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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Prochaska &

DiClemente 1983

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

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

Self-Management

Increased skills

+

Confidence, ability to make changes

=

Improve outcomes and decrease costs

Bodenheimer, T., et al.,JAMA 2002

Specific Interventions

Motivational Interviewing

Brief Negotiated Interview

Behavioral Activation

Motivational Interviewing

Partnership

Evocation

Compassion

Acceptance

• Open-Ended Inquiry• Affirmations• Reflections• Summaries

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?

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

• 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

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

1. Raise the subject

2. Provide feedback

3. Enhance motivation

4. Develop a plan

Brief Negotiated Interview

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.

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.

Goals of Behavioral Activation

Re-establish routines

Increase positive reinforcing experiences

Reduce patterns of avoidance

Increase critical thinking

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

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

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?

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

Questions and comments are

awesome

Motivational Interviewing Training

http://www.thenationalcouncil.org/areas-of-expertise/motivational-interviewing/

Pam Pietruszewski

pamp@thenationalcouncil.org

Upcoming Webinars

• March 13th, 12:00-1:30pm – Motivational Interviewing

• April 7th, 2:00-3:30pm – Tobacco Cessation

• May (exact date TBD) – Alcohol & SBIRT

Register at www.nationalcouncil.org/conference