Implementation of 'First step' into Alcohol and Drug Services – A stepped-wedge cluster randomised trial

A prospective stepped wedge cluster randomised trial will be conducted. The design involves random and sequential crossover of clusters from standard treatment to First Step until all clusters have implemented First Step. First Step is a manualised brief intervention for substance use that consists of three modules delivered over two treatment sessions. It is delivered to clients as the first step of treatment prior to commencing standard treatment in outpatient, residential, day programs or withdrawal AOD treatment services. The delivery of brief interventions are currently not standard practice at service entry. Module 1 and 2 are usually delivered in the first session (30-60 minutes). Module 3 is typically delivered in one 30-45 minute session, 1-2 weeks after Module 1 and 2. Module 1 - Assessment/Feedback/Information: All clients entering the cluster will be asked to complete a pre-intervention online assessment of their substance use, mental and physical health, quality of life and functioning (outcome measures) before enrolment into the service. They are then asked to repeat this survey at 1 and 3 months follow up, regardless of whether they are still enrolled in treatment. The survey is automatically scored by a website, which also provides immediate feedback to clients and staff via email and SMS. The feedback incorporates figures, normative data, and hyperlinks to substance-related fact sheets and information sheets on common comorbid presentations. In Module 1, staff are trained to provide feedback to the clients using the feedback sheets to increase the client’s awareness of the extent and impact of their substance use. Psychoeducation is also offered to the client using relevant substance-related fact sheets and information sheets on common comorbid conditions. They also introduce and demonstrate the use of progress charts which the client receives when they complete outcome measures at one and three-months follow up. Module 2 - Motivational Interviewing: focuses on motivational enhancement and goal setting. Motivational interviewing techniques are used to build motivation and commitment to change. The client’s patterns of substance use are first explored, and the pros and cons of making a change/not making a change in their substance use are discussed. Options for change (reduce substance use or the potential harm associated with use) are then explored. The module ends with the client setting a substance-related goal using an implementation intention framework. These are supported by worksheets and information sheets. Module 3 - Targeted Coping Skills Training: explores risk profiles that may underlie the client’s substance use behaviours and provides training in 2-3 coping strategies to target them. It ends with the client setting a second substance use goal which incorporates coping, using an implementation intention framework. There are accompanying worksheets to assist clients to complete and practice their relevant coping strategies. Clients who complete First Step and request or require further treatment (based on the clinician's judgement) will continue counselling (see standard AOD care below) or be referred to more intensive treatment (e.g. residential) at the participating service or elsewhere All of the feedback/information/harm minimisation sheets/worksheets/resources provided as part of the intervention to both clients and counsellors were designed specifically for this study. First step will be delivered by AOD counsellors in each treatment site. They will be provided with a 2-day workshop on the First Step program one month before the intervention is due to commence at the site. Staff receive resources and weekly clinical supervision and support for 4 weeks post training.