TRATAD - Together for responsible attitude towards alcohol drinking Establishment of comprehensive interdisciplinary approach for screening and brief intervention of hazardous and harmful alcohol drinking in Slovenian adults.

Tadeja Hočevar, Karmen Henigsman, Jasmina Črnko Papić

National Institute of Public Health

ESI Funds for Health: Health promotion workshop,14-15 June 2018, Zagreb, Croatia

The European Structural and Investment Funds (ESIF)

Ministry of Labour, Family, Social Affairs and Equal Opportunities

Ministry of Health(intermediary body)

National Institute of Public Health

Ministry of Health

(Beneficiaries)

1/10/2016

-

31/12/2020

CRO

AUT H

Not owning the photos - all dowloaded from internet

WHY the TRATAD (SOPA)?

LOW LEVEL OF AWARNESS ABOUT NATURE AND TREATHS OF

HAZARDOUS AND HARMFUL ALCOHOL DRINKING (H&HAD)

AMONG EXPERTS

LOW LEVEL OF AWARNESS ABOUT H&HAD AMONG OTHER

MEMBERS OF THE COMMUNITY, ESPECIALLY THE

PATIENTS/CLIENTS THEMSELVES

SYSTEM PROBLEM

THE NEED FOR EFFECTIVE APPROACH TO TACKLE THE H&HAD IN ADULTS

ALCOHOL BURDEN

Development and advocacy of interdisciplinary

approach in tackling H&HAD

LIMITED COUNSELING SKILLS OF HEALTH CARE

EXPERTS AND SOCIAL WORKERS

HOW - Brief intervention

0

200

400

600

800

1,000

1,200

1,400

1,600

1,800

0 500,000 1,000,000 1,500,000 2,000,000

Effect (DALYs averted per year)

Co

st (

I$m

per

yea

r)

A. Brief physician advice

B. Random Breath Testing

C1. Taxation (current)

C2. Taxation (current + 25%)

C3. Taxation (current + 50%)

D. Restricted access (sales)

E. Advertising ban

F1. Brief advice + RBT

F2. Tax (highest) + Ad Ban

F4. Brief advice + Tax (highest)

F5. Tax (highest) + Ad Ban + Restrict access

F8. Brief advice + Tax (highest) + Ad Ban + Restrict Access

F11. Brief advice + Tax (highest) + Ad Ban + RBT + Restrict

access

A

D-E

C1-C3

F2

F5B

F11

F8

F4F1

Source: Chisholm et al 2004

FOCUS – Hazardous and Harmful Alcohol Drinking (H&HAD)

• Continuum of (attitude towards) alcohol drinking

abstinence < health wise still < hazardous AD < harmful AD < ADS acceptable AD patterns

Brief intervention in TRATAD

• Brief intervention 1: screening and counseling with a follow up (training

the experts and piloting the intervention, end-users included)

• Brief intervention 2: screening and brief advice with informing about

sources of aid (training the experts)

• Brief intervention 3: raising awareness among members of NGO‘s and

users of employment services, about H&HAD, with informative materials

(brochures, leaflet, posters) and different events on alcohol prevention

(workshops, sport events, cultural events…) (piloting the intervention, end-

users included)

Brief intervention - practitioners

Brief intervention 1 Brief intervention 2 Brief intervention 3

Family doctors/general

practitioners (FD)

Gastroenterology NGO – body impairment

Registered nurse in Model

practice (MP)

Gynecology NGO - visual impairment and

blindness

registered health visitor

(RHV)

Otorhinolaryngology NGO – hearing impairment

and deafness

Occupational, traffic and

sports doctors

Emergency medicine NGO - charity

Preventive programs experts Cardiology NGO – family and social care

Social workers Transfusiology NGO - culture

Dental medicine NGO – sports

Oncology Employment Service

TRATAD target groups

Adults who H&HAD and community members who are exposed to the negative effects of excessive alcohol consumption of others.

Specific target groups:

1. Adult patients in community health centre

2. Adult social care centre users

3. NGOs´ members (vulnerability, interest) and

employment service users

4. Community members who come in contact with mass

media

5. (Health and social work) Experts

6. Mass media representatives

7. Municipality representatives, police

Main objective

By treating them, protect the individuals from the potential job loss due to their problems associated with alcohol. / In case of existing unemployment, treat H&HAD for empowering individuals, this wise, to entry the labour market.

The specific objectives of the operation are:

1. To strengthen the existing and build new capacities to address H&HAD on

a national, regional and local level

2. To develop, train and pilot the screening and brief intervention approach

in the community

3. To raise awareness in and train media representatives for responsible

reporting on alcohol in mass media

4. To raise awareness of general and professional public about alcohol related

problems

5. To establish protocols for addressing H&HAD

6. To propose the implementation of the approach on a system level

Phases of TRATAD

1. DEVELOPMENT

2. TRAINING THE TRAINERS

3. BUILDING CAPACITY

4. PILOT STUDY

5. SYSTEM LEVEL IMPLEMENTATION

Phases of TRATAD approach

DEVELOPMENT TRAINING THE TRAINERS BUILDING CAPACITY PILOT

Development team:

- National Institute

of Public Health

- Experts in practice

(health, social

workers NGO

representatives)

Training the trainers team:

- National Institute of Public Health

- Experts in practice (GPs)

Trainers:

- NIPH & Experts in practice: health and social workers

Trainees:

- Primary health care:

doctors, nurses, preventive

program experts

- Social care experts

- NGOs´

- Employment service

(18 local areas)

Testing

approach

among

Slovenian

adults who

H&HAD

(BI1&BI3)

(18 local areas)

Training

experts in BI2

TRATAD impact indicator - PILOT

Impact indicator is based exclusively on BI1 approach

• Impact indicator – number of persons:

- screened as persons who drink alcohol in hazardous or

harmful way and

- included in the program of BI1

- successfully treated target value = 540 individuals

TRATAD impact indicator - PILOT

Country level:

60.000 people screened for H&HAD

9.000 treated individuals

540 successfully treated individuals

Phases of TRATAD

1. DEVELOPMENT

2. TRAINING THE TRAINERS

3. BUILDING CAPACITY

4. PILOT STUDY

5. SYSTEM LEVEL IMPLEMENTATION

System level implementation proposal

Timeline of TRATAD

Phase Duration

Development (1st phase) October 2016 – March 2018

Training the trainers September 2017 – December 2017

Building capacity April 2018 – September 2018

Pilot October 2018 – June 2020

Evaluation and modification March 2018 – October 2020

System level implementation 2021 -

17

17

Questions

Thank you.