Brief Interventions
Frequently Asked Questions (FAQ’s)
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Brief Intervention Pathway
(click here for diagram)
What are they?
Behaviour Change Intervention
Definition
‘Single or multiple sessions of motivational discussion focussed on increasing the individuals insight and awareness regarding specific health behaviours and their motivation for change.'
‘A healthy lifestyle brief one to one intervention providing an opportunity for individuals to explore their lifestyle habits which could impact negatively on their health. It encourages open exchange of views and information and increases motivation to change.’
Ref NHS Yorkshire and Humber 2010 ‘Prevention and Lifestyle Behaviour Change. A Competence Framework‘ (Click here to download).
A brief intervention can be as short as 30 secs and just be a single opportunistic response.
Brief interventions involve discussion, negotiation and encouragement and can be at 4 levels starting with Level 1 Brief Advice
A Competency Framework of Prevention and Lifestyle behaviour Change
Level 1
The worker is able to engage with individuals and use basic skills of awareness, engagement, and communication to introduce the idea of lifestyle behaviour change and to motivate individuals to consider/think about making changes to their lifestyle behaviour(s)
Level 2
The worker is able to select and use brief lifestyle behaviour change techniques that help individuals take action about their lifestyle behaviour choices which may include starting, stopping, increasing or decreasing lifestyle behaviour activities.
Level 3
The worker is able to select and use appropriate techniques and approaches to provide support to individuals as they change their lifestyle behaviour(s) and facilitate individuals to maintain these changes over the longer term.
Level 4
The worker uses specialised/advanced or lifestyle and behaviour specific behaviour change approaches to support individuals.
This level is applicable to those working at a strategic level
(top of page)
Why use them?
Every Contact Counts
There is overwhelming evidence that changing health related behaviour can have a major impact on some of the largest causes of mortality and morbidity.
‘Many premature deaths and illnesses could be avoided by improving lifestyles. It is estimated that a substantial proportion of cancers and over 30% of deaths from circulatory diseases could be avoided mainly through a combination of stopping smoking, improving diet and increasing physical activity; Unhealthy behaviours and the illnesses they cause represent a significant financial cost to the NHS –estimated to be more than £6 billion a year.’ (Cost to the nhs click)
Few of us consciously choose ‘good’ or ‘bad’ health. We all make personal choices about how we live and how we behave, what to eat, what to drink and how active to be. We all make trade offs between feeling good now and the potential impact of this on our long-term health. In many cases moderation is the key. All capable adults are responsible for these very personal choices.’
(Healthy Lives, Healthy People _ Our Strategy for Public Health in England Dec 2010 White Paper), Healthy people White paper Dec 2010)
When working with the general public it is important that opportunities to introduce or bring about lifestyle behaviour changes are recognized and acted upon. ‘Every Contact Counts’ and everyone with Health and Well Being on their agenda is tasked with making the most of any opportunity to offer at minimum ‘Brief Advice’ to their client / patient
Smoking, alcohol misuse, poor diet and lack of exercise are the targeted bad habits and are modifiable.
If you can make a 5-minute window of opportunity available, to enable your client to verbalise their thoughts and attitudes about making small achievable changes in their health related behaviour, you could make a real difference to their future health and well-being. You do not have to be a health expert to do this. Research indicates that implementing simple ‘motivational interviewing techniques’ can result in reflective conversation, leading to a shift in attitude.
Brief interventions do work. Research shows that a brief intervention can help people decide to change their health behaviours.
Brief interventions are acknowledged to be cheap, easy and effective. Brief interventions are accepted and used as an effective tool for a range of health issues.
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How do I carry out a Brief Intervention?
Follow the Brief Intervention Pathway – The 4 A’s: Ask, Assess, Advise, Assist (click here for more information)
The Prochaska and Diclemente model of behaviour change is recognized as good practice which will guide your response and will optimise your interaction (Click to see the ‘Stages of Change’ model)
“There is nothing so practical as a good theory. A good theory will clarify your thinking, help you make decisions and understand what factorsinfluence those decisions… A model simplifies reality and provides a short cut.”
Keith Tones of Health Education at Leeds Metropolitan University
The model suggests a number of distinct stages which an individual may go through when altering a particular behaviour. The aim is to recognise where the client is and progress them from one stage to another (see associated chart) (top of page)
How do I relate to my client?
Doing brief interventions requires good communication skills and is more effective if motivational interviewing approaches are used
THE SPIRIT OF THE INTERVENTION
The way we talk to people about behaviour change and engage them in conversation can influence the outcome. Evidence suggests that a ‘telling approach’ can get in the way whereas a ‘guiding style’ can be more effective. This is where you are asking questions which are aimed at getting people to think about change, drawing out motivations and commitment to possible actions.
When information is shared it is done so in a neutral, non-judgmental manner.
If you find yourself doing all the work STOP and ask the client
“What do you think about what I have been saying so far?”
The way in which the professional interacts with the client is illustrated by the acronym RULE
R: resist the ‘righting’ reflex. Practitioners should avoid the inclination to put right client’s behaviour even when it will benefit their health.
U: understand and explore the client’s own motivations.
L: listen with empathy and show interest.
E: empower the client, encouraging hope and optimism. Work with positives.
COMMUNICATION SKILLS
Prochaska and DiClemente(P and D) Motivational Interviewing (MI) and Solution Focused practice (SF) have all influenced the way in which we relate in order to empower individuals, to make personal decisions related to behaviour. Many of the core values overlap but some approaches stand alone and in the following text, where possible, it has been indicated when the idea has come from Solution Focused practiced (SF)
All are adaptations of counseling skills and need practicing and coaching.
Motivational Interviewing
Is a process of exploring a person’s motivation to change through interview, in order to assist them towards a state of action. Can improve their readiness /commitment to and confidence about changing.
MI tools (click here)
Solution Focused Practice
Is not concerned with understanding problems but interested in finding individuals solutions, allowing the clients to drive the work, centering the conversation on the client’s strengths and abilities
An effective intervention is tailored to individual circumstances
- Evoke a person’s motivation through helping them to identify their own arguments for change, rather than imposing reasons for change on them
- Think about their situation
- Start where the person is
- Reflect on the positives of past experiences
- Have a shared discussion
- Listen to what people say
- Notice what they do not say
- Watch what they do
- Think about their situation
- Think about what you know about them
- Talk with them in a way which is not threatening
Work collaboratively
- Discussion with client working together to explore options.(negotiation)
- Be curious over responses as this shows that you are listening.
- Control of one’s own values and beliefs is important. No telling
Tailor to individual circumstances
- Use open ended questions to encourage them to verbalise their personal benefits resulting from behaviour changes.
- Move towards their ‘best hope’ future. (SF)
Do not focus too much on the problems ( SF)
- The client needs to move from ‘negative’ to ‘positive’ frame of mind
From Negative |
To Positive |
Focused on problems |
Focused on solutions |
Deficit focused |
Resource focused |
Professionals goals |
Working towards clients best hopes |
What’s wrong |
Finding what is working |
Feeling stuck |
Noticing progress |
Victim |
Survivor |
Hopelessness |
High expectation of improvement |
Advice giving |
Asking useful questions |
Passive client |
Maximizing co-operation |
Disempowering |
Empowering |
If you do not feel confident about doing interventions in your daily work, first practise in situations where you feel comfortable. Practise will build confidence and skills. (top of page)
What is my role and what isn’t my role?
Your Role |
To provide opportunistic advice |
To be enthusiastic about the benefits of change |
Identify the state of readiness to change within the individual and respond accordingly |
Select the most appropriate information about services that are available locally |
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Not your Role |
To give detailed specialist knowledge to clients |
To assist an individual through a specialist referral programme, or to monitor ongoing outcomes |
To prescribe any specialist intervention products |
To act as a Counsellor or to address other personal issues |
To tell a client what to do and to set goals for them |
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When would I carry out a Brief Intervention?
- Opportunistically when the individual brings the topic into a discussion or when you can relate to a reference to symptoms or linked topic of conversation
- When the emotional and physical setting is right eg approach the subject with sensitivity where possible in a quiet confidential area of the work place
- Although brief interventions are opportunistic, there are times when people may be relecting on their lives and considering change. These particularly relate to life changes eg change in employment status (Ref Nice2007).
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When wouldn’t I carry out a Brief Intervention?
- When the person doesn't wish to participate in the brief intervention process
- When a person is in a highly emotional state
- When a person is too sick or injured to share information
- When a person is drunk or intoxicated on any other drug.
Help! I need some tips
Useful opening strategies
What not to do
Traps to be cautious of when carrying out Brief Interventions
Useful opening strategies
Useful opening strategies
A professional has many things to achieve during their interaction with a client and it maybe difficult to shift the focus of the conversation to behaviour change in a way that is client focused and empowers the client to make one or more behaviour change.
- Use the values of Motivational Interviewing
- Ask “general” questions to connect with client as this makes them feel valued as a person and gets them to chat.
- Set the time boundary to manage expectation.
eg. “As part of my job I am being asked to encourage healthy lifestyles. Would you mind if we spent 5mins chatting about this?”
- Focus on the positives eg “If we are thinking about the habits that impact on our health and well being ie. smoking, eating well, being active, alcohol consumption and managing weight, may I ask you what you are pleased with?”
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What not to do
It’s important not to:
- Be warning or threatening
- Provide solutions
- Persuade with logic, or argue
- Be moralizing, preaching, lecturing (e.g. you should/ought)
- Be judging, criticizing, disagreeing, or blaming
- Be distracting, changing the subject or humouring (top of page)
Traps to be cautious of when carrying out Brief Interventions
- Question/answer trap – The health-care worker and individual fall into a pattern of question/answer, question/answer, and so on. It tends to close off access to deeper levels of the individual’s ‘unhealthy’ experience and the individual-worker relationship may become increasingly hierarchical.
- Confrontation/denial trap – If an individual is not yet ready to change, they may provide a reasonable argument in response to every statement the worker makes. The worker and individual then engage in an argumentative, confrontation/denial trap, in which the individual counters each argument for changing behaviour with an argument for remaining the same. Rather than trying to convince the individual to change, you should try to encourage the individual to voice the reasons for change, with just a little questioning and guidance.
- Expert trap – Workers fall into providing direction to the individual without first helping the individual to determine their own goals, direction and plans to change their health behaviour. Therefore, the individual may tend to passively accept the worker’s suggestions, and may only half heartedly commit to the difficult work involved in changing. In this case, try to offer suggestions for change, at the individual’s request and when their motivation is high.
- Premature Focus trap – The worker should not just simply follow the individual’s lead, focusing too quickly on a specific problem is not recommended. Difficulties with premature focus include raising individuals resistance and focusing on an unimportant or secondary problem.
- Blaming trap – Workers may feel compelled to show the individual how they are at fault for not being able to change their behaviour, this is not seen as useful. Blame is irrelevant and a “no-fault” policy should be established. The following comment is seen as suitable: “I’m not interested in looking for whose responsible, but rather what’s troubling you, and what you might be able to do about it”. (top of page)
Where I can get more information about Brief Interventions
- ‘Prevention and Lifestyle Behaviour Change. A Competence Framework‘ (What are they section)
- www.motivationalinterview.org - This is the principal international website for information on motivational interviewing. It provides a comprehensive bibliography of published research, and much other related information and reading material.
- www.stephenrollnick.com – This is an on-line discussion forum designed for practitioners who have some motivational interviewing training and wish to explore, with others, their attempts at implementing what they have learnt.
- William R. Miller & Stephen Rollnick (2002) Motivational Interviewing: Preparing People for Change (2nd Edition) Guildford Press: New York
- Stephen Rollnick, William R. Miller & Christopher Butler (2007) Motivational Interviewing in Health Care Guildford Press: New York
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