Brief Intervention Model Introduction
There are several popular models for brief intervention, and they all use a similar approach. You’ll learn about a model adapted from the Brief Negotiated Interview, or BNI. Research has shown the BNI to be effective in reducing substance use. 4
A brief intervention ranges from 10-30 minutes. You may be able to spend more time if you work in settings that allow longer sessions.
There are six steps to this model, each building on the one before it to elicit the adolescent’s motivations and plans for change.
1. Build Rapport
First, Build Rapport. In this step you can get to know the adolescent and establish a good relationship. Asking permission to raise the subject of substance use is an opportunity to build trust and explore how substance use fits in their life and what’s important to the teen.
2. Elicit Pros and Cons
Next, Elicit Pros and Cons. Explore what the adolescent likes about substance use,and then what they like less about it. Try to elicit specific experiences they’ve had and reflect any change talk. Summarizing pros and cons at the end of this step is an opportunity to "connect the dots" between substance use and the problems it can present in an adolescent’s life, building their readiness to change.
3. Provide Feedback
Then, Provide Feedback. Now that you have explored the adolescent’s perspective, you can ask for permission to share your own information on the risks involved. Adolescents are usually most receptive to information that is relevant to their life, their interests, their appearance, and their friends. Avoid sharing scientific information about long-term consequences to their health. Finally, be sure to ask the teen what the information you provided means to them.
4. Assess Readiness
Next is Assess Readiness. Having built momentum for change, explore the adolescent’s readiness to change by asking them to gauge their readiness on a scale from 0-10. It’s important to recommend abstinence, but if the teen is not receptive to quitting, explore harm reduction by asking about their readiness to cut back. Finally, ask why they didn’t pick a lower number of readiness (for example, why they picked a five and not a two) to help them talk about why they want to change.
5. Negotiate Action Plan
Then, Negotiate an Action Plan. Considering how ready the adolescent is for change, elicit a specific goal to quit or reduce substance use, and collaborate on specific, achievable steps toward that goal. You can also explore any barriers or challenges to this plan, and identify alternatives to substance use, based on what you now know about the adolescent’s life. You’ll include a referral as part of the change plan if the adolescent’s use is weekly or high-risk and they express a readiness to change
6. Summarize and Thank
And, lastly, Summarize and Thank. Summarize the action plan and make any necessary changes. If a referral is part of the change plan, offer details for further assessment and support. Be sure to schedule a time to check-in on the progress made by the teen, either in-person or by phone.
Look for these Change Concepts:
- Clearly communicate age-appropriate risks of alcohol, tobacco, and substance use to health and wellbeing, with patients reporting any past year use (*linked to screening response)
- Leverage primary care team-patient relationship to discuss behavior change, negotiating, and documenting a reasonable change plan.
- To ensure BI is responsive to screening results the primary care team should receive training that includes age appropriate assessment of risks.
4 D’Onofrio, G, Pantalon, MV, Degutis, LC, Fiellin, DA, O’Connor, PG. (March 2005). “Development and Implementation of an Emergency Practitioner-Performed Brief Intervention for Hazardous and Harmful Drinkers in the Emergency Department,” Acad Emerg Med.