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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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Brief intervention brief negotiated interview bni motivational interviewing

Brief InterventionBrief Negotiated Interview (BNI) & Motivational Interviewing

How To Do…

BNI-ART Institute

BU School of Public Health & Boston Medical Center


Sbirt toolbox outline
SBIRT Toolbox Outline

Motivational Interviewing principles and skills practice

Brief Negotiated Interview algorithm

Live demonstration

Practice SBIRT with case studies


Why do s bi rt
WHY DO SBIRT?

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.


Two approaches
Two Approaches

to talking to patients about alcohol or drugs

Doctor A

Doctor B


Blaise pascal pens es
Blaise Pascal: Pensées

“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.”


Motivational interviewing mi
Motivational Interviewing (MI)

Patient-centered

Goal-directed (behavior change)

Helps resolve ambivalence

A-C-E

affirms client’s Autonomy

Collaboration between pt & practitioner

Elicits patient’s intrinsic motivation & reasons for change


Motivational

Interviewing

Standard of Care


Brief negotiated interview
Brief Negotiated Interview:

A collaborative conversation about health promotion (shared agenda)

patients as expert in their lives

listening not telling

silence

OARS

open-ended questions, affirmations, reflective listening, summaries

Patient Voice and Choice


O ars closed v s o pen questions
OARS: Closed v.s. Open Questions

OPEN

What worries you most about your current situation?

What changes have you noticed?

How so?

CLOSED

Are you worried about your current situation?

Have you noticed changes?

Do you care

about your health?


O a rs affirmations
OARS: Affirmations

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.


Communication model
Communication Model

From Thomas Gorden

2


Oa r s r eflective listening 3 levels
OARS: Reflective Listening3 Levels

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.”


Oar s s ummaries
OARS: Summaries

Transition or ending statements

Collect “change talk” statements

Present bouquet of patient’s own reasons for change

Summary Intros:

“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…”


Brief negotiated interview1
Brief Negotiated Interview:

Guiding not directing

avoid the “righting reflex”

Client as decision maker

Patient Voice and Choice



In His Own Words

Dr. Miller explains MI

http://vimeo.com/20901845



BNI ALGORITHM

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?

  • Build rapport

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>.

Summarize


BNI ALGORITHM

3. Feedback

  • I have some information on low-risk guidelines for drinking, would you mind if I shared them with you?

  • We know that drinking

  • 4 or more (F)/ 5 or more (M) in 2hrs

  • more than 7(F)/14(M) in a week

  • use of illicit drugs

  • can put you at risk for illness and injury. It can also cause health problems like [insert medical information].

  • What are your thoughts on that?

Ask permission

Give information

Elicit reaction


BNI ALGORITHM

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?

Readiness ruler

Reinforce positives

1 2 3 4 5 6 7 8 9 10


BNI ALGORITHM

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


BNI ALGORITHM

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


BNI ALGORITHM

Give referrals if appropriate:

-Outpatient counseling

-Suboxone, methodone clinic

-Needle exchange

-NA/AA

-Primary Care

-Mental Health

-Shelter

-Handouts/Information

Thank you for sharing with me today.

Seal the deal

Thank the patient


The bni in practice
The BNI in practice

Having a conversation with a heroin user


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