When to do brief interventions

There are many opportunities for doing brief interventions. A brief intervention can be used:

when the intervention is part of a preventive strategy. For example, you can:
- talk to a well person about the benefits of increased exercise and reducing sugar intake
- advise women who are planning to have a baby that it is best not to drink alcohol when pregnant or breastfeeding
when a person has an illness in its early stages, or a short term problem. For example, an intervention about:
- weight reduction with someone who has high blood pressure
- reducing fat in the diet with someone who has cardio-vascular disease
- the benefits of not smoking, and offer support to quit, with someone diagnosed with a chest infection
- the importance of not drinking alcohol with someone taking particular medication
- ways to avoid cross infection when a family member has diarrhoea
when a person is suffering from a chronic, long-term condition. For example, a diabetic person will need information about:
- low sugar and low fat foods
- the benefits of not smoking
- the benefits of drinking little or no alcohol

In summary, a brief intervention can be done within a range of primary health care activities. You may have opportunities to do a brief intervention when doing health assessments, well women's and well men's checks, when taking a person's health history, when giving back relevant test results, when giving treatment or referring to another service, when following up with a person.

Never miss an opportunity to do a brief intervention

There are times when it is not appropriate to do a brief intervention. These include:

when the person doesn't wish to participate in the brief intervention process
when a person is in a highly emotional state
when a person is too sick or injured to share information
when a person is drunk or intoxicated on any other drug. For advice about dealing with a person who is drunk. See section 'Keep Yourself Safe' in Living With Alcohol: A Handbook for Community Health Teams by THS (1998)

Brief interventions will be most effective when used with a range of health promotion strategies. For example, suppose alcohol is an issue in the community:

*do brief interventions with individuals to make the most of opportunities to raise awareness about drinking alcohol and its health and social effects, complemented by:

conducting an alcohol education program for school children and other suitable groups
supporting the community to create and maintain safe drinking environments
supporting enforcement of local policies and legislation concerning supply and consumption of alcohol
broadcasting appropriate messages about alcohol over the community media network
supporting other community actions to reduce alcohol related harm

		see 'Alcohol and Other Drugs' chapter in Volume 2

		see 'Changing the Wider Environment' in this chapter

How to do brief interventions

This section offers a step-by-step process for doing brief interventions. It also offers examples which illustrate how brief interventions are used in primary health care practice.

Doing brief interventions requires good communication skills. It is important to:

listen to what people say
notice what they do not say
watch what they do
think about their situation
think about what you know about them
talk with them in a way which is not threatening
avoid giving a lecture about health behaviour

Training and support

THS offers training and support. A short training course in brief intervention skills has been specifically designed and trialed with community health teams.

		Contact the THS Alcohol and Other Drugs Service in your area, or the THS Alcohol and Other Drugs Program 8999 2691

		Ask about videos which demonstrate how to do brief intervention and motivational interviewing

		For course information see 'Hands On: The Public Health Education and Training Database'.

If you do not feel confident about doing interventions in your daily work, first practise in situations where you feel comfortable. Practise will build confidence and skills.

The Stages of Behaviour Change

The Stages of Behaviour Change model was developed in the alcohol and other drugs field by Prochaska and DiClemente (1986). It is used for matching interventions with a person's readiness to take on information and make changes. The model can be used for interventions in areas such as alcohol, smoking, using other drugs, changing diet, weight loss, exercise and personal hygiene - for any behaviour change.

Maggie Brady summarises the 'stages of change model' as follows:

Precontemplation - that is, not really thinking about changing
Contemplation - actually thinking about changing
Action - deciding to do something
Maintenance - keeping going once the decision has been made

These four stages were drawn up as an idea based on the general population. But listening to Aboriginal people talk (or reading their stories) about their drinking lives shows just how real these stages of change are. It is hard to move from actually thinking about changing, to deciding to do something. There are styles of counselling which … help to prod people along these stages. Motivational interviewing is one of these.

Brady 1998b:187

Some explanations of the model use up to six stages. They may include a 'preparing for action' stage (between contemplation and action) which we have incorporated into the action stage of the above model. They may also include a 'relapse' stage.

		See CARPA Standard Treatment Manual, 3rd edition (1997:123)

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