SBI with Adolescents

Step 1: Build Rapport

Ask About Life
PROVIDER: What are your favorite classes this year so far?
EMILY: Um I really like English.
PROVIDER: With Mr. Silva.
EMILY: Yeah. He's so great.
PROVIDER: What do you like about him?
EMILY: Well I draw comics, and a lot of people think they're not real books, but he gets how they are.
PROVIDER: Sounds like he's been really encouraging.
EMILY: (sigh) Yeah

EMILY THOUGHT: And now I'm blowing his class. Go me.

Ask About Life
PROVIDER: Mr. Silva noticed you've been distracted in class lately, and your quizzes haven't been quite as strong as they used to be. How are things going for you?
EMILY: Uh I mean, I've just got a lot going on.
PROVIDER: Like what?
EMILY: Just like, "life" you know? High school

Ask Permission
PROVIDER: Would it be okay if we talked about the questionnaire you just filled out about alcohol and drug use?
EMILY: Um. Sure.

Discuss Confidentiality PROVIDER: Before we go on, I just want to let you know that everything we talk about here is confidential. Unless it sounds like you might hurt yourself or someone else, or someone might be hurting you; or unless you decide to bring someone else in -- I won't share what you say here with anyone.
EMILY: (sigh) Thank god. My mom would have a heart attack.
PROVIDER: You don't want your mom to hear about anything we talk about.
EMILY: She's dealing with enough already.

Discuss Use
PROVIDER: You wrote on the form that you smoke marijuana weekly or more. Can you tell me a bit more about that?
EMILY: Sure. It's basically with friends, after school, you know we get together and hang out.
PROVIDER: How often do you smoke when you hang out with your friends?
EMILY: (embarrassed) I guess now it's like... every time?

Discuss Use
PROVIDER: Do you smoke when you're not with your friends?
EMILY: Sometimes a little lately.
PROVIDER: How many times a week do you smoke by yourself?
EMILY: (sigh) Maybe two or three?

Discuss Use
PROVIDER: When did you start smoking marijuana?
EMILY: Um I guess not that long after school started? But hardly at all.
PROVIDER: You started around the beginning of the year, but you weren't smoking that much then.
EMILY: Yeah. I mean -- I didn't really know anyone at the beginning of the year. But there was this group, and they were really nice, and someone always had some, so I tried it sometimes.
PROVIDER: And lately you've been smoking more.
EMILY: Yeah. We hang out basically every day now after school, and... I dunno. It's just been a nice way to not go home. (anxious laugh)

COACH: Reflections not only rephrase what an adolescent said; they can also move the conversation forward by suggesting or guessing their next sentence. The reflection "And lately you've been smoking more.", delivered in a calm, nonjudgmental tone, encouraged Emily to share.

Follow Up
PROVIDER: You mentioned you don't want to go home after school; could you tell me a bit more about that?
EMILY: It's just (trying to joke) not where I go when I want to relax.
PROVIDER: There's a lot of stress there right now.

Reflect
PROVIDER: Okay, so you'd rather spend time with your friends than go home.
EMILY: It's just (trying to joke) not where I go when I want to relax.
PROVIDER: (reflecting) There's a lot of stress there right now.
EMILY: Yeah My parents are splitting up. They made the "big announcement" two months ago
PROVIDER: How do you feel about that?
EMILY: I dunno. Part of me's like, "This is the worst thing ever," and part of me's like, "Well, finally"
PROVIDER: A lot of mixed emotions.
EMILY: Yeah So anyway, my dad's moving out, and my mom's, like having a breakdown, and basically, home is not my favorite place to be right now.
PROVIDER: And hanging out with your friends is a nice way to get away from that.
EMILY: Yeah. And like, the smoking helps, too. Like, with the stress.

COACH: You have a detailed picture of Emily's marijuana use and you understand why she's using. Next, explore pros and cons to learn what she does and doesn't like about how marijuana is affecting her life.

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