Interview with Angelina Brotherhood in Polish magazine for drug professionals

The November Swiat Problemowissue of „Świat Problemów” (nr 11/2014; http://www.swiatproblemow.pl) features an interview with EDPQS project researcher Angelina Brotherhood. The interview was conducted by Artur Malczewski of the National Bureau for Drug Prevention (NBDP), Poland. It took place in the context of the Bureau’s most recent annual conference in Warsaw, which was devoted to quality standards in prevention, with EDPQS partners from different countries sharing their experiences and insights (see previous blog entry).

The interview was published in Polish in print and on the webpage of „Świat Problemów”: http://www.swiatproblemow.pl/2014_11_1.html

The editors of „Świat Problemów” have kindly given permission to publish the English version of the interview below.

“Translating standards into practice”

Artur MALCZEWSKI of the National Bureau for Drug Prevention talks to Angelina BROTHERHOOD of the Centre for Public Health, Liverpool John Moores University, about European Drug Prevention Quality Standards.

Artur Malczewski: What is EDPQS? Why may this kind of document and partnership be useful for prevention in Europe and European prevention specialists?

Angelina Brotherhood: EDPQS stands for European Drug Prevention Quality Standards. We – that is, the Prevention Standards Partnership (1) – produced these quality standards between 2008 and 2011 in a project co-funded by the European Union, and the standards were then published by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). We developed the standards by reviewing existing standards for drug prevention activities, and by consulting with over 400 people working in drug prevention in six European countries. The idea behind the EDPQS was that they would define what ‘high quality’ means with regard to drug prevention – what we should expect from drug prevention activities. At the European level, before the EDPQS there was no definite consensus about what high quality drug prevention should look like.  So the EDPQS provide a common reference point for all European countries, based on a European consensus.

Who is the main target group for the EDPQS Manual? Can you highlight one or two main groups? 

We wrote the standards so that they would be relevant to everybody working in drug prevention. This is why we involved many different professional groups when developing the standards. From the beginning of the project, people who commission and fund drug prevention activities have been a main target audience for the EDPQS. Based on the feedback we have received since publishing the standards in 2011, it seems that two additional professional groups find the standards especially useful. The first group consists of prevention coordinators at local, regional and national levels. They use the standards to promote high quality prevention in their area of influence – for example, this would include the work of the Polish National Bureau for Drug Prevention to promote the EDPQS (2). The other group consists of service managers and programme developers. They can benefit from using the standards to identify strengths and weaknesses of their services and programmes. However, the challenge for this group is that they need guidance on how to use the standards. Practitioners can be quite sceptical about standards, but if you introduce the standards in a face-to-face meeting, discussing also how the standards apply to their concrete prevention projects, and if you address their concerns, we find that the feedback is very positive. We are currently developing materials to support different groups to apply the standards in a practical way.

Why do we now have a second phase of the project? Compared with the first phase, the partnership is much bigger, as we now have 16 institutions involved in the project.

The first phase of the project finished in 2011 with the publication of the quality standards by the EMCDDA. This was a big book with more than 200 pages. In the consultations with drug prevention professionals, it became very clear that if we didn’t undertake any follow-up activities, the book would just end up ‘on the bookshelf’ without having any impact on the quality of prevention in Europe. Instead, we were advised that we should keep promoting it, to make it widely known and used in practice. We also identified the need for user-friendly support materials which are targeted at specific professional groups, such as service managers or commissioners. This is what we’re focusing on in the second phase. This year we undertook additional consultations about how to promote use of the standards and we’re currently developing toolkits to complement the big book. The second phase also offered the opportunity to include new partner institutions who had expressed an interest in promoting quality standards but who had not yet participated in the first phase.

What do you think, what is the best approach to use standards in a practical way?

The really important thing here is to address misconceptions about how the standards should or shouldn’t be used. Many people are worried that introduction of quality standards will mean more administrative work, more bureaucracy, or that they will lose their funding. Our work with prevention practitioners suggests that the standards can be used in a much more positive way if they are seen as a practical tool to identify strengths and weaknesses of prevention activities. This is what we’re trying to promote through the support materials being developed in the second phase. This means that you can identify areas in your work that are in line with what is considered good practice at the European level. And the EDPQS also help you to identify areas for improvement in the future. Ultimately, all prevention providers want to do what is best for their target populations, and the EDPQS help them to do that.

We have just finished the EDPQS conference in Warsaw. What is your impression about it? Do you think that EDPQS will be useful in Poland?

The conference in Warsaw was a very useful event to promote the EDPQS and discuss their use in Poland. We had several speakers from the Prevention Standards Partnership who gave their views on the EDPQS. The questions from the audience suggested that there is a great interest in Poland in promoting quality in prevention, an interest towards evidence-based prevention. Several people said after the conference that they would be interested to offer training on the EDPQS in their local communes. There seems to be some insecurity about how the existing national standards and the national recommendation system in Poland can help to inform prevention practice in the country. I think the EDPQS can help to promote the national recommendation system, as they contextualise these national efforts as part of a broader European effort to promote quality in prevention. They help people to see that what is going in this country is in line with what is happening in other countries. In addition, the EDPQS are more detailed and more comprehensive than existing national resources, and so they can help Polish prevention professionals to achieve the national standards. Overall, I’m very pleased with how the conference went and I’m grateful that I was given the opportunity to present the EDPQS in person to Polish prevention colleagues.

You have been working in both phases of the projects. There are a lot of countries with different approaches to prevention. What was the biggest challenge for you?

I guess the greatest challenge has been to transfer the standards from paper to practice, which also requires making them attractive for the people working in the field. In the first phase of the project we focused primarily on establishing a consensus on high quality drug prevention in Europe. The resulting book will be useful to some professionals, but these are more likely to be highly motivated individuals who already know a lot about best practice in prevention. The book itself is not a sufficiently strong motivator to reach and produce change in those people who really need to learn more about quality in prevention. However, forcing the standards onto practitioners ‘from above’ can produce resistance and result in only superficial engagement with the standards. Our own experiences as well as the existing literature suggest that people will be much more likely to change their behaviour if they believe that the new practice is better than the old practice. If practitioners see the standards as a useful tool with clear benefits, it will mean that they want to use them and engage with them at a deeper level. But how to achieve this is something that we are still exploring. It’s an important aspect in the current phase of the project and will form the corner stone of any future EDPQS projects. The different approaches to prevention in Europe are relevant in this context, as target audiences want to see that the EDPQS are relevant in their specific context. At a more general level, however, different prevention approaches are not a barrier to standards implementation because the EDPQS aim to standardise the level of quality in prevention, they don’t dictate what approaches should be used. Also, prevention professionals from different countries frequently reported similar issues and concerns during the consultations, highlighting similarities rather than differences between European countries when it comes to raising the quality of prevention.

The Italian presidency has just started to work on promoting EQUS. What will be the role of EDPQS in EQUS?

To answer this question, it’s important to remember the differences between EQUS and EDPQS. The minimum European Quality Standards (EQUS) offer a short list of quality standards addressing different areas of drug demand reduction, not limited to prevention but also including treatment and harm reduction. Their main purpose is to offer a consensus document on minimum quality standards that could receive political support from national and international policy-makers across EU Member States. The EDPQS are different in that they focus only on prevention. Although they offer minimum standards, they also define a higher level of quality – you could say: the gold standard. They are therefore more detailed and comprehensive than EQUS. As I mentioned earlier, the EDPQS are intended as a tool for everybody working in prevention, especially practitioners. However, there is overlap between EQUS and EDPQS, as the prevention standards in EQUS were developed based on EDPQS. Therefore, we see EDPQS as a document that complements EQUS as a more in-depth resource. At the moment, there is a project ongoing to develop EQUS further to make it more relevant to the national policy-making level. We are collaborating with the colleagues at the Italian and forthcoming Latvian presidency to support this activity and to promote the use of quality standards.

Do you think that EDPQS could be used also for alcohol prevention?

Yes, definitely. The EDPQS were developed by synthesising 19 existing documents with national and international standards. Although we didn’t search specifically for quality standards in alcohol prevention, some of the included documents did explicitly target alcohol and drug prevention activities. Similarly, the people we consulted did not always work just in the illicit drugs field but typically had a broader remit in their work. I think this reflects the fact that prevention doesn’t have to address any specific substance. It may even be the case that substances are not mentioned at all. In reality, many standards within the EDPQS would be relevant for any kind of health or social intervention. This is because the EDPQS focus less on the content of interventions, and more on the structures and practices to enable high quality interventions (3). So although the topics may be different, the structures and practices required for a high quality intervention are actually very similar – for example, the importance of conducting a needs and resource assessments prior to implementing an activity. However, if we are specifically interested in alcohol prevention, then some standards, for example on substance use indicators, would need to be tailored to meet the specific requirements of alcohol prevention.

Where can interested prevention professionals find more information about the EDPQS?

We have a project website http://www.prevention-standards.eu including a lot of information in English as well as selected materials translated in Polish and other languages. The National Bureau for Drug Prevention as well as the Masovian Center for Social Policy have been our project partners in Poland, and they can be contacted for further information. A quick guide to the standards in Polish will be published by these organisations at the beginning of 2015. We expect that the toolkits resulting from the second project phase will also be made available in Polish.

Thank you for the interview.

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1. The Partnership currently comprises 16 organisations, led by Professor Harry Sumnall of the Centre for Public Health.

2. A Polish translation of the Standards is available at www.cinn.gov.pl/portal?id=15&res_id=454227

3. In the Standards, “intervention” refers to any action or series of actions carried out in (direct) contact with the target population in order to achieve a particular outcome (e.g. to prevent or reduce drug use).