How Might SBIRT Impact Adolescent Treatment?

1. How Might SBIRT Impact Adolescent Treatment? Shelly Dutch, CSAC, ICS

2. Barriers in the Treatment System • Few teens with AODA are identified • Those who are identified rarely receive services • Stigma associated with AODA • Health insurance reimbursement • Historically, AODA treatment has been separate from primary care

3. Characteristics of teens presenting for AODA treatment: • AOD involvement can range from mild substance abuse to physical dependence • Alcohol and marijuana are most prevalent • Multiple co-occurring problems is the norm • Multiple systems are often involved (e.g., mental health, juvenile justice)

4. Connections Counseling • An AODA and MH certified outpatient clinic in Madison, WI • Multi-disciplinary and passionate staff • Services developed with teenagers in mind (not step-down adult model) • Family (parental) involvement is key for the best outcomes • Peer mentors integrated into treatment services

5. What adolescent treatment providers can learn from the SBIRT model: Five lessons • Long-term relationships matter • Brief Intervention can be effective • Harm reduction is a valid approach • Non-specialists can be effective • Implementing evidence-based treatments is an important goal to strive towards

6. 1. Long-term relationships matter • Pediatrician-young person relationship can last over a period of years • Adolescents are highly relational • Paradigm shift in treatment: acute care versus recovery management

7. 2. Brief Intervention with teens • BI is well established with adults and shows promise with adolescents • BI is developmentally relevant for adolescents • BI expands service options (e.g., stand alone intervention, treatment readiness)

8. 3. Harm reduction is a valid approach • Abstinence is the long-term goal…AND… • Harm reduction can get the change process started • Various options: • Reduce AOD quantity, or frequency, or route of administration • Change of risky settings, times or activities

9. 4. Non-specialists can be effective • Studies show that AODA counselors without a recovery history are just as effective as those in recovery • Counselor empathy is a key predictor of outcome • Blurring of boundaries between specialist treatment and addressing AODA in other settings

10. 5. Movement toward implementing evidence-based treatments (EBTs) • Historically, AODA treatment providers have used methods discredited by research • Although there is currently a “renaissance” in adolescent treatment research, a large research-practice gap remains • In medicine there is a high standard of care based on research evidence

11. 5. Implementing EBTs (cont.) • Treatment administrators increasingly recognize the need for direct observation and feedback of practice to promote delivery of EBTs • SBIRT inspires attention to implementing EBTs and to developing better evaluations to measure our programs’ outcomes

12. Summary • The SBIRT model reflects several national trends which can greatly inform improvements in the AODA treatment system • With greater linkages to primary care comes increased accountability for what AODA treatment providers do

13. Questions and Discussion