Testing fidelity to a new psychological intervention for family members of substance misusers during implementation in Italy

Abstract

Providing treatment and help to family members of people with alcohol and drug problems is a new approach. In the UK, a new intervention—the ‘5‐Step Method’— has been developed, which has shown positive results in reducing family members' symptoms and improving their coping. This method has been utilized in Italy, also with positive results. This paper analyses 52 treatment reports compiled by the treating professionals, to examine how well the method has been introduced into the Italian sociocultural context. Information about the intervention from these treatment reports was grouped into categories by independent judges. These categories were analysed using univariate statistics, followed by multivariate dynamic analysis using STATIS, a multidimensional statistical methodology capable of analysing the temporal phenomenon (over the five sessions) in question. This methodology examined the resulting 3‐way matrix: cases, variables, and time. The analysis shows that the training was effective: the trained personnel did deliver the five steps and did do in each step what was suggested in the manual. It also suggests that some overall strategies, such as giving family members a plan and proposing up to five sessions with the family member are very helpful interventions. Suggestions for improving both the intervention, and for incorporating instruction in this method as part of initial professional training, are made.

• Training effectiveness
• family members
• 5‐Step method
• STATIS
• treatment evaluation
• drug and alcohol intervention

Acknowledgements

Thanks are due to: the Ministry of Health, General Management for Health Prevention, who funded this work; all the Italian general practitioners and Ser. T staff of Asl Napoli 1 who undertook interventions; Gabriella Ferrari Bravo, Coordinator of Centro per le Famiglie, Stefano Vecchio, Director of Servizio Dipendenze and Patrizia Iaccarino and Giuseppe Boschi, members of SIMG and coordinators of Arcipelago (associazione medici di famiglia), all of whom participated in all of the phases of this research; to Alex Copello, for help and assistance in the earlier stages of the project in Italy; and the other members of the ADF group as a whole (Jim Orford and Lorna Templeton) who, with Alex Copello and Richard Velleman, provided the ideas, methods and inspiration. Particular thanks are due to the family members who took part in the project and gave permission for their information to be used in this project.

The project was financed in Italy by the Ministry of Health, Prevention department, with the Department of Relational Sciences within the University of Naples (Federico II) directing the work, in collaboration with the Universities of Bath and of Birmingham, UK, and with the involvement of a number of professionals and services from the Italian national health system. The main collaborators were: Il Dipartimento di Scienze relazionali della Università Federico II (C. Arcidiacono, F. Procentese, E. Caianiello, U. de Georgio; P. Sarnacchiaro); il Centro per le famiglie (A. Vitiello; G. Fioretti; F. Laccetti); il Dipartimento Tossicodipendenze (S. Vecchio; A. Longobardo; A. Pastinese; L. De Simone, G. Silvestri, R. Stimolo, A. Capriello, G. D'Ascoli, P. Liccardo, L. Cappuccio, A. Caruso; A. Ascione); e Medici di medicina generale della città di Napoli, Asl Na1(G. Boschi, T. Ferrante, P. Miano, S. Porcaro, R. Barra., R. Capretti, B. Guillaro, V. Poeta, E. Simoncini, P. Iaccarino, C. Iavarone); l'Università di Bath, UK (R Velleman); l'Università di Birmingham, UK (A. Copello).

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Notes

1. They are termed IGPs to emphasize the distinction between them and UK GPs. IGPs are general doctors, working within a primary care setting. Unlike, for example, the UK situation where there are ‘walk‐in centres’, IGPs are the first reference for all medical problems, and all referrals on to mores specialist services come via them. Furthermore, in order for pharmaceutical prescriptions to be paid for (partially) by the health system as opposed to privately, all medical prescriptions must come from IGPs. Therefore, the IGP is very strongly connected to all aspects of patient care. Each IGP has a limited caseload (ranging between 700 and 2000). In Italy, all IGPs work as sole practitioners (there are no partnerships of a number of doctors, nor any ‘health centres’, nor any ancillary staff): they work with no nursing staff, health visitors, or other practice staff; and have no computerization. They refer into the more specific public health service (maternity, psychiatric and other hospital services) but are not part of the hierarchies or organizations which run these systems. IGPs have no appointment systems: people just attend and wait their turn; which contributes to the short average time that IGPs see their patients for

2. The percentages reported in this and subsequent Figures and Tables relate to whether an issue was raised or mentioned within each report, not as a function of the number of answers which were given in each report nor to the amount of time in each session given over to this issue (e.g. 60% means 60% of the 52 reports mentioned ‘x’).