What is brief intervention and harm reduction?
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Brief interventions are short discussions between a practitioner and service user about a potentially harmful lifestyle choice like substance use. They aim to motivate change, reduce harmful behavior, and assist recovery. NICE defines different types including opportunistic contacts to deliver health information or motivational counseling, and planned sessions targeting specific harms or motivation to change. Key features are focusing on reduced substance use, being delivered by non-substance professionals, addressing motivation, and remaining individualized while giving feedback, encouraging responsibility, providing options, demonstrating empathy, and enhancing self-efficacy. Brief interventions can be used for any potentially harmful lifestyle behavior by providing information, advice, discussions, or offers of support. Evidence best supports their use for problematic alcohol use.
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practice248 journal of renal nursing vol 5 no 5 Sept.docx
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248 journal of renal nursing vol 5 no 5 September 2013
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Using motivational interviewing
to encourage behaviour change
Have you ever experienced trying to get patients to change their lifestyle choices? Motivational
interviewing could benefit you, your patients and clinical practice by eliciting positive behaviour
change, as renal physiotherapist Vicky Pursey explains.
n motivational interviewing n behaviour change n lifestyle change n health promotion n collaboration
C
linicans can spend a lot of time and
effort trying to get patients to change
their behaviour for the benefit of their
health, but so many do not do what
they are told. Blaise Pascal in his writings Pensèes,
published in 1670, suggested that ‘people are
generally better persuaded by the reasons which they
themselves discover than by those which have come
into the mind of others’ (Pascal, 2005). Assuming
this is true, why do health professionals try to get
patients to engage in their health care by telling
them what to do in a directive manner?
For kidney patients, chronic disease can often
require significant changes to their lifestyle,
such as: attending haemodialysis three times
weekly; managing peritoneal dialysis daily; taking
significant quantities of medication; doing more
exercise despite the fatigue often experienced; and
restrictions being imposed on fluid intake and diet.
Martino (2011) describes how patient motivation
to self-manage tends to wane as disease progresses.
Therefore, getting kidney patients to collaborate
with health professionals can be challenging.
However, links between patient empowerment
and reduced mortality have been the subject of
several studies summarised by McCarley (2009).
These support the concept that partnership rather
than prescribing approaches should benefit kidney
patients through maximised clinical outcomes,
reduced disease burden, and improved quality of
life; and benefit practitioners through reduced
frustration at non-adherence to treatment. Using a
behaviour change technique known as motivational
interviewing (MI) can achieve improved patient
engagement with treatment in those with chronic
health problems, such as kidney disease.
What is motivational interviewing?
MI is a conversation technique between two
people that aims to focus on enhancing one party’s
intrinsic motivation to change their behaviour
in a positive way. In the context of this article,
MI is specifically between a health professional
and a renal patient with a focus on kidney health
promotion and a change of behaviours that may be
beneficial to their medical condition.
There are several important concepts that
underpin MI: a patient-centred approach focusing
on self-motivation; allowance for the person to
explore and resolve their ambivalence to change;
and collaboration between the patient and health
professional, the latter party using develo.
Η διαχείριση των μειζόνων συμπεριφορικών παραγόντων κινδύνου στην ΠΦΥ
Παρουσίαση μου στα πλαίσια του Consensus Meeting: "Η διαχείριση και ο έλεγχος των Μείζονων Συμπεριφορικών Παραγόντων Κινδύνου για την Υγεία: η συμβολή νέων "εργαλείων" για την αντιμετώπιση τους", Ελληνική Επιστημονική Εταιρεία Οικονομίας και Πολιτικής της Υγείας, Ξυλόκαστρο 6-8 Ιουλίου 2018
How to deliver a brief intervention
In this 1 hour introductory lecture you will learn about brief intervention
At the end of this session you should be able to:
Understand what is meant by “brief intervention”
Recognise the Stages of Change and how they relate to brief interventions
Describe the FRAMES approach to Motivational Interviewing
Translate examples of BI in the alcohol field to the wider substance misuse arena
National SBIRT ATTC 4 Hour Curriculum
Goals: The goal of this training is to help participants develop their knowledge, skills and abilities as Substance Use Screenng, Brief Intervention, and Referral to Treatment (SBIRT) Trainers.
At the end of this training participants will be able to understand the information screening does and does not provide,define brief intervention, describe the goals of conducting a BI, understand the counselor's role in providing BI, describe referral to treatment, identify SBIRT as a system change initiative, introduce the public health approach, and understand the continuum of substance use.
Audience: Social Workers, counselors and other behavioral health providers from all settings can benefit from understanding substance use across a continuum and its impact on clients behavioral health and other psychosocial interactions.
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This document outlines a proposed smoking cessation program in Luton, UK. It notes the high mortality rate from smoking and reduced life expectancy for smokers. A health needs assessment found reasons for smoking include stress and nicotine addiction. The program aims to reduce the number of smokers and smoking-related diseases and increase life expectancy. It will target those aged 35 and older, last one year, and have a budget of £100,000. Resources will include nicotine replacements and educational materials. The program will be commissioned every two years and evaluated every four months to improve health and reduce inequalities.
at-mod-3-info.pptx
This document provides information on interventions that can help health systems achieve cost savings while delivering better quality care. It outlines eight high impact interventions that were identified from a literature review. For each intervention, it provides a summary case study, details of additional case studies, how the intervention impacts quality ambitions, and information on implementation. The eight interventions are: early diagnosis, reducing variability in primary care, self-management programs, telehealth/telecare, case management, rapid assessment of mental health, improving dementia care pathways, and palliative care.
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This document provides an overview of health promotion. It defines health promotion as enabling people to increase control over their health. The goal of health promotion is to educate and empower people to make informed health decisions. It discusses models of health promotion that incorporate health education, protection, and prevention. Key principles outlined include taking a population-level approach and addressing social determinants of health. The document also outlines different approaches to health promotion, such as medical, behavioral, educational, empowerment, and social change approaches. Finally, it provides an example comparing how each approach may address the issue of smoking.
Ispor workshop value-based_assess_nice_kks_nov2014
The document summarizes background information on the UK's National Institute for Health and Care Excellence (NICE) taking into account additional factors like burden of illness and wider societal benefits in its appraisal of new health technologies. It discusses NICE receiving over 900 comments on its proposals to incorporate these new factors and its recommendation against changes in the short term. The rest of the document outlines the agenda and issues to be discussed in the workshop, including evidence from stated preference studies on societal values regarding severity of illness, end of life treatments, and proportional shortfall.
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practice248 journal of renal nursing vol 5 no 5 Sept.docx
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Η διαχείριση των μειζόνων συμπεριφορικών παραγόντων κινδύνου στην ΠΦΥ
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Stigma and stereotypes: unconditional positive regard
This document discusses the stigma faced by substance users and how it undermines recovery. It provides quotes from substance users about feeling ashamed to seek help from doctors due to stigma. Stigma restricts access to assistance and discourages efforts toward recovery and employment. Public attitudes spread through media often perpetuate stigma. Training professionals and having them interact with substance users can help reduce stigma, as can focusing on positive stories of change. Throughout the resource, readers are exposed to recovery stories in order to help reduce self-stigma and encourage mutual aid and recovery principles that support positive self-worth.
Introduction to stigma and stereotypes: people with problematic substance use
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This document discusses stigma related to substance use. It defines stigma as a "stain or attribute" that marks someone as unacceptable and leads to prejudice and discrimination. Negative labels used to describe those with substance use issues are stigmatizing and promote judgmental attitudes. This stigma can fuel a vicious cycle where people use drugs or alcohol to cope with feeling shamed and stereotyped. Health practitioners are key to breaking this cycle by adopting a growth mindset that believes anyone is capable of change with the right help, rather than thinking some people cannot be helped. The document advocates for person-centered care where service users can work in partnership with practitioners through good communication and tailored information.Different kinds of assets
This document discusses asset-based approaches to addressing substance use issues as opposed to traditional deficit-based models. It outlines three levels of assets - individual, community, and environmental/organizational. Individual assets include resilience and self-esteem. Community assets include social networks and social capital. Environmental assets include access to healthcare, housing, and education resources. The document also discusses Peter Sheath's activist perspective on asset-based community development and the tension with traditional social and healthcare services. Recovery capital is identified as an important framework involving personal, social, and community assets that support long-term recovery.
What are assets?
Asset-based approaches focus on individual and community strengths rather than deficits. They view people and communities in terms of the resources and assets they possess. This strengths-based perspective has been adopted by public services and health initiatives seeking to empower individuals and communities to address their own needs. Asset-based community development identifies and mobilizes local assets to improve health and reduce inequalities.
Assessment tools: alcohol
This document discusses screening and assessment tools for alcohol use. It recommends the Alcohol Use Disorders Identification Test (AUDIT) as the main screening tool for non-specialists to evaluate if someone would benefit from reducing their alcohol consumption. It also discusses screening vulnerable groups like pregnant women, younger people, older adults, and minorities. Brief assessment tools like the Fast Alcohol Screening Test (FAST) can check hazardous drinking levels. More detailed assessments tools are recommended if harm has been established or for specialist practitioners.
Maintaining a safe and effective working relationship
The document discusses the importance of maintaining safe and effective working relationships in health and social care professions. It emphasizes that establishing trust and being non-judgmental is key to engaging vulnerable clients, such as those struggling with substance abuse issues. Specific tips are provided around ensuring clear boundaries, prioritizing client needs, maintaining confidentiality, and protecting one's own safety. Case studies demonstrate how boundaries can be upheld or compromised in individual situations.
Reflection on practice
This document discusses reflective practice, specifically critical reflection. It introduces the concept of critical reflection and explains that it involves examining one's own practice and how it is shaped by social, political, and cultural contexts. The document outlines different types of reflection, such as reflection-in-action, reflection-on-action, technical reflection, and critical reflection. It also discusses the importance of a supportive environment and supervision for critically reflective practice. The outcomes of critical reflection can include new awareness, questions, understanding, and decisions.
Clinical and practice supervision
Clinical supervision provides structure, support, and opportunities for sharing knowledge to support professional development. It should be a focused relationship between supervisor and supervisee aimed at supporting standards of care, not a management process. For a practice nurse concerned about a patient eager for alcohol rehabilitation, discussing the case with her supervisor provided relief, helped assess the patient's understanding of dependency, and developed her problem-solving skills.
Alcohol withdrawal
Heavy drinking over a period of time can lead to alcohol withdrawal syndrome when blood alcohol levels fall, which is a potentially life-threatening condition requiring immediate medical care. Symptoms of alcohol withdrawal generally present within 6-8 hours and include anxiety, agitation, nausea, vomiting, tremors, and seizures within 12-48 hours. Delirium tremens occurs in around 5% of patients after 2-5 days and is a medical emergency characterized by severe tremors, confusion, hallucinations and fever. Benzodiazepines are commonly used to manage withdrawal symptoms while delirium tremens requires quick-acting benzodiazepines and antipsychotics.
Opiate overdose
Opiate overdose is a major public health issue, as over half of all drug-related deaths in the UK involve opiates like heroin. Opiate overdoses often affect older male drug users who are no longer in contact with treatment services. While naloxone is an effective antidote for opiate overdoses, those experiencing an overdose are often not taken to hospital due to fears of police involvement. Education programs teach signs of overdose and encourage calling emergency services, as naloxone can reverse an overdose if administered quickly.
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Organization
Academy of Oriental Medicine at Austin
Academy of Oriental Medicine at Austin
Academy of Oriental Medicine at Austin
About AOMA: The Academy of Oriental Medicine at Austin offers a masters-level graduate program in acupuncture and Oriental medicine, preparing its students for careers as skilled, professional practitioners. AOMA is known for its internationally recognized faculty, award-winning student clinical internship program, and herbal medicine program. Since its founding in 1993, AOMA has grown rapidly in size and reputation, drawing students from around the nation and faculty from around the world. AOMA also conducts more than 20,000 patient visits annually in its student and professional clinics. AOMA collaborates with Western healthcare institutions including the Seton Family of Hospitals, and gives back to the community through partnerships with nonprofit organizations and by providing free and reduced price treatments to people who cannot afford them. The Academy of Oriental Medicine at Austin is located at 2700 West Anderson Lane. AOMA also serves patients and retail customers at its south Austin location, 4701 West Gate Blvd. For more information see www.aoma.edu or call 512-492-303434.
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Pharmacological actions-
Antagonism of histamine-The H1 antagonists effectively block histamine induced bronchoconstriction, contraction of intestinal and other smooth muscle and triple response especially wheal, flare and itch. Constriction of larger blood vessel by histamine is also antagonized.
2) Antiallergic actions-Many manifestations of immediate hypersensitivity (type I reactions)are suppressed. Urticaria, itching and angioedema are well controlled.3) CNS action-The older antihistamines produce variable degree of CNS depression.But in case of 2nd gen antihistaminics there is less CNS depressant property as these cross BBB to significantly lesser extent.
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What is brief intervention and harm reduction?
- 1. What is brief intervention and harm reduction?
- 2. Definitions • Brief interventions are short, opportunistic discussions between the practitioner and the service user about a lifestyle choice, e.g. the use of substances, which may be harmful. • The object of a brief intervention is: – To motivate someone to change. – To reduce behaviour which may be harmful. – To assist someone towards recovery as they perceive it.
- 3. Definitions (cont.) NICE (2007) defines different types of brief intervention (BI) as follows: 1. Opportunistic contacts for: • Delivery of health information to hard to reach substance users. • Delivery of motivating counselling to change behaviour. 2. Planned, short sessions targeting a specific health harm, i.e. blood- borne viruses. 3. Planned, short sessions targeting motivation to change behaviour.
- 4. Definitions (cont.) The Scottish Government (2015) provides a breakdown of BI. It states BI should be: • Short • Evidence based • Structured around a conversation • Collaborative • Person-centred • Non-judgemental
- 5. Key features of brief interventions Upton & Thirlaway (2014) suggest key features of BI are that they: • Focus on reduced substance use • Are delivered by non-substance misuse professionals • Address the person’s motivation • Remain individualised • Have the following features: – Give feedback of risk, encourage responsibility for change, give options, demonstrate empathy, enhance self efficacy
- 6. So, brief intervention could be... • Information given to a heavy drinker about the risk of liver damage (harm reduction) • Advice given to an injecting drug user about how to avoid a blood borne virus (harm reduction) • A discussion with a heroin user about what they really want in life (motivational) • An offer to provide information about a self help group (access to recovery)
- 7. In brief: what’s it for? • Brief intervention can be used for any lifestyle behaviour which may be harmful. • Evidence best supports brief intervention for problematic alcohol use. • Evidence for effectiveness in drug misuse is less robust, but we can still use the same techniques. • Brief intervention can be used for any lifestyle behaviour which may be harmful.
- 8. References • The Scottish Government (2015) Local Delivery plan Standard: Alcohol brief interventions national guidance: 2015-16. Available at: http://www.gov.scot/Topics/Health/Quality-Improvement-Performance/NHS- Performance-Targets • NICE (2007) Drug Use: National Institute of Clinical Excellence Clinical Guideline 51. • Upton D & Thirlaway K (2014) Promoting Healthy Behaviour: A Practical Guide. Abingdon, Routledge.