Exploring the acceptability, adoption and appropriateness of alcohol screening and brief intervention (ASBI) in perinatal mental health services (ADAPT)

UK alcohol guidelines report "there is only limited evidence for the use of screening tools in pregnancy," and do not provide guidance for alcohol screening within Specialist Perinatal Mental Health Services (SPMHS). Globally, 1:10 women use alcohol during pregnancy, with one in 67 having a child with Foetal Alcohol Spectrum Disorder. The prevalence of alcohol consumption during pregnancy in the UK is 41%, amongst the highest globally. Perinatal mental health problems affect 27% of expectant or new mothers and can be associated with alcohol problems. Our pump-priming work with SPMHS identified gaps in service provision/ preparedness, including the need for training, validated screening instruments, and clear clinical pathways. The overall aim is to explore the acceptability, adoption and appropriateness of alcohol screening and brief intervention (ASBI) in SPMHS. Research questions: 1.How and when can a dialogue about alcohol consumption be embedded in clinical SPMHS appointments with women accessing SPMH services? 2.What are the views of service-users regarding their priorities of need from SPMHS care and how important is addressing alcohol problems compared with other health and lifestyle topics? 3.What are the preferences of service-users/partners regarding when, how and who should approach them about alcohol consumption? 4.What are the views of service-providers on provision of interventions and support for women accessing SPMHS s who are at risk of alcohol-related harms to their own health or the health of their infant? 5.What are health professionals views about when it would be appropriate to ask women about alcohol, and who might initiate these conversations? 6. Is Making Every Contact Count (MECC) a useful model for alcohol-harm prevention within SPMHS? Methods The study follows a mixed-methods design with four interconnected workstreams (WS): WS1: Scoping Review to synthesise implementation on alcohol screening and intervention within maternal and mental health settings. WS2: In-Depth Interviews with service-users and partners to explore perceptions of ASBI and MECC WS3: Focus Groups with healthcare professionals, clinical leaders, and ASBI implementers on feasibility, barriers, and training needs. WS4: Stakeholder Workshop to synthesise findings and co-produce recommendations for ASBI implementation. · Qualitative data will be analysed using the Framework Method, guided by the Theoretical Domains Framework and Proctor's taxonomy of implementation outcomes. Study duration: 15 months Pre-award: Initiation of scoping review and ethics (see Gantt) Months 0-3: Study set up, scoping review, ethics application and Public Advisory Group (PAG) creation Months 3-12: Recruitment and data collection Months 7- 14: Data analysis Months 12-15 Write up and results dissemination Anticipated Impact and Dissemination: This study will inform how ASBI can be implemented within SPMHS. Findings will support future funding applications to explore feasibility and acceptability of ASBI in SPMHS, followed by a definitive trial of effectiveness. Findings have the potential to identify harmful drinking patterns, improve clinical pathways, and reduce alcohol-related harm. Dissemination via peer-reviewed publications, conference presentations, policy briefings, and engagement with key academic and clinical stakeholders in maternal and mental health services and organisations working with women with lived experience. We will establish a collaborative working group to support future implementation efforts.