Brief Action Planning Connie Davis, MN, ARNP

2 Define Brief Action Planning Describe how Brief Action Planning can improve self-management What do I hope to accomplish?

3  A self-management support tool based on the principles and practice of Motivational Interviewing  It is › Structured › Patient-centered › Evidence-informed Reims et al, 2013 What is Brief Action Planning?

4  Compassion  Acceptance  Partnership  Evocation Miller W, Rollnick S. Motivational Interviewing: Preparing People for Change, 3ed, 2013 Spirit of Motivational Interviewing

5 Video

6 “Is there anything you would like to do for your health in the next week or two?” “ How confident (on a scale from 0 to 10) do you feel about carrying out your plan? ” “ Would you like to check in with me to review how you are doing with your plan? ” Behavioral Menu If Confidence <7, Problem Solve Barriers Follow-up Elicit a Commitment Statement SMART Behavioral Plan

7  “Is it okay if I share some ideas from other people who are working to improve their health? “  If yes, share two or three ideas briefly all at once  “Maybe one of these would be of interest to you or maybe you have thought of something else while we have been talking?” Skill #1 Resuming Daily Activities Exercise Taking meds Adapted from Stott et al, Family Practice 1995; Rollnick et al, 1999, 2010 Behavioral Menu Weight management

8  Action Planning is “SMART”: Specific, Measurable, Achievable, Relevant and Timed. Skill #2. Based on the work of Locke (1968) and Locke & Latham (1990, 2002); Bodenheimer, 2009 SMART Behavioral Plan

9  After the plan has been formulated, the clinician/coach elicits a final “commitment statement.” Strength of the commitment statement predicts success on action plan. Skill #3 Aharonovich, 2008; Amrhein, 2003 Elicit a Commitment Statement

10  Problem-solving is used for confidence levels less than 7. Skill #4 Bandura, 1983; Lorig et al, Med Care 2001; Bodenheimer review, CHCF 2005; Bodenheimer, Pt Ed Couns 2009 Problem Solving

11 “ A ___ (the number they chose) is higher than a zero. That ’ s good. ” “ A ___ (the number they chose) is higher than a zero. That ’ s good. ” “ Is there something you could do to raise your confidence? ” Restate plan and repeat confidence measure Behavioral Menu Yes No Problem Solving

12  Follow-up builds confidence.  Follow-up often with early action plans and decrease frequency as behavior is more secure.  Regular contact over time is better than 1x intervention.  Follow-up builds a trusting relationship Skill #5 Resnicow, 2002; Artinian et al, Circulation,2010 Follow-up

13 Follow-up “How did it go with your plan?” Success Partial success Did not try or no success Recognize partial success “What would you like to do next?” Reassure that this is common occurrence Recognize success

14 “Is there anything you would like to do for your health in the next week or two?” “How confident (on a scale from 0 to 10) do you feel about carrying out your plan?” Have an idea? Not sure? Behavioral Menu Not sure? Behavioral Menu Not at this time SMART Behavioral Plan Specific Measureable Achievable Relevant Timely Specific Measureable Achievable Relevant Timely Permission to check next time 1) Ask permission to share ideas. 2) Share 2-3 ideas. 3) Ask if any of these ideas or something else might work. 1) Ask permission to share ideas. 2) Share 2-3 ideas. 3) Ask if any of these ideas or something else might work. Elicit a Commitment Statement Confidence ≥7 Confidence <7, Problem Solving Confidence <7, Problem Solving “Would you like to set a specific time to check back in with me so we can review how things have been going with the plan?” Follow-up

15 Many settings Many kinds of helpers How do I learn it? Practice and feedback How is Brief Action Planning Used?