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Implementing SBRT in Rural Clinics: A How to
Guide
Dr. Christine Chasek
January 9, 2019
Samson Teklemariam, MA, LPC
Director of Training and Professional Development
NAADAC, the Association for Addiction Professionals
www.naadac.org
Produced By
NAADAC, the Association for Addiction Professionalswww.naadac.org/webinars
www.naadac.org/webinars
www.naadac.org/SBIRT-rural-clinics-webinar
Cost to Watch:
Free
CE Hours
Available:
1 CEs
CE Certificate for
NAADAC
Members:
Free
CE Certificate for
Non-members:
$15
To obtain a CE Certificate for the time you spent watching this
webinar:
1. Watch and listen to this entire webinar.
2. Pass the online CE quiz, which is posted at
www.naadac.org/SBIRT-rural-clinics-webinar
3. If applicable, submit payment for CE certificate or join
NAADAC.
4. A CE certificate will be emailed to you within 21 days of
submitting the quiz.
CE Certificate
Using GoToWebinar – (Live Participants Only)
Control Panel
Asking Questions
Audio (phone preferred)
Polling Questions
Dr. Christine Chasek LIMHP,
LADC, MAC
Associate Professor
1615 W. 24th Street
Kearney, NE 68845
Webinar Presenter
YourUniversity of Nebraska at Kearney
Behavioral Health Education Center of Nebraska
Dr. Shinobu Watanabe-Galloway Associate Professor, UNMC
Jason Dillard, PLMHP, PLADC Plum Creek Medical Group
Sarah Bradley, UNK Graduate Student
Health Disparity Project Partners
YourUniversity of Nebraska at Kearney
Behavioral Health Education Center of Nebraska
University of Nebraska Medical Center
Webinar Learning Objectives
Participants will
learn the
components of a
SBIRT practice
to implement in
rural clinics.
Participants will
identify the
barriers and
opportunities in
implementing
SBIRT in rural
clinics.
Participants will
have an outline of
steps to complete
when implementing
an SBIRT program.
1 32
• Many healthcare providers report that addressing alcohol and other
drug problems is one of the most challenging areas of their practice.
• Providers are unsure how to address these issues and yet they are
in a prime position to reduce the negative outcomes related to
substance misuse.
• Substance use counselors can partner with these providers to
implement cost-effective screening, brief intervention, and referral
practices that help identify and get patients the services they need.
This is a win, win, win situation for the healthcare provider,
substance use counselor, and mostly importantly the patient.
Why SBIRT in Rural Clinics?
Identify and Examine the components of SBIRT
practices
Barriers to implementing SBIRT
Opportunities
Outline of steps to implementing
Agenda
SBIRT
• Core Components
Societal Definition of “Addiction”
Addiction is a primary, chronic disease of brain reward, motivation,
memory and related circuitry. Dysfunction in these circuits, leads to
characteristic biological, psychological, social, and spiritual manifestations.
This is reflected in an individual pathologically pursuing reward and/or relief
by substance use and other behaviors.
Addiction is characterized by inability to consistently abstain, impairment in
behavioral control, craving, diminished recognition of significant problems
with one’s behaviors and interpersonal relationships, and a dysfunctional
emotional response. Like other chronic diseases, addiction often involves
cycles of relapse and remission. Without treatment or engagement in
recovery activities, addiction is progressive and can result in disability
or premature death.
ASAM Definition of Addiction (2013)
An estimated 21.0 million people aged 12 or older needed substance use treatment (2016)
1 in 13 need treatment
1 in 7 age 18-25 need treatment
Only 10% of people aged 12 or older who needed substance use treatment received it
(National Survey on Drug Use and Health, 2017)
How Pervasive is the Problem?
Adult Behavioral Issues in Primary Care
• 50% - 70% of physical complaints have no identifiable physical cause
• Anxiety
• Pain
• Depression
• Substance Abuse• Between 2004 and 2009, drug-related ER visits increased 81% from 2.5 million to 4.6 million.
• ER visits caused by non-medical use of prescription drugs increased more than 98% between 2004 and 2009
• Less than 5% with substance abuse problems receive “minimally adequate” treatment in primary care
• Less than 20% of primary care physicians believe they are prepared to identify or treat substance abuse disorders
• Kennedy Forum and DAWN
• SBIRT is an evidenced-based practice used to identify, reduce, and prevent problematic use, abuse, and dependence on alcohol and illicit drugs.
• Easy to implement in medical settings
• Endorsements:
• Institute of Medicine
• Medicare and Medicaid
• American Medical Association
• SAMHSA-HRSA Center for Integrated Health Solutions • https://www.integration.samhsa.gov/clinical-practice/sbirt
Polling Question #1
I have used screening tools in my practice.
Yes, No, Not Sure
Screening Process
and Tools
• ASSIST
• AUDIT
• DAST
Screening quickly assesses the severity of substance use and identifies the appropriate level of treatment.
Brief intervention focuses on increasing insight and awareness regarding substance use and motivation toward behavioral change.
Referral to treatment provides those identified as needing more extensive treatment with access to specialty care.
SBIRT: Core Components
Screening Tools
ASSIST
Other
Screening
Tools
• AUDIT
•
• DAST
Other
Screening
Tools
Scores and Intervention
• Low Risk: Positive Reinforcement
• Moderate: Brief Intervention
• High: Referral to Treatment
Scores
F = feedback of personal risk, e.g. that use may contribute to medical problem such as hypertension or psychosocial problems, e.g. relationship problems or work problems
R = responsibility of the patient and the patient/client has personal control
A = advice to change, e.g. to stop using or reduce reduce drinking to safe levels, treatment, ect.
M = menu of alternative goals and strategies to reduce substance use
E = empathic counseling style is more effective than confrontation
S = self-efficacy; encourage patients’/clients’ optimism that the chosen goals can be achieved.
Brief Interventions
FRAMES
Treatment Options
Least restrictive to most restrictive
• Education/substance awareness class: 6 hours
• Individual/family outpatient: 1 hour weekly on-going
• Group outpatient: 1-2 hours weekly
• Intensive outpatient program: 9 hours a week
• Partial care: 4-8 hours a day 3-5 days a week
• Detoxification: 1-7 days Short term Stabilization
• Inpatient treatment/hospitalization: 1-7 days
• Residential:
– Short Term: 21-28 days
– Long Term: 28-270 days
Polling Question #2
I am considering implementing screening in
my practice.
Yes, No, Unsure
Barriers Encountered • HealthCare providers reactions
• Paperwork concerns
• Billing Issues
Opportunities
• Cost Savings
• Patients get to level of care needed
• Savings of time in clinic
• Referrals for Substance Use Counselors
The Office of National Drug Control Policy estimated that substance use costs society around $193 billion in 2011.
Reduced Healthcare Costs
SBIRT has been shown to result in healthcare cost savings that range from $3.81 to $5.60 for every $1.00 spent.
Decreased severity of AOD use
Decreased risk of physical trauma
SBIRT
Funding opportunities
Implementation plan
Training Scripts for
implementation
Many ways to implement
Engage the nursing staff
Need a Champion!
Dr. Christine Chasek
• Licensed Mental Health Practitioner (LIMHP)
• Licensed Drug and Alcohol Counselor (LADC)
• Master Addiction Counselor (MAC)
• Associate Professor, University of Nebraska at Kearney
• BHECN-Kearney, Director
• Local Address: UNK campus (Kearney, NE)
• E-mail: [email protected]
Contact Information
American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th
ed.). Washington DC: American Psychiatric Publishing.
American Psychiatric Association (1968). Diagnostic and statistical manual of mental disorders (2nd ed.). Washington DC: American Psychiatric Publishing.
Babor, T. F., Del Boca, F. & Bray, J. W. (2017). Screening, brief intervention, and referral to treatment: Implications of SAMHSA’s SBIRT initiative for substance abuse policy and practice. Addiction, 112, 110-117.
Mee-Lee, D. (2013). The ASAM criteria: Treatment criteria for addictive, substance-related, and co-occurring conditions. Nevada: The Change Companies: Nevada.
National Survey on Drug Use and Health. (2017). Key Substance Use and Mental Health Indicators in the United States: Results from the 2016 National Survey on Drug Use and Health. Retrieved from https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2016/NSDUH-FFR1-2016.htm
NIH (2004). Helping patients with alcohol problems: A health practitioner’s guide. Evidence based practices for substances use disorders. Retrieved from http://lib.adai.washington.edu/dbtw-wpd/exec/dbtwpub.dll?BU=http%3A//lib.adai.washington.edu/ebpsearch.htm&TN=EBP&QY=Find+AccessNo=5&RF=Full+Display&DF=Full+Display&NP=3&RL=1&DL=0&XC=/dbtw-wpd/exec/dbtwpub.dll&AC=QBE_QUERY&CS=0
SAMHSA. (2015). Screening, brief intervention, and referral to treatment. Retrieved from http://www.samhsa.gov/sbirt/about
SAMHSA. (2018). SAMHSA-HRSA Center for Integrated Health Solutions. Retrieved from https://www.integration.samhsa.gov/clinical-practice/sbirt/screening
Thombs, D. L. (2006). Introduction to addictive behaviors. New York: The Guildford Press.
World Health Organization. (2017). The Assist Project. Retrieved from http://www.who.int/substance_abuse/activities/assist/en/
Zorland, J. L., Gillmore, D……Kuperminc, G.P. (2018). Effects of substance use screening and brief intervention on health related quality of life. Quality of Life Research, https://doi.org/10.1007/s11136-018-1899-z
References
Dr. Christine Chasek LIMHP,
LADC, MAC
Associate Professor
1615 W. 24th Street
Kearney, NE 68845
Thank You!
YourUniversity of Nebraska at Kearney
Behavioral Health Education Center of Nebraska
www.naadac.org/SBIRT-rural-clinics-webinar
Cost to Watch:
Free
CE Hours
Available:
1 CEs
CE Certificate for
NAADAC
Members:
Free
CE Certificate for
Non-members:
$15
To obtain a CE Certificate for the time you spent watching this
webinar:
1. Watch and listen to this entire webinar.
2. Pass the online CE quiz, which is posted at
www.naadac.org/SBIRT-rural-clinics-webinar
3. If applicable, submit payment for CE certificate or join
NAADAC.
4. A CE certificate will be emailed to you within 21 days of
submitting the quiz.
CE Certificate
January 23, 2019 February 27, 2019
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