Screening, Brief Intervention, and Referral to Treatment (SBIRT)

2. Screening, Brief Intervention, and Referral to Treatment (SBIRT) Erich Kleinschmidt May 19, 2014

3. 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

4. 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

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

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

7. SBIRT& Medical Connection Takes advantage of the “teachable moment” Patients aren’t seeking treatment but screening opens door for awareness & education Increases access to clinically appropriate care for nondependent as well as dependent persons in a non-drug treatment setting

8. 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)

9. 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

10. 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

11. Screening Tools Four commonly used screening instruments: Alcohol Use Disorders Identification Test (AUDIT or AUDIT – C) Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) Drug Abuse Screening Test (DAST) CRAFFT (for adolescents) All can be found online and downloadable

12. 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)

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

14. Has been implemented in many settings Thus far, SAMHSA has funded 26 states, 2 tribal organizations, and 12 colleges since 2003 (five yr grants to states; 3 yr to colleges) States currently includes: IN, TN, SC, NC, VT, NY, WA, IL, CO, Am Samoa, AZ, IA, NJ, NM, OH 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, urban STD clinics, National Guard installations, others…

15. SBIRT Training Programs SBIRT training of resident physicians (19 grantees) since Sept ’08 (five yr grants) New SBIRT Training for Medical Professionals (residents, social wk, nursing, counseling, others) started in Sept. 2013 (14 grantees including U.Miami – Coral Gables) for 3 years

16. Additional Initiatives Youth Build USA – recent funding from Hilton Foundation – at risk program for older adolescents & young adults construction skills New York – School-based health centers (high schools) National Guard units – IA, KY, TN, CT, LA, IN

17. Reimbursement for SBIRT Services

18. SBIRT reimbursement is available but… Need to set up system for submitting claims (typically complex for start up) Can be restrictions as to type of health professional that can bill (licensed vs unlicensed, etc…) May get resistance from medical providers to add SBIRT to already heavy workload

19. Key Considerations for Starting SBI Program Develop a Screening protocol Develop a Brief Intervention protocol Monitor and evaluate program (strong QI mgt essential) Identify community referral resources, protocols, & tracking Reimbursement strategy & considerations (work with billing dept to establish reimbursement lines) Staff training needs and supervision Program “champions” and buy-in from CEO/Admin staff

20. 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

21. Challenges & Lessons Learned Buy-in issues from existing medical staff (time/work load, don’t want to deal with “addicts”, now that we’ve identified them, now what?, etc..) Funding for additional staffing (or train existing staff) Need for management to be supportive and influence implementation (important to have “champions”) Consistent training available for new staff “Drift” from universal screening to “case finding” approach

22. SBIRT Websites/Resources http://beta.samhsa.gov/sbirt http://www.attcnetwork.org/regcenters/index_nfa_sbirt.asp

23. Questions/Discussion For further information, etc…contact: erich.kleinschmidt@samhsa.hhs.gov