This webpage is a resource that aims to supplement the BSHRC Pocket Cards with suggested ways to use the cards’ readiness rulers.
In 2014, BSHRC and its chapter organization at the Johns Hopkins University School of Medicine, Hopkins Med for Harm Reduction, created two white-coat pocket reference cards that aim to provide students and professionals with clinically relevant harm reduction strategies in sexual health and substance use. Design of the cards was done in collaboration with a student from MICA, Laura Brewer-Yarnall. The cards were printed with financial contribution from the Johns Hopkins Alumni Association and Open Society Institute-Baltimore.
Feedback is not only welcome, but requested! We have recently begun to distribute the first version of the cards. Your comments and suggestions will help us to produce a second, more refined version. The goal is to continually improve the cards and adapt them to the needs of clinicians and patients. In the future, we hope to create additional pocket cards on other Harm Reduction topics. If you have feedback, please email BaltimoreStudentHRC@gmail.com. In the subject line, please write “Pocket Card Feedback.” We will not be able to respond to all feedback individually, but once we receive enough we will examine it all collectively and make changes via consensus.
Motivational Interviewing and the Readiness Rulers
This section is not to teach the principles of Motivational Interviewing, but rather to show one technique for MI that you can use with your pocket cards. A link to a more thorough description of MI principles, strategies and techniques is in the next section.
When exploring issues related to sexual health and substance use with patients, you may solicit a specific behavior they hope to change or a task they hope to accomplish. This could range from using clean needles to reducing alcohol consumption, from leaving an abusive relationship to using condoms. It is important to allow patients to set their own goals and to respect their decisions, whether or not they ready for change.
Motivational interviewing is a collaborative, patient-centered technique aimed at eliciting and strengthening motivation for change. Motivational interviewing is a vital tool in harm reduction, as it encourages patients to set their own goals and empowers them to make changes in their lives.
One aim of motivational interviewing is to elicit “change talk.” Research shows that people who express their desire to change in their own words are more likely to make that change (add citations). Change talk falls into the following categories:
- Desire: I’d like to…
- Ability: I could…
- Reasons: It’s important because…
- Need: I have to…
- Commitment: I will…
- Activation: I’m ready to…
- Taking steps: I’ve tried… I am doing….
One tool to elicit change talk is a readiness ruler. You will see two rulers on each pocket card:
- The readiness ruler will encourage patients to express their own desires, abilities, reasons, and need for change.
- The confidence ruler will encourage patients to express their commitment, preparation and readiness, as well as highlight any small steps they are already taking towards change. It will also help to elicit any barriers to change.
Use the readiness rulers by first asking a person to choose a number on the scale that represents the readiness to make the change or their confidence that they could successfully make the change it they tried.
- Identify a change the patient is considering making.
- Ask the individual to rate her/his readiness to make that change on a scale of 1-10. Use the card for a visual guide.
- Ask the individual why they are at that number, as opposed to a zero:
“Why are you a ____ [insert their number] and not a zero?”
- Ask the individual what it would take to get them from their identified number to one number higher.
“What would it take for you to get from___ to ___[one number higher]?”
- Repeat with the confidence ruler to elicit commitment, readiness, and barriers to change.
This is one of many tools used in motivational interviewing. For a more thorough explanation of motivational interviewing, including using readiness rulers, visit this resource.
Consider enrolling in a training on Motivational Interviewing. We recommend this one in New York City by the National Harm Reduction Coalition.
Does your organization offer Motivational Interviewing trainings? Let us know and we will add it here!
Want a card?
Our info cards are distributed at most BSHRC events for free. If you are unable to make an event and would like a card, we can provide them for free while funds remain. Please contact us with “ Infocard Order” in the subject line.
If you would like a larger volume of cards, we will request the funds to cover additional printing and any shipping fees.
Interested in using or adapting the cards or material on this website?
The white-coat pocket reference cards and supplementary materials are licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
You are free to share and/or adapt these materials under the following terms:
- Attribution — You must give appropriate credit to Baltimore Student Harm Reduction Coalition, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- NonCommercial — You may not use the material for commercial purposes.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.