1. Using Brief Intervention Strategies for Health Behavior Change February 18, 2015 Pam Pietruszewski, MA Integrated Health Consultant National Council for Behavioral Health

2. Quick Reminders 2 Open and hide your control panel Join audio: Choose “Mic & Speakers” to use VoIP Choose “Telephone” and dial using the information provided Submit questions and comments via the Questions panel Note: Today’s presentation is being recorded and will be provided within 48 hours. Your Participation

3. Asking Questions Please continue to submit your text questions and comments using the Questions Panel Please raise your hand to be unmuted for verbal questions. Your Participation 3

5. Prochaska & DiClemente 1983

6. The most effective intervention is one that meets the person where he or she is at –

7. Brief Interventions 5 – 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

8. Self-Management Increased skills + Confidence, ability to make changes = Improve outcomes and decrease costs Bodenheimer, T., et al., JAMA 2002

9. Specific Interventions Motivational Interviewing Brief Negotiated Interview Behavioral Activation

10. Motivational Interviewing

11. Open-Ended Inquiry Affirmations Reflections Summaries

12. O pen 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?

13. A ffirmations 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

14. Statements. Not questions What you hear, what you observe Not problem solving or advice Tool to express empathy Indicates active listening Statements. Not questions What you hear, what you observe Not problem solving or advice Tool to express empathy Indicates active listening 14 R eflections

15. S ummarizing Collect, link, transition Validating Helps if conversation is stuck or unproductive What will I put in the bouquet? 15

16. 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

17. 1.Raise the subject 2.Provide feedback 3.Enhance motivation 4.Develop a plan Brief Negotiated Interview

18. 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 18

19. 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? 19

20. Enhance Motivation OARS Where does this information sit with you? (Open-ended inquiry) You’re tired of feeling lousy after a night of drinking. (Reflection) Readiness/confidence & importance On 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? 20

21. 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.

22. 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.

23. Goals of Behavioral Activation Re-establish routines Increase positive reinforcing experiences Reduce patterns of avoidance Increase critical thinking

24. 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

25. Self-Care Plan Elements 25 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

26. 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?

27. 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

28. Questions and comments are awesome Motivational Interviewing Training http://www.thenationalcouncil.org/areas-of-expertise/motivational-interviewing/ Pam Pietruszewski pamp@thenationalcouncil.org

29. Upcoming Webinars March 13 th, 12:00-1:30pm – Motivational Interviewing April 7 th, 2:00-3:30pm – Tobacco Cessation May (exact date TBD) – Alcohol & SBIRT

30. Register at www.nationalcouncil.org/conference