Embedding innovation in the development of a national, integrated alcohol service

 Background

The Irish Health Service Executive defines Integrated Alcohol Services as specialist services operating in community settings providing psychosocial and therapeutic interventions and developing integrated care pathways between acute and community-based services. Findings from a literature review on the delivery of alcohol services noted that evidence for standalone on-line services was lacking but where technology was used to supplement services, the evidence of efficacy was stronger.  The aim of this study was to provide recommendations on the design of a service given the review and a consultation with regions piloting an integrated service. Ethical approval was granted. 

Method

Underpinned by the “People First Framework” a concurrent, qualitative dominant, mixed methods design was adopted. Participants interviewed represented several groups including those who had accessed alcohol related services (n=10), alcohol service providers (n=12), individuals who accessed other alcohol services (n=8) and finally families, friends and supporters of those who had accessed alcohol services in the past (n=16). 

Results

Improving access arose as a common theme from all stakeholders. Access to professionals and services were restricted in some circumstances due to operational hours, unplanned discharges from hospital, and the locations of services particularly for those living in rural areas and those with complex care needs. While face to face appointments were seen as the optimum, to address this barrier a more flexible hybrid model of service delivery was recommended. All stakeholder groups highlighted the urgent need to standardize the service users’ journey as the pilot service was further developed and scaled up. It was recommended that stakeholders agree a shared value system, shared models of care and assessments, with agreed care pathways and processes meeting the varying levels of client need. To address legacy issues including stigma, on-line resources could be utilized to provide general awareness and terminology upskilling for all. It was recommended that these could be in the form of brief “Hello my name is”… videos or virtual reality messaging.  Some family members indicated strong support systems and others noted a lack of same. This varied according to the region. The further development of the hybrid model and video messaging was seen as having potential to support families.

Conclusions

Overall, the pilot model was viewed as building trust, was non-judgmental with a flexible and integrated approach. To scale-up, the development of a sustainable, pro-active, monitored and evaluated service , with an innovative hybrid model, interactive tools, which would reduce duplication and offer value for money was recommended.