Module II:Conducting a

brief intervention

How do you approach conversations about behavior

change with your patients?

Styles of communication

GuidingDirecting Following

Communication styles

Styles of communication

An example of directive communication

Styles of communication

Used with permission, University of Florida, Psychiatry Dept.

http://www.youtube.com/watch?v=2fdfzUS1qDc

Characteristics of directive communication

• Explaining why the patient should make the change

• Telling the person how they could change

• Emphasizing how important it is to change

• Persuading when meeting resistance

Styles of communication

Characteristics ofguiding communication

• Respect for autonomy of patient and their goals and values

• Readiness to change must be taken into account

• Ambivalence is common

• Targets selected by the patient, not the “expert”

• Expert is the provider of information (patient)

• Be empathic, non-judgmental, respectful

Styles of communication

Brief Interventions

• Brief interventions can be performed in as little 3 minutes

• Aimed to motivate those at-risk to change their behavior

• Aimed to motivate individuals with more severe risk to seek assessment/treatment

• Designed to provide personal feedback, enhance motivation, and promote self-efficacy to promote behavior change

Brief interventions

Steps of the brief intervention:

Steps of the brief intervention

Raise the subject

Provide feedback

Enhance motivation

Negotiate plan

Brief intervention: “Steve”

Steps of the brief intervention

http://www.youtube.com/watch?v=b-ilxvHZJDc

• Screening forms act as conversation starters

• Ask permission to raise the subject of alcohol/drug use

• “Thanks for filling out this form. Would you mind taking a few minutes to talk with me about your alcohol use and how it might relate to your ______?”

Raise the subject

Steps of the brief intervention

• Point out the patient’s zone of misuse.

• Explore connection to health issues if there is one and express concern(s)

• Educate about NIAAA Guidelines for low-risk drinking

• Use Elicit-Provide-Elicit Model

Provide feedback

Steps of the brief intervention

“On a scale of 0 - 10 , how ready are you to change any aspect of your drinking (drug use)?”

“Why did you choose that number and not a lower one?”

A strategy that helps the patient identify what motivation already exists towards making change.

Enhance motivation

Steps of the brief intervention

Enhance motivation

Explore pros and cons:

• What are some things you like about your drinking?

• What are some things you don’t like about your drinking?

Steps of the brief intervention

• Negotiate a plan on how to reduce use, abstain or seek referral

• Provide clear advice and express your concerns

• Negotiate and secure an agreement regarding changes the patient is willing to make, including scheduling follow-up when needed

Negotiate plan

Steps of the brief intervention

Readiness ruler

Readiness Ruler: front

Readiness Ruler: back

Readiness ruler

Recording the brief intervention

For clinician:

Clinician Name:___________________________ Date: _______________AUDIT Zone: ___________

Brief intervention given? Raised subject Not given Referral recommended Provided feedback Referral phone number: Enhanced motivation 1-800-923-4357 Negotiated plan

Practice: Richard

Form groups of three:

• Physician

• Patient

• Observer

Observer: Use the observation sheet and keep track of time

Practice