A&E St. Mary’s 'Scientia Vincit Timorem' Alcohol Screening and Brief Intervention Research Programme national brief intervention research consortium Paolo Deluca, PhD Institute of Psychiatry King’s College London

Programme design 3 cluster randomised clinical trials (PHC, AED, CJS) to assess – What are the barriers/facilitators to implementation in a “typical setting” – Identify most effective screening approach/tool – Most effective and cost effective intervention approach Common measures and design to allow comparisons

PHC study 24 PHC practices, 3 regions (NE, London, SE) 4 screening approaches (universal vs targeted, M-SASQ vs FAST) Targeted: New registrations, Injuries, Hypertension, Gastrointestinal problems, Mental health problems 3 intervention approaches – Patient information leaflet (DH - How much is too much?) – Brief advice (5 min) – Brief Lifestyle Counselling (20 min) 744 patients (31 each) Incentives (research, clinical) Baseline research interview 6 & 12 month follow-up research interview Attitudes, barriers and facilitators

PHC Research progress update Recruited 24 (+8) practices Trained 189 staff (nurses and GPs) Recruiting participants since May (66.8%) 6 GPs completed recruitment, 9 about to end 7 under performing and 2 dropped out 2 agreed to carry on ApproachedEligibleScreenedPositiveConsented PHC %

Training PHC staff On site training to small groups delivered by RA & AHW 1 to 2 hrs for screening and BA including role play 1 to 2 sessions for BLC training with actors in PHC Overall positive feedback on training Research elements and Alcohol Units are usually the challenging parts of the training Most welcomed receiving training and being assessed 1 session with actor was enough for all but one practice But adequate space, staff availability, time and implementation issues slowed the training stage

PHC Implementation issues Protocol: Leaflet-eligibility-screening-informed consent-baseline-intervention Ideally delivered by same person (except BLC) In practice we implemented various models to fit local needs and resources (10 min slots) Strong local lead (champion) N of staff involved (all vs just a few) Low recruitment/positives in same areas (eg Enfield) After good start, patients re-attending slowed recruitment

AED study 9 AEDs, 3 regions (NE, London, SE) 3 screening approaches (M-SASQ, 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

A&E Research progress update Recruited 9 (+2) A&Es Trained 250 staff (nurses and consultants) Recruiting participants since April (60.8%) 1 A&E completed recruitment, 3 about to end All underperforming ApproachedEligibleScreenedPositiveConsented 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

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 Staff turnover (eg August) Easily forget training if start is delayed Tendency of targeting dependent drinkers Weekly support

CJS study 96 offender managers, 18 offices 3 regions (NE, London, SE) 2 screening tools (FAST, M-SASQ) 3 interventions – Leaflet – Brief advice (5 min) – Brief Lifestyle Counselling by Alcohol Health Worker 480 participants (5 each) Follow-up 6 & 12 months Attitudes, barriers and facilitators

CJS Research progress update Recruited 96 (+11) Offender Managers from 18 probation offices Trained 131 OMs (some disappeared after training) Recruiting participants since June (31.5%) 17 OMs completed recruitment, 10 about to end, remainder underperforming-struggle to start, 24 dropped out/left ApproachedEligibleScreenedPositiveConsented CJS %

Training CJS staff On site 1 to 1 training 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 (informed consent) and ulcohol units are usually the challenging parts of the training Not very enthusiastic, most drawn into it from line manager. Adequate space, staff availability (1to1), turnover, slowed training Booster sessions, shadowing staff first few weeks

CJS Implementation issues Protocol: Leaflet-eligibility-screening-informed consent-baseline-intervention Delivered by same person (except BLC) No strong local lead (champion) Consent and contact details put some participants off Workload North/South divide Staff not engaging with SIPS team Easily forget training if start is delayed Weekly support, further incentives?

Training tools and methods List of tools – M-SASQ – FAST – SIPS-PAT – AUDIT – Screening training – PIL – Brief Advice (BA) – BA Training – Brief Life Style Counselling (BLC) – BLC training – BLC Demo video – Actors’ scripts – Staff pre-training questionnaire – Staff post-training questionnaire – BECCI + Manual – Training manual 15

Website & Alcohol Learning Centre 16

Training and intervention tools 17

Recruitment by month 18

Changes to improve recruitment Deployment of our AHWs in A&Es Additional GP surgeries to complement the underperforming ones Additional offender managers to complement the underperforming ones Extra support to offender managers Allow over-recruitment in CJS and PHC 19

Conclusions Prevalence of AUDs reflect previous studies in these settings Patients/clients are more willing to receive an intervention than previous studies Overall staff in these settings are keen to be trained However, limited time, workload and turnover are limiting implementation