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Using Brief Intervention Strategies for Health Behavior Change
February 18, 2015
Pam Pietruszewski, MA
Integrated Health Consultant
National Council for Behavioral Health
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Quick Reminders
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Open and hide your control panel
Join audio:•Choose “Mic & Speakers” to use VoIP•Choose “Telephone” and dial using the information provided
Submit questions and comments via the Questions panel
Note: Today’s presentation is being recorded and will be provided within 48 hours.
Your Participation
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Asking Questions
• Please continue to submit your text questions and comments using the Questions Panel
• Please raise your hand to be unmuted for verbal questions.
Your Participation
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Prochaska &
DiClemente 1983
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The most effective intervention is one that meets the person where he or she is at –
awarenesssmall change
reflection on a change big change
maintaining a change
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Brief Interventions5 – 30 minute engagements
http://www.integration.samhsa.gov/clinical-practice/sbirt/brief-interventions
Helps patients to accept more intensive treatment
for those who might benefit
Helps patients to understand, motivate, &
reduce risk for health problems
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Self-Management
Increased skills
+
Confidence, ability to make changes
=
Improve outcomes and decrease costs
Bodenheimer, T., et al.,JAMA 2002
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Specific Interventions
Motivational Interviewing
Brief Negotiated Interview
Behavioral Activation
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Motivational Interviewing
Partnership
Evocation
Compassion
Acceptance
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• Open-Ended Inquiry• Affirmations• Reflections• Summaries
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Open Ended Inquiry
• What is most important to you right now about your health?
• How were you able to successfully lose weight in the past?
• What would need to happen for you to begin an exercise program? Tell me more about your life at that time.
• If you could see into the future with your tobacco cravings controlled, what would that look like?
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Affirmations
Accepting
Adaptable
Alert
Ambitious
Assertive
Brave
Careful
Committed
Considerate
Creative
Determined
Eager
Faithful
Flexible
Focused
Forgiving
Hopeful
Ingenious
Mature
Open
Patient
Persistent
Reasonable
Reliable
Steady
Strong
Thorough
Trusting
Truthful
Willing
Attributes of Successful Changers
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• Statements. Not questions• What you hear, what you observe• Not problem solving or advice• Tool to express empathy• Indicates active listening
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Reflections
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Summarizing
• Collect, link, transition• Validating• Helps if conversation is stuck or unproductive• What will I put in the bouquet?
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I want to feel better
If I got this under control I could…
I’ll think about it
Nothing works I’m hopeless
Change Talk
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1. Raise the subject
2. Provide feedback
3. Enhance motivation
4. Develop a plan
Brief Negotiated Interview
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Raise the Subject
• Ask permission
I’d like to take a few minutes to review
the results, is that ok with you?
• Elicit pros & cons
What are the good things about smoking?
What are the not so good things?
• Use your OARS
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Provide Feedback
Elicit: What have you heard about e-cigarettes?
Advise: I’d like to share with you some additional information, would that be ok?
Elicit: So where does this leave you?
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Enhance Motivation
• OARSWhere does this information sit with you? (Open-ended inquiry)
You’re tired of feeling lousy after a night of drinking. (Reflection)
• Readiness/confidence & importanceOn a scale of 0 to 10, how important is it for you to make a change?
On a scale of 0 to 10, how confident are you that you can make a change?
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Develop a Plan
• Elicit patient’s own ideas
There’s a happy hour this week with co-workers, what are your options?
• Details & troubleshooting
When will it work best for you to call the Quit Line?
Where will you keep the number?
• Arrange follow-up
I’d like to check back in with you to see how things are going.
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Behavioral Activation
• Increasing pleasant activities to improve mood• Goal setting & self-management• Behavior modification
Lewinsohn PM, Graf M. J Consult Clin Psychol 1973;41:261-68. Mazzucchelli T, Kane R, Rees C. Clin Psychol Sci Prac 2009;16:383-411.
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Goals of Behavioral Activation
Re-establish routines
Increase positive reinforcing experiences
Reduce patterns of avoidance
Increase critical thinking
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BA with Substance Use
• Set consumptions goals
• Identify triggers and create a plan to manage
• Discuss options for social support
• Explore activities to start or re-initiate that will support substance use goals
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Self-Care Plan
Elements
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1. Goal or Action
2. Reason(s) to focus on this goal/action
3. First steps
4. Potential challenges
5. People who support me
6. I will know that my plan is working if:
7. Actions I will take if this plan isn’t working
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Conversation Starting Points
1. What is most important to you?
2. Where would you like to start?
3. What could you do differently?
4. What would be good about this change?
5. What is your next step?
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Medicaid Part 599• Up to 3 “pre-admission” visits for BI available• Opportunity to engage and assess needs before admitting to clinic services
and creating treatment plan
Medicare CPT code 90832• If BI is face-to-face and at least 16 minutes • No “admission” required, no “pre-admission” necessary
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Questions and comments are
awesome
Motivational Interviewing Training
http://www.thenationalcouncil.org/areas-of-expertise/motivational-interviewing/
Pam Pietruszewski
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Upcoming Webinars
• March 13th, 12:00-1:30pm – Motivational Interviewing
• April 7th, 2:00-3:30pm – Tobacco Cessation
• May (exact date TBD) – Alcohol & SBIRT
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Register at www.nationalcouncil.org/conference