Information Session

1. Information Session Screening, Brief Intervention and Referral to Treatment Primary Care Integration Joe Contris November 17, 2014 Provided in collaboration with the Washington State Department of Social and Health Service’s Division of Behavioral Health and Service Integration Administration and the Research and Data Analysis Division Funded through a federal grant from SAMHSA, CFDA#93.243

2. Alcohol and drug-related Consequences • Motor vehicle crashes • The cost of motor vehicle crashes alone is over $51 billion annually • One in six vehicular crash victims treated in emergency departments are alcohol positive • In 2011, 9,878 people were killed in alcohol-impaired driving crashed (31% of all motor vehicle traffic fatalities) • Alcohol-related injury morbidity and mortality • 60% of fatal falls • 60% of suicides and homicides • 40% of residential fires

3. What is Screening Brief Intervention, and Referral to Treatment (SBIRT)? SBIRT Model • SBIRT is a comprehensive, integrated, public health approach used to identify, reduce, and prevent problematic use, abuse, and dependence on alcohol and illicit drugs (including marijuana) • Primary care, EDs, trauma centers, community health settings provide an excellent opportunity for early intervention SAMHSA, 2013

4. WhySBIRT? SBIRT Model • SBIRT ranks in the top 4 highest ranking preventative health services, based on health impact and cost effectiveness • SBIRT is as, or more, effective as flu shots and cholesterol screening (USPSTF, 2004) • Increases abstinence, improves quality of life, reduces risky behavior, reduces health care costs (SAMHSA, 2012; Estee et al, 2006 & 2010) • Improvements in general health, mental health, employment, housing status, and criminal behavior

5. SBIRT Model • The following agencies have officially endorsed SBIRT: • American Medical Association, • American Academy of Family Physicians, • American Academy of Pediatrics, • American College of Physicians, • American Psychiatric Association, • American College of Emergency Physicians, • American College of Surgeons Committee on Trauma, • American College of Obstetricians and Gynecologists, • American Society of Addiction Medicine, and • the World Health Organization,

6. SBIRT Model Effectiveness • About SBIRT’s effectiveness—and cost-effectiveness • The data on 459,599 patients screened at various medical settings in six states. • 23 percent had drinking or drug problems or a high risk of developing them. • 16 percent received a brief intervention; • 3 percent received brief treatment; and • 4 percent received referrals for more specialized treatment. • 68% reduction in illicit drug use • 39% reduction in heavy drinking

7. Washington State Screening, Brief Intervention, and Referral to Treatment Program Final Program Performance Report: October 1, 2003 through September 30, 2009 Sharon Estee in collaboration with Alice Huber, DSHS Division of Behavioral Health

8. Binge Drinking Defined Evidence for SBIRT • NIAAA* Low Risk Drinking Guidelines: A drink is: A 12 ounce can of beer A 5 ounce glass of wine A shot of hard liquor (1 ½ oz) *National Institute on Alcohol Abuse and Alcoholism

9. SBIRT Screens Full Screen Scores Risk Levels I Low Risk or Abstain AUDIT: 0-6 (women), 0-7 (men) DAST: 0 Dependent5% IV III Harmful8% II Risky9% I Low Risk or Abstain 78% II Risky AUDIT: 7-15 (women), 8-15 (men) DAST: 1-2 III Harmful AUDIT: 16-19 DAST: 3-5 IVDependent AUDIT: 20+ DAST: 6+

10. Brief Interventions & Referrals Brief Interventions • Positive Health Message • Thanks for completing the alcohol/drug health screen. Based on your answers, the alcohol screen indicates that you are in the “low risk zone.” • People who keep their drinking to these limits are at lower risk for alcohol related health problems. • As your health care provider, I would recommend that you not exceed • (for women) 3 drinks on any one occasion and no more than 7 drinks per day • (for men) no more than 4 drinks on any one occasion and no more than 14 drinks in a week. • If you are interested I have an educational handout that outlines these guidelines. Would you like a copy?

11. Brief Interventions & Referrals Brief Interventions • Short counseling session ranging 5-50 minutes (1-4 sessions) that utilize motivational interviewing techniques • Goal is motivate “at-risk” patients to reduce their risky alcohol or drug use to prevent negative health consequences related to substance use • For individuals with more severe SUDs, the goal may be to motivate the patient to seek further assessment/treatment

12. Brief Interventions & Referrals Referrals to Treatment • Patient’s in the “harmful” or “dependent” risk categories should receive a referral to brief treatment or to a chemical dependency treatment agency for a full assessment • This procedure is no different than referring a patient to other specialty healthcare providers or referring the patient to the lab or physical therap for additional testing/assessment

13. Our Partners Franciscan Health System Swedish Residency Clinic Swedish Medical Group Sea Mar Community Health Centers Public Health - Seattle & King County Harborview Medical Center Other clinics and emergency departments

14. 5. WASBIRT-PCI Washington SBIRT-Primary Care Integration • For more information on WASBIRT-PCI please visit: www.wasbirt.com Questions?

15. References • Centers for Disease Control (CDC). (2011). Diabetes Fact Sheet. Available at:http://www.cdc.gov/diabetes/pubs/references11.htm. • CDC Vital Signs. (January 2014) www.cdc.gov/vitalsigns. American Journal of Preventative Medicine, 2011; Volume 41. • Estee, S., He, L., Mancuso, D., Felver, B. (2006). Medicaid cost outcomes. Department of Social and Health Services, Research and Data • Analysis Division: Olympia, Washington. • Estee, S., He, L., Ford Shah, M., Mancuso, D., & Felver, B. (February 2010). Impact of Screening, Brief Intervention, and Referral to Treatment on Entrance to Chemical Dependency Treatment. Department of Social and Health Services; Number 4.68.2009.1. • McCance-Katz, E.F. & Satterfield, J. (2012). SBIRT: A key to integrate prevention and treatment of substance abuse in primary care. American Journal of Addiction Psychiatry; 21(2): 176-177. • Miller PM, Thomas SE, Mallin R. Patient attitudes towards self-report and biomarker alcohol screening by primary care physicians. Alcohol and Alcoholism. 2006 May-Jun;41(3):306-10. Epub 2006 Mar 30. • National Heart, Lung, and Blood Institute.  (2009). Morbidity and Mortality: 2009 Chartbook on Cardiovascular, Lung, and Blood Diseases. Bethesda, MD: National Institutes of Health. • Substance Abuse Mental Health Servcies Administration. (2012). SBIRT: Screening, Brief Intervention, and Referral to Treatment Opportunities for Implementation and Points for Consideration. www.integration.samhsa.gov/sbirt_issue_brief_pdf. • Substance Abuse Mental Health Servcies Administration. (2013). SBIRT-HRSA Center for Integrated Health Solutions: Screening, Brief Intervention, and Referral to Treatment. www.integration.samhsa.gov/clinical-practice/sbirt. • U.S. Preventive Services Task Force. (2004). Screening and Behavioral Counseling Interventions in Primary Care to Reduce Alcohol Misuse, Topic Page. http://www.uspreventiveservicestaskforce.org/uspstf/uspsdrin.htm • Vinson, D.C., Turner, B.J., Manning, B.K., Galliher, J.M. (2013). Clinician suspicion of an alcohol problem: an observational study from the AAFP National Research Network. Annals of Family Medicine, 11; 1 (53-59).