Alcohol Screening and Brief Intervention Becomes Routine Practice in Alaska’s Public Health Nursing Clinics

The Arctic FASD RTC and the Section of Public Health Nursing (PHN) in the Alaska Department of Health and Social Services collaborated to find the best way to implement alcohol SBI. They developed and refined the intervention by using a planning team that included administrators, frontline nurses, and people knowledgeable about SBI. The team worked to

• Choose appropriate screening tools
• Decide when and how often to conduct the screening
• Identify documentation and follow-up procedures

Screening is a routine part of the work public health nurses do. To screen adults for alcohol use, many screening tools [PDF - 2.10MB] are available. The team decided to use a set of questions known as T-ACE [PDF - 64KB] but modified them with questions developed by the National Institute on Alcohol Abuse and Alcoholism regarding how often and how much alcohol is used. To screen adolescents, the team selected a set of questions known as CRAFFT [PDF - 31KB]. Because scoring procedures were similar, the plan was for nurses to work both tools into routine practice.

The screening questions were then tested with patients to determine how often and at what types of clinic visits screening should occur. This information helped the program understand the implementation challenges and determine what really worked in primary care clinics. Asking the nurses to screen for alcohol use as a part of their routine services was initially met with some resistance and hesitancy. "It's so private, and there's so much stigma around it," was one nurse's reaction. Also, it added yet another screening to nurses’ already packed schedules. Screening patients' alcohol use and conducting brief interventions with those who were drinking too much required both buy-in from the nurses and training to improve their skills and confidence.

Alaska's public health nurses have reported successes in interacting with patients and developing their own unique styles to conduct alcohol SBI. “We should be asking these questions,” one nurse said. “I think it's right in there with our usual screenings or questions that we ask people regarding their well-being and health habits."

Nurses now perform alcohol SBI whenever people visit the clinics for family planning, sexually transmitted infections, or tuberculosis. The involvement of a team with different roles and perspectives has helped make this effort a success.

Building on this success, Alaska PHN integrated alcohol SBI into all 22 of Alaska’s public health centers and more than 240 villages across the state. It took 15 months of training and procedural changes to incorporate alcohol SBI into clinical practice for more than 180 staff members. Since July 2014, alcohol SBI has been part of routine screening in Alaska's public health nursing practice.