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
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
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