Brief Intervention Brief Negotiated Interview (BNI) & Motivational Interviewing. How To Do…. BNI-ART Institute BU School of Public Health & Boston Medical Center. SBIRT Toolbox Outline. Motivational Interviewing principles and skills practice Brief Negotiated Interview algorithm
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How To Do…
BU School of Public Health & Boston Medical Center
Motivational Interviewing principles and skills practice
Brief Negotiated Interview algorithm
Practice SBIRT with case studies
200 Homeless patients with alcohol dependence MGH ED in 1962
Chafetz et al. Establishing treatment relations with alcoholics.. J Nerv Ment Dis 1962; 134: 390-410.
to talking to patients about alcohol or drugs
“People are generally better persuaded by the reasons which they have themselves discovered than by those which have come in to the mind of others.”
Goal-directed (behavior change)
Helps resolve ambivalence
affirms client’s Autonomy
Collaboration between pt & practitioner
Elicits patient’s intrinsic motivation & reasons for change
Standard of Care
A collaborative conversation about health promotion (shared agenda)
patients as expert in their lives
listening not telling
open-ended questions, affirmations, reflective listening, summaries
Patient Voice and Choice
What worries you most about your current situation?
What changes have you noticed?
Are you worried about your current situation?
Have you noticed changes?
Do you care
about your health?
Statements and gestures that recognize strengths and acknowledge behaviors that lead in the direction of positive change
I am really impressed with the way you….
That’s great how you’ve reached your goal of cutting back on your drug use.
Using protection shows that you have real respect for yourself and your partners.
From Thomas Gorden
Repeat - restate using the same words
Rephrase - use synonyms
Paraphrase - infer meaning behind the words or emphasize emotional aspects
Client:“I got jumped outside the bar. They probably saw me as an easy mark because I was stumbling a little bit. It really sets me off.”
Practitioner:“You don’t like being unable to defend yourself.”
Transition or ending statements
Collect “change talk” statements
Present bouquet of patient’s own reasons for change
“Here is what I’ve heard so far…..What did I miss?
“We’ve gone over quite a bit. Let me make sure I am understanding you…”
Guiding not directing
avoid the “righting reflex”
Client as decision maker
Patient Voice and Choice
Dr. Miller explains MI
Would you mind taking a few minutes to talk about your [X] use? Before we go further, I’d like to learn a little more about you.
What is a typical day like for you?
Where does your [X] use fit in?
2. Ask about Pros & Cons
Help me understand through your eyes the good things about using [X]?
What are some of the not so good things about using [X]?
So on the one hand you said <PROS>, and on the other hand <CONS>.
4. Readiness to Change
This Readiness Ruler is like the Pain Scale we use in the hospital. On a scale from 1-10, with one being not ready at all and 10 being completely ready, how ready are you to change your [X] use?
You marked ___. That’s great. That means you’re ___% ready to make a change.
Why did you choose that number and not a lower one like a 1 or 2?
1 2 3 4 5 6 7 8 9 10
Create action plan
What are some options/steps that will work for you? What do you think you can do to stay healthy and safe? What will help you to reduce the things you don’t like about using [X]?
Tell me about a time when you overcame challenges in the past. What kinds of resources did you call upon then? Which of those are available to you now?
Identify strengths & supports
Those are great ideas! Is it okay for me to write down your plan, your own prescription for change, to keep with you as a reminder?
Will you summarize the steps you will take to change your [X] use?
I’ve written down your plan, a prescription for change, to keep with you as a reminder.
5. Prescription for Change
Write down action plan
Give referrals if appropriate:
-Suboxone, methodone clinic
Thank you for sharing with me today.
Seal the deal
Thank the patient
Having a conversation with a heroin user