Keeping Our Youth Alcohol & Drug Free

1. Keeping Our Youth Alcohol & Drug Free Southeast Region SBIRT Project 2012-2013 Body Level One

2. Outline • The players • The problem • The solution: SBIRT • Next steps Body Level One

3. What is AWY? • 1999 • Funded by drug offense citations in each county • 5 Regional Prevention Centers--Southeastern, Northern, Northeastern, Southern and Western Body Level One

4. About AWY Southeast Region • Jefferson, Kenosha, Milwaukee, Ozaukee, Racine, Walworth, Washington and Waukesha Counties • Jewish Family Services • The Planning Council for Health and Human Services Body Level One

5. SBIRT S Screening BI Brief Intervention RT Referral to Treatment Body Level One

6. AWY-SE SBIRT Grant • April 1, 2012 – March 31, 2013 = $50,000 • Wisconsin Partnership Program (University of Wisconsin School of Medicine & Public Health) • April 2014 - Possible $300,000 implementation grant Body Level One

7. Grant Staff:Academic Partner Richard L. Brown, MD, MPH Professor of Family MedicineDirector, WIPHL School of Medicine and Public Health University of Wisconsin Body Level One

8. Grant Staff:Project Evaluator Candace Peterson, Ph.D. Evaluator UW Population Health Sciences Body Level One

9. Grant Staff:Project Coordinator Julie Whelan Capell, MS, CPH Director of Planning and Development Planning Council for Health and Human Services Body Level One

10. Help AWY-SE coalitions to recruit partners Identify barriers to implementation and strategize solutions Secure commitment from 6 AWY-SE coalitions to pilot SBIRT in next phase Project Objectives Increase AWY-SE coalitions’ understanding of SBIRT Body Level One

11. Outline • The players • The problem • The solution: SBIRT • Next steps Body Level One

12. Cigarette Smoking- Wisconsin - Last Month - 2011 - Body Level One CDC:YRBS

13. Alcohol Use- Wisconsin - Last Month - 2011 - Body Level One CDC:YRBS

14. Binge Drinking- Wisconsin - Last Month - 2011 - Body Level One CDC:YRBS

15. Marijuana Use- Wisconsin - Last Month - 2011 - Body Level One CDC:YRBS

16. Prevalence of Lifetime Alcohol Dependence vs. Age of Onset of Drinking– National Survey of 43,093 Adults – LifetimePrevalenceof Alcohol Dependence Age of Onset of Drinking Body Level One Hingson, Archives of Pediatric and Adolescent Medicine, 2006

17. Physician Impressions vs. Actual Substance Use by 509 Teens

18. Outline • The players • The problem • The solution: SBIRT • Next steps Body Level One

19. Screen Brief Assessment Low risk Intermediate risk High risk Follow-up and support Reassure andreinforce Intervene Refer SBIRT Model

20. Lowrisk Highrisk Loss of control Cravings Preoccupation Mildproblems Absti-nence Heavy use Severeproblems Continuum of Substance Use Body Level One

21. many few Continuum of Substance Use Universal screening!!! BriefIntervention Treatment Lack of idealreferral resourcesshould notdeter SBIRT Largestbenefitof SBIRT! Body Level One Manwell, Journal of Addictive Disease, 1998

22. CRAFFT • Forget • Family/Friends • Trouble • Car • Relax • Alone All questions are Yes/No

23. CRAFFT Validity • Study of 14 to 18 yr olds • Hospital-based clinic • Diagnostic classifications strongly correlated with CRAFFT scores Knight, J.R. et al, Arch Pediatr Adolesc Med 2002, p 607.

24. Screening Questions • In the past 12 months, have you ... • drunk any alcohol - more than a few sips? • smoked any marijuana? • used any other substance to get high? Body Level One

25. Screening Questions If positive If negative Full CRAFFT Car question only Body Level One

26. Car-Have you ever ridden in a car driven by someone (including yourself) who was high or had been using alcohol or drugs? Relax-Do you ever use alcohol or drugs to relax, feel better about yourself, or fit in? Alone-Do you ever use alcohol or drugs by yourself, alone? Body Level One

27. Family/Friends-Do your family or friends ever tell you that you should cut down on your drinking or drug use? Forget-Do you ever forget things you did while using alcohol or drugs? Trouble-Have you ever gotten in trouble while you were using alcohol or drugs? Body Level One

28. Risk Stratification and Response Body Level One

29. Interpretation of the CRAFFT Number ofPositive Responses Probability of Abuse or Dependence Body Level One

30. “Usual” Motivational Approach Interviewing Paternalistic Confrontational Provider-centered Information-based More likely toantagonize teens Easy to deliver Requires littletraining & support Collaborative Motivational Patient-centered Based on teens’ values More likely to elicitbehavior change More difficult to deliver Requires ampletraining & support Body Level One

31. For current abstainers: Teens who initiated drinking alcohol in the next 12 months For current drinkers: Teens who drank alcohol in the next 3 months 44% 38% Effectiveness of SBIRT for Teens • 9 New England pediatric practices - ages 12 to 18 • Impacts of computer-facilitated screening and intervention: SK Harris et al, Pediatrics 2012, published online on May 7, 2012.

32. Outline • The players • The problem • The solution: SBIRT • Next steps Body Level One

33. Criteria for Selecting Interventions Fit with local diagnosis Capacity to implement Evidence of effectiveness Part of a comprehensive plan Body Level One

34. DFC Requires Environmental Strategies Universal screening creates awareness about the number-one preventable health issue—substance abuse. SBIRT provides the tools, counseling and coaching … to understand the potential negative health consequences of substance abuse. Body Level One http://www.integration.samhsa.gov/clinical-practice/SBIRT_Colorado_WhySBIRT.pdf

35. National Institute on Alcohol Abuse and Alcoholism Recommendations • Establish a community coalition • Enhance enforcement of the drinking age • Restrict alcohol outlet density • Increase alcohol prices through excise taxes • Promote responsible beverage service • Provide alcohol expectancy education • Systematize screening and intervention Body Level One

36. Healthiest Wisconsin 2020 Focus Areas • Alcohol & Drug Use • Change underlying attitudes & knowledge • Reduce risky and unhealthy alcohol & drug use • Crosscutting Objectives • Prepare youth & families to protect their health and the health of their communities • Evaluate the effectiveness & impact of health programs Body Level One

37. Help AWY-SE coalitions to recruit partners Identify barriers to implementation and strategize solutions Secure commitment from 6 AWY-SE coalitions to pilot SBIRT in next phase Project Objectivesby March 31, 2013 Increase AWY-SE coalitions’ understanding of SBIRT Body Level One

38. SBIRT Planning Questions for Coalitions • What behavioral topics does our coalition want to address? • Who can we partner with to deliver SBIRT? • What age group do we want to target? • What barriers would challenge implementation? • Does our coalition want to pilot SBIRT in our community? Body Level One

39. Questions? http://atoda-sewisconsin.wikispaces.com/SBIRT Body Level One

40. Questions? Julie Whelan Capell, MS, CPH 414-224-3066 jwhelancapell@planningcouncil.org Body Level One