Evaluation of short term support for emergency department attendees who present with moderate and high levels of stress: a pilot study

The detection of health problems before they become severe will enable intervention and support to be provided at an early stage. The Brief Intervention (BI), based on Motivational Interviewing (MI) principles, will be designed to encourage and motivate study participants to seek and obtain further assistance for their psychological needs which may improve health and prevent further deterioration. The MI intervention is designed to be pragmatic in that the MI will be necessarily tailored to each participant’s individual circumstances. Following recruitment, all participants will be provided with 'standard care' (i.e. usual care from their ED admittance). Those participants who have been randomised into the intervention group, the BI will be delivered by telephone interview 48-96 hours after the participant’s ED attendance, with a ‘booster’ MI of three telephone calls during the two week period following the initial BI. The initial MI and the three subsequent MIs are each expected to be 60 minutes in length. (approx 4 hours total for each study participant) Follow up of all participants will occur at one, three, six and twelve months by telephone contact. Pre and post-intervention measures will be used to assess mental health and well-being, subjective quality of life (SQOL); and intervention based outcomes including motivation and confidence, healthcare-seeking behaviour and appropriate health service utilisation. Motivational interviewing (MI) is client-centred, directed therapy, which prepares individuals to become more receptive to change by exploring dissonance in the perceived benefits and costs of behaviours. Its central principal is that motivation to change should be elicited from people, not somehow imposed on them. MI is non-confrontational, assumes equity in the client counselor relationship, emphasises the client’s right to define their own problems and to choose how to deal with them. The counselor uses empathetic listening to minimise resistance and increase motivation for change. Motivation is viewed as a state of readiness to change which fluctuates and can be influenced by others. The stages of change model have proved useful for the understanding and conduct of a motivational interviewing session. MI is particularly useful for working with clients who are ambivalent, resistant or reluctant to change. All change is preceded by some degree of ambivalence. When using an interview technique these components are applied by: exploration of the person’s thoughts about the issue e.g. feeling depressed or stressed; use of reflective listening; showing respect and willingness to understand; giving relevant and accurate health information and providing explanations; helping to clarify personal goals or role in the community; avoiding argument; and helping people to look at their behaviour and how it impacts on others.