Implementing change in the clinical skills

What educational background should the health coach have? The education of your health coaches depends on the role you expect them to play. For example, if your health coaches are going to provide clinical education, a nurse or social worker may be a good option. If the health coach will reinforce the physician's plan of care and use phone calls to keep patients committed to their treatment regimens, someone without a clinical license could acquire that skillset.

Implementing change in the clinical skills

S Levy, L Shrier. Reprinted under Creative Commons Attribution-Noncommercial 4. Incorporating screening into the patient care visit logically assumes that the spectrum of possible screening outcomes will be addressed by using effective approaches and available resources most suitable for the particular patient population and locale.

Brief Intervention Brief intervention BI is a conversation that focuses on encouraging healthy choices so that the risk behaviors are prevented, reduced, or stopped. In the context of SBIRT, regardless of which substance use screening tools are used, the BI strategy is identical, because it is a direct response to the reported substance use severity.

BI encompasses a spectrum of potential pediatrician responses, including positive reinforcement for adolescents reporting no substance use; brief, medically based advice for those reporting use but showing no evidence of an SUD; brief motivational interventions when a mild or moderate SUD is revealed; and referral to treatment of those with a severe SUD.

Using motivation-enhancing principles is compatible with all BI dialogue regarding any level of substance use and risk. Among adolescents presenting to an ED for a substance use—related problem, BI has been shown to reduce subsequent alcohol use, 43 marijuana use, 44 and associated problems 45 and to be cost-effective compared with brief education.

Positive Reinforcement It has been recommended that adolescents reporting no substance use whether tobacco, alcohol, or other drugs receive positive reinforcement for making this smart decision and related healthy choices.

Choosing to abstain from substance use can be framed as an active decision, and the adolescent is given credit for making a healthful decision and acting on it.

A Implementing change in the clinical skills comprising clear, pointed advice to stop substance use combined with succinct mention of the negative health effects of use can lead to decreased use or abstinence in adolescent patients who use substances infrequently.

Marijuana use interferes with concentration and memory and is linked to getting lower grades at school. I hope you will consider how your marijuana use could change all that, and whether or not that is what you really want.

For example, an adolescent may realize that marijuana use is causing tension in the relationship with his or her parents but continue to use marijuana because of perceived greater benefit from marijuana use to relieve stress or as a pleasurable activity shared with friends.

The pediatrician can assist the patient in making a specific intervention plan to record in the medical record and facilitate follow-up Box 1. The pediatrician screens a year-old boy who reports monthly alcohol use. The pediatrician asks follow-up questions about patterns of use and associated problems.

Implementing change in the clinical skills

The patient mentions binge drinking and not always knowing how he gets home from parties. He admits preferring not to think about it because it frightens him. The patient is given brief advice and challenged to make a behavior change: How do you think you can protect yourself better in the future?

The pediatrician gives advice about alcohol and motor vehicle—associated risks and suggests developing a safety plan. Planning is documented in the medical record and a follow-up appointment is scheduled in 3 months. Medical home follow-up can be conducted after a few weeks of attempted behavior change to assess whether risk behaviors have diminished, remained the same, or escalated.

Adolescents who are found to have met the agreed-on substance use behavior change goals can benefit from discussing the pros and cons of their decreased use and identifying any motivating factors that can be reinforced to sustain the behavior change and lead to abstinence.

Adolescents who are unable to meet the behavior change goals may benefit from more extensive substance use—targeted individual counseling provided by an allied mental health professional, such as a social worker or psychologist.

When available, referral to mental health professionals within the same medical home practice setting may optimize patient compliance. Brief Intervention Focused on Referral to Treatment Severe SUD, or addiction, is a neurologically based disorder resulting from the disruption of neurons in the reward center of the brain as the result of repeated exposure to a psychoactive substance.

Despite this challenge, it is important for the pediatrician to remain engaged with the patient and family and supportive during discussions and decision-making about the care options as well as throughout the entire course of care and aftercare.

In response to S2BI screening in the medical home, a year-old girl reports weekly marijuana use.

Implementing change in the clinical skills

The pediatrician then asks questions to determine quantity, frequency, and context of use and to explore for problems. The patient says she relies on marijuana to help calm her down when she is stressed and that she does not see the harm in it. She also states that her mother knows about her use and thinks marijuana use is bad for her, so their relationship has gotten tense over this disagreement.

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