Screening and Intervention Programme for
Sensible Drinking
Staff Training for Intervention
Screening and Intervention Programme for Sensible Drinking
(SIPS)
INDEX
The Questionnaires ........................................................................................... 3
How these have been used in SIPS .............................................................. 3
1. The Short Alcohol and Alcohol Problems Perception Questionnaire .......... 4
How it has been used in SIPS ....................................................................... 4
2. Behaviour Change Counselling Index (BECCI) and Assessing Staff’s
Competence ...................................................................................................... 5
The Behaviour Change Counselling Index (BECCI) ...................................... 5
Scoring the BECCI ......................................................................................... 6
Application of BECCI ..................................................................................... 6
References ........................................................................................................ 7
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Screening and Intervention Programme for Sensible Drinking
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Staff Training and Intervention questionnaires
Monitoring the attitudes staff have regarding alcohol screening and brief
intervention, including the provision of care to those with alcohol use disorders,
previous experiences, perceived barriers or facilitating factors, is an important
part of the SIPS training programme. In order to monitor and assess these
aspects the SIPS team has developed three ad-hoc questionnaires partly based
on previous pilot work and from Babor et al (2005).
The Questionnaires
The Pre training questionnaire contains questions that elicit demographic
information as well as current role and seniority, workload and previous
training on alcohol and alcohol related problems SAAPPQ Pre Training
Questionnaire It takes only a few minutes to complete and it also includes the
Short Alcohol and Alcohol Problems Perception Questionnaire (see next section)
SAAPPQ Questionnaire
The Post training questionnaire is a follow-up to the questionnaire staff
completed prior to participation in the SIPS training program. It is designed to
assess their attitudes and beliefs towards patients with alcohol-related
problems. To measure any changes in attitudes since the training some of the
questions in the Pre training questionnaire are repeated. The questionnaire
begins with the SAAPPQ and continues with a series of 8 likert scale and
open ended questions on the perceived usefulness of screening for alcohol
problems and providing brief intervention in that specific setting as well as
eliciting the main perceived barriers. There are also 6 feedback questions
regarding the training session, and the questionnaire ends with a set of 8
multiple choice questions designed to assess that key information has been
conveyed (e.g. prevalence of alcohol use disorders in England, effectiveness
of brief intervention, understating of alcohol units). Overall it takes
approximately 10 minutes to complete SAAPPQ Post Training Questionnaire
The Post intervention questionnaire contains most of the questions asked in
the Post training questionnaire but has in addition other questions on the
experiences of implementing alcohol screening and brief intervention during
the 9 months period of participants’ recruitment into the SIPS trial.
Finally, although the questionnaires are not anonymous due to the need to
track individual changes in attitudes, only aggregate data will be used in
reporting the results of the surveys.
How these have been used in SIPS
At the very start of the training session participating staff were given an
information leaflet explaining the aims of the questionnaires and a consent
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Screening and Intervention Programme for Sensible Drinking
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form. Provided that they agreed to take part, the pre-training questionnaire
was distributed. Immediately after the training session, the post training
questionnaire was also distributed for completion before leaving the session.
The Post intervention questionnaire is distributed only after a setting has
recruited all the participants into the study. This period could range from a
couple of months to the maximum 9 months.
Expected outcome
These questionnaires will show changes, if any, in behaviour, attitudes and
management of people with alcohol use problems. They will also provide
further understanding and qualitative information of key issues around the
enabling or impeding factors as well as the experiences in implementation of
brief intervention, which might inform the ideal implementation model.
Moreover, the feedback on the training session and the outcome of the
multiple choice questions will be used to improve the training sessions and
tools further.
1. The Short Alcohol and Alcohol Problems Perception Questionnaire
The SAAPPQ is a 10 item, 7-point Likert-type questionnaire measuring the
attitudes of professionals towards the provision of care to those with alcohol
use disorders (SAAPPQ, Anderson and Clement, 1987; Appendix 14). The
SAAPPQ is a shorter version of the original AAPPQ (Cartwright, 1980).
The SAAPPQ measures two attitudinal dimensions – role legitimacy and
therapeutic commitment. ‘Role legitimacy’ refers to how professionals
perceive the adequacy of their skills and knowledge in relation to problem
drinkers and how appropriate it is for them to work with such clients.
‘Therapeutic commitment’ refers to the extent to which professionals seek to
engage drinkers in treatment and the extent that they find the work rewarding
on both a professional or personal level (Gorman and Cartwright 1991).
How it has been used in SIPS
The SAAPPQ has been adopted in the SIPS programme because of its
brevity and acceptable psychometric properties. Furthermore the SAAPPQ
has proved to be appropriate for evaluating attitude change among alcohol
health workers in screening and brief intervention studies in the UK (Oyefeso
et al., 2005; Anderson et al., 2004).
The SAAPPQ is being used in all SIPS trials to evaluate the impact of training
participants to deliver brief advice and brief lifestyle counselling (PHC only) on
their role legitimacy and therapeutic commitment in delivering these
interventions. The SAAPPQ is administered to participants pre- and posttraining
and after completion of all interventions.
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Screening and Intervention Programme for Sensible Drinking
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Expected outcome
We anticipate significant improvements in participants’ role adequacy and
therapeutic commitment attributable to brief intervention training and
continuous practice.
2. Behaviour Change Counselling Index (BECCI) and Assessing Staff’s
Competence
Previous studies have identified that the characteristics and competence of
therapists delivering alcohol treatment interventions are important elements in
improving successful outcomes. All too often it is believed that to adequately
train a practitioner, a workshop or training session will achieve the required
standard. However, training a clinician in behaviour change counselling is a
discreet intervention, or series of tasks, in itself. Behaviour change counselling
can be delivered by a number of different practitioners however, the training
package will need to reflect different needs, styles and settings. It will be rarely
appropriate to use a single workshop and different methodologies should be
explored such as; small group work, supervision, and observed practice, to
ensure any practitioner is appropriately skilled (Rollnick et al, 2000).
The Behaviour Change Counselling Index (BECCI)
The Behaviour Change Counselling Index (BECCI; Lane, 2002) is an
instrument designed for trainers to score practitioners’ use of Behaviour
Change Counselling in consultations BECCI. The instrument was
developed to measure the skills involved in behaviour change counselling and
is thought to have utility in both research and clinical practice. The BECCI has
been tested for reliability mainly on simulated consultations and has been
previously applied in similar studies (STEPWICE; Drummond et al, 2003).
The BECCI is designed to assess the skills of practitioners and is not
designed to measure patient outcomes. However, the patient’s behaviour
during consultations helps to assess the practitioner’s performance. The scale
contains 11-items related to practitioner behaviours and skills. Each item is
accompanied by a Likert scale to reflect the degree to which the action was
carried out: 0 = Not at all, 1 = Minimally, 2 = To some extent, 3 = A good
deal, 4 = A great extent. Additionally the proportion of time spoken by the
practitioner compared to the patient is assessed.
Importantly, it has been identified that due to the manner in which behaviour
change counselling is employed not all items on the BECCI Scale may be
utilised in one consultation. Three out of eleven items should only be scored
when these elements occur in consultations:
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Screening and Intervention Programme for Sensible Drinking
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

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the practitioner inviting the patient to talk about behaviour change ( item 1,
the patient requests information (item 9)
the patient and practitioner talk about possible methods (goals) of how
change can be achieved (item 11)
Scoring the BECCI
The main purpose of the checklist is to inform trainers and practitioners as to
the level of skills attained. Therefore it may be more valuable to consider
scores on individual items of the BECCI. However, an overall score can be
extracted to give a Practitioner BECCI Score. Full details are outlined in the
BECCI manual (Lane, 2002; )
Application of BECCI
SIPS recruited Alcohol Health Workers (AHWs) to deliver the SIPS brief
lifestyle counselling (BLC) within identified accident and emergency
departments (AED) and criminal justice settings (CJS). The AHWs also
recruited and trained primary health care (PHC) professionals to deliver BLC
in identified general practices.
AHWs recruited to the SIPS programme held Agenda for Change Band 6
posts and met the following requirements:


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A relevant professional qualification
Diploma in drug and/or alcohol studies, or equivalent
5 years post qualification experience; including 2 years practicing in the
alcohol/drug specialty
Previous level of knowledge of psychological interventions including
motivational interviewing in the trial underwent formal
The AHWs received formal training and regular supervision from the point of
recruitment. Supervision was facilitated by a consultant in addiction psychiatry
and supported AHWs on the attainment of appropriate clinical skills for the
delivery of BLC, orientating AHWs to different settings (AED, CJS and PHC),
recruitment and training of staff and adherence to the study protocol.
All AHWs participated in simulated consultations with actors. Simulated
consultations were recorded onto MP3 files for rating by three independent
clinical assessors. The independent clinical assessors were made up of two
consultants in addiction psychiatry and one consultant nurse in addiction.
AHWs were assessed for adherence to the SIPS BLC protocol as well as
behaviours and skills using the BECCI. Assessors submitted BECCI ratings,
comments and supervision points for each consultation. This information
informed training and supervision and further simulated consultations were
submitted until the required standard had been achieved and agreed by the
independent clinical assessors.
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References
Anderson, P. and Clement, S. (1987) The AAPPQ Revisited.
Measurement of general practitioners’ attitudes to alcohol problems.
British Journal of Addiction 82, 753–759.
Anderson, P., Kaner, E., Wutzke, S., Funk, M., Heather, N.,Wensing,
M., Grol, R., Gual, A. and Pas, L et al. (2004) Attitudes and managing
alcohol problems in general practice: An interaction analysis based on
findings from a WHO collaborative study. Alcohol & Alcoholism, 39,
351-356.
Canagasaby, A. & Vinson, D.C. (2005). Screening for hazardous or
harmful drinking using one or two quantity–frequency questions.
Alcohol and Alcoholism, 240(3):208-213.
Cartwright, A.J.K (1980) The attitudes of helping agents to the alcohol
alcoholic client: the influence of experience, support, training and selfesteem.
British Journal of Addiction, 77, 413-431.
Centre for Drug and Alcohol Studies. (1993) The Drink-Less
Programme. Sydney: Department of Psychiatry, Sydney University,
Australia.
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Drummond, C., James, D., Coulton, S., Parrot, S., Baxter, J., Ford, J.,
et al. (2003). The Effectiveness and Cost effectiveness of Screening
and Stepped-care Intervention for Alcohol Use Disorders in the Primary
Care Setting (STEPWICE Project). Final report to the Wales Office for
Research and Development. London: St. Georges’ Hospital Medical
School.
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Gorman, D.M. and Cartwright, A.K. (1991) Implications of using the
composite and short version of the Alcohol and Alcohol Problems
Perception Questionnaire (AAPPQ). British Journal of Addiction, 86,
327-334.
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Hodgson, R., Alwyn, T., John, B., Thom, B., Smith, A. (2002) The
FAST Alcohol Screening Test. Alcohol & Alcoholism, 37(1): 61-66.
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Lane, C (2002) The Behaviour Change Counselling Index (BECCI)
Scale. University of Wales
http://www.cardiff.ac.uk/sonms/resources/200302BECCIScale.doc
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Lane, C (2002) The Behaviour Change Counselling Index (BECCI):
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Manual for Coding Behaviour Change Counselling. University of Wales
http://www.cardiff.ac.uk/sonms/resources/20020930BECCIManual.doc
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McAvoy, B.R., Kaner, E.F.S., Haighton, C.A., Heather, N., Gilvarry, E.
(1997) Drinkless - marketing a brief intervention package in UK general
practice. Family Practice, 5: 427-428.
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Oyefeso, A., Jenner, J., Perryman, K. and Drummond, C. (2005)
Evaluation of alcohol screening and brief intervention among drug
intervention programme clients. Final Report submitted to the Home
Office, October.
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Patton, R., Hilton, C., Crawford, M.J., Touquet, R. (2004) The
Paddington Alcohol Test: a short report. Alcohol & Alcoholism, 39, 2668.
Rollnick S, Mason P, and Butler C (2000) Health Behaviour Change: A
Guide for Practitioners Edinburgh: Churchill Livingstone
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Saunders, J. B., Aasland, O. G., Babor, T. F., de la Fuente, J. R. &
Grant, M. (1993). Development of the Alcohol Use Disorders
Identification Test (AUDIT): WHO Collaborative Project on Early
Detection of Persons with Harmful Alcohol Consumption--II. Addiction,
88, 791-804.
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Williams, R., Vinson, D.C. (2001) Validation of a single screening
question for problem drinking. Journal of Family Practice, 50:307-12.
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