Stafford Borough Council & South Staffordshire LPC - Alcohol Screening, Brief Intervention, AUDIT and Follow-up Service

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Stafford Borough Council & South Staffordshire LPC - Alcohol Screening, Brief Intervention, AUDIT and Follow-up Service Background Alcohol misuse is recognised nationally as being of critical concern

1 Stafford Borough Council & South Staffordshire LPC - Alcohol Screening, Brief Intervention, AUDIT and Follow-up Service Background Alcohol misuse is recognised nationally as being of critical concern in respect of health, including the rise in emergency admissions, complex cases and delayed transfers of care, as well as alcohol related violence. Many areas have developed strategies aimed at reducing alcohol related harms, some of the rationale behind these is summarised below. Unlike illegal drugs, alcohol is a legal, freely available, culturally acceptable substance. Individuals of their own free will can consume as much alcohol as they wish, within the constraints of civil and criminal law. There are many patterns of alcohol consumption and some forms of harm are more associated with particular problems than others. For example, some chronic health problems, such as alcohol related liver cirrhosis, will almost always be associated with long term heavy drinking. Other acute alcohol related problems, such as violence, accidents or vandalism might result from an occasional bout of heavy drinking. Acute harms are common among the large number of people who regularly binge drink, yet these people are not necessarily alcohol dependent and do not conform to the popular stereotype of the alcoholic. A focus on individual drinkers will be combined with support to the families and others caring for people with alcohol related harms. Alcohol is a significant factor in a range of domestic problems including domestic violence, relationship breakdown and child abuse. Some alcohol related problems are best addressed at a population level. For example, some behavioural or health problems need to be tackled, at least in part, through the use of health education and other preventative campaigns. Others, such as public disorder, vandalism and the many accidental injuries related to alcohol, are better addressed through approaches involving the context in which drinking takes place, such as management of the licensed premises or the availability of public transport late at night. Staffordshire Health and Wellbeing Strategy (SHWBW) states that alcohol and drugs misuse undermine family and community life. The problems that arise out of misuse, addiction and dependency destroy potential and hope, and have a devastating effect on the most vulnerable in our society. Jobs and homes can be lost, friendships and family ties broken and for the children of families where alcohol and drug misuse is prevalent there is a danger of abandonment and neglect. There is a need to work with people and organisations to recognise and realise their potential impact on communities. To support individuals and communities to take responsibility for their own health and well being. Across the Staffordshire economy, alcohol related harm is estimated to cost 322 million per year. Public opinion surveys suggest that most people think alcohol consumption is a problem and the root of the problem lies in the English drinking culture and that many people are too willing to tolerate drunkenness and antisocial behaviour as an accepted part of life. For increasing numbers of people, getting drunk has become the definition of a good night out. Many take little personal responsibility for their behaviour in getting drunk in the first place, or their subsequent actions when drunk. Similarly to other parts of the UK, Staffordshire has seen an increase in the amount of alcohol consumed by the general public and the subsequent impact of that increase. In Staffordshire there are 131,000 hazardous drinkers, 32,000 harmful drinkers and 21,000 alcohol dependent drinkers. Data from the Local Alcohol Profiles for England shows that generally alcohol related harm using these measures is greater for males than for females. Across Staffordshire 30% of children aged reported drinking alcohol in the week, compared with 21% nationally. One in ten young people arrested by police during 2008/09 claimed to have recently consumed alcohol, demonstrating the link between underage drinking and criminal behaviour. Page 1 of 12

2 It is a priority to reduce the harm cause by alcohol misuse: by promoting a responsible attitude to drinking; by reducing the numbers of chronic, binge, hazardous, harmful and dependent drinkers; and by breaking down barriers, reducing stigma and helping communities to understand alcohol misuse, chronic drinking and alcohol dependency. Stafford Borough Data from the Staffordshire Observatory shows that during recent years, hospital admissions as a result of increased consumption of alcohol have increased considerably. The rate of alcohol specific admissions, which are those that are conditions wholly related to alcohol, such as alcoholic liver disease and overdose, has increased among both males and females in Stafford Borough, equating to 323 per 100,000 male population and 211 per 100,000 female population. Similarly, alcohol-attributable admissions, which also include conditions that are caused by alcohol, such as unintentional injury and stomach cancer, have increased in Stafford Borough from 1,237 per 100,000 population in 2006/07 to 1,709 in 2010/2011. Hospital admissions for under 18 s was higher for females than for males, and binge drinking estimates for Stafford are among the highest in the county and higher than the estimates for the West Midlands as a whole. The Stafford Health Profile for 2012 shows that Stafford has approximately 107 per 100,000 alcohol related hospital stays in the under 18 age group (significantly worse than the average for England). The rate of people drinking at increasing and higher risk levels in Stafford is 24% of adults (individuals age 16 years and over); higher than the average for England (although not significantly higher). There were 470 alcohol related violent offences during 2011/12 (where the offender is profiled as being under the influence of alcohol) which accounts for 27% of all violence in Stafford Borough4. Whilst this proportion has increased in recent years, it is thought that this is just a snapshot due to the influence of alcohol being underrecorded. Where alcohol is recorded, it is mainly a factor in violence offences in Stafford Town Centre. Forebridge ward recorded 36% of all alcohol-related violence offences in Stafford Borough during 2011/12 (170 crimes). Aims and intended service outcomes To improve access to and choice of alcohol screening and intervention support services closer to peoples homes. To provide quicker access to early assessment of potential alcohol related harm. To provide an early intervention to reduce the number of people who may become alcohol dependent. To reduce alcohol related illnesses and deaths by helping people to reduce or give up drinking. To help service users access additional treatment by offering timely referral to specialist services where appropriate. To minimise the impact on the wider community by reducing the levels of alcohol related crime and anti-social behaviour, thereby improving community safety. Service description Community pharmacies within Stafford Borough signed up to the service will deliver coordinated alcohol identification, screening and brief intervention programme as part of the borough-wide strategy. The programme has 6 elements: 1. Identification Using defined criteria, clients walking in to a participating pharmacy will be offered screening using the AUDIT alcohol assessment tool (Alcohol Usage Disorder Identification Test, WHO 1982). Initial screening will use NPA Rethink your Drink scratchcards. Defined Criteria for Screening: Any client that the Pharmacist / trained staff member identifies as needing advice/support around alcohol use, but in particular: Vulnerable groups: - Females and Males and years Page 2 of 12

3 - Black and Racial Minorities Groups (BRM) all age groups males and females - Homeless - Diabetics Clients presenting frequently with symptoms which may be associated with alcohol misuse e.g. - Gastric problems e.g. peptic & duodenal ulcers - Falls and associated injuries - High blood pressure - Depression - Anxiety / stress Identified during a Medication Use Review (MUR), New Medicines Service (NMS), or Smoking Cessation, Emergency Hormonal Contraception (EHC), Chlamydia consultation, or other conversation between pharmacist or pharmacy team members and patients/clients/customers. Self-referral by the individual Referral by another health or social care worker. People not wishing to initially engage or those who choose not to complete the programme may be offered appropriate health literature or referral to an alternative service. 2. Screening The Pharmacist / trained staff member will undertake AUDIT with the client, having first explained the unit system for measuring alcohol intake. An initial filter, comprising the first three questions of AUDIT (AUDIT-C), will be used. This will be delivered in the form of a scratch-card which the client will be invited to complete. Clients scoring 4 or less will be exited from the assessment and provided with printed notes on the dangers of alcohol and asked to pass these on as appropriate. For all other interviewees, AUDIT scores and average total number of units consumed per week will be recorded. The AUDIT score and number of units consumed per week plus client details should be tracked on a monitoring form. An online monitoring form should be completed for EACH client regardless of the AUDIT score. This screening will be provided free of charge as part of the normal pharmacy operations (Promoting healthy lifestyles essential service). 3. Brief Intervention If the AUDIT score determines that the patient scores between 8-15 (hazardous drinking category) the Pharmacist or trained staff member will carry out a brief intervention which must consist of: Explanation of daily benchmarks Re-statement of what is a unit of alcohol Explanation of category of drinker Explanation of the content of the Educational Safer Drinking Information leaflet 4. Referral If a client scores 16 or more (which moves towards either a harmful or dependent drinking category) then appropriate referrals should be made to the specialist service. The client should sign the record form to consent to referral. The pharmacy will then complete the relevant referral form and send this directly to One Recovery Staffordshire. This referral form is included in Appendix 4 and will be available via the LPC website and PharmOutcomes platform. 5. Follow up For those clients having scored 8-15 (hazardous drinking category), the pharmacy should attempt a follow up after 4 weeks and 8 weeks, using the three follow up questions of the AUDIT-C. The follow-up may be conducted in-pharmacy or by telephone and details of responses to each of these calls will be recorded using the PharmOutcomes platform and the results will be available for viewing in real time. Page 3 of 12

4 6. Monitoring of the service Pharmacies will be expected to: Agree to and use screening and data collection tools (AUDIT-C (scratch-card) and AUDIT form. Monitoring via online Form input into PharmOutcomes) Agree to record details about all brief interventions and referral processes on the online recording system PharmOutcomes. There will be one monitoring entry per client, and these will be saved securely on the computer system which will be available to all pharmacies in the borough. Activity data will be recorded online on PharmOutcomes and this system will generate any claims for payments. The monies and payments will be managed by the LPC. Quality Indicators The pharmacy has appropriate health promotion material available for the user group and promotes its uptake. The pharmacy reviews its standard operating procedures and the referral pathways for the service on an annual basis. The pharmacy can demonstrate that pharmacists and staff involved in the provision of the service have undertaken CPD relevant to this service. The pharmacy participates in any organised audit of service provision. The pharmacy co-operates with any locally agreed assessment of service user experience. Measurable Outcomes Number of Rethink your Drink Scratchcards issued Number of Full AUDIT assessments undertaken, scores recorded and outcomes Number of Drinkers scoring 8-15 on full AUDIT recorded Number of follow-up interventions undertaken on those scoring 8-15 on full AUDIT Number of people scoring 16 or above on full AUDIT referred to specialist service Additional Information (not forming part of the service specification) CPPE training which may support this service: Open Learning: Alcohol Misuse: Support and Advice from the Pharmacy Team Other training and resources: South Staffordshire LPC website Alcohol Learning Centre - Alcohol Academy DrinkAware Rethink you Drink Page 4 of 12

5 Acceptance of SLA 1 form required per community pharmacy premises: Please note that South Staffordshire LPC/Stafford Borough Council have the right to withdraw this Service Level Agreement at any time, or if the requirements are not being met, giving four weeks written notice. If the Pharmacy wishes to withdraw from the scheme, four weeks written notice is required. For and on behalf of the Community Pharmacy: Signature: For and on behalf of South Staffordshire LPC and Stafford Borough Council: Signature: Name of Signatory: Name of Signatory: Position: Position: Date of Signing: Date of Signing: A signed copy of this agreement will be kept by the Pharmacy and South Staffordshire LPC on behalf of Stafford Borough Council. Please also complete the following details: Pharmacy name Pharmacy OCS code (PPA code) Pharmacy Stamp Pharmacy address Phone number Fax number Contact Name address Page 5 of 12

6 STAFFORD ALCOHOL SERVICE - AUDIT-C SCORE RECORD Appendix 1 Pharmacy stamp: Sheet Number: CLIENT NUMBER GENDER (M/F) POSTCODE (1ST HALF) AGE AUDIT-C SCORE Page 6 of 12

7 Appendix 2: Stafford Alcohol Identification and Brief Advice Service Stage 1 Full AUDIT result and intervention for clients scoring 5 or more on the scratch card. Date DOB Gender Patient Name Postcode Person completing intervention Medical Information: Is your health? Excellent Good Average Poor Do you suffer from? Diabetes Gastric problem (eg peptic +/or Falls and associated injuries duodenal ulcer High blood pressure Depression Stress / Anxiety Other; please give details if appropriate Are you pregnant? Yes No Male N/A AUDIT SCORES AUDIT-C score (scratch card) (max score 12) AUDIT part 2 score (max score 28) Full AUDIT score (max score 40) Interventions Info leaflet given Advice given Referred to One Recovery Referred but declined Other No Action Declarations and Consent Share info with One Recovery? Phone Number Phone contact acceptable? Date for follow up Stage 2 First follow up (week 4) Date Patient Name AUDIT-C score (max 12) Person completing intervention Interventions Info leaflet given Advice given Referred to One Recovery Referred but declined Other No Action Stage 3 Second follow up (week 4) Date Patient Name AUDIT-C score (max 12) Person completing intervention Interventions Info leaflet given Advice given Referred to One Recovery Referred but declined Other No Action Page 7 of 12

8 Appendix 3 This is one unit of alcohol and each of these is more than one unit AUDIT C Questions How often do you have a drink containing alcohol? How many units of alcohol do you drink on a typical day when you are drinking? Scoring system or less 2-4 times per month 2-3 times per week 4+ times per week Your score How often have you had 6 or more units if female, or 8 or more if male, on a single occasion in the last year? Less than monthly Weekly Daily or almost daily Scoring: A total of 5+ indicates increasing or higher risk drinking. An overall total score of 5 or above is AUDIT-C positive. SCORE Page 8 of 12

9 Score from AUDIT- C (other side) SCORE Remaining AUDIT questions Questions How often during the last year have you found that you were not able to stop drinking once you had started? How often during the last year have you failed to do what was normally expected from you because of your drinking? How often during the last year have you needed an alcoholic drink in the morning to get yourself going after a heavy drinking session? How often during the last year have you had a feeling of guilt or remorse after drinking? How often during the last year have you been unable to remember what happened the night before because you had been drinking? Have you or somebody else been injured as a result of your drinking? Has a relative or friend, doctor or other health worker been concerned about your drinking or suggested that you cut down? Scoring system No No Less than monthly Less than monthly Less than monthly Less than monthly Less than monthly Yes, but not in the last year Yes, but not in the last year Weekly Weekly Weekly Weekly Weekly Daily or almost daily Daily or almost daily Daily or almost daily Daily or almost daily Daily or almost daily Yes, during the last year Yes, during the last year Your score Scoring: 0 7 Lower risk, 8 15 Increasing risk, Higher risk, 20+ Possible dependence TOTAL Score equals AUDIT C Score (above) + Score of remaining questions TOTAL Page 9 of 12

Appendix 4 REQUEST FOR ONE RECOVERY ASSESSMENT REFERRAL FORM *PLEASE COMPLETE ALL SECTIONS FAILURE TO DO SO MAY MEAN IT CANNOT BE PROCESSED* ** ONCE COMPLETED PLEASE SEND BACK TO YOUR LOCAL SERVICE.

FOUND ON THE LAST PAGE ** Referral Date: Name of Referring Professional: Referring Agency: Contact : Agency Address: Client Details Forename: Surname: D.o.B.

10 Appendix 4 REQUEST FOR ONE RECOVERY ASSESSMENT REFERRAL FORM *PLEASE COMPLETE ALL SECTIONS FAILURE TO DO SO MAY MEAN IT CANNOT BE PROCESSED* ** ONCE COMPLETED PLEASE SEND BACK TO YOUR LOCAL SERVICE. ADDRESSES CAN BE FOUND ON THE LAST PAGE ** Referral Date: Name of Referring Professional: Referring Agency: Contact : Agency Address: Client Details Forename: Surname: D.o.B. Gender: Ethnicity: NHS : Address: Tel : Post Code: Second contact : GP name & address: Other services currently involved & keyworker (1): Other services currently involved & keyworker (2): Any known literacy problems? Preferred method of contact? (phone or letter) Drug/Alcohol Information Reason for referral Alcohol Use: Opiate Use: Other Drug: (please specify) Current Drug Use Current use of illicit substances. Please circle YES or No. If yes, state amount used and route of use Amount Route 1. Opiates Yes or No 2. Cocaine Yes or No 3. Benzodiazepines Yes or No 4. Cannabis Yes or No Page 10 of 12

11 5. Other(s) Yes or No Current alcohol use Current amount of alcohol/week. Please state number of units and type of drink Alcohol dependence symptoms present: YES NO AUDITS Current PRESCRIBED medication - circle YES or NO (If more drugs please use extra sheets of paper) Please identify any risks/details with reference to: Pregnancy Domestic violence Physical health Mental health Disability IV drug use Other Identified Risks Please identify any other relevant details Page 11 of 12

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SMART Wokingham Young persons Screening and Referral Form

SMART Wokingham Young persons Screening and Referral Form Referral Source Date: Name of worker: Contact number: Referring Agency: Email address: Client Information Surname First Name Title Previous Name