Simple Charts for Follow Up

Simple adapted CAGE QUESTIONNAIRE follow up

Time visit follow up just say better or worse than previous time

Date

control n°

0

1

2

3

4

5

1. Have you ever felt you should quit

2. Have people mentionned if

3. Have you ever felt bad or

4. Have you ever taken a use it to start in the morning

(2 or more positive responses indicate a likely problem). 0 is first contact. 1 is first date within therapeutic path. Between 2 date (but 0 and 1) there should be at least one month. So not too detailed

Drug Abuse Feelings Balance

Mood Balance Score Scale (1 = minimum; 5 = maximum)

1

2

3

4

5

Any purpose to finish all that?

Feel depressed?

Relating this to organic feelings?

What about health? (& medicines?) Score Scale (1 = minimum; 5 = maximum)

1

2

3

4

5

Bad health, bad feeling?

Drugs relieve you?

Medicines disturb you?

What about your communicability? Score Scale (1 = minimum; 5 = maximum)

1

2

3

4

5

Feel sorry?

Drug consumption last week?

You think or people show you, hard to communicate with you?

Psychotic problems? (observer's assessment) Score Scale (1 = minimum; 5 = maximum)

1

2

3

4

5

Feel persecuted?

Hallucinations, (voices or visual)?

Hard to managed contradictions?

Patient-centred approach

Regard the person's behavior as their personal choice

acknowledge benefits as well as costs to behaviour understanding and acknowledging the patient's choices enhances their autonomy and responsibility

Let the person decide how much of a problem they have, i.e. how important it is for them to quit

systematically explore benefits (likes) and costs (dislikes) as perceived by the patient use examples and issues raised by the patient encourage the patient to rate their motivation and confidence out of 10. If score is low, explore what would increase this score. If the score is high, why?

Avoid argumentation and confrontation

confrontation within the patient is the goal separate information from persuasive imperative

Encourage discrepancy

change is likely to occur when behaviour is seen to be in conflict with personal goals use the Decision Balance to identify discrepancies

Help patients re-evaluate their substance use

Three ingredients are necessary for any behaviour change: concern with current behaviour belief that change will lead to improvement belief that change is possible (self-efficacy)

Cultural Dimension: Why Health care workers are influential amongst Indigenous people

Reason

Explanation

Privacy of consultation

Avoids the potential stigma of attending an identified alcohol and other drug service, and provides the necessary confidentiality.

Expectations of the doctor's role

Indigenous patients expect doctors and health care workers to talk honestly about their health problems, to diagnose and give advice. It is particularly important to link the presenting problem with alcohol- or drug-related problems where possible, as patients knowledge about these links may be minimal. It is important to stress the effect of the patients drinking and/or drug use on their family responsibilities.

Respect for specialised knowledge

Medical practitioners in particular are known to have specialized knowledge of the body. This invests them with considerable authority amongst Indigenous people, and provides doctors with significant potential to motivate for change in drinking and other drug use behaviour.

Personalized advice and providing evidence of harm

Linking advice on alcohol consumption to the individuals presenting problem is more influential than a general talk about alcohol awareness. Indigenous patients seem to respond well to offers of biological tests, the results of which provide objective proof of the harmful effects of alcohol misuse. Such evidence can be particularly useful to the indigenous patient.

Neutral advice from an informed outsider

Professional advice on changing drinking behavior can motivate the individual to consider change, partly because a doctor is usually an outsider, not of the patient's family or community. Community health workers known to the patient can sometimes find it intrusive to discuss alcohol- or drug-related matters with other indigenous people. In the face of intense social pressures to drink, authoritative advice from an outsider can be of particular value. Having an external reason can legitimize an individual's refusal to participate in drinking sessions with friends and family members, without causing offense.