A brief intervention is a time-limited (between 5 to 30 minutes) interaction/conversation between a practitioner and patient focused on addressing hazardous and harmful behaviours. (1)

The term 'brief intervention' means an intervention that takes very little time. It can be conducted by any health professional and typically consist of 5 to 60 minutes of counselling and education, with usually no more than three to five sessions. (2)

A brief intervention can be undertaken to address any behaviour which affects health such as smoking, inadequate nutrition, excessive alcohol consumption, inadequate physical activity, use of other drugs.

Key components of brief interventions include asking individuals about their health behaviours, assessing readiness to change and providing advice, support and referral where appropriate, then arranging follow-up. (3)

• Models and Evidence
• Resources
  • Lifescripts
• Professional Development
• Links
• References

For further information please contact either Phillipa Grant - Program Coordinator at pgrant@gpqld.com.au or Sabrina Ostowari - Program Coordinator at sostowari@gpqld.com.au.

Models and Evidence

Models
Brief interventions are a treatment strategy that can vary in length, have flexibility to operate from a variety of frameworks and can utilise numerous techniques.(4)

Many brief interventions follow the 5As methodology which was adapted from the smoking cessation framework developed by the US Department of Health and Human Services.(5) The five major steps which are similar across all lifestyle and behavioural risk factors include the following: (6)

• Ask: identify patients with risk factors
• Assess: determine the patients level of risk and readiness to change
• Advise: provide brief advice, written information and motivational interviewing
• Assist: introduce pharmocologies, support and self monitoring
• Arrange: provide referrals to specialist services, social support groups, phone information/counselling and arrange follow-up with the GP

Evidence
There is a vast amount of evidence that demonstrates the effectiveness of brief interventions to address behaviour change and lifestyle risk factors. However, the majority of the evidence relates to the effectiveness of brief interventions for the alcohol and other drugs misuse particularly in primary care settings.(7) There have been numerous randomised control trials of brief interventions addressing alcohol and other drug misuse in a variety of health care settings which have been conducted in Australia, Bulgaria, Mexico, the United Kingdom, Norway, Sweden, the United States, and many other countries.(8) Outcomes of these randomised control trials indicate the success of a brief interventions approach in supporting patients to modify risk taking behaviours.

It should be noted that brief interventions are not a treatment strategy unique to the alcohol, tobacco and other drugs area but are often employed by health care professionals to address a diverse range of health behaviours.(7) In light of this, the supporting evidence may be applicable across a range of risk factors including smoking, inadequate nutrition, alcohol consumption, physical activity and overweight and obesity. There is a clear need for further research across all lifestyle risk factors.

Resources

There are a range of evidence-based brief intervention tools, resources and training available to support health professionals to assist patients to address lifestyle risk factors for chronic disease (e.g. smoking, poor nutrition, alcohol misuse, physical inactivity and unhealthy weight).

Click here for a comprehensive summary of evidence-based brief intervention, tools, resources and training.

Resource	Summary	More Information
Lifescripts	The Lifescripts initiative provides health professionals with tools, guidelines and skills to assist patients address the main lifestyle risk factors for chronic disease including smoking, poor nutrition, alcohol misuse, physical inactivity and unhealthy weight. The initiative assists with the provision of tailored advice to patients on modifying their lifestyle.	Lifescripts
Indigenous Risk Impact Screen and Brief Intervention	The Indigenous Risk Impact Screen and Brief Intervention program provides a culturally secure and validated screening instrument and brief intervention designed to meet the specific needs of Aboriginal and Torres Strait Islander communities in Queensland and across Australia.	IRIS: www.health.qld.gov.au Organisation: Queensland Health
SmokeCheck	The SmokeCheck brief intervention involves assessing people’s readiness and motivation to quit smoking, and uses the 5As approach (ask, assess, advise, assist, arrange follow up) to giving advice. SmokeCheck resources are evidence based and include a DVD demonstrating brief motivational interviewing, a health workers' guide and desk top tool card, pamphlets for clients, a poster and a fridge magnet. SmokeCheck resources are available to those who complete the one day SmokeCheck training workshop.	SmokeCheck:  www.smokecheck.com.au Organisation: Queensland Health
Nutrition and Physical Activity Brief Intervention for Aboriginal and Torres Strait Islanders	The Nutrition and Physical Activity Brief Intervention project provides training and resources for primary health care staff to provide one-on-one client support to address poor nutrition and physical inactivity.  The Brief Intervention resource consists of a nutrition flipchart with seven nutrition-related handouts based on the stages of change. Similarly, a physical activity flipchart is provided with accompanying handouts based on the stages of changes. The Tropical Population Health Network offers training and ongoing support.	Contact: Deanne Minniecon,   Senior Health Promotion Officer Indigenous Health,   Nutrition and Physical Activity Team Health Promotion Branch, Preventative Health Directorate Phone: (07) 33289261 Organisation: Division of the Chief Health Officer
Alcohol Screening and Brief Intervention	A training tool primarily for teaching the skills of alcohol screening and brief intervention to those who deliver front line services to the veteran community and who are in a unique position for early and appropriate intervention for alcohol use. It is also intended to be used as an intervention resource manual for continuing reference by service providers as part of their skill development for alcohol intervention.	Department of Veteran Affairs: www.dva.gov.au/Pages/home.aspx Organisation: Department of Veteran Affairs
Talkin’ Up Good Air: Indigenous Tobacco Control Resource Kit	This tobacco control resource kit for Indigenous Australian communities aims: To assist health professionals, along with community and education workers, to become community leaders in the area of tobacco control. To raise the priority of tobacco control in Indigenous communities. To build community ownership in tobacco control by supporting community-initiated and controlled action.	Centre for Excellence in Indigenous Tobacco Control: http://www.ceitc.org.au/talkinupgoodair Organisation: Centre for Excellence in Indigenous Tobacco Control

Professional Development

Brief Interventions Workshop Project
This project, funded by Queensland Health (QH), responds to a need identified through the Commitment to Partnership (2006-2009) and joint work plan between QH and GPQ to improve capacity to conduct brief interventions with patients in order to reduce the risk of developing chronic conditions.

The project focuses on collaboration between Queensland Health professionals and General Practice professionals to build and further develop capacity for shared systems which enhance the effectiveness of brief interventions.  Funding supports the delivery of (6) workshops across Queensland where, through an interprofessional learning approach, participants will discuss current brief intervention tools, identify barriers and enablers to uptake and inform referral pathways to respond to patient’s identified needs.

Target locations have been determined by taking into consideration population demographics such as socio-economic status, indigenous population, and prevalence of SNAP-O risk factors. Target locations include:

• Rockhampton
• Cairns
• Mt.Isa
• Ipswich
• Brisbane South
• Goondiwindi

An interactive workshop has been developed to increase uptake of brief interventions in general practice and Queensland Health services to reduce chronic disease risk factors and foster better health for all Queenslanders.

A reference group, including representatives from the Queensland Health's Primary & Community Health Partnerships Unit and Chronic Disease Strategy Unit, a General Practitioner representative, and General Practice Queensland Chronic Disease Team representatives were consulted during the development of this workshop.

The purpose of the workshop is to enhance the health service capacity to implement a coordinated, systematic approach to opportunistic early detection and management of disease markers that targets at risk populations

Workshop learning objectives include:

• Enhanced understanding of brief interventions and lifestyle modifications
• Increased awareness of brief intervention tools and resources
• Development of collaborative service delivery models for general practice and Queensland Health including referral pathways
• Analysis and understanding of barriers to the provision of brief interventions
• Professional networking, peer learning and multidisciplinary team work in the local context

Please note that RCNA, ACRRM and RACGP QA & CPD points apply.

A process and impact evaluation will be undertake to enable the learnings from the Brief Interventions Project to be shared widely across QH and general practice networks to support future uptake of brief interventions.

Further Training and Professional Development

• Health Coaching Training and Motivational Interviewing Training: Click here for a comprehensive summary of Health Coaching and Motivational Interviewing Training
• Physical Activity and Nutrition Brief Intervention for Aboriginal and Torres Strait Islanders Training – contact Deanne Minniecon, Senior Health Promotion Officer Indigenous Health,  (07) 33289261
• Indigenous Risk Impact Screen and Brief Intervention Training: www.health.qld.gov.au
• Smokecheck Training www.smokecheck.com.au/
• Department of Veteran Affairs Alcohol Screening and Brief Intervention Training: www.dva.gov.au

Links

• RACGP SNAP Guidelines: a population health guide to behavioural risk factors in general practice
• RACGP Guidelines for Preventative Activities in General Practice – The Red Book
• RACGP Putting Prevention into Practice – The Green Book
• Health Coaching Australia: www.healthcoachingaustralia.com
• Motivational Interviewing: www.motivationalinterview.org
• Motivational Interviewing: a systematic review and meta-analysis: www.nwlcn.co.uk
• Stages of Change: www.addictioninfo.org
• Lifestyle Medicine: www.lifestylemedicine.net.au

References

1. Glasgow Health Technology Board for Scotland
2. Higgins-Biddle JC & Babor TF 1996, Reducing Risky Drinking: A Report on Early Identification and Management of Alcohol Problems Through Screening and Brief Intervention, Alcohol Research Center, University of Connecticut Health Center, Farmington, Connecticut
3. Queensland Strategy for Chronic Disease 2005-2015
4. Heather, N., Raistrick, D., & Godfrey, C. (2006). A Summary of the Review of the Effectiveness of Treatment for Alcohol Problems. London: The National Treatment Agency for Substance Misuse
5. Fiore MC, Bailey WC, Cohen SJ, et al. Treating Tobacco Use and Dependence. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. June 2000
6. Harris M (Ed.). Smoking, nutrition, alcohol and physical activity (SNAP). A population health guide to behavioural risk factors in general practice. Melbourne; The Royal Australian College of General Practitioners, 2004
7. Swan, A., Sciacchitano, L., & Berends, L. (2008). Alcohol and other drug brief intervention in primary care. Fitzroy, Victoria: Turning Point Alcohol and Drug Centre
8. Thomas F. Babor & John C. Higgins-Biddle (2001). Brief Interventions for Hazardous and Harmful Drinking: A Manual for Use in Primary Care. Department of Mental Health and Substance Dependence, World Health Organisation