Integrating evidence-based family-intervention into

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Transcript Integrating evidence-based family-intervention into

INTEGRATING EVIDENCE-BASED FAMILY-INTERVENTION INTO
ROUTINE ADDICTION SERVICES: BRIDGING THE GAP BETWEEN
RESEARCH AND PRACTICE
Claire Hampson, Alex Copello & Jim Orford
Alcohol, Drugs and Addiction Research Group • School of Psychology • University of Birmingham
email [email protected] • phone 0121 414 7209
Introduction
Evaluation measures
Despite the recognition that family members of people with alcohol
or drug problems have considerable needs in their own right,
addiction treatment services are set up to predominantly focus on
the individual drinker or drug user (Orford et al, 2008).
The impact of the training on the brief interventions on familyfocused practice will be evaluated combining qualitative and
quantitative methods:
One possible reason for this lack of response to the underlying
needs of family members is that addiction services do not have
available to them the theoretical and practical tools with which to
respond to these needs (Copello et al, 2000).
This project is providing an alcohol treatment organisation,
Aquarius, an opportunity to receive training and ongoing
supervision in two family-orientated brief-interventions, aiming to
promote a shift towards family-focused practice and to further
advance implementation of family work into routine addiction
services.
Methods
Managers and frontline staff will be trained in two family-orientated
interventions: the ‘5-step approach’ and Social Behaviour and
Network Therapy (SBNT) (see Copello et al, 2000). Two teams
were allocated to be part of a pilot phase. Following the pilot phase
the remaining four teams were randomly assigned to receive either
the immediate or delayed (control group) training and supervision
support package. The support package includes: a two-day training
event; 8 monthly supervision meetings with the research team and
a one-day refresher training event at the end of the intervention.
The quasi-experimental method will be made up of two phases
over a two-year period. The study design will allow comparisons of
the immediate and delayed training on the implementation of
family-focused service at various time points.

Baseline and post-intervention ‘diary snapshot’ results for phase 1
Two questionnaires at baseline and 9 months after posttraining: the AAFPQ** and a questionnaire developed for the
study (see further attitude measurement)
3%
6%3%
6%
50%50%

Baseline and 3-monthly post-training ‘diary snapshot’: taking
a weekly snapshot of focal client / family member activity
from staff diaries

Detailed process notes from monthly supervision meetings
(conducted qualitatively with staff at various points)

Documentary evidence - monitoring any changes to process
documents, e.g. invitation letter sent to clients / family
member; confidentiality form etc.
Results
So far, as part of the pilot, total AAFPQ scores for Knowledge,
Confidence, Support, Legitimacy, Motivation and Self-belief
increased over time, Phase
suggesting
attitudes. The only
1: Total improved
scores for AAFPQ
significant change wasMeasure
in total
score
(t= -3.741, p<0.5). Impact
(pilot
teams)
decreased very slightly over time.
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Total scores for
AAFPQ measure –
Pilot Teams
Baseline
146.00
*
Post-intervention
144.00
142.00
27%
41%
Contact
with Professional
Contact
with professional
Family
(inown
their own
Family
work work
(in their
right)right)
19%
Focal client and family
Focal client and family
member (together)
member (together)
41%
41%
Phase I: Pilot teams baseline activity
13%
Phase I: Pilot teams post-intervention activity
Using the differences in proportions test, the proportion of both family
activity in their own right and focal clients being accompanied by a
family member significantly increased (p<0.01). The proportion of
individual focal client work decreased post-intervention.
Further attitude measurement
Based on the feedback from the AAFPQ results, we decided to develop
a more sensitive family-specific measure, aiming to tap into attitudes
specific to working with family members, in addition to using the
previously adapted AAFPQ. The ‘Attitudes to Involving Family Members
in Treatment Questionnaire’ (AIFMTQ) was piloted and developed.
141 staff working in addiction services (statutory and non-statutory)
completed the pilot measure. Statistical analyses of the original 32 items
using principal components analysis (PCA) resulted in the identification
of a reduced 22-item measure with four factors (sub-scales) described
as General Orientation (α=.93), Confidence in Managing Interpersonal
Issues (α=.66), Concern About Involving Family Members (α=.69), and
Perceived Compatibility (α=.69). Cronbach’s alpha coefficient for the
measure was 0.89 indicating high reliability. The criterion group method
was also used to establish construct validity.
Discussion
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Initial outcomes for the pilot teams are promising. So far, an overall
increase in positive attitude towards involving family members in
treatment sessions has been shown post-intervention, as well as an
increase in the proportion of family-focused activity within the teams.
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Figure 1: Timeline showing phases of quasi-experimental method
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This project in the long run will allow comparisons between all teams at
different time periods in order to evaluate the impact of the training on
family-focused service.
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132.00
130.00
Baseline
Key: TW=Initial training event; MM=Monthly Supervision Meeting; DS= Diary snapshot; BM=Baseline attitude measure (pre-training);
FUAM= post-intervention attitude measure; FUW=Follow-up workshop
FocalFocal
clientclient
work work
Post-intervention
**The Alcohol and Alcohol Problems Perception Questionnaire (AAPPQ) was originally developed by Cartwright (1980) to measure the overall
professionals working with people with alcohol problems. The AAFPQ has since been adapted (see Templeton et al., 2004).
References
1. Copello A, Templeton L, Krishnan M, Orford J, Velleman R. (2000a). A treatment package to improve primary care services for the relatives of people with alcohol and drug problems. Addiction Research, 8, 471 – 84.
2. Copello, A. & Orford, J. (2002) Addiction and the family: is it time for services to take notice of the evidence? Addiction, 97, 361–1363.
3. Copello, A., Orford, J., Velleman, R., Templeton, L., & Krishnan, M. (2000b). Methods for reducing alcohol and drug related family harm in non-specialist settings. Journal of Mental Health, 9, 319-333.
4. Copello, A., Velleman, R., Templeton, L., (2005) Family interventions in the treatment of alcohol and drug problems. Drug and Alcohol Review 24, (4), 369-85.
5. Orford J., Natera, G., Copello, A., Atkinson, C., Mora, J., Velleman, R., el al. (2005a). Coping with alcohol and drug problems: The experiences of family members in three contrasting cultures. London: Brunner-Routledge.
This project continues to promote further implementation of familyfocused practice within routine addiction services.
therapeutic commitment to
Acknowledgment: Study funded by Aquarius, University of Birmingham and BSMHT (NHS)
6. Orford, J., Natera, G., Davies, J., Nava, A., Mora, J., Rigby, K., et al. (1998). Social Support in coping with alcohol and drug problems at home: Findings from Mexican and English families. Addiction Research, 6, 395-420.
7. Orford, J., Templeton, L., Velleman, R. & Copello, A. (2005b). Family members of relatives with alcohol, drug and gambling problems: a set of standardised questionnaires for assessing stress, coping and strain. Addiction,
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