Brief Action
Planning: Tools for
Increasing Patient
Engagement
Elaine M. Skoch, RN, MN, NEA-BC, PCMH-CCE
Health Systems Redesign Solutions
Learning Objectives:
At the end of this presentation, the participant
will be able to:
Recognize and utilize basic interaction skills
necessary in Brief Action Planning
Describe the steps in Brief Action Planning
Name an example of a “behavioral menu”
What is Motivational
Interviewing (MI)?
Motivational interviewing is a collaborative
conversation style to strengthen a person’s
own motivation and commitment to change.
Miller and Rollnick
Motivational Interviewing: Helping People Change
3rd ed., 2013
Another Definition of MI
Dancing vs. Wrestling
Why use Motivational
Interviewing Tools & Techniques
MI is method that works by facilitating and
engaging intrinsic motivation within the
client in order to change behavior.

Goal-oriented, client-centered

Focused on eliciting behavior change by
helping clients to explore and resolve
ambivalence
Supports Self-Management
Healthy communities and supportive family,
friends and caregivers
Expert methods
Advanced approaches
Motivational interviewing, care
management, problem-solving
therapy, shared medical
appointments, etc.
Behavior change support
Goal setting, action planning,
problem-solving, follow-up
Culture
Health literacy
Activation
Health Council of Canada: Self-management Support for Canadians with Chronic Conditions, May 2012
Spirit of
Motivational Interviewing-”MI”




Compassion
Acceptance
Partnership
Evocation
Miller W, Rollnick S. Motivational Interviewing: Helping People Change, 3ed, 2013
CAPE
 Sign of respect
 Protection –
creating a space
for them to
work on change
 Not “tricks” or
“techniques”
The Spirit of MI is the
Foundation for
Brief Action Planning
What is Brief Action Planning?
 Highly structured
 Person-centered
 Stepped-care
 Evidence-informed
 Easy to use
It is a Self-management support technique
based on the principles and practice of
Motivational Interviewing.
Reims et al, Brief Action Planning White Paper, 2013
available at www.centreCMI.ca
Four Basic Interaction Skills
are Necessary
 The ability to ask open-ended
questions
 The ability to provide affirmations
 The capacity for reflective listening
 The ability to periodically provide
summary statements to the client
Steps in the BAP Process
“Is there anything you would like to do for your health in
the next week or two?”
Behavioral Menu
SMART Behavioral Plan
Elicit a Commitment Statement
“How confident or sure do you feel about carrying out your
plan (on a scale from 0 to 10)?”
If Confidence < 7, Problem Solve Barriers
“Would it be helpful to set up a check on how things are
going with your plan?”
Check on progress
BAP Video, All Skills
Sharon and Dr Nee
http://www.centrecmi.ca/Centre_for_CMI/BAP_videos.htm
l
What Did You See?
What wasn’t there?
Question #1:
Concentrates on Focusing Action
“Is there anything you would like to do for your health in the
next week or two?”
Possible Responses to
Question #1
Have an idea
Need some help with an idea
(or not sure what you mean)
Not at this time
Healthy
Not interested
Skill #1
Behavioral Menu
Offer a behavioral menu when needed or
requested.
Behavioral Menu
1. “Is it okay if I share some ideas from other people
who are working on something similar?”
2. If yes, share two or three varied ideas briefly all
together in a list. Then say…
3. “Maybe one of these would be of interest to you or
maybe you have thought of something else while we
have been talking?”
Exercise
Healthier
eating
Better sleep
Adapted from Stott et al, Family Practice 1995; Rollnick et al, 1999, 2010
Skill #2
SMART Behavioral Plan
Action Planning is “SMART”:
Specific, Measurable, Achievable, Relevant
and Timed
With permission:
•What?
•When?
•Where?
•How
often/long/much?
•Start date?
Based on the work of Locke (1968) and Locke & Latham (1990, 2002); Bodenheimer, 2009
Skill #3
Elicit a Commitment Statement
After the plan has been formulated, the
clinician/coach elicits a final “commitment
statement.”
Strength of the commitment statement predicts
success on action plan.
Aharonovich, 2008; Amrhein, 2003
Question #2: Using a
Confidence Scale
“How confident or sure do you feel about carrying out
your plan (on a scale from 0 to 10)?”
Skill #4
Problem Solving
Problem-solving is used for confidence levels less
than….
Bandura, 1983; Lorig et al, Med Care 2001; Bodenheimer review, CHCF 2005; Bodenheimer, Pt Ed Couns 2009.
Self-Efficacy
Mt Frosty, BC by C. Davis
People’s beliefs about
their capabilities to
perform specific
behaviors and their
ability to exercise
influence over events
that affect their lives.
Self-efficacy beliefs
determine how
people feel, think,
motivate themselves
and behave.
- Albert Bandura
Problem Solving
Confidence <7
“A __ is higher than a zero, that’s good! We know
people are more likely to complete a plan if it’s higher
than 7.”
“Any ideas about what might
raise your confidence?”
Yes
No
Behavioral Menu
Assure improved confidence.
Restate plan and rating as
needed.
Question #3 - Accountability
“Would it be helpful to set up a check on how things are
going with your plan?”
Skill #5
Check on progress
Checking on the plan builds confidence.
Check often with new action plans
and decrease frequency as
behavior is more secure.
When working with a clinician:
• Regular contact over time is
better than 1x intervention.
• Follow-up builds a trusting
relationship.
Resnicow, 2002; Artinian et al, Circulation, 2010
Checking On Progress of the
Plan
“How did it go with your
plan?”
Completion
Partial
completion
Did not carry out plan
Recognize
success
Recognize partial
completion
Reassure that this
is common
occurrence
“What would you like to do
next?”
“Is there anything you would like to do for your health in the next
week or two?”
Have an
idea?
With permission:
What?
When?
Where?
How
often/long/muc
h?
Start date?
Not sure?
Behavioral Menu
SMART Behavioral Plan
Elicit a Commitment
Statement
Not at
this time
Permission to
check next
time
1) Ask permission
to share ideas.
2) Share 2-3 ideas.
3) Ask if any of
these ideas or one
of their own ideas
might work.
“How confident or sure do you feel about carrying out your
plan (on a scale from 0 to 10)?”
Confidence
≥7
Confidence <7,
Problem Solving
“Would it be helpful to set up a check on how things are going with
your plan?”
How?
When?
Check on Progress
Let’s Try It Now!
Make a plan for something you want to
do = REAL PLAY
Work in trios
One is themself, making a Brief Action Plan
The second is the helper, guiding them through
the Brief Action Plan process
The third is the observer, using the Listening
Guide
Debrief using the listening guide after each
practice. Re-practice anything that was skipped.
Then SWITCH (time permitting)
Some interesting facts….
If you see 20 patients a day in your
primary care clinic…
And 50% of the time, you ask Question #1 to
10 patients/day…
Of those:
• 25% will not be ready or not need help or
are healthy (2 pts.) Respect autonomy
• 25% will easily make a plan Simple BAP
• 25% will need a behavioral menu or problem BAP, all skills
solving
• 25% will need advanced skills Return visit, referral
Questions?
Elaine M. Skoch, RN, MN, NEA-BC, PCMH-CCE
Health Systems Redesign Solutions