Intervention modelling has had a positive and sustainable impact on public health behaviours, as two case studies from the north of England detail.
Intervention modelling involves service providers forming partnerships with external suppliers to deliver services at their point of need. This model provides new pathways to reach hard-to-reach groups by adapting to the needs and circumstances of individual citizens through long-term programmes of work. It is already helping reshape social norms and supporting sustainable behaviour change on key public health issues such as smoking, obesity and alcohol misuse across the UK.
- The traditional method of public service delivery doesn’t promote sustainable behaviour change. However, intervention modelling provides the practical tools for a flexible, needs-based approach. It can be localised to different areas, running outside usual office hours.
- The evidence for the need and effectiveness of individual behaviour change interventions is found in the NICE guidance Behaviour Change at Population, Community and Individual Levels, which recommends that every contact with the public should be a health promoting contact.
- Taking this collaborative approach is vital to success. Services can build on best practice by sharing expertise through integrated networks, thus identifying wider needs and providing more cost effective solutions to tackle entrenched behaviours.
Promoting sustained behaviour change
Liverpool Primary Care Trust’s alcohol outreach project is one successful example of how the intervention model can work in practice. Following on from a successful year-long initiative which ran in north Liverpool, the project aims to engage, inform and advise people across the city who are at increased and high risk from alcohol as a result of excessive consumption.
It is delivered by full-time heath intervention workers alongside project support staff from social change specialists ICE. The team specifically targets hard to reach groups, identified as 35-55 year olds, who are more at risk of chronic illnesses and have the most impact on hospital admissions.
“We take this service out into the community, meeting people on their own terms and ‘on their turf,” explains Stuart Dodd, Liverpool PCT’s public health lead for alcohol. “It is a targeted approach which identifies people by profiling local health needs assessments and using an extensive network of statutory, voluntary and community organisations. A 10-point audit tool is used to assess current alcohol consumption behaviour and people’s readiness to change. If someone is within safe drinking limits, then the team talks to them about maintaining that behaviour and gives them bespoke information to take away.”
Jayne Hampson, executive director of social change at ICE continues, “But if an individual falls into the hazardous or harmful categories, we give them advice and support there and then to maximise the impact and reduce the possibility of them not following up.
“This is done through what we call a ‘validated brief intervention’. In these cases, appreciative inquiry and motivational interviewing techniques are used to examine their behavioural patterns around alcohol.
“Using digital innovations such as electronic hand held audit tools, the team not only accurately records their findings, but follows up participants to better understand how their attitudes, understanding and behaviours towards alcohol have changed following the screening. It also means we can offer sustained support through motivational messages, helping them self-manage through tools such as drinks diaries and habit-breaking plans, and signposting to the wider support services that are best suited to them.”
Over the nine month project, the team has conducted 4,330 direct screenings alongside more than 1,430 validated interventions. Mr Dodd says, “Crucially, the management team consists of behaviour change, social research and communication specialists who use theory and practical evidence and experience to manage the project from end-to-end. This includes scoping, mapping, building and maintaining networks, to delivering at grass-roots level and reporting back against key performance indicators. It’s a strategic approach which ensures we get best value and achieve maximum impact for both the community and the PCT.”
The intervention model has brought success for the Asgard project in north east Lincolnshire. This insight-led programme developed by North East Lincolnshire Care Trust Plus sought to support young people who were misusing health services and falling between the gaps in healthcare provision due to underlying issues such as health inequalities, teenage pregnancy, substance misuse, disrupted families and low aspiration.
Here, intervention workers work directly with 16-19 year old patients following their discharge from A&E to offer one-to-one support and advice on managing health issues.
The Asgard team work closely with a network of 37 different agencies and during a 12 month period, they have referred 76 per cent of young people, compared to a target of 50 per cent, into accessing the right service including housing support and mainstream contraceptive services.
The project has also helped reduce the number of frequent flyers (those presenting at A&E more than three times a month with inappropriate health and/or social care issues) by 11 per cent. This has generated a saving of £66,450, against a target of £12,500 for North East Lincolnshire Care Trust Plus.
Most recently, the initiative has gone mobile and is now dealing with referrals from other agencies, such as a local GP clinic in Grimsby. Specialist project lead and Asgard champion, Annie Darby, says, “Most of the young people come from home environments where health needs are a low priority. The Intervention Model allows the team to engage this group at their point of need, to address their low health and life aspirations, and support them with practical help and advice targeted to their individual circumstances. Another two GP practices have recently expressed interest in using Asgard workers, rather than traditional practice staff, to fulfil this role.
“At the moment, we’re also developing a cancer care programme, running in parallel with Asgard which opens up the channels to mothers and daughters. It’s based on the same model to help tackle non-attendance at screenings by pro-actively contacting those who fail to attend appointments, particularly mammograms and cervical cytology smears. Again, we are using individual one-to-one support and outreach work from specifically recruited health trainers to help individuals through screenings, ongoing tests and interventions.
“Similarly, we are working on an Outreach Immunisation Project for Hard to hard-to-reach families, proactively engaging with persistently defaulters to get immunisations done.”