Implementation and effectiveness of an early intervention program (QuikFix) for young people experiencing alcohol and other drug-related harm

Approximately 50% of the alcohol and drug clinicians (n = 10) across seven sites will be trained in the risk-targeted QuikFix intervention. The 1-day training (8 hours) will involve a face to face group workshop facilitated by 1 experienced clinical psychologist and 2 psychologists. It will be delivered twice, with smaller groups of clinicians (approximately 5 clinicians). The training will cover (1) a refresher of motivational interviewing, assessment feedback, and psychoeducation, (2) developing a QuikFix plan targeted to personality styles, (3) effectively using the telehealth model of QuikFix (phone intervention and 'Clinical Companion' website), and (4) integrating QuikFix into clinical practice. Participants randomly assigned to clinician will receive either personalised assessment and feedback via email and usual care, or 2-3 sessions of the telephone-delivered QuikFix intervention using the e-QuikFix 'Clinical Companion' website. (i) Brief Risk-Targeted QuikFix Intervention: The Brief Risk-Targeted QuikFix intervention involves a psychological risk-targeted assessment and feedback, motivational interviewing, and cognitive-behavioural coping skills training components. These are delivered over the phone and using a e-QuikFix ‘Clinician Companion’ website. The intervention is designed to target how individuals with specific psychological risk factors cope with their vulnerability to alcohol and other drug (AOD) use. It is not intended to change these risk factors, but to alter specific alcohol and other drug-related behaviours. In Session 1, participants are given personalised assessment and feedback via email, which not only includes a focus on alcohol or drug use, but also includes psychoeducation about their dominant psychological risk factor (anxiety proneness, depression proneness, impulsivity, or sensation seeking), associated problematic coping behaviors (e.g. avoidance, aggression, risky behaviors), and how this may affect their alcohol and other drug use. Using an motivational interviewing style and the e-QuikFix ‘Clinician Companion’ website, therapists guide individual exploration of the personal relevance of these issues using the e-companion tool. Participants are given information on alcohol or other drug harm minimisation strategies and are encouraged to think about how they could have used some of these strategies to prevent the recent alcohol or drug-related injury or illness which resulted in them accessing support care services. The intervention encourages them to develop implementation intentions, a technique based on the Theory of Planned Behavior. Implementation intentions are specific hypothetical or actual plans for change, which take the form “if situation Y is encountered, I could use Z coping behaviour, in order to achieve my alcohol use goal”. Young people are guided to develop an implementation intention for future AOD use situations. They are asked to identify an alcohol or other drug use situation in which they could test this plan in the next week and are asked to rate their level of confidence (1-10) in implementing the plan. They recall past successes in behaviour control to build their self-efficacy, and they identify and address any potential impediments. For homework, they are encouraged to implement their alcohol or drug use plan, and are emailed a session summary and a brief SMS message as a reminder. The plan and additional resources are emailed to young people at the end of the session. In Session 2, the young person’s success in implementing their alcohol or drug use plan is reviewed and if necessary, the plan is revised. They then receive risk-targeted training in two cognitive behavioural coping skills guided by the e-QuikFix ‘Clinician Companion’ website. Those predominantly with anxiety proneness are given training in mindful breathing and thought awareness and acceptance training for anxious thoughts. Individuals high in depression proneness receive behavioural activation and thought awareness and acceptance training for depressive thoughts. Sensation seekers receive training in savouring techniques to increase their awareness and ability to focus on and experience positive feelings from everyday activity (e.g. mindful eating) and are encouraged to identify and schedule natural highs from functional activities (e.g. exercise, skateboarding, rock climbing) and daily experiences (food, sex, music). Participants with high levels of impulsivity receive mindfulness training to increase awareness of their thoughts and are encouraged to apply the Stop-Think-Do rubric to help them slow down their decision-making processes sufficiently to consider likely outcomes of behavioural alternatives. Session 2 concludes with participants developing an implementation intention for future alcohol or other drug-related situations, which incorporates their specific coping skills. They are encouraged to rehearse this plan in session, and identify and address potential impediments. A session summary of their QuikFix plan is subsequently sent via email as well as the coping tools. Finally, the clinician then makes 2 brief phone calls (maximum 30 minutes) at 2 months post-baseline to check in with the young person and remind them of session content. The 2 sessions are designed to be delivered over a period of 2 weeks, however, the sessions can be delivered over a maximum of 4 weeks as flexibility in the implementation of these sessions is considered important as the intervention is being delivered in a clinical setting.