Have a Word

Preventing alcohol misuse offending and injury through motivational advice in criminal justice and health services.

What it is

A series of randomised trials carried out with research partners by the Violence Research Group showed that screening for and brief advice on alcohol misuse:

• reduced reoffending when delivered in probation services
• did not reduce alcohol misuse or offending but decreased injury among offenders when delivered in magistrates’ courts
• reduced alcohol misuse when delivered in general practices
• did not reduce alcohol misuse when delivered in accident and emergency departments
• reduced alcohol misuse when delivered in health service injury clinics.

This research programme was designed to find out if, where and when motivational advice – brief interventions – reduces alcohol misuse, injury and offending; and in which format this advice is more effective. This programme was also designed to translate effective practice into public service practice.

Every week in Wales, 1,200 hospital admissions are attributed to alcohol. We know the cost to the NHS in Wales and the cost to people’s health is enormous. I am delighted to launch this campaign.

Impact

This research and campaign have resulted in:

• 19,000 health and other professionals trained in Wales and England
• screening and brief advice delivered to 140,000 UK armed forces personnel
• 'train the trainers' courses in England and Wales
• accreditation of Have a Word training courses at degree level
• web based training materials.

Phase one

The randomised trials of screening and brief advice on alcohol showed that most benefit was achieved when it was delivered at “teachable moments” in patients’ and offenders’ lives - at times when their thoughts were not dominated by the immediate effects of injury or conviction, but later on, when the immediate effects had passed and the causes of offending and injury were uppermost in their minds.

Thus, brief advice was effective when it was delivered to offenders in probation settings and to patients in NHS trauma clinics when injured people had their wounds dressed or their stitches removed; but ineffective when delivered earlier.

Overall, after screening for alcohol misuse using a valid and reliable method such as the four question screening instrument AUDIT-C, feedback from a health professional or probation officer was just as effective when it was reinforced with an advice leaflet as it was if it took the form of lifestyle counselling or structured verbal brief advice.

Phase two

Since changing traditional practice is challenging, a new, practical and attractive approach to embedding effective brief advice in routine service delivery was needed. This was developed by:

• generating a brief advice brand in focus groups of practitioners
• testing branded training courses of different lengths and formats
• establishing partnerships with local health, police, probation and armed services
• forming partnerships with key national agencies which could drive sustainability
• building a new social media platform.

Outputs

This phase of research and development, funded through two Knowledge Transfer Partnerships with Welsh Government and Public Health Wales resulted in:

• the Have a Word brand: “Brief Advice Works, Have a Word!”
• local collaboratives centred on NHS health boards across Wales
• four accredited training programmes specifically for practitioner groups with opportunities to deliver screening and brief advice
• have a Word Twitter feed, Facebook pages and website.
• partnership with the Ministry of Defence for adoption across the armed services
• export of Have a Word materials to Public Health England.

Aims

This Have a Word campaign has two main aims:

• to improve the image of brief interventions so that delivery is not seen as a burdensome addition to workloads
• to motivate practitioners who have received training to include brief interventions in ordinary conversation with people identified as drinking at hazardous and harmful levels.