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The University of Iowa College of Nursing

SBIRT-TIPS: Screening, Brief Intervention, and Referral to Treatment – Training Iowa Preceptors and Students. The University of Iowa College of Nursing With funding from the Substance Abuse and Mental Health Services Administration (SAMHSA). SBIRT-TIPS: Brief Review.

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The University of Iowa College of Nursing

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  1. SBIRT-TIPS:Screening, Brief Intervention, and Referral to Treatment – Training Iowa Preceptors and Students The University of Iowa College of Nursing With funding from the Substance Abuse and Mental Health Services Administration (SAMHSA)

  2. SBIRT-TIPS: Brief Review The 3-year SAMHSA-funded training project has two main goals: • To educate doctor of nursing practice (DNP) and physician assistant (PA) students on applying SBIRT in clinical practice • To promote adoption of SBIRT as “standard of care” by health systems, settings, and practitioners in cooperation with SBIRT Iowa, the statewide initiative

  3. Brief Review • Take four “Core” SBIRT modules mandated by SAMHSA, plus Motivational Interviewing training • Overview: why it matters • Screening: universal prescreen; 2 “full” scales • Brief Intervention (BI): based on motivational interviewing (MI) • Referral to Treatment: “how to” if needed *3 modules on MI as foundation to BI

  4. Brief Review • Use SBIRT in Clinical Practice • Apply methods in clinical practicums supervised by preceptors • Share information/talk to your preceptors regarding expectations • Track application experiences • Complete assignments as directed by your course instructor

  5. Brief Review • Come prepared to talk with your preceptor about SBIRT-related expectations • Application is YOUR responsibility, not THEIRS • You will provide a packet of materials • SBIRT-related tools, supportive materials • Explanation of course expectations for applying with clients and assignments • Use the SAMHSA Treatment Facility Locator to make a list of resources for your/your preceptor’s review

  6. Back to the Basics… The primary goal of SBIRT is to identify and effectively intervene with those who are at moderate or high risk for psychosocial or health care problems related to their substance use.

  7. This is Substance Use Disorder: Concept developed by Daniel Hungerford, PhD, Centers for Disease Control and Prevention (Used with Permission).

  8. And This is Harmful Use: Concept developed by Daniel Hungerford, PhD, Centers for Disease Control and Prevention (Used with Permission).

  9. Start here! ThisSBIRT Process Overview handout is a great reminder of steps taken in clinical care. This is available on our website clearinghouse: www.uiowa.edu/sbirt/ Pocket Card

  10. UI-branded copy of the annual (prescreening) form This is available on our website clearinghouse: www.uiowa.edu/sbirt/ Note: the alcohol question depends on age and sex Pocket Card

  11. What is “A Drink”? Pocket Card National Institute on Alcohol Abuse and Alcoholism. (2013). What is a standard drink? Retrieved from http://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/standard-drink

  12. UI-branded copy of the AUDIT form This is available on our website clearinghouse: www.uiowa.edu/sbirt/ Pocket Card

  13. UI-branded copy of scoring information This is available on our website clearinghouse: www.uiowa.edu/sbirt/ Pocket Card

  14. UI-branded copy of the annual (prescreening) form This is available on our website clearinghouse: www.uiowa.edu/sbirt/ Illicit drug use, but also use of prescription drugs for non-medical purpose! Pocket Card

  15. UI-branded copy of the DAST-10 This is available on our website clearinghouse: www.uiowa.edu/sbirt/ Pocket Card

  16. Prescription Drug Misuse • Many people take medications that are not prescribed to them (“borrow” meds), or don’t take their prescription drugs “as prescribed” • SBIRT is primarily concerned with “recreational use” (non-medical purpose) • Opioids • Benzodiazepines • Depressants • Stimulants

  17. Screening: Summary • Screening is the first step of the SBIRT process and determines the severity and risk level of the patient’s substance use • The result of a screen allows the provider to determine if a brief intervention or referral to treatment is a necessary next step for the patient Remember! We can’t identify risk and reduce harm if we don’t ASK!

  18. Brief Intervention ~ if needed • Educatethe patient on safe levels of substance use • Increase the patient’s awareness of the consequences of substance use • Motivatethe patient towards changing substance use behavior • Assistthe patient in making choices that reduce their risk of substance use problems

  19. Remember! Shift the focus… From feeling responsible for changing patients’ behavior To supporting them in thinking and talking about their own reasons and means for behavior change

  20. Steps in the Brief Intervention Using the Brief Negotiated Interview • Build rapport—raise the subject • Explore the pros and cons of use • Provide information and feedback • Assess readiness to changewith the “readiness ruler” • Negotiate an action plan

  21. Goals of the Brief Intervention NOTE  Goals are fluid and dependent on a variety of factors: • The patient’s screening score • The patient’s readiness to change • The patient’s specific needs

  22. Use a “Ruler” • On a scale from 1 to 10… • How ready are you to make a change? • How important is it? • How confident are you?

  23. Use this form to apply the semi-structured interview This is available on our website clearinghouse: www.uiowa.edu/sbirt/ Pocket Card

  24. Referral Resources SAMHSA’s National Treatment Facility Locator http://findtreatment.samhsa.gov

  25. Making Referrals • Make a plan with the patient • Actively participate in the referral process  the warmer the referral handoff, the better the outcome! • Decide how you will interact/communicate with the treatment provider • Confirm your follow-up plan with the patient • Decide on ongoing follow-up support strategies you will use

  26. Common Mistakes to Avoid • Rushing into “action” and making a treatment referral when the patient isn’t interested or ready • Referring to a program that is full or does not take the patient’s insurance • Not knowing your referral base • Not considering pharmacotherapy in support of treatment and recovery • Seeing the patient as “resistant” or “self-sabotaging” instead of having a chronic disease

  27. Back to the SBIRT Process… Statistically speaking… • Many prescreens are negative; few full screens needed • Even with full screen, many are low risk Being READY is the key! • Briefintervention  Feeling comfortable following the guide/having the conversation • Referral to treatment  Knowing who/where/what is available; warm handoff

  28. For more information… Go to the University of Iowa SBIRT website clearinghouse: www.uiowa.edu/sbirt/

  29. Acknowledgements

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