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Alcohol Treatment Matrix

Effectiveness Bank Alcohol Treatment Matrix

Includes brief interventions

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Effectiveness Bank Drug Treatment Matrix

Includes harm reduction

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Organisational functioning; Screening and brief intervention

Seminal and key studies on how organisational functioning affects screening and brief intervention. Highlights a striking illustration of the importance of organisational context emerging from the unprecedented implementation drive at the US health care system for ex-military personnel. See the rest of row 1 of the matrix for more on screening and brief interventions.


S Seminal studiesK Key studiesR ReviewsG Guidancemore Search for more studies

Links to other documents. Hover over for notes. Click to highlight passage referred to. Unfold extra text Unfold supplementary text

S London emergency department pioneers systematic screening and brief advice (1996). Innovations which led to a 10-fold increase in the proportion of patients advised about their drinking included: developing a very quick screening test tailored to the setting; allowing doctors to restrict screening to categories of patients most likely to be drinking heavily; and employing a specialist to shoulder most of the intervention load. For discussion click and scroll down to highlighted heading.

K Standard screening and brief intervention inappropriate in range of working contexts in Scotland (2015). Move beyond the usual medical settings for screening and brief intervention and even after training, seven out of nine practitioners did not engage in these activities at all because they felt them inappropriate for their clients. Message is that implementation efforts must accept the possible downsides of discretionary, non-standardised approaches, including loss of impact. For discussion click and scroll down to highlighted heading.

K Abandon researched packages in favour of a ‘conversation’ about drinking, say midwives in Scotland (2019). Fitting screening and brief interventions into the working context of midwives meant abandoning the standard, scripted approaches tested in research in favour of a more individualised and nuanced conversation – and then not initially about current drinking, but the less threatening topic of pre-pregnancy consumption. For discussion click and scroll down to highlighted heading.

K Non-health contexts in England demand flexible ‘chats’ not scripted questions and advice (2016). Discussions with housing, probation and social work practitioners indicated that standard screening methods and structured brief advice are unlikely to be implemented in many non-health settings. For discussion click and scroll down to highlighted heading.

K Research report (2016) and article (2016) on the role of training in delivering screening and brief interventions in sectors such as social and community services and policing, based partly on feedback from trainees in four English regions. Implementation levels remained low after training, partly because screening was often felt inappropriate to the working context. Suggests “Training needs to be related more directly to organisational cultures, behaviour, and development needs.” For discussion click and scroll down to highlighted heading.

K ‘Advise this patient’ reminders little use without organisational backing (2010). Contrasting this study with another from the same US primary care system for ex-military personnel shows that screening/intervention rates can hinge on how the organisation handles implementation in general. For discussions click here and here and scroll down to highlighted headings.

K Implementation at US primary care clinics ranges from zero to near universal (2005). Implementation rates at clinics offered training and support depended on complex provider and organisational characteristics. These differed for screening versus brief advice and contributed to a 0–95% range in the proportion of risky drinkers offered advice. For discussions click here and scroll down to highlighted heading, and click here, scroll down to the highlighted heading, and unfold Unfold supplementary text the supplementary text.

K Positive organisational climate fosters widespread screening and brief intervention (2013). From Brazilian primary care clinics comes a rare confirmation that a positive organisational climate is associated with overcoming barriers to widely implementing screening and brief intervention programmes. For discussion click here, scroll down to the highlighted heading, and unfold Unfold supplementary text the supplementary text.

R Strategies to implement alcohol screening and brief intervention in primary care (2011). Provides a useful map of a large and complex territory enabling you to identify which implementation levers you are already pulling and which you might also turn your hand to. For discussions click here, here and here, and scroll down to highlighted headings.

R Barriers and facilitators to implementing alcohol screening and brief intervention (2011). UK-focused review for Britain’s National Institute for Health and Care Excellence.

more Search for all relevant Effectiveness Bank analyses or for sub-topics go to the subject search page or hot topic on brief interventions.

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