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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