Raise the subject

1. SBIRT Screening Brief Intervention Referral to Treatment Primary Care Residency Initiative www.sbirtoregon.org Annual screen • Annual screen of all patients >18 years old: • Purpose: Quickly identify primary care patients who misuse substances. • 1 alcohol question • 1 drug question + Low-risk drinking limits Misuse Low risk or abstention Full screen • Full screen for alcohol (AUDIT) • Full screen for drugs (DAST) • Purpose: Stratify patients who screen positive into zones of misuse. + AUDIT: 20+ DAST: 6+ IV Dependent III AUDIT: 16-19 DAST: 3-5 Harmful Risky AUDIT: 8-15 DAST: 1-2 II I Brief Intervention For clinician: Clinician Name:______________ Date: ___________AUDIT Zone:___________ Advise referral IV • Brief intervention:  Raised subject  Not done  Referral •  Provided feedback recommended:  Enhanced motivation line: 1(800)923-4357) •  Negotiated plan Coding: 99408 (<15m) or 99409 (>15m) + 25modifier Brief intervention III II I • Record brief intervention No intervention Steps of the Brief Intervention Raise the subject • “If it’s okay with you, let’s take a minute to talk about the annual screening form you’ve filled out today.” Provide feedback • “As your doctor, I can tell you that drinking (drug use) at this level can be harmful to your health and possibly responsible for the health problem you came in for today.” • Stages of change • Oregon alcohol and drug referral helpline: • 1-800- • 923-4357 Enhance motivation Pre- contemplation • “On a scale of 0-10, how ready are you to cut back? • If >0: “Why that number and not a ____ (lower one)?” • If 0: “Have you ever done anything while drinking (using drugs) that you later regretted?” Relapse Contemplation Maintenance Negotiate plan • “What steps can you take to cut back your use? • “How would your drinking (drug use) have to impact your life in order for you to start thinking about cutting back?” Preparation Action • Video demonstrations of brief interventions are available at: www.sbirtoregon.org