Brief Intervention: Process And Techniques

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Brief Intervention: Process and TechniquesRebecca Bullion, LCSW, CIPJanuary 24, 2018

Thomas Durham, PhDDirector of TrainingNAADAC, the Association for Addiction Professionalswww.naadac.orgtdurham@naadac.org

Produced ByNAADAC, the Association for Addiction Professionalswww.naadac.org/webinars

www.naadac.org/webinars

www.naadac.org/brief-intervention-webinar

CE CertificateCost to Watch:FreeCE Hours Available:1 CEsCE Certificate forNAADAC Members:FreeCE Certificate forNon-members: 15To obtain a CE Certificate for the time you spent watching thiswebinar:1.Watch and listen to this entire webinar.2.Pass the online CE quiz, which is posted atwww.naadac.org/brief-intervention-webinar3.If applicable, submit payment for CE certificate or joinNAADAC.4.A CE certificate will be emailed to you within 21 days ofsubmitting the quiz.

Using GoToWebinar – (Live Participants Only) Control Panel Asking Questions Audio (phone preferred) Polling Questions

Rebecca Bullion, LCSW, CIPwww.cohesiontn.com615-414-2995Cohesion Intervention Services inNashville, TNYour

Webinar Learning Objectives1Learning Objective #1Attendees will apply the 7steps in the briefintervention process2Learning Objective #2Attendees willcomprehend 3 roadblocksto success in the briefintervention process3Learning Objective #3Attendees will identify 6elements of Brief Interventions

Polling Question #1Have you worked in any capacity conductinginterventions in the substance use disorder field?Yes or No

Overview of Webinar Agenda1.2.3.4.5.6.7.8.Discussion of brief vs. full interventionSteps of conducting Brief InterventionTeam Building/Assessing the Intervention Team ReadinessRoadblocks to Successful InterventionDiscussion of Family Roles and how they affect the Team dynamicsHow to address crisis management if neededInformed Consent and Disclaimer reviewDiscussion of Pros and Cons of Brief Intervention

Polling Question #2Have you had previous training in intervention orbrief intervention?Yes or No

What Is a Full Intervention?Full intervention usually requires much more planning andpreparation time and thorough care is taken on each detailand step involved in getting a client to treatmentIn Full Intervention, usually more tasks of intervention arehandled by the interventionist.Follow-up care time is usually longer in full intervention.

What is Brief Intervention?Brief Intervention utilizes theprimary process of interventioninside of an abbreviated time frame.It uses the power of the group in aface-to-face meetingto motivate an IP to get appropriate help

“Soft” Intervention vs. Brief Intervention Definition of soft intervention Places to use soft intervention Tools for soft intervention

Some Reasons to Conduct Brief vs. Full Intervention1. Limited finances of family to spend on intervention.2. IP is incarcerated or in hospital and transfer to treatment needs to be expedited.3. Size of intervention team is very small and usual team preparation time is less4. IP is already very motivated for treatment and group intervention is not necessary.

Limitations ofBrief Intervention vs. Full Intervention Agenda of the family/team gets addressed as primary agenda vs. agenda ofInterventionist. Most families call for an intervention when they are in partial or full crisis mode and want immediateintervention. Interventionist joins with family in expediting the process which may lessen the desired outcomes for familysystem change through extra team building and facilitation of change for the family system. Time for attention to detail is limited. Time for support of individual team members is limited. Time for picking best possible resource for treatment may be limited.

Steps in Brief Intervention1. Initial call usually from concerned family member or friend Establish rapport by listening to their concerns for about 5 minutes byallowing them to vent) Start to complete questions on the Intake/Screening Form2. Schedule Conference Call with potential Intervention Team asap3. During call debrief team on steps/structure of intervention process4. Discuss roadblocks to successful intervention/educate about disease5. Help them write/edit the love letters, plan transport, pick treatment center,manage insurance benefits6. Be available during the intervention for phone support7. Be available for contingency planning phase if needed

I. Initial Call from Client/Caller:II. Identified Pt. Name and DOB:III. Phone Number of Caller:Time/Date of Call:Location of Caller:Amount of Time Caller wants totalk on this call (15 minutes preinterview needed):Location of IP:DOC:Detox Need: YES NOCurrently Using: YES NO

Tips for Working with the Initial Caller Know that this person is often the most aware of the problem Know that this person can often be the most controlling of what kindof help is needed and may not be on target Know that this person can think that they have the situation fullyassessed when actually major points have not been factored in Know that this person is overwhelmed often and needs centering Know that this person may want interventionist to take over butcan’t let go of the control Minimize extensive discussion of all aspects and history of theaddiction of IP

Tips for Written Contract It is best to have a written contract outlining duties of interventionistand expectations of the team in order to increase understanding ofthe process. Email to client and ask for signature. Use of programs like Doc-U-Signcan help reduce time involvement when clients are in a hurry Don’t skip this step Disclaimer concerns

Steps for Team Guided Intervention Appoint a Team Lead person who transmits information to all teammembers and is the interventionist primary point of contact forcommunication Plan time, date, location of intervention Appoint appropriate person to address insurance/payment issuesand make intake plans with treatment center (can be team lead butmay be spouse or other person)(can be interventionist as well) Contingency plans for the 72 hours following Intervention with IP if IPrefuses to go

Choosing the Treatment Center In full intervention, the interventionist usually makes therecommendations for best fit after doing investigation of level of careneeded, financial resources and other logistical issues. In brief intervention, picking the treatment center may become thejob of the team lead or other team member in order to save time. This presents a risk in that the treatment center has not perhaps beenadequately vetted by interventionist. This vetting role, again, may be passed to team members if they are able. Disclaimer needs to be applied in this situation.

Level of Care Placement Assess as much as possible what level of care seems appropriateutilizing information from the team knowing that ultimately thetreatment center will make that call Choose treatment centers for each level of care, ideally both levelsinside of one treatment center in order to reduce complications ifhigher level of placement is needed Be aware that clients will minimize use and cannot be used as areliable source of information

Assessing IP Willingness Initially assessed by the opinion/viewpoint of the caller Continue to assess by speaking with the team duringphone conference Speak to client and use motivational interviewing ifusing an intervention model that supports this

Assessing Chief Enabler Willingness Team needs to clearly understand that chief enablergetting on board with intervention 100% is key Key enabler needs consistency in action and wordwith the team and with the IP Education about disease of addiction using additionalreading materials provided to team and enablerabout disease of addiction

Address Roadblocks to SuccessfulIntervention with the TeamBiggest roadblock is allowing the power of the group to getoff track via: Allowing too much discussion with the IP in the interventionmeeting Arguing/getting into family fight with IP Not following the monologue letter reading format Not re-directing other manipulations from IP or any other teammember

Other types of Roadblocks Inadequate appropriate treatment resources Financial and treatment funding issues Trying to go too fast and not allow time for roadblocks to beworked out Shifting commitment of any team member to be involved inthe intervention Suicidal ideation or other mental health issue with IP notbeing appropriate for chosen treatment

Linking family to Additional Resources 12 STEP and Al Anon referrals are always recommended. Use Al-Anonwebsite to provide locations Referrals to supportive counseling for team members as needed Legal and/or financial resources as needed Additional reading resources

Co-Occurring DisordersCo-occurring disorders can become a roadblock tointervention success as they arise and must be dealt with inorder to insure appropriate placement of IP. If mental healthissues are previously identified/diagnosed/treated, some ofthe Intervention Team and almost always the IP will want tomake the mental health problem the primary focus vs.addiction as a primary problem.

Co-Occurring Disorders Con’t.In Brief Intervention, any discussion of medicationmaintenance or recommendations for anything thatwould be considered a treatment issue or not withinthe scope of practice of Intervention needs to beminimized and re-directed as it cannot become a focusof the intervention. Assure family that the issue will bedealt with by treatment staff in the facility that IP willbe attending.

Disclaimer to Intervention TeamIt is best practice to gather emails from each team member and send adisclaimer about the Elements of Successful Intervention and aDisclaimer Statement/Hold Harmless statement if Intervention doesnot lead to IP going to treatment or any other outcome that might bedeemed “negative”, “unintended” or “less desirable outcome”

Amount of Time to Conduct BriefIntervention Brief intervention can be conducted ideally in a 3-4 hour timecommitment if no major roadblocks surface or are identified Additional time can be added by contract with Team Interventionist needs to estimate based on family dynamics after Initial Conference Call how much time will be needed to get throughall steps(Family dynamics may slow down getting to Intervention Day andmay need to be addressed as an issue prior to organizing theactual intervention.)

Codependent Family Dynamicsas a Roadblock Interventionist needs to understand that he/she is entering into thefamily system and needs to work from the standpoint that allmembers are operating from a codependent stance no matter whatthe role of each person looks like, i.e. hero child vs. scapegoat. Family Dynamics may start to derail the process and cause BriefIntervention to move toward Full Intervention need. Contract with team as needed if process derails and add more time.

Family System Roles1. Hero Child – Is often the initial caller – most insightful/objective2. Chief Enabler – May be the initial caller/less objective but soundsat initial call as if there is more objectivity/ recovery than thereactually is3. Scapegoat or Lost Child - often is the IP4. Mother/Father’s Surrogate - may be the IP5. Mascot/Cheerleader6. Member may have more than one role

Use of Motivational Interviewing andCoaching to Prepare the Team Since less time is spent with team building in Brief Intervention, it isimportant to provide the Team with additional support reading afterthe Initial Conference Call. Working with the family/team dynamicsneeds to emphasize keeping the focus on love and concern for IP’swelfare and suffering vs. just getting into an argument or negativederailment. Provide points for keeping a positive focus via the use of the loveletters and a list of pitfalls to avoid during the intervention is veryhelpful.

Elements of Brief Intervention(Excerpt from Brief Intervention by Ken Winters quoting Miller and Sanchez’ FRAMES)FRAMES1. Feedback on personal risk2. Responsibility for Changes Originates with the Client3. Advice to Change (suggestion to change)4. Menu of Change Options5. Empathy6. Self-Efficacy and Optimism

The Difference Between Brief Intervention andEarly Intervention (according to FRAMES)1. Less feedback about negative aspects ofsubstance use with brief intervention2. Menu of change options are not offered inearly intervention3. All other elements are the same

Working with Client Resistance After coaching the team/family and using additional resources toprovide psychoeducation to them, the interventionist may still needto provide “live-time” coaching by phone during the intervention if IPprovides resistance. IP will very frequently try to negotiate for counseling or seeing apsychiatrist vs. going to treatment for addiction. Provide instructionon how to “hold the line” when resistance arises.

Crisis Contingency Planning

Accessing Emergency ServicesIf the IP becomes suicidal at any point, beprepared with resources for local emergencymanagement phone numbers, etc. The team leadperson can be the one to gather these for thegeographic area for where the intervention willbe held

Case Study ExampleUse of case of “Stewart” to discuss how briefintervention case was handled using pointsof discussion from webinar.

What is the Measure of Success of the Intervention? Is it solely measured by the outcome of the IP going totreatment? Can it be measured by the success of the ceasing ofenabling? Can it be measured by the growth and change of teammembers? Harm reduction as a measure of success

Following Up with the Team/Family At two and four week points after the last contact Necessary to address need for further intervention Used to reinforce team members seeking their own help for copingwith the disease of addiction and family issues Follow-up should be addressed in the initial conference to insureteam understanding about how long it can take to get an IP intotreatment and dispel magical thinking

Thank You!Rebecca Bullion, LCSW, CIPwww.cohesiontn.com615-414-2995Cohesion Intervention Services inNashville, TNYour

www.naadac.org/brief-intervention-webinar

CE CertificateCost to Watch:FreeCE Hours Available:1 CEsCE Certificate forNAADAC Members:FreeCE Certificate forNon-members: 15To obtain a CE Certificate for the time you spent watching thiswebinar:1.Watch and listen to this entire webinar.2.Pass the online CE quiz, which is posted atwww.naadac.org/brief-intervention-webinar3.If applicable, submit payment for CE certificate or joinNAADAC.4.A CE certificate will be emailed to you within 21 days ofsubmitting the quiz.

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Limitations of Brief Intervention vs. Full Intervention Agenda of the family/team gets addressed as primary agenda vs. agenda of Interventionist. Most families call for an intervention when they are in partial or full crisis mode and want immediate intervention. Interventionist joins with family in expediting the process which may lessen the desired outcomes for family

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