THE SCALA FRAMEWORK
the main outcome of SCALA, provides step-by-step guidance and issues to consider when implementing the SCALA 'ask and advise about alcohol' program through a primary health care system at the municipal level, to tackle the public health impacts of alcohol in Latin America and globally.

• SCALA FRAMEWORK

SCALA FIGSHARE
Access all the available data and papers through figshare here

SCALA INFOGRAPHIC
Click here to download the SCALA infographic

SCALA FINDINGS VIDEOS
Following the completion of a 6-month second implementation phase (Phase 2), to recover data lost due to disruption due to COVID, the lessons and findings from the SCALA experience have been condensed into 5 short videos.

The SCALA Study – tailoring a primary health care programme for alcohol and co-morbid depression:
 

Tailoring the SCALA programme to local contexts in Perú, Colombia and Mexico:
 

The SCALA Project in Latin America – Experiences, challenges and lessons from Peru, Colombia and Mexico.
 

The SCALA Project Outcomes – Can we improve alcohol and depression measurement in primary health care?
 

The Economic Outcomes – Is it worth investing in alcohol measurement in primary health care?
 

• Supplement to the SCALA Training Manual. Adapting face-to-face training in SBI for primary health professionals in response to a health crisis

• Cordis Summary: Countering heavy drinking and depression in Latin America

• Amy O’Donnell, Christiane Sybille Schmidt, Fiona Beyer, Margret Schrietter, Peter Anderson, Eva Jane-Llopis, Eileen Kaner and Bernd Schulte (March 2021). Effectiveness of digital interventions for people with comorbid heavy drinking and depression: A systematic review and narrative synthesis. Journal of Affective Disorders.

• Solovei A, Mercken L, Jané-Llopis E, Bustamante I, Evers S, Gual A, Medina P, Mejía-Trujillo J, Natera-Rey G, O'Donnell A, Pérez-Gómez A, Piazza M, de Vries H, Anderson P. (Nov 2021).Development of community strategies supporting brief alcohol advice in three Latin American countries: a protocol. Health Promot Int.

• Adriana Solovei, Jakob Manthey, Peter Anderson, Liesbeth Mercken, Eva Jané Llopis, Guillermina Natera Rey, Augusto Pérez Gómez, Juliana Mejía Trujillo, Inés Bustamante, Marina Piazza, Alejandra Pérez de León, Miriam Arroyo, Hein de Vries, Jürgen Rehm, Silvia Evers (2021).Costs of an Alcohol Measurement Intervention in three Latin American Countries. International Journal of Environmental Research and Public Health.

• Scoppetta, Orlando, DG, PhD; Anderson, Peter; Pérez-Gómez, Angusto; Mejia-Trujillo, Juliana, Mtr, Antr,PhD; Solovei, Adriana; et al. (Aug 2021).Feasibility of implementing alcohol health literacy tests in Colombia. Journal of Alcohol and Drug Education; Lansing Tomo 65, N.º 2, (Aug 2021): 61-85.

• Anderson, P., Manthey, J., Llopis, E. J., Rey, G. N., Bustamante, I. V., Piazza, M., ... & Rehm, J. (2021).Impact of Training and Municipal Support on Primary Health Care–Based Measurement of Alcohol Consumption in Three Latin American Countries: 5-Month Outcome Results of the Quasi-experimental Randomized SCALA Trial. Journal of general internal medicine, 1-9. doi.org/10.1007/s11606-020-06503-9

• Kokole, D., Mercken, L., Jané-Llopis, E., Rey, G. N., Arroyo, M., Medina, P., ... & de Vries, H. (2021).Perceived appropriateness of alcohol screening and brief advice programmes in Colombia, Mexico and Peru and barriers to their implementation in primary health care–a cross-sectional survey. Primary Health Care Research & Development. 22.E4. doi:10.1017/S1463423620000675

• D Kokole, L Mercken , E Jané Llopis , G Natera Rey, M Arroyo, P Medina, A Pérez Gómez, J Mejía Trujillo,M Piazza, I V Bustamante, A O’Donnell, E Kaner, A Gual, H Lopez-Pelayo, B Schulte, J Manthey, J Rehm, P Anderson, H de Vries (2021).Factors associated with primary health care providers’ measurement of their patients’ alcohol consumption in Colombia, Mexico and Peru. ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/wsub20 DOI: 10.1080/08897077.2021.1903658

• Jakob Manthey, Adriana Solovei, Peter Anderson, Sinclair Carr, Jürgen Rehm (2021) Can alcohol consumption in Germany be reduced by alcohol screening, brief intervention and referral to treatment in primary health care? medRxiv preprint doi: https://doi.org/10.1101/2021.05.18.21257405

• Amy O`Donnell, Bernd Schulte, Jakob Manthey, Christiane Sybille Schmidt, Marina Piazza, Ines Bustamante Chavez, Guillermina Natera, Natalia Bautista Aguilar, Graciela Yazmín Sánchez Hernández, Juliana Mejía-Trujillo, Augusto Pérez-Gómez, Antoni Gual, Hein de Vries, Adriana Solovei, Dasa Kokole, Eileen Kaner, Jurgen Rehm, Peter Anderson and Eva Jane Llopis (2021) Primary care-based screening and management of depression amongst heavy drinking patients: Interim secondary outcomes of a three-country quasi-experimental study in Latin America.

• Jané-Llopis E, Anderson P, Piazza M, et al. (2020) Implementing primary healthcare-based measurement, advice and treatment for heavy drinking and comorbid depression at the municipal level in three Latin American countries: final protocol for a quasiexperimental study (SCALA study). BMJ Open 2020;10:e038226. doi: 10.1136/bmjopen-2020-038226

• Anderson, P., O'Donnell, A., Kaner, E., Gual, A., Schulte, B., Gómez, A. P., ... & Rehm, J. (2017). Scaling-up primary health care-based prevention and management of heavy drinking at the municipal level in middle-income countries in Latin America: Background and protocol for a three-country quasi-experimental study.F1000Research, 6.

• SCALA Deliverable report D3.1 - SCALA Protocol. 2019

• SCALA Deliverable report D3.2 - Municipal Action Plans. 2019

• SCALA Deliverable report D6.1 - SCALA Engagement, Communication,Dissemination and Exploitation (ECDE) Plan. 2019

RAI. Reunión Anual de investigación del Instituto Nacional de Psiquiatría Ramón de la Fuente, Cuidad de Mexico, October 1st, 2021

• Natalia Bautista Aguilar, Perla Sonia Medina Aguilar, Guillermina Natera Rey, Miriam Arroyo Alejandra Pérez, Sergio Hernández - La gente no va a dejar de tomar por un consejo". Creencias del personal de salud sobre el consumo y la implemenatción de un programa de detección y consejo breve en APS.

SCALA Workshop, INEBRIA conference, Lübeck, September 1st, 2021

• Guillermina Natera, Perla Medina, Jakob Manthey, Dasa Kokole, Eva Jane, Peter Anderson, Miriam Arroyo, Alejandra Pérez - The impact of COVID-19 on alcohol measurement rates in primary health care (PHCCUs) in Mexico.

21st WPA World Congress of Psychiatry, Online August 1st, 2021

• Natalia Bautista Aguilar, Perla Sonia Medina Aguilar, Janeth Karina Ruíz González, José Antonio, Orozco Mata, Daniela Ríos Alonso, Sergio Alfredo Hernández Hernández, Guillermina Natera Rey - Health personnel' beliefs about the consuption of alcohol in the first level of care.Impact of the global public health crisis in the addictions field

PHCC Jalalpa, Online July 15th, 2021

• Miriam Arroyo - Alcohol en el embarazo.

The Pan American Health Organization (PAHO), SCALA Project: Implementing an Intervention for Alcohol Use Disorders in Latin America, June 28th, 2021

• Peter Anderson, University of Newcastle, UK and University of Maastricht, Netherlands - The role of primary health care in reducing alcohol consumption
• Jürgen Rehm, Center for Addiction and Mental Health, PAHO/WHO Collaborating Center, Toronto, Canada - SCALA in the global context. Implementation of screening and brief interventions, costs and benefits
• Augusto Pérez and Juliana Mejía, Nuevos Rumbos, Colombia - SCALA in Colombia: challenges and achievements.
• Marina Piazza and Inés Bustamante, Universidad Peruana Cayetano Heredia - Telemedicine and brief intervention of alcohol use disorders in primary care in times of COVID: SCALA project in Peru.
• Guillermina Natera and Perla Medina, PAHO/WHO Collaborating Center Instituto Nacional de Psiquiatria Ramon de la Fuente Muniz, Mexico D.F., Mexico - From theory to practice, lessons learned. The SCALA experience of Mexico.
• Peter Anderson, University of Maastricht, Netherlands- Outlook: beyond the implementation period.

RAI. Reunión Anual de investigación del Instituto Nacional de Psiquiatría Ramón de la Fuente, August 10th, 2020

• Arroyo Belmonte Miriam, Natera Rey Guillermina, Sánchez Hernández Graciela Yazmín, Pérez de León Alejandra, Bautista Aguilar Natalia, Medina Aguilar Perla Sonia, López Marroquín Scherezada, Hernández - Poster: Estrategia DIT en el primer nivel de atención para la prevención del consumo de alcohol: factores que favorecen la implementación.

INEBRIA conference, Online September 25th, 2020

• Guillermina Natera - La COVID, el alcohol y la depresión: ¿Qué pasó en México en el primer nivel de atención y las DIT, durante la pandemia?

XVII Cayetano Heredia Research Meeting – EPICAH, Lima, Perú, JULY 23rd, 2020

• Marina Piazza, Inés Bustamante, Liz Valentín - Opportunities and challenges in the implementation in primary care of an intervention to identify and reduce alcohol consumption problems in Colombia, Mexico, and Peru.

RAI. Reunión Anual de investigación del Instituto Nacional de Psiquiatría Ramón de la Fuente, October 11th, 2020

• Arroyo Belmonte Miriam, Natera Rey Guillermina, Medina Aguilar Perla Sonia, Pérez De León Alejandra, López Marroquín Scherezada, Bautista Aguilar Natalia - Poster: ¿Es difícil incorporar la detección e intervención breve del consumo de alcohol en el primer nivel de atención?: Necesidades y creencias del personal de salud.

Conmemoración del Día Nacional contra el uso nocivo de bebidas alcohólicas, Mexico, November 14th, 2019

• Guillermina Natera - Implementación de la detección oportuna del consumo de alcohol y depresión en el primer nivel de atención: una investigación internacional.

SCALA Workshop, INEBRIA conference, Lübeck, September 26th, 2019

• INEBRIA SCALA INTRO - Scale up of prevention and management of alcohol use disorders and comorbid depression in Latin America.
• Amy O'Donnell - Development of locally tailored intervention packages to address heavy drinking,depression and alcohol health literacy.
• Adriana Solovei - Assessing costs of SBI in Latin America .
• Jacob Manthey - Reducing disease burden with alcohol brief interventions in Columbia, Mexico and Peru: first results from a modelling study .
• Peter Anderson On behalf of all Scientists in the SCALA Project Consortium - Scaleup of prevention and management of alcohol use disorders and comorbid depression in Latin America, Design and Baseline Results.

Each municipality in the SCALA study has developed audiovisual communication material with the aim of raising awareness about common problems related to alcohol and reducing the stigma of talking about alcohol problems, in order to increase screening, detection of problems and disclosure of information.

PERU - Images, videos and radio spots related to 3 key themes: tuberculosis, unprotected sex and violence



       

Peru - Videos:
   

Peru - Radio spots:
   

Peru - Peruvian versions of Mexican materials

         

        

    

         

COLOMBIA - 2 types of videos - 1) short tutorials or 'capsules' explaining key definitions and ideas, and 2) videos with messages integral to the intervention on alcohol and depression

Colombia - Capsules - standard drinks + signs of depression
 

Colombia - Videos - various messages about alcohol, the risks of drinking and indicators of an alcohol problem
           

Colombia - Posters: 

         

 

         

 

      

 

MEXICO - Infographics and videos with messages related to alcohol and depression, including the importance of reducing alcohol consumption to prevent COVID-19 infection

Mexico - Infographics


      

    

    

     

    

    

    

 


Mexico - Videos - various messages about alcohol, weekly recommended limits and teh additional risk of drinking during confinement due to the COVID pandemic

  

Study arms 1, 2 & 3 (short form)

Protocol: Scale-Up of Prevention and Management of Alcohol Use Disorders and Comorbid Depression. Short form. EN.

Information sheet: Baseline Measurement Period. Short form. EN.

A Guide for Health Care Professionals: Screening and Intervention for Alcohol Use and Depression. Short form. EN.

Study arm 4 (standard form - collapsed with arm 3 in Nov 2020)

Protocol: Scale-Up of Prevention and Management of Alcohol Use Disorders and Comorbid Depression. Standard form. EN.

Information sheet: Baseline Measurement Period. Standard form. EN.

A Guide for Health Care Professionals: Screening and Intervention for Alcohol Use and Depression. Standard form. EN.

Care pathways

Simplified Care Pathway. Short form - Arms 123. EN.

Simplified Care Pathway. Standard form - Arm 4. EN.

Study arms 1 (control)

Protocol: Scale-Up of Prevention and Management of Alcohol Use Disorders and Comorbid Depression. Short form. EN.

A Guide for Health Care Professionals: Screening and Intervention for Alcohol Use and Depression. Short form. EN.

Study arms 2 (control with training) & 3 (short form programme)

Patient alcohol leaflet. Short and long form. EN.

Patient Brief Advice Leaflet. Short form. EN.

Patient depression leaflet. Short and long form. EN.

Study arm 4 (standard form programme - collapsed with arm 3 in Nov 2020)

Patient alcohol leaflet. Short and standard form. EN.

Patient Brief Advice Leaflet. Standard form. EN.

Patient depression leaflet. Short and standard form. EN

Study arms 1, 2 & 3 (short form)

Tally Sheets Cover Form. EN.

Very Short Tally Sheet. EN.

PHC Provider questionnaire. EN.

Drop out documentation. EN.

Study arm 4 (standard form - collapsed with arm 3 in Nov 2020)

Tally Sheets Cover Form. EN.

Short Tally Sheet. EN.

PHC Provider questionnaire. EN.

Drop out documentation. EN.

Study arms 1 (control)

Very Short Tally Sheet. EN.

Provided extended Tally Sheet. EN.

Patient consent to further questions. EN.

Tally Sheets Cover Form. EN.

Drop out documentation. EN.

PHC Provider questionnaire 3 month follow up EN.

PHC Provider questionnaire 13 month follow up. EN.

Patient questionnaire 3 months and 13 months. EN.

PHCC cost assessment 12 months. EN.

Study arm 2 (Control with training)

Very Short Tally Sheet. EN.

Provided extended Tally Sheet. EN.

Patient consent to further questions. EN.

Tally Sheets Cover Form. EN.

Drop out documentation. EN.

PHC Provider questionnaire 3 month follow up EN.

PHC Provider questionnaire 13 month follow up. EN.

Patient questionnaire 3 months and 13 months. EN.

PHCC cost assessment 12 months. EN.

Provider training documentation. Training and Booster. EN.

Provider Training questionnaire Training1. EN.

Provider Training questionnaire Booster 2. EN.

Study arms 3 (Short form programme)

Very Short Tally Sheet. EN.

Provided extended Tally Sheet. EN.

Patient consent to further questions. EN.

PHC Provider questionnaire 3 month follow up EN.

PHC Provider questionnaire 13 month follow up. EN.

Patient questionnaire 3 months and 13 months. EN.

PHCC cost assessment 12 months. EN.

Provider training documentation. Training and Booster. EN.

Provider Training questionnaire Training 1. EN.

Provider Training questionnaire Booster 2. EN.

Provider questionnaire 3 month follow up. EN.

Provider questionnaire 13 month follow up. EN.

Study arm 4 (Standard length programme - collapsed with arm 3 in Nov 2020)

Provided extended Tally Sheet. EN.

Patient consent to further questions. EN.

PHC Provider questionnaire 3 month follow up EN.

PHC Provider questionnaire 13 month follow up. EN.

Patient questionnaire 3 months and 13 months. EN.

PHCC cost assessment 12 months. EN.

Provider training documentation. Training and Booster. EN.

Provider Training questionnaire Booster 2. EN.

Short Tally Sheet. EN.

Provider questionnaire 3 month follow up. Standard version. EN

Provider Training questionnaire Training1. Standard version. EN

Provider Training questionnaire Training2. Standard version. EN

Provider Training questionnaire Booster. EN

Municipality – Data collection Sheet. [Ins1]

Primary Health Care Center - Data Collection Sheet. [Ins2]

Primary Health Care Provider – Contact Documentation. [Ins3]

As well as collapsing arms 3 and 4 following evidence of the longer intervention not performing better than the shorter one, a second implementation stage of 6 months (phase 2) started in December 2020 running to May 2021 to recuperate data lost through COVID disruption - given the mental strain put on populations at this time, several of the instruments and clinical materials have been adjusted for this stage to give a greater emphasis to depression screening and support delivery in the intervention package by screening all patients visiting PHC for depression using the PHQ2 instrument (as opposed to only patients identified as heavy drinkers). This necessitated changes to the clinical care pathway, to the short and extended tally sheets, and to the healthcare professional booklet:

Phase 2 clinical materials

• Revised Clinical Protocol
• Healthcare Professionals booklet

Phase 2 instruments

• Overview of Phase 2 instruments
• Extended Tally Sheet
• Short Tally Sheet
• Baseline provider questionnaire
• Follow up provider questionnaire
• Patient questionnaire

In response to the physical lockdown of PHC units, the SCALA partners in Peru (UPCH) developed online versions of the training and intervention package for future implementation. The telemedicine package uses responsive online versions of the key clinical materials that are accessible and viewable via smartphone as well as web browser (in Spanish):

• Short alcohol leaflet for patients (Mat11)
• Patient alcohol leaflet(Mat10)
• Depression leaflet (Mat9)

SCALA training manual. Short version. EN

SCALA Training package Session 1. Short version. EN.

SCALA Training package. Booster session. Short version. EN.

SCALA training manual. Standard version. EN.

SCALA Training package Session 1. Standard version. EN.

SCALA Training package Session 2. Standard version. EN..

SCALA Training package. Booster session. Standard version. EN.

The SCALA training videos are designed to model the screening and brief intervention approach of the SCALA programme for the management of alcohol problems and co-morbid depression in primary care. The videos are all in Latin American Spanish

Videos for standard form training:

SCALA Video 1a - Screening Pedro: +alcohol, - depression +alcohol, - depresión




SCALA Video 1b - Brief intervention - Pedro: +alcohol, - depression


SCALA Video 2a - Screening - Paola: +alcohol, + depression


SCALA Video 2b - Brief intervention - Paola: +alcohol, + depression


SCALA Video 3 - Feedback and referral - Ana-María: +alcohol, ++ depression



Videos for short form training:

SCALA Video A (short form) - Screening negative - Sofia: - alcohol


SCALA Video B (short form) - Screening and brief advice - Juan: + alcohol, -depression


SCALA Video C - Javier: patient resists remission/reference - alcohol++