Module II: Conducting a brief intervention

1. Module II: Conducting a brief intervention

2. How do you approach conversations about behavior change with your patients? Styles of communication

3. Styles of communication Communication styles Following Guiding Directing

4. An example of directive communication Styles of communication http://www.youtube.com/watch?v=2fdfzUS1qDc Used with permission, University of Florida, Psychiatry Dept.

5. Characteristics of directivecommunication Styles of 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

6. 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 Characteristics ofguiding communication Styles of communication

7. 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 Brief interventions

8. Steps of the brief intervention: Steps of the brief intervention Raise the subject Provide feedback Enhance motivation Negotiate plan

9. Brief intervention: “Steve” Steps of the brief intervention http://www.youtube.com/watch?v=b-ilxvHZJDc

10. 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 ______?” Steps of the brief intervention Raise the subject

11. 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 Steps of the brief intervention Provide feedback

12. Steps of the brief intervention “On a scale of 0 - 10 , how ready are you to change any aspect of your drinking (drug use)?” Enhance motivation • “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.

13. Steps of the brief intervention • Explore pros and cons: • What are some things you like about your drinking? • What are some things you don’t like about your drinking? Enhance motivation

14. 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 Steps of the brief intervention Negotiate plan

15. Readiness ruler Readiness Ruler: front

16. Readiness ruler Readiness Ruler: back

17. 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

18. Practice: Richard Practice • Form groups of three: • Physician • Patient • Observer • Observer: Use the observation sheet and keep track of time