Handover | Issue 33 – December 2015

In the latter half of 2014 Matua Raki was invited by two of the largest Wellington public health organisations (PHOs) to provide ABC for alcohol screening and brief intervention workshops for their staff and practices. Te Awakairangi Health Network, the biggest PHO serving the Hutt Valley and Compass Health covering Wairarapa, Hutt Valley, Kapiti and Wellington, are implementing the ABC alcohol screening and brief intervention model.

Attendees at the workshops ranged from practice nurses and general practitioners through to the Well Health teams who operate outreach, health promotion workers (including dietitians and diabetes nurses) and primary mental health teams who work with clients/patients across a range of issues and interventions.

Matua Raki believes that ‘addiction is everybody’s business’ and as such has been delivering screening and brief intervention training to a variety of audiences for a number of years. Matua Raki was particularly happy to be asked to support the primary care workforce as we know many people with problematic substance use will never access specialist services, and that primary health and community care settings are the perfect places to:

  • initiate conversations about substance use
  • engage people
  • screen for substance use
  • provide brief advice and interventions as appropriate
  • provide ongoing referral.

The ABC model of screening and brief intervention (similar to the ABC approach to smoking cessation) stands for Ask, Brief Advice and Counselling. It is promoted by the Health Promotion Agency (HPA) and the Ministry of Health as an appropriate model of alcohol screening and brief intervention to use in a range of primary health care settings.

Workshop participants were able to explore attitudes, values and assumptions about people who use substances; understand some basic alcohol (and other drug) effects, both in the short- and long-term and across the lifespan; and appreciate the concept of a ‘standard drink’ and the HPA low risk alcohol drinking advice. They learned about practice and implementation of the ABC approach and pathway alongside their colleagues and the AUDIT C that is integrated into their patient management systems/dashboards.

As part of the ABC approach, workers in primary care settings who complete ABC training are expected to be able to use the AUDIT C, offer brief advice, assess readiness to change and, where appropriate, refer to brief counselling (usually within the PHO or with local specialist addiction services).

The invaluable role brief interventions play with many people who use substances harmfully, but may never seek treatment through an addiction service, was highlighted. Participants were encouraged to practice some basic strategies and approaches to brief intervention including understanding ‘motivational approaches’ the ‘Wheel of Change’ and ‘FRAMES’ – a brief intervention acronym that encourages the provision of non-judgemental ‘Feedback’, client self ‘Responsibility’, ‘Advice’ that is realistic and pertinent, a ‘Menu’ of options suggested, and an ‘Empathic’ style in which ‘Self efficacy’ is encouraged.

Anna Nelson and Klare Braye have provided various training to these PHOs, each adapted for the target audience and requirements of the practitioners attending. The participants have been open and enthusiastic about realistic, manageable and ‘brief’ approaches to facilitating discussions about client/patient substance use. This has made the training fun and engaging.

Matua Raki is open to discussions with all PHOs about training and support regarding substance use interventions. Please contact Anna Nelson, programme lead, Matua Raḵi.