Below you will find links to the Powerpoint presentations of our presenters from last week’s September Symposium on BSI. Please do not hesitate to contact us at email@example.com if you have any questions. We are waiting on a few presentations and will have those uploaded as they come in.
“Policy to Support BSI Delivery”
“Understanding Coding and Reimbursement for BSI”
“BSI from an Employers’ Perspective”
“BSI for Cardiovascular Prevention”
“BSI in Federally Qualified Health Centers”
“BSI in High Schools and Colleges”
“BSI, Collaborative Care and Mental Health”
By Mia Croyle, MA
In the third edition of Motivational Interviewing: Helping People Change (Miller & Rollnick, 2013), we are introduced to the four processes. In previous newsletters, we discussed the first two of these, engaging and focusing. The third process is evoking. This process is where our method becomes distinctly motivational interviewing. Our objective in this process is to evoke the other person’s own motivations (or plans) for change. The evoking process pays special attention to “change talk” or the other person’s arguments for change. In the evoking process, we work on three specific practitioner skills dealing with change talk:
01. Recognizing change talk: If you listen closely enough,people often tell you their own motivations for change. One of the challenges in recognizing change talk is that it often comes intertwined with its opposite – sustain talk (a person’s arguments for not changing). A patient statement that includes that ambivalence might sound like: “I know my health would get a whole lot better if I quit smoking, and I’d save money, too, but I just don’t think I can do it right now.” The part that’s underlined is the change talk!
02. Responding to change talk: When we hear change talk, we want to affirm it, reflect it back, and ask the other person to elaborate so we can continue to encourage their internal motivation and help them build their own case for change. Using the statement from above, it’s pretty tempting to start addressing the sustain talk part of that ambivalence by convincing the patient that he can indeed do it. A response that is more likely to evoke more change talk would be to reflect the change talk and ask for elaboration. That might sounds like: “So, quitting smoking would help your health and your wallet. What aspect of your health in particular would you expect to see improve?”
03. Evoking change talk: Sometimes we have to work a little harder to get patients to offer up their arguments for change. This requires the practitioner to be strategic and intentional with the questions asked and the ways the other person’s statements are reflected back. One of the most straightforward ways to get change talk is simply to ask for it. “What would be the best thing about being an ex-smoker?” or “If you did decided to quit, what would you hope to get out of it?”
Evoking is at the heart of Motivational interviewing. When we stand on the secure foundation of an engaged and collaborative relationship and have a shared focus, we can effectively partner with our patients to help them give voice to their motivation for change and then help support them while they put that motivation into action in the planning process.
With only one month before enrollment opens for new exchanges and four months before new requirements for health plans take effect, most of us are wondering how the Affordable Care Act (ACA) is going to come together. Although polls show a wide range of opinion about the ACA and its implementation, almost everyone agrees that U.S. healthcare must be more effective and cost-efficient. Indeed, a Gallup poll earlier this year found that 81% of Americans personally worry either “a fair amount” or a “great deal” about the availability and affordability of healthcare.
Within the healthcare industry, many individuals are concerned about how cuts will affect their sectors and yet few dispute our collective need to work toward the triple aim. That’s improving health outcomes, enhancing patients’ experience of healthcare, and controlling healthcare costs.
Perhaps that’s why nearly 150 people in Wisconsin have already registered for WIPHL’s September Symposium on Behavioral Screening and Intervention (BSI), which is co-sponsored by the Wisconsin Collaborative for Healthcare Quality.
Our goals for the symposium are:
- To disseminate information on how administering systematic BSI would arguably be the largest step a clinic or hospital could take toward the triple aim;
- To highlight progress in Wisconsin and other states toward spreading BSI;
- To identify barriers to further spread; and
- To generate strategies and enthusiasm for overcoming those barriers.
Our keynote speaker, John Torinus, author of the new book “Opt Out of Obamacare, Opt Into the Private Health Care Revolution,” will describe why large and medium-sized corporations are increasingly voting with their feet to leave the mainstream U.S. healthcare system and what it would take for them to return.
During our free, day-long Symposium, I’ll review the need for BSI, its contribution toward the triple aim, WIPHL’s successful model of BSI delivery, and where BSI stands in Wisconsin. In addition, Mia Croyle, WIPHL’s Director of Development, will facilitate a panel discussion among diverse healthcare professionals whose clinics are systematically and successfully delivering BSI.
Additional sessions will include more discussion on BSI delivery models, BSI-related policy issues, employers’ perspectives on BSI, coding and reimbursement and how BSI is linked with cardiovascular prevention, federally qualified health centers (FQHCs), educational settings, and mental health disorders. Speakers from across the United States will add a national outlook as well.
The day will be full of opportunities for discussion, networking and planning next steps for dissemination of BSI. We’re fortunate our current grant from the Agency for Healthcare Research and Quality allows for registration, lunch and refreshments at absolutely no cost to participants.
If you’ve already registered, we look forward to seeing you, and feel free to invite others. If you haven’t, please register here.
Agency for Healthcare Research and Quality Highlights WIPHL for Its Work Addressing Behavioral Health IssuesPosted: September 4, 2013
The U.S. Agency for Healthcare Research and Quality (AHRQ) recognized the Wisconsin Initiative to Promote Healthy Lifestyles (WIPHL) as a “Service Delivery Innovator” for its work in implementing behavioral screening and intervention (BSI) in primary healthcare settings.
The AHRQ Health Care Innovations Exchange profiled WIPHL’s BSI service delivery model, which is a preventive approach aimed at reducing unhealthy drinking, drug and tobacco use and depression. In its profile, AHRQ reviewed WIPHL’s successful implementation strategy, summarized its results, and offered suggestions for those considering adopting BSI.
“WIPHL is extremely honored to be featured by AHRQ for our work helping primary care settings identify and address patients with important behavioral health risks,” said Richard L. Brown, MD, MPH, UW Professor of Family Medicine and Director of WIPHL. “We know many health care experts and providers view AHRQ as a well-respected resource for improving healthcare outcomes. We hope more clinics in Wisconsin and elsewhere will ensure that all patients receive cost-saving, effective BSI.”
For the past seven years, WIPHL has helped deliver BSI services to more than 150,000 patients in more than 40 primary care clinics and hospitals in Wisconsin. With grant funding from AHRQ and other sources, WIPHL provides free training, consultation services and support to healthcare professionals.
AHRQ is a federal agency within the U.S. Department of Health and Human Services responsible for improving the quality and effectiveness of healthcare in the United States. The AHRQ Health Care Innovations Exchange is an online resource that offers health care professionals and researchers opportunities for sharing evidence-based innovations and tools.
For more information, visit www.wiphl.org.
By Richard L. Brown, MD, MPH
Earlier this year, a randomized control trial by Eileen Kaner analyzing the effectiveness of screening and brief alcohol intervention in primary care settings was released. It concluded that, “All patients received simple feedback on their screening outcome. Beyond this input, however, evidence that brief advice or brief lifestyle counselling provided important additional benefit in reducing hazardous or harmful drinking compared with the patient information leaflet was lacking. ”
I believe an analysis of the trial by Essential Evidence Plus POEM, which stated the bottom line was that alcohol screening and intervention did not decrease the percentage of patients drinking to excess at six months, completely misinterpreted Kaner’s study.
Kaner’s study did not assess the efficacy of alcohol screening and intervention, which is already well-established in dozens of randomized controlled trials, including Mike Fleming’s seminal study published in JAMA in the 1990s. Kaner’s study assessed the effectiveness of training physicians and nurses in primary care settings in delivering these services. And of course, the physicians and nurses did poorly, because they simply don’t have time to adequately screen and intervene.
The message that I take away from Kaner’s study is:
- If you really want to generate the improved health outcomes and cost savings that alcohol screening and intervention will yield, you need to expand your healthcare team with staff who have the time to deliver these services.
- The same goes for evidence-based – widely-recommended, yet seldom delivered – evidence-based interventions for tobacco and depression.
- We can increase one-year quit rates from 6% to as high as 28% if we have additional staff who can spend as much as five hours with each patient over more than eight visits, according to a metaanalyses published in the most recent update of the Federal Guideline for Tobacco Cessation.
- We can increase one-year rates of complete remission from depression from 30% to 54% if we have additional staff who can deliver “collaborative care,” which includes educating patients, engaging them fully in treatment and in behaviors that help lift symptoms (such as exercise and socializing), tracking depressive symptom scores (PHQ-9), and alerting other providers when poor improvement in PHQ-9 scores indicates a need to reconsider the treatment plan. (See a metaanalysis of 69 studies by Thota, Am J Prev Med, 2012.)
If you have questions regarding Kaner’s study, the POEM analysis or my response to the POEM analysis, please email me at firstname.lastname@example.org.
For more information, see wiphl.org.
Wisconsin Initiative to Promote Healthy Lifestyles (WIPHL) announced the 2013 WIPHL Symposium on Behavioral Screening and Intervention (BSI) will be held September 17 at the Monona Terrace in Madison. The day-long event will be free and open to the public.
More than 20 experts will deliver presentations on the importance of BSI services at the Symposium, including a keynote address by John Torinus, Chairman of Seriograph, Inc. and the author of the book, “The Company That Solved Health Care.” Presenters also include leaders from The Alliance, Business Healthcare Group, Council on AODA of Washington County, University of Wisconsin-Whitewater, Wisconsin Collaborative for Health Care Quality, Wisconsin Department of Health Services, Wisconsin Primary Health Care Association and various healthcare clinics across Wisconsin.
“The time is now for behavioral screening and intervention. As WIPHL’s director, I am very excited for the breadth of participation in the Symposium from healthcare providers and purchasers, businesses, policymakers and advocates,” said Dr. Richard L. Brown, MD, MPH. “We look forward to bringing together leaders, advocates and those new to BSI for a substantive discussion of real-world solutions to continuing the expansion of cost-saving, proven-effective BSI.”
More than 200 attendees are expected to take part in WIPHL’s Symposium. The event will offer panel, discussions, valuable presentations and networking opportunities to discuss the facilitators and barriers of implementing BSI in addition to encouraging the dissemination of the services in Wisconsin.
To register and view the full agenda, visit http://onlinecommunity.wchq.org/event/BSIsymposium.
BSI screens all patients annually by questionnaire for behavioral risks in general healthcare settings. These services are aimed at reducing tobacco use, unhealthy drinking, drug use, depression and obesity, which, in total, are responsible for more than 40 percent of deaths in the United States each year.
For more information on BSI, visit www.wiphl.org.
By Mia Croyle, MA
In the third edition of Motivational Interviewing: Helping People Change (Miller & Rollnick, 2013), we are introduced to the four processes. In our newsletter, we discussed the first of these, engaging. The second of the four processes is focusing. Our objective in this process is the collaborative, ongoing process of seeking and maintaining direction.
In Motivational Interviewing. there are three main sources of focus, and in almost every instance. we rely on some combination of them all:
01. The other person (the “patient”): people generally have concerns, preferences, ideas, and values that influence our focusing process. For example, in BSI, if a patient screens positive for potential risk in the areas of tobacco use and depression, the patient will have some ideas about where he or she would like to start, and we certainly give priority to those ideas.
02. The setting: in BSI, we are in a healthcare context and generally, our health educators have a pre-established list of behaviors that they are trained and sanctioned to address. If patients have concerns that fall outside these areas, the health educator can refer patients to other resources.
03. The helping professional’s clinical expertise: in BSI, this is informed by the results of the screen and brief assessment. Other members of the healthcare team, such as the physician, may also have clinical expertise that informs our focusing process.
Like each of the four processes, focusing is an ongoing process. Once we have established a focus, we continue to attend to focusing throughout our interaction. We may need to revisit our focus at times to make sure we are still on the same page with the other person.