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Screening, Brief Intervention, and Referral to Treatment

Screening, Brief Intervention, and Referral to Treatment. CDR Kellie Cosby & CDR Erich Kleinschmidt. Recent CDC report – Jan. 2012. One in six Americans binge drinks four times per month Average number of drinks during binge is 8 40,000 deaths per year (binge-specific)

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Screening, Brief Intervention, and Referral to Treatment

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  1. Screening, Brief Intervention, and Referral to Treatment CDR Kellie Cosby & CDR Erich Kleinschmidt

  2. Recent CDC report – Jan. 2012 One in six Americans binge drinks four times per month Average number of drinks during binge is 8 40,000 deaths per year (binge-specific) 2006 - $167.7 billion alcohol-related costs Age group that binge drinks most often – 65+ Income group with most binge drinkers - $75K+ CDC Morbidity & Morality Weekly Report, Jan. 10, 2012 Vol. 61

  3. CDC Report continued – binge drinking responsible for: Risk factor for motor vehicle accidents, violence, suicide, hypertension, heart attack, STDs, unintended pregnancy, FAS, SIDS 85% of all alcohol-impaired driving episodes involved binge drinking (2010) Accounted for 50% of all alcohol consumed by adults; 90% of youth Most binge drinkers are not dependent CDC Morbidity & Morality Weekly Report, Jan. 10, 2012 Vol. 61

  4. Focus of SBIRT Brief Intervention and Referral to Treatment Harmful or Risky Use Brief Intervention Low Risk Use or Abstention No Intervention Dependent Use

  5. What exactly is SBIRT? • SBIRT—Screening, Brief Intervention, and Referral to Treatment • Universal screening of patients within medical settings with use of validated screening tools • If screened positive – brief intervention (guided discussion) with medical provider occurs • If screening reveals dependence – referral to specialty substance abuse treatment provider

  6. SBIRT: Primary Care Context Takes advantage of the “teachable moment” Patients aren’t seeking treatment but screening opens door for awareness & education Focus on addressing low/moderate risk usage as a preventative approach before addiction occurs

  7. Ranked in top ten of prevention services Discuss daily use of aspirin Childhood immunization Series Tobacco use screening and brief intervention Colorectal cancer screening Hypertension screening Influenza immunization Pneumococcal immunization Problem drinking screening & brief intervention Vision screening – adults Cervical cancer screening (Partnership for Prevention – Priorities for America’s Health: Capitalizing on Life-Saving, Cost Effective Prev Services, 2006)

  8. SBIRT “Patient Flow” Brief Treatment Cognitive behavioral treatment with multiple sessions available Brief Intervention Raises awareness of risks and motivates client toward concrete goals/actions Screen Identification of substance relatedproblems Referral to Tx Referral of those with more serious abuse/dependency

  9. Universal Prescreen Provide positive reinforcement • (+) Positive • Further screening with • ASSIST • AUDIT • CRAFFT • DAST Low risk: Provide positive reinforcement Moderate risk: Provide Brief Intervention Moderate high-risk: Provide Brief Therapy High risk: Refer to treatment (-) Negative

  10. Effective Screening Program Typically Yields… Approximately 25% of all patients will screen positive for some level of substance misuse or abuse Of those, the approximately 70% will be “at-risk” drinkers Most will be open to addressing their substance abuse problems (if discussed in a non-judgmental manner)

  11. Brief Intervention Approach Uses “Motivational Interviewing” techniques Discuss healthy drinking levels for male/females (NIAAA standards) Weigh pros/cons of cutting down or quitting Use “scaling” to assess for readiness (i.e – on a 1 to 10 scale….) Effects on quality of life and/or existing medical conditions Plan to talk about it more than once (at future doctor visits) Small, obtainable goals (let patient tell you want he/she can handle)

  12. Identify Referral Resources Short-term and long-term residential treatment centers Community agencies for referrals Hospital inpatient and outpatient centers State treatment centers

  13. Has been implemented in many settings Thus far, SAMHSA has funded 21 states, 2 tribal organizations, and 12 colleges since 2003 (five year grants to states; 3 year to colleges) Clinical sites include: trauma centers, EDs, inpatient units, community health centers, FQHCs, tribal health centers, elder services agencies, adolescent care clinics, college health centers, VA clinics, rural, urban, suburban SBIRT training of resident physicians (17 grantees) since Sept ’08 (five year grants)

  14. Other Fed Collaborations Dept of Labor – Youthbuild program – construction jobs training for at-risk young adults; pilot tested SBIRT in several sites in 2011; now plan to implement in all sites in US Dept of Navy – assisted with physician training in SBIRT; planning on implementing within medical home and readiness clinic at Bethesda, MD (National Military Medical Center) NIDA – integration of screenings within EHR systems

  15. Possible Federal Initiatives Further expansion of SBIRT model into other health conditions related to behavioral change (ie – tobacco, depression, weight mgt, medication adherence, chronic illness mgt) Further workforce development necessary to prepare medical providers to address behavioral related medical conditions

  16. Key Considerations for Starting SBI Program Reimbursement strategy & considerations Staff training needs and supervision Program “champions” and buy-in from CEO/Admin staff • Identify target population and location(s) • Develop a Screening protocol • Develop a Brief Intervention protocol • Identify staff to monitor and evaluate program (strong QI mgt essential)

  17. Additional Considerations Who Will Do the Screening and Brief Intervention? “SBIRT” counselors/health educator model Social Workers Registered Nurses Psychologists Physicians Dedicated contracted personnel Medical Assistants Para-professionals

  18. Challenges & Lessons Learned Buy-in issues from existing medical staff Funding for additional staffing (or train existing staff) Need for management to be supportive and influence implementation Consistent training available for new staff

  19. Useful Resources Numerous SBIRT grantee websites with training videos, screening protocols, insurance/billing information, toolkits, etc… Addiction Technology Transfer Centers (ATTC) – SAMHSA funded trainings in SBIRT, MI, etc… Other non-fed funded organizations offering training, resources, etc…

  20. Questions/Discussion • erich.kleinschmidt@samhsa.hhs.gov • reed.forman@samhsa.hhs.gov • Kellie.cosby@samhsa.hhs.gov For additional information and resources. Contact:

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