Last Orders Brief Advice Training

By the end of session you will: Be confident in using Brief Advice as a tool to address risky behaviour in young people Understand the principles of Brief Advice and how it is a transferable skill

What is a unit? Alcoholic content of drinks is measured in ‘units’. Group Work Exercise 1: Match the drinks to the number of units it contains.

Match the drinks answers: Drink 1 Large glass of Wine (250ml at 12%) Drink 2 Double Whiskey (50ml at 40%) Drink 3 Bottle of Lager (330ml at 5%) Drink 4 2 Pints of Bitter (568ml x2 at 4%) Drink 5 Can Super Strength Lager (440ml at 9%) Drink 6 2 Bottles of Alco pops (275ml x2 at 5%)

So what is a unit of Alcohol? One unit = 8g or 10ml of pure alcohol No of units is calculated by volume (ml) x % ABV * 1000 * ABV – Alcohol by Volume For example: Bottle of Wine 750ml x 12% ABV / 1000 = 9 units Department of Health recommends for adults:  3-4 units a day  2-3 units a day FOR YOUNG PEOPLE THERE IS NO ‘SAFE’ LEVELS

So what about ‘Binge Drinking’? ‘Binge drinking’ is considered drinking double the recommended limits Binge drinking in the media = young people either underage or in town centres Reality of binge drinking = people of all ages do it Regular ‘binge drinking’ puts you at higher risk levels So for a male that’s 8 units or more (e.g. 3 pints of 5% lager) And for a female it’s 6 units or more (e.g. 2 large glasses of 12% wine)

Effects of Alcohol The effects of alcohol misuse can be wide reaching: Group Work Exercise 2: We all know that alcohol is linked to health concerns – both short and long term illnesses - but how does it effect: 1.The individual young person who is drinking 2.The family and wider society

So what is Brief Advice? Opportunistic simple structured advice Raises awareness around risky behaviour patterns and the associated effects Delivered in 5-10 minutes by non specialist professionals Alcohol as an example: Understanding Units Understanding risk levels Benefits of cutting down Tips on cutting down MOTIVATING BEHAVIOUR CHANGE

Principles of Brief Advice Empathic Avoid labelling Understanding there are pre-conceptions: both school staff and young person receiving the Brief Advice Supportive Non threatening / non confrontational Body language and speech tone Emphasise the young person’s personal responsibility for their decisions about their risky behaviour Confidential and link to school procedure

Stages of Brief Advice It could be raised: – As routine with all young people you see – As part of planned tutorial – By the young person – As the response to the reason for seeing the young person You should seek permission from the young person to discuss their risky behaviour further (using alcohol as an example) Raise the issue

Give personalised feedback Stages of Brief Advice Give factual information on the potential effects of their risky behaviour may have on their health and wellbeing – This may include providing harm reduction messages Ask how the young person feels about this Ask if they would like to discuss it further

Raise the issue Screen and give personalised feedback Listen for readiness to change Stages of Brief Advice Listen!!!! Use open questions, reflect and summarise the discussion From the young person’s response to the information choose a suitable approach depending on where they are in the cycle of change

Cycle of Change Precontemplation Contemplation Preparation Action Maintenance Relapse Long term change (Prochaska and DiClemente, 1983)

Raise the issue Screen and give personalised feedback Listen for readiness to change Choose a suitable approach: Info and Advice Enhance Motivation Build Confidence Menu of Options Coping Strategies Choose a suitable approach: Info and Advice Enhance Motivation Build Confidence Menu of Options Coping Strategies Stages of Brief Advice If the young person is at pre- contemplation stage, start with ‘info and advice’. If the young person is already on the cycle of change, choose one or more of the other approaches (using alcohol as an example).

INFORMATION & ADVICE on the effects of alcohol on health and wellbeing and the benefits of cutting down ENHANCE MOTIVATION build the individual’s motivation to change by helping them to weigh up the pros and cons of their drinking MENU OF CHOICES for changing drinking behaviour. Ask the individual if they can suggest ways to change their drinking pattern (e.g. lower strength drinks, having drink free days, taking up other activities). Be ready to offer ideas if the individual agrees BUILD CONFIDENCE using an interviewing style that enhances the individual’s belief in their ability to change (their self efficacy). For example, identifying their previous successes, role models they can learn from and other people who can support them COPING STRATEGIES help the individual to identify times when they might find it more difficult to stick to their plans to cut down and to come up with strategies for coping with these situations Choose a suitable approach Precontemplation Contemplation Preparation Action Maintenance

Raise the issue Screen and give personalised feedback Listen for readiness to change Exit Strategy Close conversation & give info leaflet Signpost and onward referral when appropriate Exit Strategy Close conversation & give info leaflet Signpost and onward referral when appropriate Choose a suitable approach: Info and Advice Enhance Motivation Build Confidence Menu of Options Coping Strategies Choose a suitable approach: Info and Advice Enhance Motivation Build Confidence Menu of Options Coping Strategies Stages of Brief Advice

Time to have a go!!!!! In 2’s or 3’s take it in turns to deliver the brief advice One of you be the practitioner One of you be the individual receiving it One of you observe and provide feedback Swap round so everyone has had a go at delivering brief advice

What other risky behaviour could it be used for? Transferable skills

Referral Process to Support Services (internal & external) Specific to each school

Sarah McHardy Alcohol Coordinator for Oxfordshire Bill Russell Schools Drug Consultant Health Oxfordshire Schools Team