Module 9: working with young people on AOD issues: learner's workbook

3.5 Identifying and responding to a young person's readiness to change

Page last updated: 2004

The stages-of-change model is primarily of use when dealing with people with established patterns of AOD use. Remember that this model may not fit all people all of the time, but is helpful in identifying a young person's readiness for change.

There are a number of ways of determining a young person's stage of change and readiness for action. It is important to use basic counselling skills including the use of open-ended questions, reflective listening, summarising and confirming the young person's views. One of the simplest tools for assessing readiness for change is to ask someone to indicate their response on a 10-point scale. (See Tool 1, the ten point change scale below.)

Ask the young person to mark on the scale how they currently feel about changing their AOD use. It is likely that the young person will feel differently about different drugs so it may be worth using the tool with each of the drugs they use.

This approach can provide a framework for having a structured conversation with a young person about their drug use. The 'score' has subjective meaning for each young person and can also be a good base measure to return to at a later time (upon review of a case plan for example). Remember that some responses are more effective than others in initiating a conversation about the possibility of change as indicated in the section about communication roadblocks.

Some examples of questions you could use in response to the young person's position on the scale are provided. Remember that the focus of the conversation is not to convince the young person to change behaviour, but to help them consider the possibility of change and perhaps move along the stages of change. The wording of your questions and an empathic response to resistance and ambivalence are extremely important.

Tool one - the ten point change scale
Starting a conversation about change using the ten-point change scale
Summary
Distance learners

Tool one - the ten point change scale

The ten point scale consists of a horizontal line numbered 0 to 10 (from left to right).Top of page

Not considering change

If their mark is on the left end of the line (roughly 1 to 3):
  • Goal for conversation: To encourage the young person to think about the possibility of changing behaviour. Young people at this end of the scale can appear argumentative or in 'denial' and the natural tendency is to try to 'convince' them which usually provokes resistance and can be a roadblock to communication.

  • Some useful questions might be:
    'What would have to happen for you to decide that your AOD use is a problem?'
    'What warning signs might tell you to start thinking about changing?
    'What things may happen if you continue to use ...?'
    'What have other people said about your drug use?'
    'How might your use of ... have stopped you from doing other things you want to do?'
    'What are some of the hassles that your .... use may have caused?'

Thinking about changing

If their mark is somewhere in the middle (roughly 3 to 6):
  • Goal for conversation: To encourage the young person to examine the 'pros' and 'cons' of changing

  • Some useful questions might be:
    'What are some of the reasons you might like to make a change to your..... use?'
    'What might be some of the advantages in not using ...?'
    'If we were to bump into each other on the street in six months time, what do you think you would you like to tell me about your life at that point?'

Already changing

If your mark is on the right end of the line (roughly 7-10):
  • Goal for conversation: To encourage the young people to explore factors that can support their decision to change.

  • Some useful questions will be:
    'Pick one of the barriers to change and list some things that could help you overcome this barrier.'
    'Pick one of those things that could help and decide to do it by ...... (write in a specific date).'
    'If you've taken a serious step in making a change:
    What made you decide on that particular step?'
    What has worked in taking this step?'
    'What helped it work?'
    What could help it work even better?'
    What else would help?'
    'Can you break that helpful step down into smaller steps?'
    'Pick one of those steps and decide to do it by ....... (write in a specific date).'
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Starting a conversation about change using the ten-point change scale

Role play

The following role-play activity will provide you with an opportunity to practise using the ten point change scale as a tool for facilitating a conversation about the possibility of change. Remember that this is a constructive learning opportunity and its success will depend on the way you provide and take on feedback.

Working in groups of three, each participant takes a turn in the following roles:
  • the school counsellor
  • the young person
  • the observer
Read the following:
  • Role play scenario
  • Debriefing sheet
  • Observer worksheet
  • Reflection sheet
Allow approx. 10-15 minutes for the role play and a minimum of five minutes for debriefing. The observer will manage time and the debriefing process.

(A good point for student to contact facilitator.)

If you are undertaking this task as a distance learner take on the role of the worker and complete the role play with a co-worker or friend. Make sure that you complete the Debriefing Sheet and the Reflection Sheet. You can complete the Observer Worksheet as a self-evaluation task if you are unable to find an observer for your role play.

Role play scenario

Troy is a 14-year-old male who was recently found drinking alcohol on school grounds. When confronted about it by a teacher, he became extremely argumentative and aggressive and was suspended as a result. Troy has a history of getting into trouble at school for missing classes, failing to complete homework and general rudeness to teachers. A number of teachers have reported being concerned about Troy's health and wellbeing, and have stated that they were sure that they had smelt alcohol on his breath on several different occasions. They have also noticed a deterioration in his school work as well as his general demeanour.

Troy has admitted that he has been drinking 'quite a lot' and sometimes by himself to get away from things. However, he doesn't see that there is a problem with his drinking, and believes that the teachers should mind their own business. He doesn't really see the point in school because he isn't doing well anyway although he did want to at least finish high school.

The school counsellor has been asked to speak with Troy about his alcohol use and the other problems that have been arising at school.

The counsellor's aim is to:
  • start a conversation about how Troy feels about the possibility of changing his alcohol use using the ten-point change scale as a tool
  • determine what stage of change might be consistent with Troy's current state
  • respond appropriately to Troy's elected position.
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Role play debriefing sheet

Those taking the observer role are responsible for facilitating the debriefing.
  1. Ask the person who played 'the worker' to state their response to the role play - what they think they did well and what could be done differently next time.

  2. Ask the 'young person' to give constructive feedback to the worker stating how they responded to their approach. (What was helpful, and not so helpful, including verbal and non-verbal aspects of worker's approach.)

  3. Give the worker an opportunity to comment or seek any further feedback (e.g. 'How was it for you when I ....... ?')

  4. Ask the young person and worker role players to stand physically move away from their seating position and shake off the role. State their real name and two qualities about them which are different from the role they played.

  5. Observers then give constructive feedback to the worker. Finish by restating what strengths the worker demonstrated.
All group members then identify the key learning points of the role play.

Role play observer worksheet

Task - writing exercise/group activity

The observer should provide feedback on the school counsellor's response to the situtation. Respond with yes or no and provide comments to the following:
  • Approached the young person in an appropriate way (e.g. introduced themselves, non-threatening and non-judgemental)

  • Raised the issue of concern: episodes of being alcohol affected. (This should be factual focusing on incidents at the school.)

  • Introduced the ten-point scale of change and clearly explained to Troy what was required of him.

  • Responded appropriately to Troy's elected position on the scale using at least one open-ended question to explore why he positioned himself at that point on the scale.

Reflection sheet

Task

Reflect on what you have just learnt and write down your thoughts to the following questions:

Question - What went well in the role play and what didn't go so well?

Question - What constraints might you come across in this type of situation at work?

Question - What steps could you take in your workplace to apply what you have learnt in this topic?
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Summary

Lifestyle change is a difficult task. The Stages-of-Change model provides a framework for assessing and working effectively with young people.

Key points about the Stages-of-Change model:
  • Change is a process, not a single event
  • People may go around the cycle of change many times before achieving control
  • A young person's resistance may be a sign that the worker has overestimated their readiness for change.
The ten-point change scale can be a useful tool for starting a conversation focusing on how the young person feels about the possibility of changing their AOD using behaviours.

Distance learners

(A good point for student to contact facilitator.)

Distance learners should take time now to reflect on their learning, check in with their facilitator and determine their progress.