WHO-Alcohol Policy Network joint meeting Edinburgh 19 November 2018

1. WHO/EURO Project meeting on
alcohol and health
Edinburgh, United Kingdom
19 November 2018
Case stories on implementation
of screening and brief intervention
ITALY
Emanuele Scafato and Claudia Gandin
National Observatory on Alcohol
World Health Organization Collaborating Centre for Research and Health Promotion on Alcohol and
alcohol-related health problems

2. Osservatorio Nazionale Alcol - World Health Organization Collaborating Centre for
RESEARCH and HEALTH PROMOTION on ALCOHOL and ALCOHOL- RELATED HEALTH PROBLEMS
A huge contribution of knowledge comes from these major projects:
 WHO, WHO collaborative project on Identification and
Management of Alcohol related problems in PHC
 EC, PHEPA (Primary HEalth care Project on Alcohol)
 EC, AMPHORA (Alcohol public health research alliance)
 EC, ODHIN (Optimizing Delivery of Health care
INterventions)
 EC, BISTAIRS (Brief InterventionS in the Treatment of
Alcohol use disorders In Relevant Settings)
 EC, Joint action RARHA Reducing Alcohol Related Harm
The history of Early Identification and Brief Interventions for AUDs
A continuum of activities from 1983
More than 30 years of research

3. Osservatorio Nazionale Alcol - World Health Organization Collaborating Centre for
RESEARCH and HEALTH PROMOTION on ALCOHOL and ALCOHOL- RELATED HEALTH PROBLEMS
 The National Observatory on Alcohol of the ISS (NOA-ISS)
played a pivotal role in carrying out a formal activity in
preparing a country strategy aimed at the implementation of
a common standard of training now explicitly included in all
national public health documents.
 The NOA-ISS was indicated by the National Committee on
Alcohol, set by the frame law on alcohol 125/2001, as the
national provider of the training activities in tight connection
with the SIA (Italian Society of Alcohology) and the Regions.
 The NOA-ISS started its activities in April 2006 to deliver a
communication strategy and to organise conferences to
announce, promote and disseminate the EIBI PHEPA
programme.
Training on IPIB-EIBI in PHC at the ISS, Italy
12 years of standard of training implementation

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Lesson learnt on IPIB implementation in Italy
Supporting materials /
policies / protocols are
needed

5. http://www.amphoraproject.net/w2box/data/e-book/AMPHORA%20ebook.pdf
Lesson learnt on IPIB implementation in Italy
The main barrier to EIBI implementation: lack of training

6. Conclusion
One of the main barrier to the
implementation of the IPIB in
Italy is the
NETWORK
• For some professionals its
culturally difficult to collaborate
also in the light of some
existing barriers related to the
organization of the health body
and/or to the procedures to be
followed in their workplaces.
• The lack of a professional
network in some geographical
context do not help a lot to
implement IPIB as a main tool
of prevention
Lesson learnt on IPIB implementation in Italy
Another barrier to EIBI
implementation in Italy:
the lack of network

7. Osservatorio Nazionale Alcol - World Health Organization Collaborating Centre for
RESEARCH and HEALTH PROMOTION on ALCOHOL and ALCOHOL- RELATED HEALTH PROBLEMS
 Training courses opened to
GPs and
other professionals
 Two days versus one day
course
A case story on implementation of screening and brief
intervention in Italy (Example 1)

8. Osservatorio Nazionale Alcol - World Health Organization Collaborating Centre for
RESEARCH and HEALTH PROMOTION on ALCOHOL and ALCOHOL- RELATED HEALTH PROBLEMS
 1. An online survey on knowledge, attitudes,
barriers and facilitators on IPIB implementation
 2. Training programmes on IPIB
 3. A final meeting to disseminate results
A case story on implementation of screening and brief
intervention in Italy (Example 2)

9. Osservatorio Nazionale Alcol - World Health Organization Collaborating Centre for
RESEARCH and HEALTH PROMOTION on ALCOHOL and ALCOHOL- RELATED HEALTH PROBLEMS
A case story on implementation of screening and brief
intervention in Italy (Example 3)
Programma del corso
Counselling breve per la prevenzione dei principali 4 fattori di
rischio per le malattie croniche:
L’identificazione precoce e l’intervento breve nel
consumo rischioso e dannoso di alcol
nell’assistenza sanitaria primaria
Emanuele Scafato
Claudia Gandin
Mandatory training for all GPs of a local health care unit
UMBRIA Region

10. E M A N U E L E S C A F A T O 2 0 1 4
SCREENING AND BRIEF INTERVENTION - ITALYLesson learnt on IPIB implementation in Italy

11. INEBRIA, Rome, September 19th-20th 2013Lesson learnt on IPIB implementation in Italy

12. JA RARHA: 3 executive core Work Packages
http://www.rarha.eu
WP4: Monitoring
WP6:Tool kits
WP5: Guidelines

13. Multidisciplinary guidelines for
managing hazardous / harmful
alcohol consumption approved
or endorsed by at least one
health care professional body
or scientific society
European Expert Meeting
Rome, November 2014
Yes
Last 15 years of programmes
(supported by WHO and EC) to
improve the implementation of
EIBI provided positive results

14. Formazione dell’Organizzazione Mondiale della
Sanità sull’intervento breve per l’alcol
nell’assistenza sanitaria primaria

15. «RETE IPIB»
Local Body Unit network for
the early identification of
hazardous and harmful
behaviors caused by the
alcohol consumption,
gambling and new addiction
The case story on implementation of the
WHO training programme on ABI (2017) in Italy

16. RETE IPIB (IPIB NETWORK)
An experimental local project of a WHO model

17. RETE IPIB:
An experimental local project of a WHO model
The Project “Rete IPIB” (EIBI Network) derives from the
collaboration between the NOA-ISS and the Local Health
Unit - ASL of Salerno signed in June 2017, aimed at
applying the IPIB model validated by the World Health
Organization and promoted by the ISS for the creation of
a network of interventions in different life setting in
which alcohol consumption is configured as a risk factor
for health.

18. General objectives
• To invest in training to increase the knowledge, skills and motivation
of Primary Health Care and Addiction Services professionals on Early
Identification and Brief Intervention on Alcohol and/or Gambling (IPIB-
IPGAP).
• To organize and activate a network at the Salerno Local Health Unit
(ASL Salerno) on IPIB by professionals previously trained to promote
programs aimed:
1) to stop the evolution of hazardous or harmful behaviors towards
the addiction (alcohol, gambling) and to promote healthy
lifestyles.
2) to facilitate the “taking charge” of subjects with harmful behaviors
by the specialist departments of both public and private social
sectors.

19. Training programme
Training of 600 operators (480 for IPIB alcohol and 120 for IPGAP
gambling):
Training on IPIB alcohol (BASIC): 6 courses
It includes the basic elements of the use of standardized tools for the early
identification of hazardous/harmful alcohol consumption (AUDIT, Alcohol Use
Disorders Identification Test); the basic elements for a brief intervention (5-10
minutes) or "minimum" to be integrated into daily routine activities.
Training on IPIB alcohol (ADVANCED): 3 courses
For selected professionals identified during the basic couses.
Training on IPIB gambling (BASIC): 3 courses

20. Organization

21. The network
The network «rete IPIB» has activated 3 Local
Poles geographically corresponding to the
following areas:
• Agro Nocerino-Sarnese/Costa d’Amalfi/Valle
Irno;
• Salerno ed Area metropolitana / Cratere Alto
Sele and Piana del Sele;
• Cilento, Vallo di Diano and Bussentino.

22. IPIB Network

23. Target
• Primary Health Care (GPs/Pediatricians)
• Emergency and First Aid departments
• Workplace
• Gynecology and maternal-infant area
• Adolescent area (Teenagers space, NPI)
• Mental health
• School prevention
• Elderly assistance
• Third sector

24. Steps of the project
• Need analysis for training (questionnaires /
interviews on the knowledge of the local health
unit personnel to be involved in the Network on
topics related to alcohol, gambling and other
addiction)
• Planning and implementation of the local health
unit personnel’s training
• Creation, activation and monitoring of the IPIB /
IPGAP network
• ⬇️⬇️⬇️⬇️⬇️⬇️⬇️⬇️
COMMUNITY PROJECTS ACTIVATION

25. Functions of the poles
• Supporting and coordinating the IPIB activities
of those have taking part in the first and
second level of training who intend to commit
themselves.
• Disseminating information and sensibilization
on the Region, in coordination with the
programs and objectives of the Health
Promotion Local Health Plan.

26. Projects of the network ‘rete IPIB’
1. FAMILY CARE (Family and healthy lifestyles).
1.a Sub-project Target: «Healthy mother and baby».
( Alcohol, pregnancy and neonatal development).
1.b Sub-project Target: «Healthy Elderly».
1.c Sub-project Target: «Rete amica»
2. I WORK,NO DRINK (Alcohol and workplace)
3. DOMANI E’ UN ALTRO GIORNO (Tomorrow is
another day) (Safe nightlife)

27. DOMANI E’ UN ALTRO GIORNO
(Tomorrow is another day)
(Movide Sicure)
Obiettivo generale:
•Formazione di una rete di continuità assistenziale e
sicurezza sociale tra : SERD>118 / circuito Emergenza
sanitaria> Salute Mentale >Medicina di Urgenza
>Volontariato socio-sanitario > Forze dell’ordine >
Amministrazioni
Obiettivi specifici da realizzare (Ricadute attese) :
• Definire ed applicare tramite tavoli di lavoro congiunti
un protocollo operativo che declini varie opzioni di
intervento nei casi di intossicazioni acute da consumo
di alcol e/ o altre sostanze ; Erogare una assistenza
pluri-specialistica in setting e spazi dedicati alla
gestione degli stati di intossicazione acuta e
all’accompagnamento verso la presa in carico dei
ragazzi al momento della dimissione dai P.S o dai
reparti di Medicina di Urgenza da parte dei SERD e di
altri servizi, con la collaborazione del volontariato
socio- sanitario.

28. SAFE MOVIDAs
Emergency Management
SAUT
118
Ass.
Soccorso
POLO TERRITORIALE
IPIB
Equipe
Alcologica
SERD
P.S. /Med.
Urgenza
Volontariato
DSM

29. Osservatorio Nazionale Alcol - World Health Organization Collaborating Centre for
RESEARCH and HEALTH PROMOTION on ALCOHOL and ALCOHOL- RELATED HEALTH PROBLEMS
2017 2018

30. Osservatorio Nazionale Alcol - World Health Organization Collaborating Centre for
RESEARCH and HEALTH PROMOTION on ALCOHOL and ALCOHOL- RELATED HEALTH PROBLEMS
Contenuti del programma di formazione 1/2
Sessione 1. Prima parte. IDENTIFICAZIONE PRECOCE DEL CONSUMO
RISCHIOSO E DANNOSO DI ALCOL
 09.00 Il razionale e le finalità del corso
 09.15 Scheda autovalutazione. Atteggiamenti / attitudini verso l’alcol
 09.30 Dal generale al particolare: l’alcol come paradigma per
l’identificazione precoce e l’intervento breve in PHC
 09.45 Il consumo di alcol: impatto sociale e sanitario dell'alcol sulla salute
 10.00 Bicchieri standard, unità alcolica, linee guida di consumo. Le
definizioni di consumo rischioso, dannoso e alcoldipendenza
 10.30 Feedback e discussione
 11.00 Intervallo
Sessione 1. Seconda parte.
 11.30 Identificazione del consumo rischioso e dannoso di alcol: utilizzo e
valutazione degli strumenti di screening
 12.00 Criteri diagnostici dell’alcoldipendenza: focus su ICD-10, OMS
 12.30 Feedback e discussione
 13.00 Pausa pranzo

31. Osservatorio Nazionale Alcol - World Health Organization Collaborating Centre for
RESEARCH and HEALTH PROMOTION on ALCOHOL and ALCOHOL- RELATED HEALTH PROBLEMS
Contenuti del programma di formazione 2/2
Sessione 2. Prima parte. INTERVENTO BREVE NEL CONSUMO RISCHIOSO
E DANNOSO DI ALCOL
 14.00 Il modello degli stadi del cambiamento
 15.00 Esercitazione in plenaria sugli stadi del cambiamento
 15.45 Requisiti fondamentali di un intervento breve
 16.15 La comunicazione: i principali blocchi e le buone pratiche
 16.45 Intervallo
Sessione 2. Seconda parte.
 17.00 Le abilità di base dell’Intervento Breve : le strategie di apertura
 17.15 Elementi essenziali dell’Intervento breve: stile e contenuti
 17.30 Feedback e brain storming sul ruolo degli operatori sanitari per
l’identificazione precoce e l’intervento breve: barriere, supporto necessario,
proposte
 18.00 Chiusura del corso e consegna dei questionari di valutazione

32. INEBRIA, Rome, September 19th-20th 2013
Lesson learnt implementing WHO alcohol brief intervention
training programme in Italy
A huge summary of
contribution and of
knowledge on alcohol
brief intervention.
Many practice
activities.
Most of participants
don’t read handouts in
preparation for the
training course….. you
can even ask them…
send documents in
advance…..
Case studies sometimes
difficult to be explored in
term of level and
patterns of alcohol
consumption (a good
exercise but difficult
calculation for basic level
courses)
Role playing with
harmful drinker (as
Alex with AUDIT C
11) only at the end of
a basic course or for
an advanced level
only (role adequacy)
Planning the courses,
setting and target for
EIBI implementation
should be considered:
mainly hazardous
case studies for non
medical professional;
harmful cases for
medical professionals
only (role legitimacy)
Manual with a little
bit rigid structure
difficult to follow
when abandoning
the proposed
scheme
The most important think
is to get participants’
attention. Thus, change
approaches if they don’t
follow you!!!
Say to participants
that they know yet,
much better than
you, how to deal with
their patients …. and
that this is only an
integration……
During the role playing
never say to participants
what they should say
during a brief intervention
but rather give example
of “change talk” or
“sustain talk”
At the end of the
course, say that it
was exciting to
spend a day of their
precious time with
you and that you
learned a lot

33. Emanuele Scafato
National Observatory on Alcohol
WHO Collaborating Centre for Health Promotion and
Research on Alcohol and Alcohol-related problems
Istituto Superiore di Sanità, Rome, ITALY
E-mail: emanuele.scafato@iss.it | Website: www.iss.it