1
00:00:00.000 –> 00:00:01.830
Amy Shanahan: As we talked last time.
2
00:00:02.060 –> 00:00:17.859
Amy Shanahan: Maybe for folks who weren’t here, and certainly invite, DSAM or anyone from BBS to chime in if I miss anything. This is a faster track, so I start off by inviting you to think of these
3
00:00:18.110 –> 00:00:24.750
Amy Shanahan: tools of SBIRT, these processes and flows, and how are you already doing things?
4
00:00:24.830 –> 00:00:42.409
Amy Shanahan: where does it fit? So you’re already starting to think about implementation, which is why we have a little bit of redundancy in having you do the online training, and then have a conversation together so that this feels more practical for you all. So today, we move into the BI, which is Brief Intervention.
5
00:00:42.910 –> 00:00:54.870
Amy Shanahan: The background there, very quickly, the history of this is, it’s based on skills and spirit aspects of motivational interviewing, so sometimes folks
6
00:00:54.870 –> 00:01:09.500
Amy Shanahan: have, been exposed to that. Others may have not, but no worries, we’re not going to do a Motivational Interviewing 101 or anything. But just to give credit where credit’s due, because there’s a lot of evidence behind
7
00:01:09.640 –> 00:01:26.300
Amy Shanahan: the conversation style with… that we have with people who may wonder about change and be ambivalent about it. So, that’s what that’s all about, and that’s where the brief intervention comes in, based on some MI stuff, so motivational interviewing.
8
00:01:26.550 –> 00:01:43.570
Amy Shanahan: And I think Victoria already invited you to, say hello in the chat, change your name, unless you want us to call you something different. But so we… but really, so we know where you are and what agency you’re, attending from.
9
00:01:44.390 –> 00:01:45.510
Amy Shanahan: So, thank you for that.
10
00:01:45.510 –> 00:01:50.339
Amy Walkinshaw: I’m trying to do that, but I can’t figure it out. I’m Rebecca Starkweather with Hope on Deck.
11
00:01:50.630 –> 00:01:55.580
Amy Shanahan: Okay. Rebecca, thanks so much. I thought there were a lot of us Amy’s in the room.
12
00:01:55.580 –> 00:01:57.060
Amy Walkinshaw: Yeah, sorry about that.
13
00:01:57.060 –> 00:02:13.949
Amy Shanahan: Don’t worry about it, no worries. So you could either put it in the chat, or if you put your cursor over your square, you’ll see the three dots in the upper right corner, ellipses, and you can click on that, and it allows you… it should allow you to change your name.
14
00:02:14.410 –> 00:02:15.810
Amy Shanahan: Yep.
15
00:02:16.080 –> 00:02:18.209
Amy Walkinshaw: I will… I will try that.
16
00:02:18.210 –> 00:02:27.970
Amy Shanahan: Sure, no worries. If you want to try that, that’s how you do it. That’s one way to do it, but thanks for letting us know. So, remind us if we call on you and we call you Amy.
17
00:02:27.970 –> 00:02:29.650
Amy Walkinshaw: Okay, thank you.
18
00:02:29.650 –> 00:02:31.150
Amy Shanahan: Yep, no worries.
19
00:02:33.080 –> 00:02:41.279
Amy Shanahan: I’m Amy too, so there’s a few of us here. So, here’s where we are, today.
20
00:02:41.280 –> 00:02:56.130
Amy Shanahan: And if you have thoughts, and so I go through some slides. Folks here who have been with me for a while know that I like to have you involved in the conversation more than me talking at you.
21
00:02:56.130 –> 00:03:01.379
Amy Shanahan: But to get through some of the slides, I’ll go through some of them, but invite you to
22
00:03:01.410 –> 00:03:08.520
Amy Shanahan: throw in some chats, or… or have some ideas or questions as I’m going along, if I’m moving too fast.
23
00:03:08.670 –> 00:03:15.490
Amy Shanahan: slow me down, all that jazz. If I use an acronym and don’t tell you what it means, please feel free to,
24
00:03:15.990 –> 00:03:23.899
Amy Shanahan: remind me to let you know what that means, because I do throw them around too much, and I try to remember that. All right, is that Amy or Rebecca?
25
00:03:26.410 –> 00:03:27.929
Amy Shanahan: Somebody raised their hand.
26
00:03:27.930 –> 00:03:29.140
Amy Walkinshaw: It’s not me.
27
00:03:29.300 –> 00:03:32.760
Amy Shanahan: All right, the real Amy’s raising their hand.
28
00:03:33.190 –> 00:03:34.209
Amy Walkinshaw: This will be fair.
29
00:03:39.020 –> 00:03:43.490
Ilia King, DSAMH: Amy, I think you’re on two different, programs, but…
30
00:03:43.720 –> 00:03:46.059
Ilia King, DSAMH: I guess they may not be…
31
00:03:46.410 –> 00:03:51.079
Ilia King, DSAMH: close to the camera. Amy Shanahan, if you want to keep going.
32
00:03:51.080 –> 00:03:59.170
Amy Shanahan: Okay, thank you. So we’re, we’re gonna focus, today on brief intervention.
33
00:03:59.460 –> 00:04:08.549
Amy Shanahan: And we will, take a step back from last time and have any reflections or questions on screening before we dive into brief intervention.
34
00:04:08.720 –> 00:04:22.160
Amy Shanahan: And then we’ll have… so we’ll show some examples, we’ll talk about brief intervention. I think that’s the meat and the potatoes of SBIRT, and I’ll get into that, and then we’ll have always open discussion throughout.
35
00:04:22.160 –> 00:04:29.130
Amy Shanahan: And Q&A at the end, and then share some dates and next steps for our next session, and so on.
36
00:04:30.400 –> 00:04:48.219
Amy Shanahan: So, so here… here’s where we invite you from last time. Maybe something stood out to you that you learned or took away from, or relearned something. You could throw that in the chat or unmute and share with your peers and colleagues here in the space.
37
00:04:48.330 –> 00:04:55.820
Amy Shanahan: And have you considered which screening tool you’re using? Some of you already came to the table knowing and already using some screening tools?
38
00:04:55.950 –> 00:04:57.860
Amy Shanahan: we…
39
00:04:58.060 –> 00:05:11.349
Amy Shanahan: showcase TAPs a little bit, or mentioned TAPs last time, and I’ll showcase that again when we get into our brief intervention practice. But I’ll pause here and let you share with each other
40
00:05:11.880 –> 00:05:21.970
Amy Shanahan: what question… what questions you have, and what screening tools you’re already considering, if you haven’t already implemented the start of them. So, let’s stop there for a sec.
41
00:05:22.550 –> 00:05:23.650
Amy Shanahan: Few minutes.
42
00:05:41.070 –> 00:05:51.219
Amy Shanahan: And maybe even the fidelity specialist would be… it would find it helpful to know what different screening tools are being used. I know that there’s been conversation around data collection and…
43
00:05:51.400 –> 00:05:53.229
Amy Shanahan: That might help.
44
00:05:53.340 –> 00:06:04.219
Amy Shanahan: Help us as well, so if you wanted to pop that in the chat, what screening tool you’re using, just so folks have a sense of the diversity or similarities?
45
00:06:05.030 –> 00:06:14.329
Shaní Brown- House of David Milford DE, LLC: Hi, my name is Shani, I’m from the House of David in Milford, Delaware. What we’ve done, for as far as a screening tool.
46
00:06:14.560 –> 00:06:22.199
Shaní Brown- House of David Milford DE, LLC: We’ve used, the recommendations that you all have already provided, and we’ve developed a form.
47
00:06:22.320 –> 00:06:26.479
Shaní Brown- House of David Milford DE, LLC: That also incorporates, TAPs in it, too.
48
00:06:26.670 –> 00:06:40.369
Shaní Brown- House of David Milford DE, LLC: So that some of that information is collected, and we don’t have to double back, and it kind of follows, the whole process alone. It’s been, it’s been very helpful to use, because it’s…
49
00:06:40.510 –> 00:06:58.580
Shaní Brown- House of David Milford DE, LLC: like I said, the information that, as recommended that we use, collecting that information, and we’ve, it’s been very helpful to us, and it also calculates things for us, too. The different, the different tiers and the numbers and everything, so that’s helpful.
50
00:06:58.750 –> 00:07:03.100
Shaní Brown- House of David Milford DE, LLC: And it’s working for us, so…
51
00:07:03.500 –> 00:07:06.010
Amy Shanahan: Beautiful. Shanie, thanks for kicking us off.
52
00:07:06.290 –> 00:07:22.080
Amy Shanahan: And so happy to hear that, that it’s working for you. I love the, you know, how it tabulates for you and gives you the responses, so you don’t have to calculate or count or do some of them, and the TAPS does this, it gives you the recommendations of what you could do next, and I’ll showcase that for folks who haven’t
53
00:07:22.130 –> 00:07:26.869
Amy Shanahan: used it or seen it. And… and again, the other,
54
00:07:27.020 –> 00:07:33.890
Amy Shanahan: Reason and intention for us inviting you to share what you’re doing is, maybe you can help each other, and that’s what this is about.
55
00:07:33.890 –> 00:07:34.510
amy rust- Attack Addiction: Hello?
56
00:07:34.630 –> 00:07:35.550
Amy Shanahan: Yeah, hi!
57
00:07:36.600 –> 00:07:37.900
Amy Shanahan: Amy Rust.
58
00:07:38.480 –> 00:07:42.019
amy rust- Attack Addiction: I’m so sorry. I wasn’t sure if my microphone was on or not.
59
00:07:42.020 –> 00:07:42.480
Amy Shanahan: Thank you.
60
00:07:42.480 –> 00:07:46.400
amy rust- Attack Addiction: I was… I’m sorry. That’s okay. I didn’t mean that.
61
00:07:46.520 –> 00:07:50.349
Amy Shanahan: You now know your microphone works.
62
00:07:55.160 –> 00:08:00.300
amy rust- Attack Addiction: I don’t need anything, I’m sorry. I couldn’t hear, and I didn’t know if you guys could hear me, so…
63
00:08:01.230 –> 00:08:04.899
Amy Shanahan: Okay, great. Can you hear us now, then? Okay, good. Excellent.
64
00:08:05.100 –> 00:08:18.300
Amy Shanahan: All right, we got hope on Deck, love that. Just hope on Deck. But I love that you’re already doing that, the DAS 10, easy to use, you’re considering the TAPs in the future,
65
00:08:18.910 –> 00:08:25.049
Amy Shanahan: Yeah, especially if it’s at your fingertips. I don’t… I think the last… last time the question came up.
66
00:08:25.860 –> 00:08:40.340
Amy Shanahan: does the data collate, or does it aggregate, I should say, for your system, which would be helpful, and I’m not really sure about that. I haven’t used it in a systems level myself, because it was new when I was
67
00:08:40.460 –> 00:08:43.829
Amy Shanahan: It wasn’t existing when I was using SBIRT.
68
00:08:43.940 –> 00:08:45.990
Amy Shanahan: In my previous life.
69
00:08:50.470 –> 00:09:03.980
Amy Shanahan: All right, so if there’s not any specific questions, certainly share in the chat what screening tools you’re using and what you’re thinking about, so that we have a sense of where everybody’s going and where you are already.
70
00:09:03.980 –> 00:09:11.089
Amy Shanahan: And again, now we’re going to dive into the brief intervention pieces as well, so that we can
71
00:09:11.150 –> 00:09:14.339
Amy Shanahan: Spend some time on this.
72
00:09:15.100 –> 00:09:22.900
Amy Shanahan: Some people want more time with brief intervention, more practice time, and… And I…
73
00:09:23.130 –> 00:09:26.739
Amy Shanahan: Love hearing that, because sometimes it takes practice.
74
00:09:26.880 –> 00:09:38.890
Amy Shanahan: And sometimes, some of us are used to the checklist, like, hey, you scored 10, and it means this, and this is what you should do, and that’s not, the best example of a brief intervention.
75
00:09:39.440 –> 00:09:46.750
Amy Shanahan: the checklist. So, what I think about, and I’m… I know you can see the slide,
76
00:09:47.000 –> 00:09:58.279
Amy Shanahan: I just paraphrase it instead of reading it, because I already shared things about MI and backed by evidence. To me, this is the conversation that you have with people.
77
00:09:58.550 –> 00:10:07.569
Amy Shanahan: And I chuckled last time and said that the medical assistant that I saw in my place of healthcare
78
00:10:07.700 –> 00:10:13.829
Amy Shanahan: Fed me the questions, or the answers, in the way she asked the screening questions.
79
00:10:14.190 –> 00:10:15.150
Amy Shanahan: And…
80
00:10:15.420 –> 00:10:27.809
Amy Shanahan: I would highly recommend that we, observe our assistants, or whomever’s doing that level of screening if they’re not doing it on paper, and I’ll share with you
81
00:10:27.840 –> 00:10:36.999
Amy Shanahan: And you could probably imagine why. Well, let me do it… let me share an example with you all, and how do you think you’ll feel when you’re a little uncomfortable?
82
00:10:37.080 –> 00:10:41.180
Amy Shanahan: About answering it, or answering it truthfully, if you will, right?
83
00:10:41.420 –> 00:10:52.939
Amy Shanahan: What if I said, hey, so you use alcohol, probably, yeah, monthly? But no more than 3 or 4, right?
84
00:10:54.320 –> 00:10:57.150
Amy Shanahan: So what do you think about that line of questioning?
85
00:10:57.510 –> 00:10:59.110
Amy Shanahan: Where does your brain go?
86
00:11:00.710 –> 00:11:03.159
Amy Shanahan: So, that’s…
87
00:11:03.340 –> 00:11:19.500
Amy Shanahan: how the person, asked me the question. So, it’s best, as you probably already know this, you know, in the last 12 months, how much alcohol I’ve used, how frequent, how much, how often, and make it broad and open.
88
00:11:19.600 –> 00:11:25.609
Amy Shanahan: And to me, this part of the brief intervention is the conversation you have about their answers.
89
00:11:26.790 –> 00:11:34.889
Amy Shanahan: And respond to them, and reflect. And I can go on and on, but I’m going to wait for the example instead of me sharing all the examples.
90
00:11:35.260 –> 00:11:54.480
Amy Shanahan: So, what I have experienced in my career and rotation around screening and brief intervention, I’ve worked with physical therapists, I’ve worked with emergency departments, I’ve worked with psychiatric hospitals, and certainly, outpatient
91
00:11:54.580 –> 00:12:00.579
Amy Shanahan: Various outpatient clinics, and people talk about two main things.
92
00:12:01.020 –> 00:12:03.950
Amy Shanahan: I’m not really comfortable having the conversation.
93
00:12:04.580 –> 00:12:06.319
Amy Shanahan: And I don’t have time.
94
00:12:07.060 –> 00:12:15.219
Amy Shanahan: So, those are the things that you want to think about in your implementation process. How do you
95
00:12:15.320 –> 00:12:21.660
Amy Shanahan: guide the staff to have the conversation, and where is the timeframe? Where do they get to spend this time?
96
00:12:22.320 –> 00:12:28.469
Amy Shanahan: I think about going to my physician, and she does brief interventions just by having a conversation with me.
97
00:12:29.940 –> 00:12:33.309
Amy Shanahan: By sharing the risk of the medication I’m taking.
98
00:12:33.770 –> 00:12:41.110
Amy Shanahan: By informing… and that informed consent, if I keep doing this, so…
99
00:12:41.410 –> 00:12:46.309
Amy Shanahan: I consider that conversation from my care provider, whether it’s a,
100
00:12:46.580 –> 00:12:54.600
Amy Shanahan: A nurse practitioner or my doctor, interventions can be interjected in your conversations.
101
00:12:54.950 –> 00:12:57.559
Amy Shanahan: I’m wondering what you know about
102
00:12:57.660 –> 00:13:00.980
Amy Shanahan: What happens if you continue to drink this way?
103
00:13:01.230 –> 00:13:11.619
Amy Shanahan: So, that’s one of my go-tos, because a lot of people already know the risks. Some don’t. So let them tell you what they already know. So that’s the piece about
104
00:13:11.760 –> 00:13:23.969
Amy Shanahan: creating a conversation, and… and here’s the specific, you know, why and what about brief interventions. It’s to open up a conversation. So if we’re…
105
00:13:24.030 –> 00:13:37.110
Amy Shanahan: asking closed questions and we’re feeding the answers and the screening aspect, it’s gonna… we’re gonna have a hard time coming away from that checklist to open up the conversation, so my recommendation would be to
106
00:13:37.110 –> 00:13:46.379
Amy Shanahan: Practice, have the team members practice, using more open questions, and following those screening-type questions so they’re more open instead of
107
00:13:46.400 –> 00:13:54.850
Amy Shanahan: I call it leading the witness. I hang around lawyers sometimes too much. Leading the witness, feeding them the answer.
108
00:13:54.880 –> 00:14:00.420
Amy Shanahan: Another thing, too, besides asking them what they already know.
109
00:14:00.560 –> 00:14:06.809
Amy Shanahan: is… is highlight their… their efforts and their abilities. So we call these affirmations.
110
00:14:07.110 –> 00:14:09.909
Amy Shanahan: Because this enhances their self-efficacy.
111
00:14:10.550 –> 00:14:23.479
Amy Shanahan: I don’t know about you, but in my career in addiction treatment and behavioral health care, I’ve been trained to look for the problem and look for what’s wrong with the picture, to find the solution to the problem.
112
00:14:23.700 –> 00:14:40.919
Amy Shanahan: And the foundation of my MI training, has taught me that people know what’s best for them, people know what their strengths are, people know what they can and can’t do right now, and can we highlight their strengths, to enhance their
113
00:14:41.000 –> 00:14:45.540
Amy Shanahan: Their commitment to change, and their even willingness to talk about it.
114
00:14:46.260 –> 00:14:49.149
Amy Shanahan: Because if I feel guilty, or if I feel ashamed.
115
00:14:49.650 –> 00:14:55.690
Amy Shanahan: Well, I’m gonna ask you this. If you feel guilty, or if you feel ashamed, because you do have knowledge.
116
00:14:55.970 –> 00:14:58.120
Amy Shanahan: About your use and your patterns.
117
00:14:58.240 –> 00:14:59.849
Amy Shanahan: Or have some sense of it.
118
00:15:00.480 –> 00:15:06.380
Amy Shanahan: Are you going to open up in the conversation that we’re having? Right, thank you. No, not really.
119
00:15:06.540 –> 00:15:23.759
Amy Shanahan: So we want to also tap into the natural supports, invite them to talk about who supports them. Do they have people in their lives that are going to support their health optimization?
120
00:15:24.140 –> 00:15:27.550
Amy Shanahan: I know that there’s some conversation around
121
00:15:27.740 –> 00:15:39.839
Amy Shanahan: harm and reducing harm in our world of healthcare, and I am stealing this from a doctor in Baltimore, and I’m sorry, I forgot his name. I should have wrote it down.
122
00:15:39.950 –> 00:15:47.870
Amy Shanahan: Health optimization. How can we plant the seeds so this person might consider reducing their use?
123
00:15:48.510 –> 00:15:51.639
Amy Shanahan: Sometimes we simply just have to stop.
124
00:15:52.250 –> 00:16:04.099
Amy Shanahan: Or go to specialized care. Yeah, thanks, Amy. Yeah, it’s all about planting that seed, so thanks for highlighting that, and that’s what that means.
125
00:16:04.730 –> 00:16:16.180
Amy Shanahan: Capitalizing on a teachable moment could be all about, you know, maybe they came in with a broken arm, and they fell, and this is the third time, or maybe they’re coming to physical therapy again.
126
00:16:16.230 –> 00:16:25.350
Amy Shanahan: And we’re not connecting the dots, they’re not connecting the dots, but in a very empathic, kind way, say, you know, I’ve noticed
127
00:16:25.490 –> 00:16:36.650
Amy Shanahan: That lately you’ve been talking about these falls, and this is, like, the second time. They might not connect the dots, but capitalize on that teachable moment.
128
00:16:37.000 –> 00:16:39.960
Amy Shanahan: And I’m wondering what you think you could do differently
129
00:16:40.490 –> 00:16:46.540
Amy Shanahan: Not… I’m wondering what you could do to stop using or drinking. I’m wondering what you think you could do differently.
130
00:16:47.700 –> 00:16:54.140
Amy Shanahan: And some folks who… who work with people who’ve had driving under the influence charges.
131
00:16:54.190 –> 00:17:10.030
Amy Shanahan: or injuries related to use, they might say, well, maybe I shouldn’t operate machinery when I’m drinking or using. Maybe I shouldn’t drive and use anymore. So that’s what I… what, at least in my mind, I interpret as the teachable moment.
132
00:17:10.109 –> 00:17:13.909
Amy Shanahan: I would suspect that you have some… some thoughts as well.
133
00:17:15.339 –> 00:17:31.769
Amy Shanahan: So I’m going to pause there for a minute. I’ve said a lot of things. Maybe you have some thoughts or… or beautiful things that you’re already doing in this realm of how you explore these things with people, and help create, and this is what I call this, an environment where people feel comfortable and safe.
134
00:17:32.580 –> 00:17:35.669
Amy Shanahan: To share as much as they’re willing to share.
135
00:17:38.050 –> 00:17:38.959
Amy Shanahan: Because even though…
136
00:17:39.270 –> 00:17:40.040
Dawn Sheehan Hope on Deck: Yeah, go ahead.
137
00:17:40.040 –> 00:17:41.589
Amy Shanahan: Please. No, please, go ahead.
138
00:17:41.870 –> 00:17:57.760
Dawn Sheehan Hope on Deck: I think for us, a big thing is, and it’s very beneficial, is we kind of see the same people every week. And so you get a rapport with them, and I think not everybody can do that, we know, but once you… if you’re going to see them.
139
00:17:57.840 –> 00:17:59.960
Dawn Sheehan Hope on Deck: often,
140
00:17:59.960 –> 00:18:21.869
Dawn Sheehan Hope on Deck: I think that they are more open, because, you know, sometimes when we go out, or… which is for an example, if somebody comes into the Resource Center and it’s their first time, you know, they don’t know who we are, they don’t know what we’re about, so they might give us different answers just because they don’t know us, and they don’t want to. But then 3 times in, and we’re still doing it, then they might open up.
141
00:18:21.870 –> 00:18:25.410
Dawn Sheehan Hope on Deck: So, I think that, if… if you…
142
00:18:25.430 –> 00:18:43.130
Dawn Sheehan Hope on Deck: I think it’s beneficial if you see them more often than just one time. I think one time, they don’t know who you are, that you don’t have rapport, they don’t know what you’re about. And then same thing when we do outreaches. I think if you go to the same outreach often, they open up more. And I, you know, so I think it’s kind of…
143
00:18:43.740 –> 00:18:49.519
Dawn Sheehan Hope on Deck: Hard when you only see them once, because they’re less prone to reach out to you when they need something.
144
00:18:50.490 –> 00:19:02.660
Amy Shanahan: Thanks so much for that, Dawn. And, you know, underscoring for sure, when you have more time to develop a relationship, you’re gonna get more. And it underscores a good point.
145
00:19:02.830 –> 00:19:20.419
Amy Shanahan: that the brief intervention and the planting of the seed still is impactful, and I’m going to steal from Bill Miller, who, when we ask him, well, can you do motivational interviewing in 5 minutes? He goes, can you play a beautiful song that moves people in 5 minutes?
146
00:19:20.950 –> 00:19:39.790
Amy Shanahan: So that… I steal that quote from that analogy of, when you meet with somebody for the first time, you… you can still have an impact, and I’m going to share my own experience, and maybe you all have your own examples of a time when you were like, oh man, I am not telling this person anything.
147
00:19:40.150 –> 00:19:46.030
Amy Shanahan: Or, you had an experience that you go, huh, maybe I would tell them.
148
00:19:46.640 –> 00:19:58.049
Amy Shanahan: Maybe next time. I’m a little scared. What’s gonna happen? Are they gonna judge me? Are they gonna shame me? Are they gonna tell me I gotta go to formal treatment? Because I don’t want to go to formal treatment.
149
00:19:58.450 –> 00:20:12.870
Amy Shanahan: And, from my experience, even when… and I shared the example of the medical assistant that fed me the answers to the questions, I still walked away thinking about my relationship.
150
00:20:13.050 –> 00:20:30.559
Amy Shanahan: with substances and alcohol, because she broached the subject. So there’s… there’s a lot in there, Dawn. So yes, indeed, when you have more time, people probably will open up more if you have a consistent, empathic, non-judgmental style.
151
00:20:30.690 –> 00:20:39.530
Amy Shanahan: And you can still plant the seed, because what we know is that the seeds of change may sprout when we don’t see them.
152
00:20:41.050 –> 00:20:48.590
Amy Shanahan: Maybe next session, maybe next year, but because of your kind heart and your non-judgmental approach.
153
00:20:48.690 –> 00:20:56.849
Amy Shanahan: they have it in their minds, okay, someday, you know. I’ve been talking about stopping eating carbs forever.
154
00:20:57.390 –> 00:21:13.290
Amy Shanahan: And then when my cholesterol went off the charts, I made a decision to do something about it. So we all change at different reasons for different times. So that’s my vulnerable piece about my own health optimization.
155
00:21:13.410 –> 00:21:14.330
Amy Shanahan: Dang it.
156
00:21:14.440 –> 00:21:16.550
Amy Shanahan: I always knew it. Had to do it.
157
00:21:17.400 –> 00:21:24.330
Amy Shanahan: But, you know, it’s simpler when we don’t have a stigmatizing, subject to talk about.
158
00:21:24.460 –> 00:21:30.560
Amy Shanahan: And that’s what I love about SBIRT, is its intention is to move it into this realm of…
159
00:21:30.670 –> 00:21:42.689
Amy Shanahan: Having a conversation with people about their relationship with tobacco, alcohol, other substances, including medications that they’re not taking, the way they’re prescribed.
160
00:21:42.690 –> 00:21:55.079
Amy Shanahan: So, making it standard operating procedure, you put my blood pressure cuff on, I shared this last time, I don’t question it. You tell me to step on the scale, well, sometimes I wrinkle my brow, but I do it anyway.
161
00:21:57.700 –> 00:22:16.699
Amy Shanahan: But if we get this screening done and brief interventions and a non-judgmental approach throughout our systems of any kind of healthcare, it’ll be just like showing up and expecting the doctor to put the cuff on, or the medical assistant to invite you, sometimes tell you to step on the scale.
162
00:22:17.560 –> 00:22:24.640
Amy Shanahan: So, you may already know this, you may have ex- experienced this in the, online course.
163
00:22:25.830 –> 00:22:39.739
Amy Shanahan: Raising the subject, and how you do it. So I won’t beat that one, I already shared that already. How you raise the subject, what you sound like, are you seeming afraid? Are you asking open questions?
164
00:22:40.320 –> 00:22:47.140
Amy Shanahan: Being comfortable and open to provide the feedback about the results of the screening and their answers.
165
00:22:48.220 –> 00:22:54.849
Amy Shanahan: This one is the tough one that people struggle. What do I say? Well, you scored a 10, might sound easier.
166
00:22:55.310 –> 00:23:03.520
Amy Shanahan: Now, you could say that, you know, according to the answers that you gave in the screening tool, it’s put the onus on them.
167
00:23:04.330 –> 00:23:13.099
Amy Shanahan: It seems that you fall in this category because of… so you can share the numbers if you’d like, and then tell them what the numbers mean.
168
00:23:13.620 –> 00:23:15.770
Amy Shanahan: I’m wondering what you make of that.
169
00:23:16.000 –> 00:23:18.800
Amy Shanahan: Give them time to digest that.
170
00:23:19.180 –> 00:23:21.699
Amy Shanahan: Because that could be the first time they’re hearing it.
171
00:23:22.900 –> 00:23:25.560
Amy Shanahan: Or, they’re not surprised at all.
172
00:23:26.380 –> 00:23:27.889
Amy Shanahan: So let them answer that.
173
00:23:28.310 –> 00:23:31.480
Amy Shanahan: And then they’re enhancing their motivation.
174
00:23:31.900 –> 00:23:40.800
Amy Shanahan: Comes in with, what do you make of it? What do you think about that as it relates to what you’re seeing me for today?
175
00:23:41.180 –> 00:23:49.569
Amy Shanahan: That tie it into what they want to do with their health, and negotiating a plan is a collaborative process.
176
00:23:50.110 –> 00:23:51.860
Amy Shanahan: What do they want to do?
177
00:23:52.470 –> 00:24:01.530
Amy Shanahan: Are we knee-jerking to a big, pie-in-the-sky plan? Like, well, I need you to lose 50 pounds? Well, if my doctor told me that.
178
00:24:01.530 –> 00:24:15.160
Amy Shanahan: Or if my doctor told me I could never eat carbohydrates ever, I probably would run home and eat all the carbohydrates in the world, and then some, and cry, and be really sad, and…
179
00:24:15.410 –> 00:24:25.210
Amy Shanahan: Yeah, so when we plug these things into some other health optimization behaviors, think about what it would be like.
180
00:24:25.720 –> 00:24:29.150
Amy Shanahan: So maybe you’d be willing to reduce
181
00:24:29.800 –> 00:24:47.289
Amy Shanahan: the numbers of times, or the amount in your week. So negotiating a plan is collaborative and not prescriptive. So collaboration, I want to highlight, is collaborative. It doesn’t mean that you erase yourself from the mix. So when we talk about partnership in motivational interviewing.
182
00:24:47.290 –> 00:25:01.140
Amy Shanahan: I would be asking you, I wonder what you make of this now that we’re having this conversation, and how it relates to your blood pressure issue, or your broken arm issue, or your numerous DUIs, or your,
183
00:25:01.780 –> 00:25:07.710
Amy Shanahan: Your housing insecurity, or your financial situation, how does this relate to you!
184
00:25:09.780 –> 00:25:13.920
Amy Shanahan: And then, what are you willing to do, and how can I be helpful in that process?
185
00:25:14.760 –> 00:25:19.630
Amy Shanahan: So these are my interjections from my… my world.
186
00:25:20.110 –> 00:25:24.570
Amy Shanahan: Checking the time. I’d like to… share…
187
00:25:25.610 –> 00:25:34.270
Amy Shanahan: These are each 5 minutes, so I’m going to share 2 different examples, and… see how…
188
00:25:34.460 –> 00:25:36.099
Amy Shanahan: So, we’re all different.
189
00:25:37.000 –> 00:25:40.410
Amy Shanahan: We all have different ways, and I think I shared this last time.
190
00:25:40.770 –> 00:25:48.080
Amy Shanahan: you find your own way, your own language, the way you would do it. So when you’re watching the video.
191
00:25:48.300 –> 00:25:49.830
Amy Shanahan: videos.
192
00:25:50.130 –> 00:25:51.690
Amy Shanahan: think about…
193
00:25:51.840 –> 00:25:59.429
Amy Shanahan: hmm, what stands out that you think would be helpful? Some language or some phrasing? And maybe there’s some stuff that’s not helpful.
194
00:25:59.650 –> 00:26:06.159
Amy Shanahan: It’s not about criticizing this beautiful healthcare worker, it’s about what fits my style.
195
00:26:06.370 –> 00:26:13.140
Amy Shanahan: So, I’d like to invite you to think about that, and maybe what would you do differently? How would you react differently?
196
00:26:15.930 –> 00:26:26.510
Amy Shanahan: Steve is a 30-year-old male presenting with the chief complaints of insomnia and feeling anxious. Steve’s audit score places him in Zone 2, the risky category of use.
197
00:26:27.330 –> 00:26:43.420
Amy Shanahan: Steve, before we’re done with our visit today, I was wondering if you’d be willing to take a few minutes to talk about your drinking. Okay, like what? Well, you filled out this survey for us today, which was great, thank you very much. I just wanted to review a couple things on here. I noticed that you said that you drink 2 to 3 times a week.
198
00:26:43.530 –> 00:26:54.780
Amy Shanahan: drink 3 or 4 drinks at a time when you do drink, and weekly, have more drinks than that. So, 6 or more drinks, it says on here. Does that sound realistic? Yeah, on the weekends. Okay.
199
00:26:54.780 –> 00:27:11.509
Amy Shanahan: Okay, I just want to let you know I’m a little bit concerned about your level of drinking. We know that excessive drinking can make problems worse, or can actually cause health problems at times. And I was just wondering if you thought about the connection between your drinking and things like the anxiety and the insomnia that you came in with today.
200
00:27:12.140 –> 00:27:14.740
Amy Shanahan: No, I guess I haven’t really thought much of it.
201
00:27:15.270 –> 00:27:27.430
Amy Shanahan: you know, I don’t really think I drank that much in the first place, so I have a hard time believing that it’s causing my anxiety. In fact, on the nights when I don’t drink, I have a harder time going to sleep.
202
00:27:27.550 –> 00:27:45.320
Amy Shanahan: Well, you’re not alone. A lot of people think that drinking helps them sleep better, and in reality, drinking might make you fall asleep faster, but it has what’s called this rebound effect, and this rebound effect means that you wake up… might wake up in the middle of the night or early in the morning and have a hard time falling back asleep.
203
00:27:45.320 –> 00:27:50.640
Amy Shanahan: Yeah, I guess I do have it. About 2 AM, I tend to wake up on the nights I drink too much.
204
00:27:50.980 –> 00:27:58.790
Amy Shanahan: I just wanted to show you this little chart here. For your age, as a male, you’re drinking more than those at a low-risk level.
205
00:27:59.040 –> 00:28:13.249
Amy Shanahan: The low risk level for men under 65 was no more than 14 drinks a week, and no more than 4 a day. And in this case, a drink is considered 12 ounces of beer, 5 ounces of wine, or an ounce and a half of distilled spirits.
206
00:28:13.390 –> 00:28:30.270
Amy Shanahan: And you’re right, you’re not drinking as much as some people out there. The way you answered our questions here, you’re actually falling in the high-risk category, the risky or hazardous category, category 2. Geez, no, I didn’t think I was that bad. That’s why it’s helpful to look at this and give some perspective.
207
00:28:30.790 –> 00:28:40.189
Amy Shanahan: on a scale of 1 to 10, what is your readiness to change? One being, I don’t want to change at all, and 10 is, I really want to change.
208
00:28:41.670 –> 00:28:49.719
Amy Shanahan: Well, I don’t know, I mean, this is all news to me. I don’t want to do anything to put myself at risk, and I’ve always thought of myself as a pretty healthy guy.
209
00:28:50.120 –> 00:28:58.469
Amy Shanahan: I guess I’d put myself right in the middle at a 5. Well, that’s great. That’s halfway there. What kept you from just giving it a 1 or a 2? Something lower?
210
00:28:58.930 –> 00:29:04.619
Amy Shanahan: Well, you know I’m training for the marathon, and that’s why I’m coming in, is because I need to be able to get my sleep back on track.
211
00:29:05.150 –> 00:29:09.759
Amy Shanahan: But I also don’t think myself as a hazardous drinker, and I’m certainly not an alcoholic, so…
212
00:29:10.390 –> 00:29:15.560
Amy Shanahan: That’s… that’s why the middle ground, 5. Well, that’s a good place to start. So, I heard you say your health is important.
213
00:29:15.610 –> 00:29:32.090
Amy Shanahan: And you’re getting ready to run a marathon, so you want to be able to do what you can to make that successful, and you also were a little bit surprised that you fell into this risky or hazardous category. Yes. Okay, so based on all that information, what are you willing to think about doing to change right now?
214
00:29:32.920 –> 00:29:37.120
Amy Shanahan: Well, I think the natural thing would be to cut back a little on my drinking.
215
00:29:37.300 –> 00:29:40.310
Amy Shanahan: So what would that look like for you?
216
00:29:42.490 –> 00:29:50.280
Amy Shanahan: yeah, I guess drink no more than maybe 3 or 4 times a week, and on the weekends, which is when I would drink the most.
217
00:29:50.720 –> 00:30:07.460
Amy Shanahan: Back to no more than 5 or 6 beers. Okay. Okay. Well, sometimes when people are ready to make changes like this, it helps if they write down their goals, gives them a chance to see them in black and white. If you were to look at this little form here, and figure out where you want to go with your drinking, what would you put down as your goal?
218
00:30:09.250 –> 00:30:12.780
Amy Shanahan: Doing the math, I guess.
219
00:30:13.320 –> 00:30:32.610
Amy Shanahan: no more than 18 drinks a week. Okay, so that’s an improvement. So you’re headed in the right direction. I do want to let you know that with 18 drinks a week, you’re still falling above this low-level risk category, and that it would be my recommendation that at some point you would fall below into this routine.
220
00:30:32.690 –> 00:30:46.930
Amy Shanahan: for less a week. But it’s an improvement, and it’s a great place to start, and I really commend you for your willingness to take a look at this and try to make some improvements. Thanks. So I’m hoping that in your appointment next month, we can touch base on this and see how it’s going.
221
00:30:47.430 –> 00:30:48.240
Amy Shanahan: Sure.
222
00:30:48.770 –> 00:30:49.480
Amy Shanahan: Cool.
223
00:30:51.460 –> 00:30:56.229
Amy Shanahan: Alright, I’m gonna stop sharing so I can see your lovely names and faces, and…
224
00:30:57.860 –> 00:31:04.289
Amy Shanahan: What do you make of that? What stood out that you’d take away that you liked what happened there?
225
00:31:04.440 –> 00:31:09.620
Amy Shanahan: Or any thoughts or questions about that example, I have another example to share as well.
226
00:31:14.710 –> 00:31:15.829
Amy Shanahan: Go ahead, Amy.
227
00:31:16.870 –> 00:31:24.890
amy rust- Attack Addiction: I think she allowed the patient the chance to understand where she was getting to, instead of leading him there.
228
00:31:25.500 –> 00:31:29.630
amy rust- Attack Addiction: She helped him identify something that he didn’t even recognize.
229
00:31:31.690 –> 00:31:37.269
Amy Shanahan: So her guiding style, and that’s what I love about these examples, because they’re 5 minutes long.
230
00:31:38.150 –> 00:31:50.199
Amy Shanahan: So some may, depending on your role, if you’re the one that’s doing the brief intervention, do this as a result of other conversations you’re having and interweaving it. That’s what my PA did with me.
231
00:31:50.500 –> 00:32:04.459
Amy Shanahan: Or you carve out this time to have this exacting brief intervention where you’re focused in on this, so you can spend that cadence of time to listen and respond back to what they’re saying.
232
00:32:05.370 –> 00:32:07.349
Amy Shanahan: What else did you notice, folks?
233
00:32:16.150 –> 00:32:23.900
Shaní Brown- House of David Milford DE, LLC: It seemed as if, just the interaction… she was providing him with information, and…
234
00:32:23.930 –> 00:32:42.580
Shaní Brown- House of David Milford DE, LLC: not necessarily telling him what he needed to do, but just giving him information as to where he fell, you know, as far as the guy, you know, the different areas, and, how that may affect other things, and she asked him questions. She didn’t assume anything.
235
00:32:42.690 –> 00:32:59.009
Shaní Brown- House of David Milford DE, LLC: And he was able then to tie in, oh, I didn’t look at it that way, and this is, you know, now I understand that. But helping him to make a decision with regards to how he wanted to deal with it. It wasn’t, you know, she suggested some things openly.
236
00:32:59.030 –> 00:33:04.140
Shaní Brown- House of David Milford DE, LLC: But it was ultimately his decision to make, and he did that.
237
00:33:04.500 –> 00:33:23.900
Amy Shanahan: Yeah, nice catch. And these videos may or may not be helpful for you if you wanted to share them with team members that might be doing the brief interventions and might want to see some examples. Of course, again, there’s… we have two examples, but there’s many of us that have our own style about how we would go about this, so I want to really highlight that, and we’d use our own
238
00:33:23.900 –> 00:33:27.169
Amy Shanahan: language. For me, it seemed very formal.
239
00:33:27.170 –> 00:33:34.360
Amy Shanahan: if I’m talking about my style, I would want it more conversational for me, from my comfort zone.
240
00:33:34.740 –> 00:33:37.749
Amy Shanahan: One thing that I… that I’ll… I’ll offer you up.
241
00:33:38.060 –> 00:33:57.330
Amy Shanahan: that I… I… I borrow from my mentor when he does brief interventions. He will talk about this high risk or hazardous risk categories, or even low risk, but what he’ll say is, you know, what this means to me is that
242
00:33:57.530 –> 00:34:03.570
Amy Shanahan: If you continued to use at this level that you’re saying you’re using.
243
00:34:03.770 –> 00:34:09.400
Amy Shanahan: You’re at more risk for health and other concerning issues.
244
00:34:10.159 –> 00:34:21.040
Amy Shanahan: So, what this means is, if you choose to continue this way, that’s a nice planting. I loved it because, for me, it was like planting the seed. It’s your choice.
245
00:34:21.560 –> 00:34:31.880
Amy Shanahan: If you choose to drink at this level, or if you choose to use this quantity and amount and frequency, you know, you don’t have to say all that stuff. If you continue in this pattern.
246
00:34:31.889 –> 00:34:49.819
Amy Shanahan: you’re putting yourself more at risk for some… because, you know, this guy talked about he’s a healthy guy, he’s… what was he, running a marathon, you know, so he doesn’t think that it’s a lot, you know, and maybe he wouldn’t have any risks, so my mentor shared with me, we can’t threaten people, because we… we don’t know.
247
00:34:50.190 –> 00:34:53.230
Amy Shanahan: If they’re gonna… it’s likely?
248
00:34:53.340 –> 00:34:56.070
Amy Shanahan: Based on what we know, Hmm?
249
00:34:56.179 –> 00:35:03.509
Amy Shanahan: Yeah, the scaling, Abby wrote in the chat about the scaling,
250
00:35:04.150 –> 00:35:13.930
Amy Shanahan: One thing that I’ll highlight, and this practitioner did it, we go low on the scale, not higher. So if I asked you, and you all said you’re a 5,
251
00:35:14.150 –> 00:35:21.129
Amy Shanahan: And I said, well, why aren’t you a 6 or a 7? What does that do to your brain or your response?
252
00:35:22.360 –> 00:35:26.400
Amy Shanahan: you say you’re a 5, and I’m like, why aren’t you a 6 or a 7?
253
00:35:27.490 –> 00:35:30.540
Amy Shanahan: What do you think about that line of questioning?
254
00:35:40.640 –> 00:35:42.180
Amy Shanahan: Any reactions?
255
00:35:44.630 –> 00:35:58.649
Amy Shanahan: It is judgmental, right? It can be ju… and it… well, let’s put it this way. I didn’t mean to be judgmental. Right, Sabrina? It could come across as judgmental and or an expectation.
256
00:35:58.680 –> 00:36:06.169
Amy Shanahan: that you should be higher than the number you picked. So when you choose to use the scales, they’re really powerful tools to plant those seeds.
257
00:36:06.380 –> 00:36:12.919
Amy Shanahan: When people walk away, they’re thinking about it. So, you picked a 5. Why didn’t you pick a 3 or a 4?
258
00:36:14.070 –> 00:36:19.519
Amy Shanahan: And now they start to think… they start to come up with change language. Well…
259
00:36:19.790 –> 00:36:24.279
Amy Shanahan: I… I guess I do drink more than some other people, yeah?
260
00:36:24.460 –> 00:36:33.280
Amy Shanahan: And it’s non-judgment. It’s better for non-judgmental approach. Yeah. Anything else that stood out to you that you’d like to share?
261
00:36:34.600 –> 00:36:44.020
Amy Shanahan: Right, Danielle. Daniel, it allows people to reflect on their reasons for using. And that’s a neutral stance for us.
262
00:36:46.320 –> 00:36:51.979
Amy Shanahan: I may have a judgment, and I do, I don’t know if I’m the only one in the room.
263
00:36:52.050 –> 00:37:07.999
Amy Shanahan: No, I’m not alone. And judgment is good, too. I could misrepresent my judgment because I have a halo for someone, or I could be negatively judging someone, and that could impact me being neutral about their own thoughts about their use.
264
00:37:08.350 –> 00:37:15.060
Amy Shanahan: Some people may have cut down significantly already, and I still have a judgment that they’re using too high level.
265
00:37:15.850 –> 00:37:21.150
Amy Shanahan: And some people choose that they’re gonna take their lifetime to cut down, and who am I to say?
266
00:37:21.330 –> 00:37:24.829
Amy Shanahan: That they are or aren’t… they should or shouldn’t do that.
267
00:37:26.270 –> 00:37:42.669
Amy Shanahan: Another thing that I’ll add and introduce that I took away from this video, that, I train people in brief action planning, which is part of an MI thing as well. One thing we ask people to… and the practitioner did this, she wasn’t as specific.
268
00:37:42.920 –> 00:37:47.609
Amy Shanahan: What are you willing to do differently in the next couple of weeks?
269
00:37:48.890 –> 00:37:53.220
Amy Shanahan: Give them a time… what are you willing to do?
270
00:37:53.470 –> 00:37:55.510
Amy Shanahan: In the next couple of weeks.
271
00:37:56.840 –> 00:38:03.460
Amy Shanahan: And it’s okay if they decide they need to talk to their spouse, their loved one, their family member.
272
00:38:04.240 –> 00:38:13.570
Amy Shanahan: It’s okay if they decide that they’re just gonna cut down a little bit, or think about it, because even thinking about it is something to do.
273
00:38:14.570 –> 00:38:18.490
Amy Shanahan: And then she did it at the end, the follow-up piece.
274
00:38:19.580 –> 00:38:27.219
Amy Shanahan: I’m wondering if it’s okay with you, and I’d always ask permission instead of just, maybe we could talk about it next time, I’d be more definitive?
275
00:38:27.900 –> 00:38:31.800
Amy Shanahan: I’m wondering if it’s okay with you that when we meet next time.
276
00:38:32.060 –> 00:38:34.860
Amy Shanahan: We’ll check in together, just to see how it’s going.
277
00:38:35.920 –> 00:38:46.920
Amy Shanahan: and then affirm them, and, you know, I’m not here to hold you accountable that you have to do it all the right way, but I just want to see if you need my support there. Because accountability is very…
278
00:38:47.810 –> 00:38:49.099
Amy Shanahan: What do you got, Darnell?
279
00:38:51.040 –> 00:38:52.120
Darnell Waples/Unique Minds: Excuse me?
280
00:38:52.400 –> 00:38:54.599
Amy Shanahan: I just thought you were sharing something, because you unmuted.
281
00:38:54.600 –> 00:39:00.580
Darnell Waples/Unique Minds: Oh, no, I just hit the… I just hit the mute button. I was agreeing with what you said, but I was on mute, so I didn’t know if you heard me or not, I’m sorry.
282
00:39:00.580 –> 00:39:04.589
Amy Shanahan: Oh, no, no, share, share your voice. Love your voice, yes.
283
00:39:07.790 –> 00:39:09.689
Amy Shanahan: Anything you want to add, Darnell?
284
00:39:09.690 –> 00:39:11.919
Darnell Waples/Unique Minds: Oh, no ma’am, I’m sorry.
285
00:39:11.920 –> 00:39:12.420
Amy Shanahan: You’re alright!
286
00:39:12.420 –> 00:39:17.209
Darnell Waples/Unique Minds: I’m just observing. I’m in the observer right now, taking all the notes down.
287
00:39:17.210 –> 00:39:30.059
Amy Shanahan: All right. Well, you can write down your thoughts, too, in the chat, folks, and I’ll share the, next example, so we can have some time where I can show you a showcase a role,
288
00:39:30.130 –> 00:39:40.040
Amy Shanahan: And maybe we could practice, like, what would we say next? You don’t have to do the whole brief intervention with me, but I’m going to invite you all to be part of the, what would you say next?
289
00:39:40.250 –> 00:39:43.799
Amy Shanahan: But I’ll show you another example before we go there.
290
00:39:51.550 –> 00:39:52.340
Amy Shanahan: steep.
291
00:39:56.870 –> 00:40:07.710
Amy Shanahan: Jill is a 54-year-old female who is being seen for a follow-up visit related to her hypertension. She also presented 6 months ago with a fractured arm from a fall on her steps.
292
00:40:07.890 –> 00:40:13.260
Amy Shanahan: During this visit, Jill scored in Zone 3 on the audit, the harmful category.
293
00:40:14.270 –> 00:40:31.369
Amy Shanahan: So, Jill, I know you’re here to talk about your blood pressure today. Before we get into that, I see you filled out our annual screening forms here, so if you’re okay, can we take a minute to talk about that? Sure. Okay, great. It looks like, the way you filled out the alcohol form
294
00:40:31.400 –> 00:40:34.329
Amy Shanahan: Puts you into our, third…
295
00:40:34.360 –> 00:40:52.329
Amy Shanahan: zone of drinking. Can you… can you tell me a little bit about your drinking habits? Where you drink? What do you like to drink? I drink wine, mostly. Okay. I go down to the little hub down the street, have a few glasses of wine. Okay. Kind of socializing. All right. How often do you do that?
296
00:40:54.800 –> 00:40:57.329
Amy Shanahan: Perform times a week.
297
00:40:57.560 –> 00:41:03.089
Amy Shanahan: Probably. Okay, and in a regular night, how much do you… how many glasses of wine would you guess you drink?
298
00:41:05.210 –> 00:41:07.440
Amy Shanahan: 3 or 4 or 5.
299
00:41:07.660 –> 00:41:10.819
Amy Shanahan: Maybe on a weekend, maybe 6. Okay.
300
00:41:11.020 –> 00:41:13.820
Amy Shanahan: Okay. Over a wa… over a period of time.
301
00:41:14.740 –> 00:41:29.920
Amy Shanahan: So, let me just show you on this, card here, from a medical perspective, we know that there’s good evidence that shows that women your age who drink more than, 3 drinks on any one occasion, at any sitting, or more than 7 in a week.
302
00:41:30.260 –> 00:41:41.319
Amy Shanahan: are likely to run into health problems from their drink, either problems they’re having right now, or maybe in the future. Are you serious? Yeah. Surprisingly. 7 drinks in a week doesn’t seem like that much.
303
00:41:41.620 –> 00:41:44.250
Amy Shanahan: It sounds like you’re drinking a bit more than that right now.
304
00:41:45.450 –> 00:41:51.079
Amy Shanahan: Yeah, I didn’t think it was much, but that makes it look like I’m drinking way too much.
305
00:41:51.240 –> 00:42:09.310
Amy Shanahan: From this drinker’s pyramid over on this side of the card, you can see that the score on your screening sheet shows that you’re up in the harmful category of drinkers, so that it’s likely you’re drinking, you know, in quantities, probably more than about 90% of the folks who come in to see me here at the clinic.
306
00:42:09.970 –> 00:42:13.420
Amy Shanahan: Well, I know my drinking has increased a little since
307
00:42:14.090 –> 00:42:16.340
Amy Shanahan: I got divorced and moved to Portland, but
308
00:42:17.050 –> 00:42:21.500
Amy Shanahan: I don’t think it’s that much of a problem. Doesn’t feel like a problem to you right now.
309
00:42:22.070 –> 00:42:37.259
Amy Shanahan: No, not really. Yeah, okay. And then the other thing I should mention, Jill, drinking more than these quantities, it’s possible it could be pushing your blood pressure up a bit, and I’m wondering if that might be affecting the difficulty we’re having getting your blood pressure down right now.
310
00:42:37.820 –> 00:42:41.530
Amy Shanahan: I didn’t realize that drinking had anything to do with blood pressure.
311
00:42:42.600 –> 00:42:44.550
Amy Shanahan: Yeah, it can sometimes.
312
00:42:46.540 –> 00:42:47.620
Amy Shanahan: Oh!
313
00:42:47.860 –> 00:42:54.310
Amy Shanahan: Well, then… I guess that could be a problem. My perspective as a doctor, it would be good
314
00:42:54.440 –> 00:43:00.509
Amy Shanahan: If you could think about cutting back a little bit, or doing something different about your drinking. What do you think about that?
315
00:43:01.140 –> 00:43:03.610
Amy Shanahan: I guess I could cut down some. Okay.
316
00:43:03.860 –> 00:43:12.279
Amy Shanahan: So, on a scale of 0 to 10, 0 being not ready at all to do that, and 10 being very ready, where would you lie on that scale?
317
00:43:12.960 –> 00:43:15.250
Amy Shanahan: Probably a 6. Okay.
318
00:43:15.900 –> 00:43:23.969
Amy Shanahan: Okay, so that sounds… I think that’s great. So why would you be up at a 6 and not down at a 2 level? What kinds of things would push you to be up there?
319
00:43:24.290 –> 00:43:29.809
Amy Shanahan: Well, I didn’t realize that drinking was related to my blood pressure problems. Yeah.
320
00:43:31.140 –> 00:43:33.349
Amy Shanahan: And I did fall.
321
00:43:34.110 –> 00:43:38.560
Amy Shanahan: earlier this year, on my way home from the bar and hurt my shoulder. I don’t think…
322
00:43:39.130 –> 00:43:44.070
Amy Shanahan: the drinking made me fall, but it probably didn’t help the situation. Okay.
323
00:43:45.190 –> 00:43:48.639
Amy Shanahan: But my son keeps telling me that I’m drinking too much.
324
00:43:50.300 –> 00:43:56.090
Amy Shanahan: And it’s scary to think that my drinking is harmful. That’s a big word. Yeah, yeah.
325
00:43:57.460 –> 00:44:01.629
Amy Shanahan: So, you’ve got some good reasons to try to cut back a little bit.
326
00:44:02.070 –> 00:44:18.260
Amy Shanahan: Sounds like it to me. Yeah, and it sounds like you’re willing to maybe try not going to the bar quite as much, and maybe drinking a little bit less when you go to the bar? I think I could try to do that, yeah. Okay, so to what levels do you think you could do that? Where would you want to go with your drinking?
327
00:44:18.660 –> 00:44:20.849
Amy Shanahan: I guess I could use those numbers, and…
328
00:44:21.760 –> 00:44:26.359
Amy Shanahan: I can’t make any promises, but I could try to drink less than 3.
329
00:44:26.620 –> 00:44:31.139
Amy Shanahan: in the night, and less than 7 in a week. Okay, okay.
330
00:44:31.720 –> 00:44:34.850
Amy Shanahan: That’d mean I could only drink 2 or 3 times a week.
331
00:44:35.500 –> 00:44:41.910
Amy Shanahan: So you would drink maybe just a couple times a week, and maybe a little bit less on each occasion? Is that what you’re saying?
332
00:44:42.260 –> 00:44:52.519
Amy Shanahan: I can try that, yeah. Okay, okay. I don’t think I need to quit, but I think I could try to cut down. And you think you’re able to cut down to those levels of no more than 7 a week?
333
00:44:53.510 –> 00:44:57.200
Amy Shanahan: That’s what I’ll shoot for. Okay, I think that sounds like a great step forward.
334
00:44:57.680 –> 00:45:00.849
Amy Shanahan: I’m gonna pause this here for the sake of time, and…
335
00:45:01.180 –> 00:45:10.180
Amy Shanahan: invite you to write in the chat what… what did you like? Or maybe there was things that you’d do differently.
336
00:45:10.490 –> 00:45:16.199
Amy Shanahan: So I can spend a few minutes, going through a case scenario and showing you the TAPs and…
337
00:45:16.360 –> 00:45:24.919
Amy Shanahan: Trying that on… This one seemed a little different. This… Physician’s style was different.
338
00:45:25.230 –> 00:45:29.609
Amy Shanahan: So now we’re gonna try it on a bit before we wrap up.
339
00:45:30.340 –> 00:45:34.970
Amy Shanahan: Any thoughts, reactions? Feel free to put it in the Chat?
340
00:45:39.290 –> 00:45:42.780
Amy Shanahan: So, I’m gonna, put my…
341
00:45:43.590 –> 00:45:47.139
Amy Shanahan: All right, Terry liked the negotiation pieces.
342
00:45:48.900 –> 00:45:53.139
Amy Shanahan: Certainly shared the information, about the risks.
343
00:45:53.280 –> 00:45:55.259
Amy Shanahan: And related to high blood pressure.
344
00:45:56.710 –> 00:46:01.059
Amy Shanahan: And he tied it into the initial visit, right, so it’s keeping with the objectives.
345
00:46:01.240 –> 00:46:02.360
Amy Shanahan: is catch.
346
00:46:03.410 –> 00:46:10.229
Amy Shanahan: I think for me, I might even ask her, what do you already know? So there’s this phrasing of ask, offer, ask?
347
00:46:10.810 –> 00:46:21.070
Amy Shanahan: If you wanted to share your thoughts or opinions, and you want to try it that way, what do you already know about alcohol and how it impacts your blood pressure?
348
00:46:21.710 –> 00:46:25.820
Amy Shanahan: And then you could offer the information, because they might already know something.
349
00:46:26.650 –> 00:46:32.139
Amy Shanahan: And I might even ask, what do you make of all this information? You seem shocked. Yeah.
350
00:46:32.330 –> 00:46:36.779
Amy Shanahan: I seem non-judgmental and gave some evidence-based stuff, very much so.
351
00:46:37.520 –> 00:46:42.660
Amy Shanahan: So I’m gonna, play a role of…
352
00:46:44.580 –> 00:46:59.199
Amy Shanahan: someone other than Amy, so I’ll be a… I don’t know, Jacqueline. My brother wanted me to be Jacqueline, so I’ll be Jacqueline. And I’m a 42-year-old mother, and I just want you to start to get into this notion of you know how I…
353
00:46:59.200 –> 00:47:16.000
Amy Shanahan: what my risks are, and what would you say next? So you could plug in, maybe, and pull some of these things that you just saw in the videos, or use… and obviously use your own style. Yep, excellent provider education, that’s part of the brief intervention as well.
354
00:47:16.170 –> 00:47:24.710
Amy Shanahan: So in my case, as Jacqueline, I’m 42, I’m a mom, I,
355
00:47:24.930 –> 00:47:43.240
Amy Shanahan: I have financial issues, I’ve recently been laid off, so I have some elevated stress levels, and I’ve been using alcohol most nights to cope when I put my kids to bed. I certainly acknowledge my drinking,
356
00:47:43.440 –> 00:47:52.729
Amy Shanahan: That’s not making me feel great, but I’m not really sure what to do. I don’t know what I should do differently. I have some ambivalence about,
357
00:47:53.150 –> 00:48:03.960
Amy Shanahan: engaging in support around the drinking, but I’m open to talk about it. I’m honest about it, and yeah, I’m willing to talk about it, but I’m not sure what I want to do.
358
00:48:04.320 –> 00:48:13.779
Amy Shanahan: So I’m going to show the screen, because I plugged this scenario into the taps. So for folks
359
00:48:13.920 –> 00:48:19.530
Amy Shanahan: Who are familiar, this might look familiar to you, and folks who
360
00:48:19.710 –> 00:48:22.610
Amy Shanahan: haven’t seen the results of a TAPS.
361
00:48:23.730 –> 00:48:35.140
Amy Shanahan: So I plugged in Jacqueline’s information, answered all the questions, and you’ll see in the taps that it indicates that I have a high risk for alcohol use disorder.
362
00:48:35.560 –> 00:48:48.079
Amy Shanahan: And it shares implications here, that I’m at high risk for adverse outcomes related to my use. And in the TAPs, it gives you some suggestions for taking action.
363
00:48:49.300 –> 00:48:57.849
Amy Shanahan: What I say to folks is that sometimes here, you might be referring this person, me, out for further evaluation.
364
00:48:58.080 –> 00:49:04.839
Amy Shanahan: And I’m thinking, hmm, I might be a little scared about that, because I’m willing to talk about it
365
00:49:04.840 –> 00:49:24.949
Amy Shanahan: But I’m not necessarily ready to go to any professional or specialized care. So this is an opportunity where you can use brief intervention to stay connected to this person, have this person stay engaged with you in the conversation about their relationship with alcohol.
366
00:49:24.950 –> 00:49:29.839
Amy Shanahan: And not rush to referral to treatment. I’ve seen this happen a lot.
367
00:49:29.960 –> 00:49:43.020
Amy Shanahan: For providers who just want to check the list, holy crap, this is scary. You’re probably… you probably likely meet the diagnostic criteria, so therefore I’ll send you off to a specialty.
368
00:49:43.560 –> 00:49:50.250
Amy Shanahan: Specialists. So… There I am as Jacqueline, so I’m going to stop sharing. You’ve got a sense of…
369
00:49:50.530 –> 00:50:07.840
Amy Shanahan: And also, the TAP shares additional resources, if you want, so… and also the other implications about the other questions that I answered, but I basically said I didn’t smoke, and I didn’t use other substances to make this one easier.
370
00:50:07.880 –> 00:50:16.900
Amy Shanahan: So, I’m going to stop sharing, and just from a brief intervention perspective, and we’re all in this together, and you all have your own style.
371
00:50:17.320 –> 00:50:27.099
Amy Shanahan: what’s the next thing you might say to me if I were sitting with you, as your start of raising the subject in a brief intervention?
372
00:50:28.350 –> 00:50:39.049
Amy Shanahan: What would… what would you say? You can unmute, or you could write it in the chat, so the beauty here is we can see different examples. There’s hundreds of ways to go about this.
373
00:50:40.080 –> 00:50:42.460
Amy Shanahan: What would you say next?
374
00:50:43.110 –> 00:50:46.270
Amy Shanahan: How would you introduce the subject to me?
375
00:50:53.540 –> 00:50:59.830
Amy Shanahan: And if it’s helpful to have the taps up so you can see the language and the words, let me know if that’s helpful.
376
00:51:05.410 –> 00:51:10.889
Amy Shanahan: Jenny, you are willing to brave the waters?
377
00:51:12.400 –> 00:51:14.939
Shaní Brown- House of David Milford DE, LLC: I was gonna ask,
378
00:51:15.090 –> 00:51:17.460
Shaní Brown- House of David Milford DE, LLC: Well, just based off of what you shared, like.
379
00:51:17.580 –> 00:51:33.299
Shaní Brown- House of David Milford DE, LLC: what are some things that concern you today? Like, there were certain things that were mentioned, about the loss of job and different things, but also finding out, like, what are some concerns, what are some certain things that I can help you with today?
380
00:51:33.510 –> 00:51:34.040
Amy Shanahan: And then…
381
00:51:34.040 –> 00:51:42.360
Shaní Brown- House of David Milford DE, LLC: And once that conversation is opened up, that may help me to, provide more information, and it’s not,
382
00:51:43.980 –> 00:51:52.709
Shaní Brown- House of David Milford DE, LLC: Not necessarily just giving information for the, for the, for the screening itself, but…
383
00:51:52.890 –> 00:51:57.020
Shaní Brown- House of David Milford DE, LLC: If that person is there, and they’re having all these other issues.
384
00:51:57.040 –> 00:52:15.930
Shaní Brown- House of David Milford DE, LLC: not just physical, but they’re encountering financial. It doesn’t make sense to just focus just on that. We may not be able to solve everything, but at least putting them in the right direction so that it’ll help alleviate some of the stresses that they have. So even with the financial part, like.
385
00:52:16.380 –> 00:52:30.740
Shaní Brown- House of David Milford DE, LLC: you know, what type of industry were you in? What, you know, have you connected with this particular agency? I can give you a referral. You know, you want to give them more information to help them with their overall, issue, because it won’t necessarily… may not stop.
386
00:52:30.890 –> 00:52:38.110
Shaní Brown- House of David Milford DE, LLC: The drinking or the usage of anything, but it’ll help and give them hope so that they can
387
00:52:38.430 –> 00:52:45.279
Shaní Brown- House of David Milford DE, LLC: Then start to take in some of what you’re saying as to how that is affecting their health and other things.
388
00:52:45.600 –> 00:53:04.609
Amy Shanahan: Beautiful. And what I would summarize with that is that you decided to ask me an open question in gen… in a general way. How can I be helpful? What’s… what’s troubling you today? And that’s engaging. Engaging the person and meeting them where they’re at. We throw those phrases around.
389
00:53:04.610 –> 00:53:09.710
Amy Shanahan: And I probably would talk about my food insecurity, and that would be helpful.
390
00:53:10.090 –> 00:53:26.919
Amy Shanahan: Because when we talk about a hierarchy of needs, I’m not going to want to talk about my drinking when I’m hungry, or when I feel guilty that, yep, I’m broke, but I’m still finding a way to get myself some alcohol. So, yep, I want to talk about that. Nice.
391
00:53:28.150 –> 00:53:32.520
Amy Shanahan: What else would folks… maybe there’s some other things you might say.
392
00:53:35.110 –> 00:53:40.840
Amy Shanahan: If you were starting to raise the subject, In a brief intervention.
393
00:53:43.940 –> 00:53:45.510
Amy Shanahan: Different examples.
394
00:53:58.850 –> 00:54:02.719
Amy Shanahan: Shani ripped the band-aid off and got us started.
395
00:54:04.780 –> 00:54:06.480
Amy Shanahan: Am I… I’m saying your name right?
396
00:54:07.360 –> 00:54:08.120
Amy Shanahan: Okay.
397
00:54:09.380 –> 00:54:11.759
Amy Shanahan: I, I heard you, wanna make sure I got it right.
398
00:54:12.660 –> 00:54:17.459
Amy Shanahan: All right, I just got my two-minute warning, so…
399
00:54:18.980 –> 00:54:27.839
Amy Shanahan: You all have the videos, you have thought about this, you can raise the subject by even introducing the… you filled out this
400
00:54:28.020 –> 00:54:32.569
Amy Shanahan: form that we gave you, I’m wondering if we could talk about it.
401
00:54:32.920 –> 00:54:35.180
Amy Shanahan: So there’s that introduction.
402
00:54:35.440 –> 00:54:37.989
Amy Shanahan: Sharing what it means.
403
00:54:38.410 –> 00:54:50.919
Amy Shanahan: What does it mean? What were you thinking when you were filling out the form? Sometimes people have thoughts, like, I don’t know if I want to answer that question. Some people might have thoughts. What thoughts did you have while you were filling out the form?
404
00:54:51.170 –> 00:55:10.470
Amy Shanahan: So, those are some kind of break the ice, rip the band-aid-off kind of engaging, easing into it, so that you’re not going, hey, according to the answers, you’re hazardous risk or high risk, because from the previous video, the person was… the woman was shocked by the terminology that’s used.
405
00:55:10.890 –> 00:55:13.310
Amy Shanahan: And I think that would be shocking to me, too.
406
00:55:13.530 –> 00:55:23.280
Amy Shanahan: So I have to pop up my slides and shift gears, so that we can wrap our… up our time today, and I thank you for
407
00:55:25.620 –> 00:55:28.989
Amy Shanahan: Your feedback and your attentiveness to the pieces.
408
00:55:29.330 –> 00:55:48.140
Amy Shanahan: So Fidelity monitoring, again, you’ll see these pieces, but just these four iterations of what your fidelity monitor is going to look for is that permission. It’s always a good thing to have it in your pocket. Is it okay that we talk about it? Is it okay that I share feedback? Use reflections.
409
00:55:48.820 –> 00:56:01.420
Amy Shanahan: Pay attention! Are you still volleying back and forth with just questions? Both examples in the videos reflected back what they heard the patients say before they started another question.
410
00:56:02.170 –> 00:56:06.590
Amy Shanahan: You highlighted in the chat the practitioner shared feedback about the risks.
411
00:56:06.730 –> 00:56:10.509
Amy Shanahan: And if you could tie it specifically to something that they showed up for.
412
00:56:10.600 –> 00:56:21.419
Amy Shanahan: But in my role-playing exercise, Shanie, you highlighted, sure, there’s a lot of things going on with me. So, that beautiful, engaging way of, what do you want to focus on?
413
00:56:21.480 –> 00:56:26.690
Amy Shanahan: And then negotiate that goal. So that’s what the Fidelity Monitor is going to look for when they
414
00:56:26.740 –> 00:56:43.250
Amy Shanahan: Check… check your lists of how you’re doing. We see each other again on the 3rd, where we’ll have a continuing conversation about brief intervention, and how we now move into referral to treatment. So…
415
00:56:43.900 –> 00:56:53.550
Amy Shanahan: I whiplashed you through the end. I will hang out if anybody has a question or a thought, a comment.
416
00:56:53.550 –> 00:56:55.279
Victoria Pauline, (she/her) | BBS: Thanks so much, Amy.
417
00:56:55.280 –> 00:57:19.340
Victoria Pauline, (she/her) | BBS: And thanks, everyone, for your participation today. I did drop some links in the chat while Amy was wrapping up, so if you haven’t done so already, please register for Monday’s third and final group TA session. The registration link is in the chat, and then in addition to that, we’d love your feedback on, today’s session, so I also dropped the link for post-session evaluation. Everyone can expect to receive a follow-up email within the next 24 hours or so.
418
00:57:19.340 –> 00:57:23.760
Victoria Pauline, (she/her) | BBS: With those links and any relevant details, along with the recording.
419
00:57:23.760 –> 00:57:26.259
Victoria Pauline, (she/her) | BBS: Thank you all so much!
420
00:57:27.270 –> 00:57:29.339
Victoria Pauline, (she/her) | BBS: I hope you have a good rest of your day.
421
00:57:29.500 –> 00:57:30.150
Amy Shanahan: Yeah?