BNI Help Sheet

This document provides detailed steps to complete a BNI. These are the steps that will be assessed
during the Skills Practice portion of the SBIRT training. In addition to this “skeleton” of the BNI steps,
suggested statements are provided on pages 2-4. You will also find a scaled down version of these BNI
steps on the pocket and lanyard cards.

BRIEF NEGOTIATED INTERVIEW STEPS

Raise the Subject
Ask permission to discuss single screening results provided in the scenario
Build rapport (Day in the life type question)
Screen patient/client with AUDIT or DAST
Review Standard Drink (If using AUDIT/discussing alcohol use)
Assess discomfort
Ask permission to review results and talk about effects on health
Provide Feedback
Review results of AUDIT/DAST with the patient/ client
Express concern about these patterns
Show patient/client national substance use norms and show where patient/client scores
Ask about connection between results and why you are seeing patient/client
Reflect the patient/client’s statement(s).
Enhance Motivation
Evoke response (What do you make of this information?)
Explore decisional balance – pros & cons
Ask patient/client about Importance/Interest in making change using readiness ruler (1-
10)
Develop Discrepancy: Ask why they chose that number and not a lower one
Use reflective listening
Use open-ended questions to explore change talk/develop elaboration
Reinforce positives (use affirmations)
Elicit response (Where does all of this leave you?)
Negotiate and Advise
Negotiate a goal for reduction (See note below for referral to treatment)
Help patient/client generate menu of options
Give advice as needed. (Optional; May use health information sheets)
Identify strengths and supports/past success
Summarize the goal/plan (This is what I have heard you say…)
Remain non-judgmental
Suggest follow-up
Thank the patient/client and express optimism that they will meet success

(NOTE: For patients/clients being referred to treatment, you will typically negotiate an
agreement for treatment referral and connect them with the referral source.)
.

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 Helpful Statements

Raise the Subject

Ask permission/Establish rapport

Hello, I am ______. I notice that you answer the screening question for substance use (alcohol and/or
drug) positively. Can we spend a few minutes talking about how this might affect your health? (Get
answer) Before we start, can you tell me about a typical day in your life? Where does your [X] use fit in?

Screen (if not already done)

Thank you for being willing to talk about this. Can we spend a few minutes to go through a few questions
to get a better picture of how you use [X]?

After completing AUDIT or DAST

Your score indicates that there are some risks related to this level of use. Can we spend a few minutes
talking about this?

Provide Feedback

Ask permission to review results

Can we spend a few minutes going over your results?

Using information about substance use levels and health connections

I have some information about the guidelines for low‐risk drinking, would you mind if I shared them with
you?

Or

I have some information about the risks of drug misuse. Do you mind if I share it with you?

Establish connection between use and reason for visit to you.

What connection (if any) do you see between your [X] use and [medical issue]? What are your thoughts
on that?

Reflect patient’s statements

You see that there might be a connection between the {X} use and (reason you are seeing them).

Enhance Motivation

Evoke a response to the information

What do you make of this?

Or

What would you like to do about this?

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Explore Decisional Balance - Establish pros and cons of use

What are some of the good things about using [X].

What are some of the not so good things about using [X]?

Establish importance/interest; confidence; readiness

Can we talk for a few minutes about your interest in making a change?

If we use this ruler as a guide, on a scale from 1‐10, with 1 being not ready at all and 10 being completely
ready, how ready are you to make any changes in your [X] use?

Develop Discrepancy – Reflective statements

This is something you’ve given some thought about – OR – You really care about your health.

Or

You’re sort of in the middle with some things holding you back and some other things ready to move you
forward (letting you know you can do it; telling you it’s important to you).

Or

Changing isn’t something high on your list right now.

Develop Discrepancy (Elicit change talk) – Open-ended questions

Why did you choose that number and not a lower one like a 1 or a 2?

What might put you at a ____, just one point higher on the scale?

You say you want to be at a 9 or 10, what might put you just one step closer to that?

What else?

What would be the first thing you notice that tells you are there?

What might be a sign that tells that _____ has become a problem for you?

Reinforce positives – Use affirmations

You marked ___. That’s great. That means you are ___ % ready to make change. (If number is middle to
high. If low number, this type of response can be construed as sarcastic).

Or

I’m impressed by how committed you are to the idea of improving your health.

Or

I appreciate you having this conversation with me. It can be tough to discuss.

Elicit a response

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While there are things that you enjoy about using [X], it sounds like you have some important reasons for
change.

Or Sounds like you are ready to make some changes to improve your health.

Negotiate and Advise

Negotiate a goal

What changes (or reduction) in your use {X} do you want to make right now?

Generate a menu of options

What part of this can you see yourself changing?

What ideas do you have about how to go about it?

Give advice/health information sheets

If you stay within these limits you are less likely to experience further illness or injury related to substance
abuse

Based on what you have told me and what we know from the health information we might need to
consider …what do you think? (asked this way to support autonomy)

Negotiate a plan

What are some options/steps that will work for you?

ELICIT-PROVIDE-ELICIT – I have some thoughts/suggestions if you’d like to hear them. Some people
have _________ and I’ve seen other people find _______useful. What are your thoughts about those?

Identify strengths and supports – past successes

Tell me about a time when you overcame challenges in the past. What kinds of resources did you call
upon then? Which of those are available to you this time?

Summarize the goal

This is what I have heard you say about where you are and might work for you ………

Suggest/schedule follow-up

Would it be possible for you to return in a month to just see how you are doing on meeting your goals?

Thank the patient and express optimism

Thank you for taking the time to talk with me about your {X} use. I feel confident that you can reach these
goals and improve your health.

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