Step 5: Negotiate an Action Plan

• Collaborate on specific steps
• Explore challenges to change
• Offer a referral for further support

Elicit Steps
PROVIDER: You have a really clear idea of what might be challenging for you about quitting. It's great that you're thinking ahead like that. How would you feel about brainstorming some ways to tackle those challenges?
EMILY: (open to it) Sure.

Elicit Steps
PROVIDER: What else could you do with your time after school?
EMILY: I dunno.

Elicit Steps
PROVIDER: Well, if you're looking for something else to do, there are a lot of after-school activities.
EMILY: (skeptical) Like what?
PROVIDER: There's that painting class Ms. Markovic runs. She does that class for younger students, too -- you might even be able to help her teach that.
EMILY: Hmm. That could be cool.

COACH: Although it's generally best to let teens suggest their own steps in an action plan, if you've already asked them for ideas and they feel stuck, it's fine to suggest some ideas of your own.

Explore Challenges
PROVIDER: How do you think your friends would react if you quit?
EMILY: I mean, I don't know, but it's what we do together when we hang out, so I feel like it's gonna be weird.
PROVIDER: They might be upset if you quit.
EMILY: Well... not upset, just it's gonna be so awkward. Like, I don't know what I'd say.

COACH: Reflections (like "They might be upset if you quit.") can be useful even if they're not perfect. If you misunderstood the adolescent, this gives her the chance to correct you ("Well, not upset, it's going to be awkward.")

Explore Challenges
PROVIDER: What could you tell your friends, if they ask why you're quitting?
EMILY: Well, maybe if I told them about my mom busting me, and all the drama with her maybe they'd be cool with that. I mean, they all know about my parents, and if I were just like, "It's too weird at home right now, and I can't handle pot also being a whole thing with my mom"
PROVIDER: You think they'd be okay with that.
EMILY: Yeah. I mean, some of them might be like, "So just smoke with us, don't do it at home", but I dunno. (looks at Player, confidently) It'll be fine.

Offer Referral
PROVIDER: You mentioned that marijuana helps you deal with the stress at home. What other ways do you have to ease that stress?
EMILY: Um (embarrassed) I don't know.
PROVIDER: There are actually a lot of really healthy ways to manage stress. Could I maybe share a few?
EMILY: Okay
PROVIDER: A couple examples might be journaling, deep breathing techniques, exercise, talking to someone you trust
EMILY: Hm
PROVIDER: A lot of teens also find it really helpful to meet with someone who can help them think things through and practice some of those coping skills -- healthy ways to lower stress.
EMILY: What, like a therapist?
PROVIDER: Like a kind of counselor, yeah.
EMILY: Okay. So if I do see someone like that how would that work? Would my parents have to know? Because, like, it would kill my mom if she knew how messed up my life is.

COACH: Asking permission is a great way to get teens on board before you share suggestions. It's always better to elicit ideas if you can, but if you have to provide them, asking permission is an important first step.

Affirm
PROVIDER: Big changes at home are stressful and unsettling for everyone -- teens and adults. It's not unusual for people to need help when that kind of thing is happening.
EMILY: (sigh) I just mean My mom's already so stressed. I don't want to give her more to worry about.
PROVIDER: Well, most parents are actually proud of their kids for finding help when they need it. And they actually feel like they have less to worry about, because, you know, you're showing them you're mature enough to realize when there's a problem and solve it yourself.
EMILY: (thoughtfully) Hm. Okay.

Discuss Referral
PROVIDER: So, what do you think your parents would say, if you told them you've been really stressed lately, and you've found someone really helpful to speak with about that? We could mention the marijuana as a sort of side effect of the stress, but keep the focus on how this has been a hard time for you and you just want to talk it over with someone. How do you think your mom would respond to that?
EMILY: I feel like she'd be sad, but she'd understand.
PROVIDER: And how do you feel about presenting it that way?
EMILY: That sounds okay.

Discuss Referral
PROVIDER: So how do you want to bring this up with your parents? We could have them come in and we'd talk it over with them together, if you'd like that; or you could talk it over with them first; or I could give them a call and fill them in on your plan to see a counselor What feels right to you?
EMILY: I think telling them together would be good. My mom will freak out if she just gets a random phone call about this. And I feel like I need to tell them. But it would be nice to have some backup.
PROVIDER: Great. How about I send them an email saying I'd like to set up a time for all four of us to speak?
EMILY: That sounds okay.

COACH: You've come up with a plan that addresses Emily's concerns about her friends and connects her to a counselor. A specific plan like that, tailored to her needs, will make it much easier for her to stick with her decision to quit. Your next goal is to summarize the plan and solidify how you'll follow up with Emily.