In the brief intervention part of SBIRT, we teach people to give feedback as a way to educate patients on drugs and alcohol, consistent with the tenants of motivational interviewing: respecting the patient’s autonomy and building a shared agenda toward behavior change. We recommend using “elicit-provide-elicit” when providing any feedback or health education.

The first “elicit” is two pronged: one, asking permission if it’s ok to talk about the issue and two, eliciting what the patient may already know about it.

For example, a patient screens positive for risky alcohol use:

“Do you mind if we talk a little about the effects of alcohol on your health?”

This gives a patient a “voice and a choice” in their healthcare visit. The patient may say no and we have to respect that. And, quite frankly, if a patient doesn’t want to talk about it, you can tell them all kinds of scientifically sound and thought provoking things about alcohol and health but they will probably not hear you.

This is followed by:

“Great. What do you already know about the way alcohol effects your health?”

This is the first “elicit.” We are eliciting from the patient what they may already know about the effects of alcohol on their health. They may more than you may think. Knowledge alone doesn’t always translate to action or change. You may also learn what is important to the patient in terms of their health and some of the things that may be related to their reasons for change. Perhaps most importantly, the patient feels good about contributing their own ideas to the visit and feels a sense of ownership in their own care. Feeling good about something and having a positive experience does all kinds of wonderful things for our confidence and desire to take action. I think this can’t be understated.

The “provide” part is also two pronged. First, asking permission if it’s ok to share something you (the provider) know about the effects of alcohol. Then, providing the feedback in the form of easy to understand health information that is relevant to the patient. You may even expand on some of the topics they brought up to be especially pertinent to the patient.

Continuing with our example:

“Is it ok if I share with you some things about alcohol use and your health?”

Again, this functions as a way for the patient to have some autonomy and feel good about their visit. If you’ve got this far in the conversation, the likelihood a patient says no is pretty slim but it’s still important to ask.

“We know that drinking 4 or more (F)/ 5 or more (M) in 2hrs or more than 7(F)/14(M) in a week or use of illicit drugs can put you at risk for illness and injury. It can also cause health problems like [insert medical information].

This is a pretty generic feedback example but you can see the point. We will do a post, or maybe a couple posts, on specific education around different types of substances and the health effects. A lot of hesitation in discussing alcohol or drugs with a patient comes from being unfamiliar with the topic or unsure of what exactly to say. Medical and behavioral health training doesn’t mean someone understands everything about alcohol and drugs. For all the daily news we see about heroin in Massachusetts, it’s still a relatively unfamiliar subject for a lot of people. Not to mention, the drugs are constantly changing and can be geographically or culturally specific.

The last part, the second “elicit” in our strategy, asks what that patient thinks about the health information you provided.

To finish our example:

“What are your thoughts on that?”

Getting the patient’s feelings on the information is essential. It gives you a measure of where the patient is at with their potential to change and also gives the patient a chance to put into their own words what may or may not resonate with them in terms of their reasons for change. This flows quite naturally into the next part of the BI – assessing readiness for change.

Take a look at the brief negotiated interview (BNI) to get the full context of feedback in the brief intervention.

http://www.bu.edu/bniart/files/2012/04/Adult-BNI-Alg_English-Spanish-4.17.12.pdf