TABLE 5.

Behaviour Change Counseling Checklist (BCCC)

BCCC: SP assessment_ _ _ _ _ _ _ _ _ _
BCCC: Self-assessment (Student)_ _		DATE:_ _ _ _ _ _ _ _ _ _ _ _ _ _ _	SBIRT ID _ _ _ _ _  _ _ _ _ _  _ _ _ _ _  _ _ _ _ _
Question Style:
1	Questions are closed ended and student interrupts patient. Does not allow for silence.	Utilises one or two open-ended questions, may occasionally interrupt patient.	Utilised multiple open-ended questions, allowed the patient to tell their story. Utilises silence appropriately.
	0	0.5	1
2	Communication with patient is unidirectional. Most statements are telling patient what to do.	Elicits information from patient but does not respond to patients or concerns or assess understanding of information provided.	Ensures bidirectional communication with student asking for patient’s perspective. Consistently assesses understanding when providing information or explanations.
	0	0.5	1
Respects patient autonomy:
3	Does not ask about patient’s perceptions on behaviours	Student asks about patient’s perceptions but does not explore this.	Student asks about patient’s perception of the behaviour and explores this.
	0	0.5	1
4	Does not ask for patient preferences on changing. Does not respect patient preferences when provided.	Respects patient preferences when offered but does not actively solicit preferences. Student may ask for permission to discuss their views on the behaviour change but does not give options (tells the patient what to do next).	Solicits and respects patient preferences. Asks the patient for permission to discuss change or to give their opinion and offers options to the patient to consider.
	0	0.5	1
Demonstrates a Curious Tone:
5	Neither explores pro or cons of continuing with behaviour.	Either explores pro or cons of continuing with behaviour.	Explores with the patient both the pros and cons of continuing with their behaviours.
	0	0.5	1
6	Does not identify nor respond to the patients unique characteristics that contribute to his behaviour	Seeks to understand some but not all of a patient’s unique characteristics that contribute to the patient’s behaviour.	Both identify and adapts to the patient’s unique characteristics (demographic, cognitive, physical, cultural, socioeconomic, or situational needs) that contribute to the behaviour.
	0	0.5	1
7	Does not ask about willingness or readiness to change.	Asks if willing to change but does not explore readiness or confidence in change.	Asks patient’s opinion on willingness to change. Explores readiness or confidence in change. May utilise a scale to rate readiness or confidence in change.
	0	0.5	1
Fosters Collaborative Relationship:
8	Does not solicit or address patient preferences for plan. Unidirectional with doctor providing the decision-making.	Provides options for patient to consider but does not ask about their preference. Beginning to incorporate the patient’s opinions in decision-making.	Provides options for the patient to consider and asks about patient’s preferences. Engages in shared decision-making. Actively seeks out patient’s input.
	0	0.5	1
Empathic Listening:
9	Does not respond to questions asked, follow-up questions are not based on patient answers, questions are repeated which indicate not fully listening to patients answers earlier in the conversation.	Demonstrates some careful listening skills.	Responds appropriately to questions, follow-up questions are directed by patient’s answers, does not repeat questions or ask about things they have already been told. Actively listens-Reflects patient’s concerns and perspective.
	0	0.5	1
10	Does not summarise.	Summarises but does not ask for clarification or ensure that the story has been heard correctly	Summarises information that the student has heard. Checks for clarification.
	0	0.5	1
11	Does not recognise or comment on strengths the patient has.	Identifies strengths and/or prior successes but does not provide positive reinforcement (does not highlight for the patient that these are strengths or successes).	Affirmations are used—Student recognises strengths patient may have and provides positive reinforcement for previous successes.
	0	0.5	1