2015 NPN SBIRT Power Session

Creating a prevention vital sign: Using Screening, Brief Intervention, and Referral to Treatment (SBIRT) to integrate substance abuse prevention into healthcare

Mallori DeSalle is the Indiana SBIRT Outreach Coordinator in the School of Public Health at Indiana University-Bloomington. Ms. DeSalle is an undergraduate instructor and professional trainer for SBIRT, Motivational Interviewing and Substance Abuse Prevention Skills Training. Ms. DeSalle is listed on the National Registry of SBIRT trainers and is a member of the Motivational Interviewing Network of Trainers. She is a Licensed Clinical Mental Health Counselor, certified by the National Board of Certified Counselors and an internationally Certified Prevention Specialist.

Kaitlyn Reho, MPH, is the Screening, Brief Intervention, and Referral to Treatment (SBIRT) Outreach and Training Specialist at Indiana University-Bloomington, School of Public Health. Kaitlyn is responsible for linking public health research to the workforce through research translation and the development of online trainings. Her expertise includes prevention science, SBIRT, and alcohol and drug topics. Kaitlyn is a part of the SBIRT primary care expansion process in Indiana.

SBIRT POWER SESSION

NATIONAL PREVENTION NETWORK

NOVEMBER 17-19, 2015

Mallori DeSalle,

MA, LMHC, NCC, CCMHC, CPSIndiana SBIRT Outreach and Training Coordinator

Member of Motivational Interviewing Network of Trainers

Collaborator:

Kaitlyn Reho, MPH

Indiana SBIRT Training Specialist

WHAT IS SBIRT?

SBIRT stands for:

Screening

Brief Intervention

Referral to Treatment

WHAT DOES A ALCOHOL PROBLEM LOOK LIKE?

Often the terms “risky drinker” and “alcoholic”

are thought to mean the same thing.

Image source: http://www.posterplanet.net/simpsonshomerbeerposter.htm

DRINKING LEVELS IN US SOCIETY

Low risk drinkers

Abstainers

Both are

considered

alcohol

problems

Dependent

At-risk or

harmful

drinkers

5%

20%

35%

40%

We now know that people can experience harm from alcohol use

without: Being unable to limit their drinking or drinking in dangerous situations.

We use new vocabulary (“risky” and “harmful”) to address other levels of drinking.

THE RANGE VIEW OF ALCOHOL USE

Alcohol use viewed as a continuum

based on level/frequency of use.

ADULT ALCOHOL PREVENTION

5%

20%

35%

40%

Tertiary

Prevention

Secondary

Prevention

Primary

Prevention

WHERE IS SBIRT ON CONTINUUM OF CARE ?

7

Brief Intervention Referral to Treatment

LOCATING RISKY AND HARMFUL DRINKERS:

THE BEGINNING OF SBIRT

SBIRT is opportunistic.

It can be integrated into

existing systems.

Contact with

risky/harmful drinkers

might occur in a variety

of locations.

These systems are ideal

locations for screening.

USING SBIRT TO INTEGRATE SUBSTANCE

ABUSE PREVENTION INTO HEALTHCARE

1. Regular visit to

a health care

provider.

2. Once a year answera few questions.

3. Talk to a health careprovider to review the

screening.

SUSTAINABILITY

LONG TERM RELIABLE RESULTS

Expansion

Seed funding for:

Primary Care

FQHCs

CHCs

RHCs

Strategies:

State Level

Policy

Strengthen

workforce

development

Model for

successful

SBIRT

integration

SBIRT POLICIES AND PRACTICES:

State LevelMedicaid and Medicare billing Integrated Care credentialing

Organizational LevelElectronic Health Records

Policy and Procedures

STRENGTHEN SBIRT WORKFORCE

SBIRT Training Curriculum

Introduction to SBIRT

SBIRT Implementation for Adults

SBIRT Implementation for Youth

Introduction to Motivational Interviewing

Drug Overview-6 modules +

Fidelity Reviews

Online Trainings*

Online Training for

ProfessionalsPatient Education Brochures

www.indianasbirt.org

SBIRT Implementation Tools

SBIRT EXPANSION PROJECT

Seed funding for:

Primary Care

FQHCs

CHCs

RHCs

EVALUATION

PROCESS & OUTCOME

SBIRT Implementation

Planning

Feedback

SBIRT Procedure

Feedback

Active Implementation

Feedback

ADJUSTING TO CHALLENGES

• Misunderstanding of SBIRT

• Administrative process changes

• Working process=Team effort

SBIRT RESEARCH

Campbell KP et al, eds. A Purchaser’s Guide to Clinical Preventive Services: Moving Science into Coverage. Washington, DC: National Business Group on Health; 2006.

Estee S et al. Medical Care 2010; 48:18-24.

Fleming MF et al. Medical Care 2000; 26:36-43.

Fleming MF et al. Alcoholism: Clinical and Experimental Research 2002; 26: 36-43.

Gentilello LM et al. Annals of Surgery 2005, 241:541-550.

Quanbeck A et al. Wisconsin Medical Journal 2010; 109:9-14.

Indiana SBIRT Website: www.indianasbirt.org

Resources include:

• Alcohol and Drug Screening Booklet

• Brief Intervention Step-by-Step

• Readiness Ruler

• Drug Effects Brochures

• Low-Risk Drinking Limits Business Cards

• Marketing Fact Sheet

• Provider Information Sheet

• SBIRT Brochure

• “We Ask Everyone” Poster

• SBIRT Implementation Webinar

• SBIRT Readiness Assessment

• Implementation Decisions Worksheet

• Billing Codes

• Fidelity Instruments

• Online Trainings:

o Introduction to SBIRT in Primary Care

o Introduction to Motivational Interviewing

o Drug Overviews (Alcohol, Marijuana, Cocaine, Prescription Drugs, Heroin,Tobacco)

SBIRT in Community Health Centers

Screening- While in the waiting room, patients are screened to identify their level(s) of substance use using a

validated instrument.

Brief Intervention (BI)- Those patients whose screening indicates risky or harmful levels of use receive a BI,

which is a 10-15 minute conversation to motivate positive behavior change.

Referral to Treatment (RT)- For those whose screening indicates heavy/dependent use, providers make a referral

for further treatment.

SBIRT is Effective A meta-analysis of randomized control trials concluded that heavy drinkers receiving BI services are twice as

likely to reduce their drinking as heavy drinkers receiving no intervention.1

Results of SAMHSA’s SBIRT program in six states show reductions of 39% in heavy alcohol use, 68% in

drug use, and improved levels of general and mental health at 6-month follow up.2

In a study of low-income minority men and women, individuals receiving brief motivational intervention during

routine medical visits were more likely to be abstinent for cocaine alone (22.3% vs. 16.9%), heroin alone

(40.2% vs. 30.6%) and both drugs (17.4% vs. 12.8%).3

SBIRT is Recommended The National Commission on Prevention Priorities ranked the top 25 preventive clinical services recommended

by the U.S. Preventive Services Task Force (U.S.P.S.T.F.) on

preventable burden (PB) and return on investment (ROI). On this

list alcohol screening and intervention ranked #4, just lower

than childhood immunizations and smoking cessation, and higher

than screening for high blood pressure, cholesterol, STIs,

osteoporosis, or breast, cervical or colon cancer. 4,5

The World Health Organization, U.S.P.S.T.F, and the Committee

on Trauma of the American College of Surgeons have endorsed

routine SBIRT in primary health care settings and Level I Trauma

Centers.

1. Wilk AI, Jensen NM, Havighurst TC. Meta‐analysis of randomized control trials addressingbrief interventions in heavy alcohol drinkers. J Gen Intern Med. 1997;12(5):274-283.

2. Madras BK, Compton WM, Avula D, Stegbauer T, Stein JB, Clark HW. Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites: comparison at intake and 6 months later. Drug Alcohol Depend. Jan 2009;99(1-3):280-295.

3. Bernstein J, Bernstein E, Tassiopoulos K, Heeren T, Levenson S, Hingson R. Brief motivational intervention at a clinic visit reduces cocaine and heroin use.Drug and Alcohol Dependence. 2005;77(1):49-59.

4. Maciosek MV, Coffield AB, Edwards NM, Flottemesch TJ, Goodman MJ, Solberg LI. Priorities among effective clinical preventive services: results of asystematic review and analysis. American journal of preventive medicine. 2006;31(1):52-61.

5. Solberg LI, Maciosek MV, Edwards NM. Primary care intervention to reduce alcohol misuse: ranking its health impact and cost effectiveness. American journal of preventive medicine. 2008;34(2):143-152. e143

Substance Use Screening, Brief

Intervention and Referral to

Treatment

Rankings of 25 Preventive ClinicalServices Recommended by USPSTF

# Service PB ROI

1 Aspirin to prevent CVS

disease

5 5

2 Childhood

immunizations

5 5

3 Smoking Cessation 5 5

4 Alcohol screening and

intervention

4 5

PB & ROI scoring: 1 = lowest; 5 = highest References

For more information go to indianaSBIRT.org