Having been invited to make a presentation to an expert meeting at the EMCDDA I’ve returned feeling that I’ve learnt as much as I’ve contributed.
As anyone who was following my Tweets from the event would have seen I was preceded by contributions from Spain, Poland, Germany and Jim McCambridge from the UK.
As might be expected a lot of the evidence that was presented focused on the experience of implementing brief interventions in medical settings – primary care and emergency departments – but we also covered trying to create an on-line intervention and in using mainstream educational settings – FE colleges and our experience of implementing through informal education and outreach youth work.
What I took from the day were some general rules of thumb:
- Training while crucial isn’t sufficient. Addressing barriers to implementation (role, competence incentives) and providing ongoing support (coaching, supervision, management data) is just as critical.
- Who does the intervention isn’t critical, if they buy into the process, but the intervention works best with those not self-identifying as needing help (those people have already made the mental leap).
- Working where people are makes sense (primary health care, educational settings, workplace), but can be challenging (time, uncovering need, reputation), and in some cases may overwhelm a BI (ED?).
- Measuring at scale is going to be more difficult than you think! Whole systems carry so much data already that it is difficult to add to that burden, but your existing data sets probably wont be adequate.
- Austerity may make change inevitable, and in some cases this will be positive (silos will bust open) but don’t expect that to be easy, or without costs.
Then there were other issues that are less clear, but are worth thinking about:
- To screen or not to screen? It was suggested that screening could be an unnecessary precondition to delivering BI, but this depended on the issues of substance misuse arising as part of wider discussion.
My own view – for what it is worth – is that for universal (or near universal) settings that a screening tool can be useful – our feedback from Street Talk has been that it opened up the possibility for a discussion on substance misuse as well as identifying those taking risks.
- Confounders – there’s evidence emerging that screening on its own has led to self-reported behaviour change – perhaps out of politeness or a desire by the responder not to give the ‘wrong’ answer.
- Does making the intervention compulsory make a difference to outcome? It may not but doing in that environment will take additional skills.
- When is MI not MI? Jim McCambridge was at pains to point out that Motivational Interviewing is a particular technique with a well-defined methodology. Often interventions which are styled MI don’t include all of those elements and in those cases it may be more accurate to describe them as Motivational Brief Interventions.
Personally I took a lot of comfort from much of this discussion as it mirrored learning points we had with Street Talk. But at the same time it was humbling to be given a platform alongside programmes and experts with such rigorous research methodologies or that have achieved almost system wide reach.
The EMCDDA will be writing a short report summing up what they took from the day and have said they will publish the presentations, and I hope point to some tools that practitioners can use with confidence.