This document provides an agenda and materials for a training on implementing SBIRT (Screening, Brief Intervention, and Referral to Treatment) in health centers. The agenda includes checking in, reviewing a learning activity on screening tools, discussing motivational interviewing skills, and previewing next week's topic. It also shares resources on SBIRT and screening tools like AUDIT, DAST, and CRAFFT. Materials cover using the tools to assess risk levels and provide appropriate interventions, as well as techniques for brief interventions including open-ended questions, reflections, summaries and the Brief Negotiated Interview approach.
Detailed understanding of Motivational Enhancement Therapy for management of Substance Use Disorders with contextual inputs for Indian population and sub-culture.
Detailed understanding of Motivational Enhancement Therapy for management of Substance Use Disorders with contextual inputs for Indian population and sub-culture.
Guidance and Counselling for children. The basic skills which need to be mastered by a counselor to provide effective service.
Attending skills, listening skills, paying attention skills, giving responses skills, identifying problems skills and intervention skills.
Review of motivational interviewing techniques and strategies most useful at each phase of change. NBCC, NAADAC, CAADAC, and California Board of Behavioral Sciences approved Mental Health continuing education and addictions counselor training series. Narrated versions and CEUs available at http://www.allceus.com
Counselling of people living with HIV/AIDSSANJAY SIR
IT HELPS THE PARAMEDICS & NURSING PERSONNEL REGARDING COUNSELING SESSION OF PEOPLE LIVING WITH HIV/AIDS & ALSO HELPS THE EDUCATOR TO TEACH THEIR STUDENTS REGARDING COUNSELING . IT ALSO CREATE AWARENESS AMONG COMMON PEOPLE ABOUT IT.
Addiction Medicine Certificate Course by Muktaa Charitable Foundation
Course Material by Dr Narayan Perumal
Lecture conducted at Aga Khan Palace
More material on Fullnasha.com
Financial counselors and educators find themselves in a quandary. They offer their clients a wealth of information about how to overcome financial obstacles and achieve financial goals. However, clients often lack the motivation to act on this information. Good information is necessary but often insufficient to motivate action. Motivational Interviewing, or MI, provides a powerful set of tools any helping professional can use to motivate change. MI has been refined by 30 years of research resulting in over 200 published studies with a variety of populations. MI has been found effective wherever helping professionals need to motivate behavior change.
Register for webinar, find supportive materials and join the webinar here: https://learn.extension.org/events/2638
Training for drug and alcohol counselors on using motivational interviewing counseling techniques to improve retention in treatment and move clients through the stages of change model.
Motivational Interviewing - Dr Igor Koutsenok MD, MSjames_harvey_phd
Session 1 "Motivational Interviewing Course: Assisting Patients in Making Sustainable Positive Lifestyle Changes"
Presented by Dr Igor Koutsenok MD, MS (University of California San Diego, Department of Psychiatry) on 05/06/2020 during the first session of an ISSUP virtual training on MI.
**PLEASE NOTE that video slides have been removed to reduce file size**
Presentation content and learning outcomes:
After orientation to the underlying spirit and principles of MI, practical exercises will help participants to strengthen empathy skills, recognize and elicit change talk, and roll with resistance. Research evidence will be reviewed for the efficacy of MI and for the importance of building a therapeutic relationship in clients’ outcomes. Integration of MI with other treatment modalities will be considered.
Learning outcomes:
Introduction: Motivation and behavioral change in addiction medicine
Review of the concepts of Ambivalence, Stages of change, the righting reflex, limits of persuasion.
Spirit of MI
Expressing empathy
Roadblocks to communication
Four Processes in MI
Full details: https://www.issup.net/about-issup/news/2020-05/motivational-interviewing-course
Guidance and Counselling for children. The basic skills which need to be mastered by a counselor to provide effective service.
Attending skills, listening skills, paying attention skills, giving responses skills, identifying problems skills and intervention skills.
Review of motivational interviewing techniques and strategies most useful at each phase of change. NBCC, NAADAC, CAADAC, and California Board of Behavioral Sciences approved Mental Health continuing education and addictions counselor training series. Narrated versions and CEUs available at http://www.allceus.com
Counselling of people living with HIV/AIDSSANJAY SIR
IT HELPS THE PARAMEDICS & NURSING PERSONNEL REGARDING COUNSELING SESSION OF PEOPLE LIVING WITH HIV/AIDS & ALSO HELPS THE EDUCATOR TO TEACH THEIR STUDENTS REGARDING COUNSELING . IT ALSO CREATE AWARENESS AMONG COMMON PEOPLE ABOUT IT.
Addiction Medicine Certificate Course by Muktaa Charitable Foundation
Course Material by Dr Narayan Perumal
Lecture conducted at Aga Khan Palace
More material on Fullnasha.com
Financial counselors and educators find themselves in a quandary. They offer their clients a wealth of information about how to overcome financial obstacles and achieve financial goals. However, clients often lack the motivation to act on this information. Good information is necessary but often insufficient to motivate action. Motivational Interviewing, or MI, provides a powerful set of tools any helping professional can use to motivate change. MI has been refined by 30 years of research resulting in over 200 published studies with a variety of populations. MI has been found effective wherever helping professionals need to motivate behavior change.
Register for webinar, find supportive materials and join the webinar here: https://learn.extension.org/events/2638
Training for drug and alcohol counselors on using motivational interviewing counseling techniques to improve retention in treatment and move clients through the stages of change model.
Motivational Interviewing - Dr Igor Koutsenok MD, MSjames_harvey_phd
Session 1 "Motivational Interviewing Course: Assisting Patients in Making Sustainable Positive Lifestyle Changes"
Presented by Dr Igor Koutsenok MD, MS (University of California San Diego, Department of Psychiatry) on 05/06/2020 during the first session of an ISSUP virtual training on MI.
**PLEASE NOTE that video slides have been removed to reduce file size**
Presentation content and learning outcomes:
After orientation to the underlying spirit and principles of MI, practical exercises will help participants to strengthen empathy skills, recognize and elicit change talk, and roll with resistance. Research evidence will be reviewed for the efficacy of MI and for the importance of building a therapeutic relationship in clients’ outcomes. Integration of MI with other treatment modalities will be considered.
Learning outcomes:
Introduction: Motivation and behavioral change in addiction medicine
Review of the concepts of Ambivalence, Stages of change, the righting reflex, limits of persuasion.
Spirit of MI
Expressing empathy
Roadblocks to communication
Four Processes in MI
Full details: https://www.issup.net/about-issup/news/2020-05/motivational-interviewing-course
This presentation developed by Michelle Constable and Jim McManus, explores how health psychology can help the work of Environmental Health Officers and was part of an introductory workshop for the Environmental Health Profession organised by the Beds and Herts Branch of the Chartered Institute of Environmental Health
Guidance is an assistance made available by a competent counselor to an individual of any age to help him direct his own life, develop his own point of view, make his own decision & carry his own burden.
Counseling is essentially a process in which the counselor assists the counselee to make interpretations of facts relating to a choice, plan or adjustment which he needs to make.
Linkage and Retention in HIV Medial CareProceedNCTSTA
This workshop session will present the fundamental skills of Motivational Interviewing and Strengths-based Case Counseling as they relate to linkage and retention to HIV Medical Care and Essential Support Services. Through interactive exercises, participants will have the opportunity to role-play linkage and retention to HIV Medical Care scenarios using the counseling skills examined at the start of session.
Navigating Conflict in PE Using Strengths-Based ApproachesCHICommunications
Led by CHI's Patient Engagement team, this session is intended to teach users how to deal with and prepare for conflict as it arises in patient engagement.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
3. Agenda
• Check In
• Review Learning Activity-Discuss Video and
review scoring of AUDIT and DAST
Welcome
• Motivating People to Change
• Using Brief Intervention Skills
• Brief Negotiated Interview
Presentation
• Preview of next week
• Assign Learning Activity- Videos and
Proficiency checklist
• Questions
Summary
6. • SAMHA SBIRT
• https://www.samhsa.g
ov/sbirt
• IRETA Online Training and
Toolkit and Webinars
• https://ireta.org/resourc
es/sbirt-101/
• https://ireta.org/resourc
es/sbirt-toolkit/
• https://ireta.org/?sfid=2
43&_sft_resource_type
=webinar
• On-line Training and other
Resources
• http://www.sbirt.care/Resources
7. Full Screening
Tools-
Targeted for
those
positive on
Brief Screen
AUDIT: Alcohol Use Disorder Identification Test
DAST: Drug Abuse Screening Test
ASSIST: Alcohol, Smoking, and Substance Abuse
Involvement Screening Test
GAIN or GAIN-SS: Global Appraisal of Individual
Needs
5Ps Plus: For pregnant and post-partum women
CRAFFT: Car, Relax, Alone, Forget, Family or Friends,
Trouble (adolescents)
10. NWATTC SBIRT Slides, 2014
Risk Levels
Severe
Harmful
Risky
IV
III
II
I
Low Risk or Abstain
Score Risk Level
14+
Zone 4: Severe Use,
Probable Substance
Use Disorder
10-13 Zone 3: Harmful Use
4-9 Zone 2: Risky Use
0-3 Zone 1: Low Risk Use
What do the AUDIT Scores Mean?
11. Severe
Harmful
Risky
IV
III
II
I
Low Risk or Abstain
Risk Levels
• Positive health message –
describe low-risk levels
• Low risk is not necessarily
NO risk
Recommended Intervention
• Patient NOT at risk for health or
social complications based on
alcohol use
Zone 1 defined: 0-3
NWATTC SBIRT Slides, 2014
What do the AUDIT Zones Mean?
12. NWATTC SBIRT Slides, 2014
Severe
Harmful
Risky
IV
III
II
I
Low Risk or Abstain
Risk Levels
• Brief Intervention (BI) with goal
of reducing alcohol use
Recommended Intervention
• Alcohol use likely leads to new
health problems or makes existing
ones worse
• An individual can fall into this zone
based on amount of alcohol use
alone (no negative consequences)
Zone 2 defined: 4-9
What do the AUDIT Zones Mean?
13. NWATTC SBIRT Slides, 2014
Severe
Harmful
Risky
IV
III
II
I
Low Risk or Abstain
Risk Levels
• Brief Intervention to reduce or
abstain (Brief Treatment if
available) and specific follow-up
appointment
Recommended Intervention
• Patient has experienced repeated
negative consequences
• Patient continues to use despite
persistent problems
Zone 3 defined: 10-13
What do the AUDIT Zones Mean?
14. NWATTC SBIRT Slides, 2014
Severe
Harmful
Risky
IV
III
II
I
Low Risk or Abstain
Risk Levels
• Brief Intervention to accept
referral to specialist treatment
for diagnostic evaluation
Recommended Intervention
• Multiple signs of substance use
disorder, such as:
– Negative consequences; tolerance;
withdrawal; uncontrolled use
• Is not a diagnosis in and of itself
Zone 4 defined: 14+
What do the AUDIT Zones Mean?
16. DAST-10 Scoring
Score Degree of Problems r/t Drug
Abuse
Suggested Action
0 No Problem Reported None at this time
1-2 Low Level Monitor, Reassess at a Later Date
3-5 Moderate Level Further Investigation
6-8 Substantial Level Intensive Assessment
18. • Standardized tools to quickly assess risk level
• Pre-screen - universal
• Full Screen - targeted
Screening
• Help patients understand their substance use
and health impact; motivate behavior change.
Brief
Intervention
• Help patients showing signs of a substance
use disorder to access specialty care.
Referral to
Treatment
SBIRT:
Brief
Intervention
20. Motivational interviewing is a counseling style
based on the following assumptions:
• Ambivalence about continued substance use and
change is normal.
• Ambivalence can be resolved by working with your
patient's intrinsic motivations and values.
• The alliance between you and your patient is a
collaborative partnership to which you each bring
important expertise.
TIP #35 SAMHSA
25. • Standardized tools to quickly assess risk level
• Pre-screen - universal
• Full Screen - targeted
Screening
• Help patients understand their
substance use and health impact;
motivate behavior change.
Brief
Intervention
• Help patients showing signs of a substance
use disorder to access specialty care.
Referral to
Treatment
SBIRT:
Screening
26. Forrest =
• Spirit of Motivational Interviewing
• Motivate the patient to consider
changing behavior
Trees =
• Brief Intervention
Steps
Brief Intervention –
See the Forrest, Not Just the Trees
27. Rollnick, Miller, Butler, 2008
FollowingGuidingDirecting
Which Communication Styles Do You Use with
Patients, and When?
28. Oregon SBIRT Primary Care – Curriculum Module II
Directive Communication Guiding Communication
• Explain why • Respect for autonomy, goals, values
• Tell how • Readiness to change
• Emphasize importance • Ambivalence
• Persuading • Empathy, non-judgment, respect
• Clinician is the expert • Patient is the expert
Communication Styles
What Makes Brief Intervention Different?
32. • “I just have a couple of drinks to help
me relax.”
• “I’m not paying you to talk to me about
drinking! Geez, I’m just here for a cold.”
• “Everyone smokes a little weed.”
• “Sure once in a while I drink more than
I should, but it doesn’t cause any major
problems in my life.”
• “My dad was an alcoholic. I don’t drink
like him.”
Sailing through Sustain Talk:
Pause and Reflect
33. “You are the only one who can decide what
the best thing for you is relative to your use of
alcohol.”
“I’m not here to tell you what to do. I’m just
interested in finding out what some of your
thoughts are and sharing some information
with you.”
“It’s totally up to you whether you make a
change.”
“You may, or may not, decide to make a
change based on our conversation today.”
Sailing through Sustain Talk:
Support Patient Choice
34. • A few good reasons to make the
change
• How they could change
• How important it is to change
• Persuade
• If you meet resistance, REPEAT!
(This is NOT using the spirit of
motivational interviewing)
Dyad Practice
35. • How would you make this
change?
• What are the 3 best reasons
to do it?
• On a scale from O to 10, how
important would you say it is
for you to make this change?
• Why are you not a zero?
• Give a short summary
• So what do you think you’ll
do?
. . . and just listen.
Dyad Practice
- With a Twist
36. “People are generally better
persuaded by the reasons which
they have themselves discovered
than by those which have come
into the mind of others.”
—Blaise Pascal
Quote
38. SAMHSA SBIRT, 2013
• What are open-ended questions?
• Gather broad descriptive information
• Require more of a response than a simple yes/no or fill in the blank
• Often start with words such as—
• “How…”
• “What…”
• “Tell me about…”
• Usually go from general to specific
Open-Ended Questions
39. 39
✓Ask for examples &
elaboration
✓ Anticipate response
✓Try: How…What…Tell me…
• Not yes/no or brief answer
• Not fact-finding
• Rather than: Why?
Open-ended inquiry
40. • What does your drug use do for you?
• How many drinks do you have on a typical day?
• What are the pros and cons of your drinking?
• Did you know your drinking could be causing your acid
reflux symptoms?
• What do you think about that?
• Where are you from?
Closed- or Open-Ended Questions
41. 2. Reflective
Listening
•Reflective listening is one of the
hardest skills to learn.
•Without reflections it isn’t MI
•“Reflective listening is a way of
checking rather than assuming
that you know what is meant.”
(Miller and Rollnick, 2002)
42. 42
• Statements. Not questions
• What you hear, what you observe
• Not problem solving or advice
• Selective & intentional
• Simple to complex
Reflections
43. SAMHSA SBIRT, 2013
• Demonstrates you have heard and
understood the patient
• Strengthens the empathic relationship
Why Reflective Listening?
44. 44
Alcohol doesn’t pose any problems
for you and if it did you would do
something about it.
Hanging out with your friends is an
opportunity to relax.
Drinking is not a problem.
“I like to chill with my friends. I’m not going to quit drinking
because it’s not a problem.”
45. Summaries
• Examples
• “So, let me see if I’ve got this right…”
• “So, let me summarize what we’ve talked
about”
• “Make sure I’m understanding exactly what
you’ve been trying to tell me…”
• Double sided reflections are often highly
effective as summaries to illustrate
ambivalence.
• “On the one hand, you like a, b, c about
your drug use, AND on the other hand, you
don’t like x, y, and z.”
46. When patients feel
understood they are more
likely to strengthen self-
esteem, become
intrinsically motivated, be
more willing to trust and
talk about making changes.
(SAMHSA SBIRT, 2013)
Why Summarize?
47. The Yale Brief Negotiated Interview, Manual D’Onofrio, et al. 2005
* Miller and Tonnigan, 1996; Prochaska and DiClemente, 1992
• Developed for use in emergency rooms –
D’Onofrio et al., 2005
• Adapts spirit and skills from Motivational
Interviewing*
❑ Patient-centered, collaborative approach
❑ Goal-directed conversation method used to
enhance patient’s own motivation to change
❑ Recognizes patient’s conflicting feelings
about a particular behavior change
Brief Negotiated Interview (BNI)
