESEARCH and HEALTH PROMOTION on ALCOHOL and ALCOHOL- RELATED HEALTH PROBLEMS 20 Main characteristics of 98/168 participants to the IPIB-PHEPA training courses at the ISS Number: 98 Age - average(min-max): 47ys (24-60) Gender distribution (%): M=38% F=62% Professional categories (%): Physicians: 62% Psychologists: 38%

Osservatorio Nazionale Alcol - World Health Organization Collaborating Centre for RESEARCH and HEALTH PROMOTION on ALCOHOL and ALCOHOL- RELATED HEALTH PROBLEMS 21 Distribution (%) of participants by professional categories

Osservatorio Nazionale Alcol - World Health Organization Collaborating Centre for RESEARCH and HEALTH PROMOTION on ALCOHOL and ALCOHOL- RELATED HEALTH PROBLEMS 22 PHEPA evaluation form At the end of the course, participants fulfilled the original PHEPA evaluation form. The training course has received a good evaluation by the trainees.

Osservatorio Nazionale Alcol - World Health Organization Collaborating Centre for RESEARCH and HEALTH PROMOTION on ALCOHOL and ALCOHOL- RELATED HEALTH PROBLEMS 23 PHEPA Evaluation form -Early Identification

Osservatorio Nazionale Alcol - World Health Organization Collaborating Centre for RESEARCH and HEALTH PROMOTION on ALCOHOL and ALCOHOL- RELATED HEALTH PROBLEMS 24 PHEPA Evaluation form- Brief Intervention 1/3

Osservatorio Nazionale Alcol - World Health Organization Collaborating Centre for RESEARCH and HEALTH PROMOTION on ALCOHOL and ALCOHOL- RELATED HEALTH PROBLEMS 25 PHEPA Evaluation form- Brief Intervention 2/3

Osservatorio Nazionale Alcol - World Health Organization Collaborating Centre for RESEARCH and HEALTH PROMOTION on ALCOHOL and ALCOHOL- RELATED HEALTH PROBLEMS 26 PHEPA Evaluation form- Brief Intervention 3/3

Osservatorio Nazionale Alcol - World Health Organization Collaborating Centre for RESEARCH and HEALTH PROMOTION on ALCOHOL and ALCOHOL- RELATED HEALTH PROBLEMS 27 Could you apply what you have learnt in your daily job? n=96 At National level, the definition of professionals working in the wide area of the Primary Health Care settings to be involved in the train course is still open.

Osservatorio Nazionale Alcol - World Health Organization Collaborating Centre for RESEARCH and HEALTH PROMOTION on ALCOHOL and ALCOHOL- RELATED HEALTH PROBLEMS 28 Conclusion As a final consideration we may say that the work it’s a never ending process mainly oriented by a dynamic evolution of the demand coming by the different priorities in the huge area of Primary Health Care. Our experience was extremely important to tailor some customized training issues devoted to comply with the need to integrate into the daily work of very different type of health professionals mainly having in mind the priority targets identified by changing contexts for which a specific approach has to be developed.

Osservatorio Nazionale Alcol - World Health Organization Collaborating Centre for RESEARCH and HEALTH PROMOTION on ALCOHOL and ALCOHOL- RELATED HEALTH PROBLEMS 29 Conclusion The main barrier to the implementation of the IPIB is FUNDING Where the possibility to pay for the implementation of the IPIB in the daily activities of health professionals will become a reality, then we will receive a new impetus to give people more chances to be really protected by the alcohol impact on health and safety.

Osservatorio Nazionale Alcol - World Health Organization Collaborating Centre for RESEARCH and HEALTH PROMOTION on ALCOHOL and ALCOHOL- RELATED HEALTH PROBLEMS 30 Conclusion Another main barrier to the implementation of the IPIB is NETWORK For some professionals its culturally difficult to collaborate also in the light of some existing barriers related to the organization of the health body and/or to the procedures to be followed in their workplaces. The lack of a professional network in some geographical context do not help a lot to implement IPIB as a main tool of prevention.

Osservatorio Nazionale Alcol - World Health Organization Collaborating Centre for RESEARCH and HEALTH PROMOTION on ALCOHOL and ALCOHOL- RELATED HEALTH PROBLEMS 31 IPIB working group E.Scafato (Coordinator), V.Patussi, T.Codenotti, C.Gandin, L.Mezzani, I.Londi, S.Ghirini, L.Galluzzo, M.Di Rosa, S.Bruni, E.Vanni, S.Martire, L.Di Pasquale, A.Scafato, N.Parisi, R.Scipione, R.Russo, R.Travaglini, T.Fanucchi ISS, National Centre on Epidemiology, Surveillance and Health Promotion (CNESPS) National Observatory on Alcohol Centro Alcologico Regionale (CAR) Tuscany Region Working Group CSDA Centro Servizi Documentazione Alcol EUROCARE Italy WHO CC for Research and Health Promotion on Alcohol and alcohol- related problems Thanks for your attention

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