How to do brief intervention
- 1. How to do brief intervention
- 2. Remember... Brief intervention should be: – Short – Evidence based – Structured around a conversation – Collaborative – Person-centred – Non-judgemental (The Scottish Govt. 2015)
- 3. So... let’s take an opportunistic BI • About 5-10 minutes • Within a conversation • On equal terms • Based on the service user’s perspective • Not preachy!
- 4. Brief intervention for alcohol (NHS Scotland, 2015) • The practice delivery for brief intervention is guided by the acronymn FRAMES: Feedback – tell them about the risks of their current level of alcohol use. Responsibility – reinforce any decision to change (or not) lies with the service user. Advice – based on facts about their drinking, offer simple and direct advice to the service user re impact on them and offer your advice to change. Menu – provide them with a menu of options for behaviour change. Empathetic interviewing – consider their perspective; be non-judgemental. Self-efficacy – encourage the person to believe they can change.
- 5. NHS Scotland (2015) • NHS Scotland is ahead of other UK nations with strategies to reducing alcohol harm. • Their simple strategy for practice is: 1. Raise the issue – ask about drinking. 2. Screen for harmful use and give brief feedback on the harmfulness. 3. Listen for signs of readiness to change.
- 6. Use open questions • These encourage the person to explore the issue. For example: – What do you understand about binge drinking? – How much do you know about the harm to the liver? – What do you understand about the reason you are in hospital/arrested/have a health issue? – What do you think is sensible use of alcohol?
- 7. Empathetic interviewing Use questions and feedback in a positive way rather than preaching or judging. For example: – I know it isn’t easy talking about these things but it’s important to discuss the extent to which you may have damaged your liver through your drinking. – It is likely that there may be changes in your liver with a history of alcohol use like yours. – You may have damaged your liver by drinking too much. Which is better?
- 8. Emphasising responsibility and motivational interviewing • It is important that the person feels they are able to change, but also that they are the only ones who can really make that change. • It is important to encourage optimism and hopefulness to motivate people to change: – It is important for you to choose how you want to reduce your drinking – what do you think would suit you best? – Some people find a drinking diary helpful – do you think that might suit you or is there another way you would like to monitor your intake?
- 9. Listening for motivation to change This is connected to the ‘stages of change model’ (see How to talk about substance use). You should be listening for the person: – Contemplating change – Planning change – Putting change into practice – Attempts to maintain change
- 10. Listening for motivation to change For example: – I’m more careful about my drinking but I still struggle when I’m with mates. – I tried abstinence for a while but there was that party ... – I thought I should tackle my stress levels first – I should really cut down my drinking • Which one is which stage of change? •(theyareinreverseordertoabove)
- 11. Motivating – enhancing confidence, options and self efficacy If someone appears to be contemplating change, this is an opportunity to help them develop their motivation and ability to make the change. • Reward positive statements and contemplation. • Encourage the person to weigh up pros and cons of change – focus on the positive ones! • Keep the door open – with options – better if they generate them themselves. • Build confidence – identify the areas in which they have already achieved success, e.g. being willing to talk to you about it, spending time thinking about change, making previous attempts to change.
- 12. Examples of responses If someone stated: ‘I should really cut down my drinking’, you have a number of ways to respond: – Reward – ‘it’s good that you understand that this is important’ – Pros & cons – ‘what concerns you most about your drinking?’ (this also highlights the main motivator) – Options (self-generated) – ‘what ways of cutting down do you think might work for you?’ – Build confidence – ‘you told me that you have succeeded once for a while – that shows you can do it!’
- 13. References • NHS Scotland (2015) Delivering an ABI: Process, screening tools and guidance notes. Edinburgh, NHS/Health Scotland. Available at: http://www.healthscotland.com/uploads/documents/3273- rimary%20care%20cribsheet.pdf • The Scottish Government (2015) Local Delivery plan Standard: Alcohol Brief Interventions National Guidance: 2015-16. Edinburgh, NHS Health Scotland.