Volume 6, No. 12, December 2008/January 2009
From Your Colleagues
David Boyd, HQE
Tribal Alcohol Screening and Brief Intervention (ASBI) Program
American
Indians and Alaska Natives suffer far higher rates of alcohol-related injuries
and deaths than any other racial or ethnic group. Trauma remains the largest
cause of death and disability in Indian country, especially in those between
15 and 44 years of age. The ASBI program was developed to help young adults who
are at high risk for alcohol-related injuries understand the connection between
their drinking and their current injury or medical problem.
WHAT
IS ASBI?
ASBI uses alcohol screening, brief feedback, and motivational interviewing with
young adults who arrive in Indian Health Service (IHS) trauma centers, emergency
rooms, or primary care clinics with an alcohol-related injury. Intervention at
these “teachable moments” can interrupt the alcohol–injury
cycle that causes so much personal, family, and community suffering.
WHO CAN PERFORM ASBI?
ASBI can be performed by any trained healthcare provider, including physicians,
nurses, social workers, and community health educators. The skills needed are
compassionate, nonjudgmental listening and the ability to guide patients to the
connection between their alcohol consumption and their injury.
WHO DOES ASBI TARGET?
Alcohol use occurs on a continuum, ranging from people who abstain to people
who are physically dependant. The ASBI program serves a specific subset of people––hazardous
and harmful drinkers–– who obtain medical care in IHS hospitals or
clinics. The National Institute of Alcohol Abuse and Alcoholism estimates that
20% of the U.S. population are hazardous/harmful drinkers (see Figure 1). Because
the rate of injury and death from alcohol-related incidents is much higher in
American Indian and Alaska Natives, the impact of this program on the behavior
of hazardous/harmful drinkers can be enormous.
Figure 1: Percent of people in the U.S. who are hazardous/harmful drinkers.
WHAT ARE THE GOALS OF ASBI?
The primary goal of this program is to reduce injuries and deaths in American
Indians and Alaska Natives by teaching them to take action to reduce their risks
from harmful or hazardous drinking. ASBI screening and intervention helps reduce
repeat visits to hospitals due to alcohol-related injuries and decreases health
disparities in behavioral health and chronic diseases. The ASBI program also
reduces harmful/hazardous drinking in patients who go to primary health clinics
with minor alcohol-related injuries.
HOW MUCH TIME DOES ASBI TAKE?
The screening and intervention process takes only 4–14 minutes. First,
healthcare providers use the 3-question AUDIT-C tool to identify harmful or hazardous
drinkers. Next, the Yale Brief Negotiated Interview is conducted to raise the
subject of drinking, provide feedback, enhance motivation, and negotiate possible
behavior change. This process results in a written drinking agreement for motivated
patients. Many ASBI programs also use a letter, phone call, or follow-up visit
to boost the effectiveness of the intervention.
HOW EFFECTIVE IS ASBI?
A large randomized controlled trial at a level 1 trauma center of injured persons
who tested positive for alcohol use revealed that alcohol use was initially reduced
in both the control and intervention groups at 6 months but remained reduced
in the brief intervention group at 1 year.
WHAT ARE THE NEXT STEPS?
The Indian Health Service has a 1.9 million service population, which includes
a considerable number of people who could benefit from this effective program.
In 2008, training of healthcare professionals in program techniques will continue
at national conferences and training sessions. Plans to monitor program implementation
and evaluate outcomes in current settings are underway. For system-wide implementation,
ASBI needs additional funding, further recognition, local community support,
and spread to primary care and behavioral health clinics.
For Additional Information Contact: David R. Boyd, MDCM, FACS, National Trauma Systems Coordinator; IHS Emergency Services; IHS; 801 Thompson Ave Suite 320; Rockville, MD 20852; David.Boyd@ihs.gov; (301)443-1557
Program Development and Support: The IHS-Tribal ASBI Program was developed by Dr. David Boyd, Dr. Anthony Dekker, and Dr. Jim Flaherty. The program is fully endorsed by the Area Office Chief Medical Officers and Behavioral Health Consultants and widely by clinicians throughout the Service Unit Clinics. It has also been supported with consultation and program assistance from National leaders in the field such as Dr. Larry Gentilello, Dr. Carl Soderstrom, Dr. Daniel Hungerford, Dr. Janet Selway, Dr. Carol Scumer, Dr. Gail D’Onofrio, Dr. Linda Degutis, Dr. Susan Boyd, and Ms. Carol Rottenbiller
Scott Giberson, IHS Headquarters
Indian Health Service HIV Testing Guidance and Resources are now available on-line
The IHS HIV Program is now able to provide guidance as well as other resources and templates for use by health care clinics to move forward in advancing HIV services toward more universal HIV testing. Many questions often arise about guidance from IHS regarding HIV testing. As we begin to develop more sites and clinics with successful HIV testing practices, we are able to formulate guidance to assist with implementation, advocacy and awareness. Please refer to the following url within the IHS HIV Website: http://www.ihs.gov/MedicalPrograms/HIVAIDS/index.cfm?module=testing&option=ihsGuidance .
Once you have clicked on this page, additional resources can be found by navigating through the top box which lists: “More HIV Testing and Guidance Information”.
Funding Opportunity: Comprehensive Alcohol Research Center on HIV/AIDS
The National Institute
on Alcohol Abuse and Alcoholism (NIAAA) is soliciting applications for funding
to launch a research center that looks at the relationship between alcohol and
HIV/AIDS.
The $2-million Comprehensive
Alcohol Research Center on HIV/AIDS grant will support establishment of a
research center that "is multidisciplinary, thematically integrated, synergistic,
and will serve as a national resource for NIAAA," according to the grant
announcement.
"NIAAA seeks to encourage basic research that can be translated into interventions in order to reduce infection and transmission of HIV," the agency noted. "NIAAA will give highest priority to research that will develop and test biomedical prevention technologies that apply basic knowledge of HIV infection to intervention strategies for preventing the spread of HIV between individuals and within communities in the context of alcohol use; and develop knowledge of the interaction between alcohol and new agents or drug regimens to prevent and treat comorbidities and comortalities (malignancies, liver and cardiovascular diseases, metabolic disorders, and other complications) associated with long-term HIV disease and antiretroviral treatment in the context of alcohol use." http://www.jointogether.org/news/funding/opportunities/2008/comprehensive-alcohol.html
Nonprofits,
for-profit entities, schools, governments, and others may apply. Application
deadline is May 1, 2009.
For full details, see the grant
announcement online.
Myra Tucker, CDC
Maternal and Child Health Journal Issue Dedicated to AI/AN Mothers and Children
The first Maternal and Child Health Journal issue
dedicated to AI/AN - Research for Maternal and Child Health Practice in American
Indian and Alaska Native Communities - was published recently. "It
has been the realization of a dream to bring this journal issue to fruition," explains
Myra Tucker, BSN, MPH (CAPT USPHS), and tribal liaison in the Division of Reproductive
Health (DRH). Working with journal editors and authors to produce this special
issue has been a natural partnership for DRH, which conducts a broad range of
surveillance, research, and programmatic activities to develop the evidence base
for improving maternal and infant health in the US.
Questions? Contact Ms. Tucker at mjt2@cdc.gov.
Abstract Of The Month ‹ Previous | Next › Hot Topics
OB/GYN
Jean Howe, MD, MPH is the Obstetrics and Gynecology Chief Clinical Consultant (OB/GYN C.C.C.). Dr. Howe is very interested in establishing a dialogue and/or networking with anyone involved in women's health or maternal child health, especially as it applies to American Indian and Alaska Native women and also indigenous peoples around the world. Please don't hesitate to contact her by e-mail (jean.howe@ihs.gov) or phone at (928) 674-7422.
Acrobat
MS Word
PowerPoint
