Complete the following statement, I could improve my health if I [fill in the blank].

Raphael Gaeta, PhD, Senior Researcher

If you’re like me, the first answer for the blank above that comes to mind is: increase my level of physical activity. Over the last few years, I’ve not made enough time for exercise. However, our recent New Editions’ Walking Competition and the company’s participation in The Arc of Northern Virginia Corporate & Community Team Challenge 8k Run got me thinking about getting more active.

Despite my typically low daily step count, I enjoy a good challenge, competing, and being a part of team. I’m also realistic about my current fitness level. So, I set a personal goal for the Walking Competition. Something that would be a challenge, but also achievable and a step toward better fitness. By the end of the four weeks, I aimed to walk an average of at least 10,000 steps a day. Yes, this is the commonly recommended step count per day, but for someone who does more like 3,000 steps a day, it felt like a worthy goal.

I finished the competition with an average daily step count of 10,143 and learned some important things along the way. Namely, I really liked having real-time information about my activity level. At any given time, it was motivating to know my progress and how many steps I needed to reach my daily goal. Prior to our walking competition, I had never worn a fitness tracker and now it’s always on my wrist. I think this is will be an important tool for maintaining and increasing my level of exercise over time.

In thinking about Men’s Health Month, which is celebrated every June, and in reflecting on the whole experience, I realized there is a link to some of my professional work in behavioral health, mainly with an intervention model called SBIRT (Screening, Brief Intervention, Brief Treatment, and Referral to Treatment). SBIRT was originally developed as a stepped public health approach to identifying and intervening with individuals who have substance use disorders, or who are at risk of developing a substance use disorder. The first step involves universally screening individuals, often patients in a health care setting, to risk stratify, or separate those who are at low or no risk of substance use disorder from those who may be at risk of substance use disorder.

In a general population, the vast majority of individuals will screen as low or no risk and receive no further intervention. Some individuals will screen as at-risk users, who do not yet meet the full criteria for substance use disorder and could benefit from early interventions designed to help change substance use behaviors. These individuals receive a brief intervention or series of brief therapy sessions led by a clinician that are designed to:

assess individual readiness and motivation to change,
raise awareness and provide education on consequences of risky substance use,
set reasonable goals for behavior change, and
address tools and supports to help achieve those goals.

A very small minority of individuals will screen as high risk and receive a referral to specialty care for a more comprehensive assessment and, as appropriate, treatment for substance use disorder.

Since 2003, the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) has provided funds to states and universities for training and implementing SBIRT in a wide range of health and social service settings. As SBIRT has grown, applications of the model have emerged for various populations and behavioral health issues, including mental health conditions and even gambling. The flexibility of SBIRT can be better understood by looking more closely at some of the ideas behind the model.

A major underlying theory for SBIRT is the Transtheoretical Model, commonly referred to as Stages of Change, first developed by James Prochaska and Carlo DiClemente in the 1970s. The model outlines several stages of behavior change that can be used to determine an individual’s readiness to change, as well as to guide the process and strategies for goal-setting and acting on the healthy behavior. Simple descriptions for each of these stages are provided below. As a closing exercise, think about where you might fall in terms of the healthy behavior that first came to mind when you began reading this blog post.

Precontemplation – No intent to change within the next six months.
Contemplation – Intend to start the healthy behavior within the next six months.
Preparation – Getting ready to start the healthy behavior in the next 30 days.
Action – Started the healthy behavior in the last six months.
Maintenance – Continued the healthy behavior past six months.

What might help you move from your current stage to the next?

More information and education about consequences of the unhealthy behavior?
Weighing the pros and cons of behavior change?
Tools, strategies, and resources to help facilitate the behavior change?

This is only a quick glance into SBIRT and related concepts in behavior change. For more information about SBIRT, visit SAMHSA’s SBIRT websites: https://www.samhsa.gov/sbirt and https://www.integration.samhsa.gov/clinical-practice/sbirt.

Raphael Gaeta is a Senior Researcher with 10 years of experience in federal contracting. Prior to joining New Editions, he worked on several national program evaluations and technical assistance projects for the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA). Raphael earned his PhD in Health Services from the University of Maryland, College Park.

Focus or Topic

Health