TUTORIAL MODULE 1 ASBIRT Alabama Screening, Brief Intervention, Referral, and Treatment Program

1. TUTORIAL MODULE 1ASBIRTAlabama Screening, Brief Intervention, Referral, and Treatment Program

2. SBIRT:MODULE 1 • Participants will: • Understand the history ofSBIRT. • Understand why it is used in Alabama. • Learn about the MODIFIED ASSIST Screening Tool, what it covers and the information it will provide to the health care professionals. • Become familiar with issues to consider before administering the MODIFIED ASSIST Screening Tool. • Learn ways to administer the MODIFIED ASSIST Screening Tool.

3. SBIRT:A BRIEF HISTORY • Early screening tools were used to detect persons with alcohol dependence and refer them to treatment. • Swedish research showed systematic screening with brief intervention in health care settings reached large numbers of at risk drinkers and helped to reduce their alcohol use. The findings led the World Health Organization (WHO) to start a program in 1981. Join Together: Screening and Brief Intervention: Making a Public Health Difference 2008.

4. SBIRT:A BRIEF HISTORY • The SBIRT Initiative represents a paradigm shift in the provision of treatment for substance use and abuse. Until now, the primary focus of specialized treatment has been persons with more severe use or those who have met the criteria for a Substance Use Disorder. • The SBIRT Initiative targets those with non-dependent substance use and provides effective strategies for intervention prior to the need for more extensive or specialized treatment. • The SRIRT Program determines the severity of substance use and identifies the appropriate level of intervention. It provides brief intervention or brief treatment and refers those needing more extensive services to appropriate providers.

5. WHY ALABAMA SBIRT • 2006 PRAMS Data for Alabama shows that 875 women died from accidents. 89 women died from homicide, 96 from suicide, 64 from falls, and 422 from motor vehicle accidents. • Additional 2004-2005 National Survey on Drug Use and Health (NSDUH) results indicate that 113,000 (3%) Alabama citizens reported illicit drug dependence or abuse within the past year. Approximately 74,000 (1.98%) reported past year illicit drug dependence. • 2006 PRAMS Data showed that 162 women in Alabama died from chronic liver disease and cirrhosis that year. PRAMS Surveillance Report Alabama 2004 & 2006 http://www.adph.org/healthstats/assets/PRAMS06.pdf Office of National Drug Control Policy, Drug Policy Information Clearinghouse, State of Alabama 2007

6. WHY ALABAMA SBIRT • According to 2004-2005 National Survey on Drug Use and Health (NSDUH) data, approximately 92,000 (2.47%) Alabama citizens reported needing but not receiving treatment for illicit drug use within the past year. • Research has demonstrated screening and brief intervention can promote significant reductions in alcohol and other drugs use including tobacco. • The CDC reports that smoking during pregnancy is the single most preventable cause of illness and death among mothers and infants. Approximately 8% of infants who die within a week of birth expire due to conditions caused by maternal smoking during pregnancy. PRAMS Surveillance Report Alabama 2004 & 2006 http://www.adph.org/healthstats/assets/PRAMS06.pdf Office of National Drug Control Policy, Drug Policy Information Clearinghouse, State of Alabama 2007

7. ALABAMA SBIRT:EVIDENCE OF EFFICACY Outcomes • Reduced alcohol and drug consumption. • A 47% reduction in injuries requiring Emergency Department (ED) visits. • A 48% reduction in injuries requiring hospital admissions. • Reduced health care costs. Join Together: Screening and Brief Intervention Making a Public Health Difference 2008

8. BENEFITS OF CONDUCTING ALABAMA SBIRT IN HEALTH CARE SETTINGS Overall Benefits • Reduced health care costs (savings of $3.81 for every $1.00 spent on screening and intervention.) • Decreased risk of becoming alcohol and drug dependent. ENA Injury Institute/EN CARE Alcohol Screening, Brief Intervention and Referral to Treatment- BENEFITS

9. BENEFITS OF CONDUCTING ALABAMA SBIRT IN HEALTH CARE SETTINGS For Nurses, Delivery Health Care Professionals, and Midwifes • Increased recognition of the Nurse, Delivery Health Care Professional and Midwife as leaders, pioneers and professionals. • Increased opportunity for Nurses, Delivery Health Care Professionals, and Midwifes to provide prevention efforts to the ED and their community. • Once SBIRT techniques are learned, they can be applied to other risky behaviors. • Increased opportunity to obtain Continuing Education Contact Hours. ENA Injury Institute/EN CARE Alcohol Screening, Brief Intervention and Referral to Treatment- BENEFITS

10. BENEFITS OF CONDUCTING ALABAMA SBIRT IN HEALTH CARE SETTINGS For the Maternity Patient • Reduced emergency room repeat visits. • Decreased risk for all types of injuries (falls, sprains, etc). • Potentially reduced motor vehicle crashes. • Overall reduced infant low birth rates. • Reduced infant and mother mortality rates. • Women are more likely to accept help in the time of crisis.

11. WHAT IS THE MODIFIED ASSIST? • Alcohol, Smoking, and Substance Involvement Screening Test. • Developed by the World Health Organization and international team of Substance Abuse Researchers. • A brief screening questionnaire to find out about people’s use of psychoactive substances. • This screening instrument is appropriate for patients age 18 or older. WHO-Assist: Guidelines for Use in Primary Care, Draft version only V1.1, September 2003

12. Tobacco Alcohol Cannabis Cocaine Amphetamine type stimulants Sedatives Hallucinogens Inhalants Opiates Other drugs WHAT DOES THE MODIFIED ASSIST COVER? WHO-Assist: Guidelines for Use in Primary Care, Draft version only V1.1, September 2003

13. WHAT INFORMATION DOES THE MODIFIED ASSIST PROVIDE? • A listing of substance (s) people have never used. • A listing of substance (s) they used in the past 3 months. • Problems related to their substance use. WHO-Assist: Guidelines for Use in Primary Care, Draft version only V1.1, September 2003

14. BEFORE YOU BEGIN USING THE MODIFIED ASSIST SCREENING • While most health care settings have established processes • and procedures for patient screening of health conditions • such as high blood pressure, cholesterol, breast or prostate • cancer, etc., drug abuse screening in general medical • settings involves additional practical considerations: • Determine staffing roles, including who will administer the screening instrument; discuss results with patients; and intervene and/or refer when necessary. • Train designated staff to conduct screening, intervention, and referral.

15. BEFORE YOU BEGIN USING THE MODIFIED ASSIST SCREENING • Decide how screening results will be used and develop a procedure for handling positive and negative results. • Apply existing office procedures to screening practices, including patient documentation, consent procedures, confidentiality and HIPAA procedures, storage of records, and patient flow. Note: Screening is not a full assessment; refer patients for a full assessment if a problem is indicated by the screen or through discussion with the patient.

16. BEFORE YOU BEGIN USING THE MODIFIED ASSIST SCREENING Maternity medical providers will be able to bill in accordance with Medicaid reimbursement policies for: • Alcohol and/or drug screening: Code H0049 • Alcohol and/or drug service, brief intervention, per 15 minutes: Code H0050

17. BEFORE YOU BEGIN USING THE MODIFIED ASSIST SCREENING • Establish relationships and linkages with external providers who will accept referrals for additional assessment and/or drug treatment. • Consider patient reading level when providing educational and support materials. • Deal with severe, immediate life threatening medical consequences of substance abuse as you would any other medical emergency.

18. WAYS TO ADMINISTER THE TOOL • Online screening tool is available online at http://www.drugabuse.gov/nmassist/ The online screening tool does not allow patient identifying data to be saved and stored. It allows responses to be entered and willautomatically lead you to the next appropriate question and tally the scores at the end. • PDF fill-able version of the screening tool is available in the handouts section of this training. The PDF fill-able version allows patient identifying data to be saved and stored. It allows responses to be entered and willautomatically lead you to the next appropriate question and tally the scores at the end.

19. You have now completed the Module 1 Tutorial. • Please take the self administered Test for Module 1.