Building capacity of health and social services to deliver screening, brief interventions and referrals using WHO ASSIST technical package

Implementing Organization
World Health Organization
Description

Building capacity of health and social services to deliver screening, brief interventions and referrals using WHO ASSIST technical package, consisting of 

  1. The Alcohol, Smoking and Substance involvement Screening Test (ASSIST); 
  2. The ASSIST-linked brief intervention for hazardous and harmful substance use; and 
  3. Guide for self-help strategies for cutting down or stopping substance use. 
Background

The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) was developed for the World Health Organization (WHO) as a technical tool to assist with early identification of substance use related health risks and substance use disorders in primary health care, general medical care and other settings.  The unique features of the ASSIST instrument is its ability to identify substance use across different classes of psychoactive substances including synthetic drugs and demonstrated psychometric properties of the instrument.  The WHO ASSIST package includes three interlinked manuals: (1) The Alcohol, Smoking and Substance involvement Screening Test (ASSIST); (2) The ASSIST-linked brief intervention for hazardous and harmful substance use; and (3) Self-help strategies for cutting down or stopping substance use: a guide. The package of the three above-mentioned tools presents a comprehensive approach to screening for substance use and providing brief interventions and is designed to identify early stages of substance use (including synthetic psychoactive drugs, alcohol, nicotine), deliver brief structured prevention interventions or provide referrals to in-depth assessment or specialized services depending on the stage and patterns of substance use.  Although the package is particularly aimed at primary health care workers, it may also be useful for other health and social care professionals who work with population groups with high prevalence of substance use or increased risk of substance use, including synthetic drugs.   
 
The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST)  
The ASSIST-Linked brief intervention for hazardous and harmful substance use  
Self-help strategies for cutting down or stopping substance use (ASSIST)  

Accomplishments to Date

The ASSIST has been through three main phases of testing to ensure that it is a reliable and valid instrument in international settings, and able to link into a brief intervention.  


Phase I of the WHO ASSIST project involved the development of the first version of the ASSIST (version 1.0). The draft questionnaire had 12 items. The reliability and feasibility of the questionnaire items were assessed in a test-retest reliability study which was carried out in Australia, Brazil, India, Ireland, Israel, the Palestinian Self-Rule Areas, Puerto Rico, the United Kingdom of Great Britain and Northern Ireland and Zimbabwe. The sites were chosen to ensure that study participants would be culturally diverse and have different substance use patterns. The results showed that the ASSIST had good reliability and feasibility and was revised to an 8-item questionnaire (version 2.0) on the basis of feedback from the study participants to ensure that all items were easy to administer and understand. 


Phase II of the project was an international study to validate the ASSIST questionnaire in a variety of primary health care and drug treatment settings. Validity investigates whether a test is measuring the constructs and conditions intended to be measured. The study was carried out in Australia, Brazil, India, Thailand, the United Kingdom, the United States of America and Zimbabwe. Participants were recruited from both primary care and alcohol and drug treatment services to ensure that individuals with different substance use patterns were adequately represented. The study demonstrated that the ASSIST had good concurrent, construct, predictive and discriminant validity, including the development of cut-off scores for ‘lower’, ‘moderate’ and ‘high’ risk. The resulting questionnaire ASSIST v3.0 was finally revised to the ASSIST v3.1 for clinical use in health and welfare settings whereas the version 3.0 is advised to be used for research purposes. A pilot study also conducted at the same time demonstrated that participants recruited from primary health care settings did reduce their substance use if given a brief intervention related to their ASSIST scores. 


Phase III of the study consisted of a randomized controlled trial investigating the effectiveness of a brief intervention linked to ASSIST scores for moderate risk cannabis, cocaine, amphetamine-type stimulant or opioid use. Participants were recruited from primary health care settings and scored within the moderate risk range for at least one of these substances.  
The study was conducted in Australia, Brazil, India and the USA. The brief intervention lasted between 5 and 15 minutes and was based on the FRAMES model and incorporated Motivational Interviewing techniques. It focused on the delivery of personalized feedback regarding the participant’s ASSIST scores and associated risk through the use of a purpose-designed ASSIST feedback report card. The brief intervention was bolstered with take-home self-help information. The results showed that participants receiving a brief intervention for illicit substances had significantly reduced ASSIST scores after 3 months compared with control participants who did not receive a brief intervention for their substance use. Moreover, over 80% of participants reported attempting to cut down on their substance use after receiving the brief intervention and also provided positive comments on the impact of the brief intervention. 

Project Activities
  1. planning of capacity building and scaling up activities in collaboration with national authorities and professional groups; 
  2. adaptation of the WHO ASSIST package to the national context and, if necessary, translation following WHO procedures for assessment instruments; 
  3. update and adaptation of ASSIST training materials; 
  4. capacity building activities (workshops with duration from 2 to 4 days depending on the target groups) that may include training for health administrators and service managers as well as researchers; 
  5. integration of the training workshops into the national or subnational education/training and capacity building activities and, if appropriate, research activities. 
Global Level Outcomes

Strengthening evidence-base and further adaptation of the WHO ASSIST package and associated training materials to different settings and regions 

National Level Outcomes
  1. national adaptation of the WHO ASSIST package and associated training materials (if necessary); 
  2. trained health professionals and counsellors on ASSIST-based SBIRT implementation in different settings and their increased ability to intervene at early stages of substance use; 
  3. roadmaps on scaling up training and implementation activities with evaluation plans; 
  4. increased capacity of health administrators and service managers to support and scale up SBIRT for people using psychoactive drugs and other substances in health care settings; 
  5. increased capacity for the country-based research using SBIRT model and research implemented. 

Current State Participants 

Currently ASISST is implemented in many countries as a standard tool for screening and brief interventions. WHO is providing technical support on request, for example in 2023 trainings have taken place in Zimbabwe and Afghanistan. 

Contact

Vladimir Poznyak (poznyakv [at] who [dot] int (poznyakv[at]who[dot]int)) Dzmitry Krupchanka (krupchankad [at] who [dot] int (krupchankad[at]who[dot]int))