Screening, Brief Intervention, And Referral To Treatment Practices Research Articles

Attitudes and current practice in alcohol screening, brief intervention, and referral for treatment among staff working in urgent and emergency settings: An open, cross-sectional international survey.

The aim of the study was to ascertain the views and experiences of those working in urgent and emergency care (UEC) settings towards screening, brief intervention, and referral to treatment (SBIRT) for alcohol, to inform future practice. To explore i) views towards health promotion, ii) views towards and practice of SBIRT, iii) facilitators and barriers to delivering SBIRT, iv) training needs to support future SBIRT practice, and v) comparisons in views and attitudes between demographic characteristics, geographical regions, setting and occupational groups. This was an open cross-sectional international survey, using an online self-administered questionnaire with closed and open-ended responses. Participants were ≥18 years of age, from any occupational group, working in urgent and emergency care (UEC) settings in any country or region. There were 362 respondents (aged 21-65 years, 87.8% shift workers) from 7 occupational groups including physicians (48.6%), nurses (22.4%) and advanced clinical practitioners (18.5%). Most believed that health promotion is part of their role, and that SBIRT for alcohol prevention is needed and appropriate in UEC settings. SBIRT was seen to be acceptable to patients. 66% currently provide brief alcohol advice, but fewer screen for alcohol problems or make alcohol-related referrals. The most common barriers were high workload and lack of funding for prevention, lack of knowledge and training on SBIRT, lack of access to high-quality resources, lack of timely referral pathways, and concerns about patient resistance to advice. Some views and attitudes varied according to demographic characteristics, occupation, setting or region. UEC workers are willing to engage in SBIRT for alcohol prevention but there are challenges to implementation in UEC environments and concerns about workload impacts on already-burdened staff, particularly in the context of global workforce shortages. UEC workers advocate for clear guidelines and policies, increased staff capacity and/or dedicated health promotion teams onsite, SBIRT education/training/resources, appropriate physical spaces for SBIRT conversations and improved alcohol referral pathways to better funded services. Implementation of SBIRT could contribute to improving population health and reducing service demand, but it requires significant and sustained commitment of time and resources for prevention across healthcare organisations.

Multidimensional Evaluation of Screening Brief Intervention and Referral to Treatment Training for Medical Students.

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based approach to identifying and addressing alcohol use in non-specialty settings. Many medical schools teach SBIRT, but most published evaluations of these efforts exclude rigorous skill assessments and teaching methods. During the 2017-2018 academic year, 146 third-year medical students received classroom-based learning on SBIRT and motivational interviewing (MI) and at least two SBIRT practices with feedback as part of a 4-week psychiatry clerkship. The objective of this curriculum was to improve SBIRT knowledge, attitudes, and confidence and enable learners to skillfully deliver SBIRT. Outcomes evaluated included satisfaction, knowledge, attitudes and confidence, and clinical skill in delivering SBIRT to a standardized patient (rated by the actor, as well as an expert). Results indicated acceptable satisfaction at post-curriculum and significant improvements in attitudes and knowledge from pre- to post-curriculum. On the clinical skills exam, all students were rated as having mastered at least 80% of SBIRT elements by standardized patients and 91.8% were rated at this level by a faculty expert. Student attitudes and knowledge were unrelated to expert ratings, and standardized patient ratings had limited associations with expert ratings. These results suggest curriculum objectives were achieved and provide unique contributions to the SBIRT curricular outcome research for healthcare trainees. Other findings included that trainee knowledge and confidence may not relate to skill, and standardized patient feedback provides different information on SBIRT and MI skill than expert ratings.

Screening, brief intervention, and referral to treatment (SBIRT) training reduces stigma and prepares orthopaedic providers to identify and intervene in opioid misuse: a prospective cohort study

Background: Despite the evolution of responsible opioid prescription for musculoskeletal pain, patients remain at risk for opioid problematic use, misuse, and addiction. Screening, brief intervention and referral to treatment (SBIRT) is an evidence-based practice to identify, reduce, and prevent those outcomes. This pilot study investigated the use of SBIRT practices developed to target opioid misuse in the orthopaedic practice environment and its applicability in the orthopaedic population. Methods: In this prospective cohort study, 19 orthopaedic providers underwent SBIRT training. Participants reported on their use of SBIRT over 6 wk and completed the Medical Condition Regard Scale (MCRS). Results: Twelve participants successfully implemented SBIRT, screening an average of 58.5% of patients. Seventeen percent of patients screened to an elevated risk level. Patients who screened as medium or high risk were 5.8 and 8.4 times more likely, respectively, to receive intervention compared with patients who screened to low risk or not screened (P<0.01). Regard for patients with opioid use for pain increased from an MCRS score of 44.6 to 52.5 (P<0.01). Ninety-five percent of participants found the training useful, and 89% would recommend the training to a colleague. Conclusions: This study demonstrated integration of SBIRT practices into an orthopaedic environment in which a significant proportion of orthopaedic patients screened to elevated risk of opioid misuse and qualified for brief intervention by the orthopaedic provider. SBIRT training had a positive impact on opioid-use stigma, a recognized barrier to care. Further study is warranted to determine the effect on patient outcomes and optimal implementation strategy. Level of Evidence: Level II.

Implementing adolescent SBIRT: Findings from the FaCES project

Background: Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based approach to early intervention of substance misuse. Methods: This mixed-methods evaluation assessed the implementation of an adolescent SBIRT change package across 13 primary care clinics. These clinics participated in an 18-month learning collaborative, during which they received training and technical assistance on SBIRT practices. Results: Six major themes emerged around the implementation of the change package: operational readiness of the sites, training of staff members, factors around the screening process, factors around intervention delivery, the referral process, and the adaptation and utilization of the electronic health record (EHR). Conclusions: Through the guidance of the change package and the associated training and technical assistance, the participating primary care clinics were able to implement SBIRT practices within their existing workflows. There was also an observed reduction in reported substance use among the at-risk adolescents served by these clinics.

Provider and Practice Characteristics and Perceived Barriers Associated With Different Levels of Adolescent SBIRT Implementation Among a National Sample of US Pediatricians.

Pediatrician Screening, Brief Intervention, and Referral to Treatment (SBIRT) practices vary widely, though little is known about the correlates of SBIRT implementation. Using data from a national sample of US pediatricians who treat adolescents (n = 250), we characterized self-reported utilization rates of SBIRT among US pediatricians and identified provider- and practice-level characteristics and barriers associated with SBIRT utilization. All participants completed an electronic survey querying the demographics, practice patterns, and perceived barriers related to SBIRT practices. Our results showed that 88% of respondents reported screening for substance use annually, but only 26% used structured/validated screening instruments. Furthermore, 40% of respondents provided evidence-based brief interventions, and only 11% implemented all core SBIRT practices. Common barriers (eg, confidentiality and insufficient time) and unique provider- and setting-specific barriers to implementation were identified. These findings indicate that although most pediatricians deliver some SBIRT components in their practice, few implement the full SBIRT model, and barriers persist.

Adolescent SBIRT Practices Among Pediatricians in Massachusetts.

Adolescent Screening, Brief Intervention, and Referral to Treatment (SBIRT) in primary care is a key strategy to prevent, identify, and respond to substance use problems and disorders, including opioid and other drug addictions. Despite substantial investment in recent years to increase its implementation, few studies have reported on recent levels of SBIRT implementation among pediatricians. We aimed to assess self-reported use of the SBIRT framework with adolescent patients among Massachusetts pediatricians, and describe trends since an earlier survey. We analyzed responses to a cross-sectional survey mailed in 2017 to a representative sample of pediatricians in Massachusetts. We computed response frequencies for all SBIRT practice questions. We used the chi-square test to compare current data to data collected in 2014, as we found no demographic differences between the 2 samples. Nearly all pediatricians in the 2017 sample (n = 160) reported annual screening of their adolescent patients (99%). The majority reported giving positive reinforcement (87%), brief advice (92%), counseling (90%), and referral to treatment (66%) in response to screen results. Compared with 2014, a significantly higher proportion of pediatricians in 2017 referred patients who screened positively for problematic alcohol use, but perceived barriers to screening and follow-up remain, such as insufficient time to screen and patient refusal to return. Among respondents to a Massachusetts pediatrician survey, we found high rates of delivering SBIRT in accordance with published guidelines, though barriers remain. Whether the content of the counseling adheres to guidelines is unknown.

The Learning Process of Social Work Students After Exposure to an SBIRT Training

ABSTRACTTo better understand how to train social work students on Screening, Brief Intervention, and Referral to Treatment (SBIRT) we tested a path model of students’ learning processes for SBIRT principles. We proposed the following model for the development of students’ SBIRT aptitude: (a) reductions in negative stereotypes about substance usage would lead to (b) increases in the identification of appropriate SBIRT practices, producing (c) gains in commitment toward working with substance users, resulting in (d) greater self-efficacy toward SBIRT practice. Using student test data for analysis (N = 226), the results of structural equation modeling indicated that a model consistent with the proposed theory fit the data well (χ2(2) = 1.45, p = .484, root mean square error of approximation = .00, 90% confidence interval [.00, .12], standardized root mean square residual = .01; comparative fit index = 1.0). Such results suggest that when training students on SBIRT, dispelling myths about substance use might be an important antecedent for the promotion of other important learning outcomes.

Screening, brief intervention, and referral to treatment for adolescent alcohol use in Canadian pediatric emergency departments: a national survey of pediatric emergency physicians.

Problematic alcohol use is associated with detrimental cognitive, physiological and social consequences. In the emergency department (ED), Screening, Brief Intervention, and Referral to Treatment (SBIRT) is the recommended approach to identify and treat adolescent alcohol-related concerns, but is underused by physicians. This study examined pediatric emergency physicians’ perceptions of adolescent drinking and treatment, and their current self-reported SBIRT practices. Physicians in the Pediatric Emergency Research Canada database (n=245) received a 35-item questionnaire that was administered through a web-based platform and paper-based mail-outs. Recruitment followed a modified Dillman four-contact approach. From October 2016 to January 2017, 166 pediatric emergency physicians (46.4% males; mean age=43.6 years) completed the questionnaire. The response rate was 67.8%. Physicians recognized the need (65%) and responsibility (86%) to address adolescent alcohol problems. However, confidence in knowledge and abilities for SBIRT execution was low. Twenty-five percent of physicians reported never having practiced all, or part of, SBIRT while 1.3% reported consistent SBIRT delivery for adolescents with alcohol-related visits. More alcohol education and counselling experience was associated with higher SBIRT use; however, physicians generally reported to have received minimal alcohol training. SBIRT practices were also associated with physician perceptions of problematic alcohol use and its treatability. Pediatric emergency physicians acknowledge the need to address problematic adolescent alcohol use, but routine SBIRT use is lacking. Strategies to educate physicians about SBIRT and enhance perceived self-competency may improve SBIRT use. Effectiveness trials to establish SBIRT impact on patient outcomes are also needed.

Screening, Brief Intervention, and Referral to Treatment in the Emergency Department

There is increasing interest in deploying screening, brief intervention, and referral to treatment (SBIRT) practices in emergency departments (ED) to intervene with patients at risk for substance use disorders. However, the current literature is inconclusive on whether SBIRT practices are effective in reducing costs and utilization. This study sought to evaluate the health care costs and health care utilization associated with SBIRT services in the ED. This study analyzed downstream health care utilization and costs for patients who were exposed to SBIRT services within an Allegheny County, Pennsylvania, ED through a program titled Safe Landing compared with 3 control groups of ED patients (intervention hospital preintervention, and preintervention and postintervention time period at a comparable, nonintervention hospital). The subjects were patients who received ED SBIRT services from January 1 to December 31 in 2012 as part of the Safe Landing program. One control group received ED services at the same hospital during a previous year. Two other control groups were patients who received ED services at another comparable hospital. Measures include total health care costs, 30-day ED visits, 1-year ED visits, inpatient claims, and behavioral health claims. Results found that patients who received SBIRT services experienced a 21% reduction in health care costs and a significant reduction in 1-year ED visits (decrease of 3.3 percentage points). This study provides further support that SBIRT programs are cost-effective and cost-beneficial approaches to substance use disorders management, important factors as policy advocates continue to disseminate SBIRT practices throughout the health care system.

SCREENING, BRIEF INTERVENTION, AND REFERRAL TO TREATMENT (SBIRT) FOR ADOLESCENT ALCOHOL USE IN EMERGENCY DEPARTMENTS: A NATIONAL SURVEY OF PEDIATRIC EMERGENCY PHYSICIANS

Abstract BACKGROUND: Problematic alcohol use is hazardous to adolescents – early use is a predictor of later dependence or abuse – and is associated with harmful health consequences. Screening, brief intervention, and referral to treatment (SBIRT), the recommended clinical approach for adolescent alcohol-related concerns, is underused in emergency departments (ED). Use of electronic tools to conduct SBIRT (technology-based SBIRT) in the ED has been shown to reduce subsequent alcohol-related consequences, and is currently regarded as a promising strategy to engage clinicians, and facilitate standardized and efficient care. A better understanding of ED physicians’ decision-making around SBIRT practice and technology acceptance is needed. OBJECTIVES: To examine pediatric emergency physicians’ alcohol SBIRT practices, perceptions of adolescent drinking and treatment, and acceptance of technology-based SBIRT. DESIGN/METHODS: We conducted a cross-sectional, pan-Canadian survey using a validated questionnaire based on the Substance Abuse and Attitude Scale and the Technology Acceptance Model. We surveyed pediatric emergency physicians sourced from the Pediatric Emergency Research Canada database (n=245). The questionnaire was administered through a web-based platform and paper-based mail-outs. Recruitment followed a modified Dillman four-contact approach and spanned October 2016 to January 2017. RESULTS: A total of 164 of 245 physicians (67%) responded. Twenty-five percent of respondents reported never having practiced SBIRT; 1.2% consistently administered all, or part of, SBIRT when treating adolescents for alcohol-related visits. A lack of appropriate tools (49%) and time constraints (41%) were the main reasons for SBIRT underutilization, as reported by physicians. Most physicians (85%) felt responsible for addressing alcohol problems with adolescent patients, however, confidence in knowledge and abilities for SBIRT execution was reported as low. Responses were moderately positive for the perceived value, usability, and potential impact of technology-based SBIRT. Physicians across all frequency levels of current SBIRT use indicated that an electronic tool would increase SBIRT practices. CONCLUSION: The routine use of SBIRT by pediatric emergency clinicians is lacking. However, we identified common barriers to use – resources and training – that can be feasibly addressed. Technology-based SBIRT is an acceptable innovation that physicians are willing to consider for use during the care of adolescents. Strategies to support implementation in the ED are necessary.

Adolescent substance use: Assessing the knowledge, attitudes, and practices of a school-based health center workforce

ABSTRACTBackground: Recent attention has focused on the potential for school-based health centers (SBHCs) to provide access points for adolescent substance use care. In 2015, the University of New Mexico began screening, brief intervention, and referral to treatment (SBIRT) training for providers at New Mexico Department of Health (NMDOH)-funded SBHCs across the state. This study assesses baseline knowledge, attitudes, and practices of the New Mexico SBHC provider workforce regarding adolescent substance use and provision of services. Methods: In early 2015, the NMDOH administered an SBHC provider workforce survey (N = 118) and achieved a 44.9% response rate. This descriptive analysis includes all survey respondents who self-identified as a primary care or behavioral health provider in an SBHC serving middle or high school students (n = 52). Results: Among respondents, the majority (57.7%) were primary care providers, including nurse practitioners, physicians, and physician assistants. The remaining 42.3% of respondents were master's-level behavioral health providers. Only 44.2% of providers reported practicing the full SBIRT model at their SBHC, and 21.2% reported having received continuing education on SBIRT within the previous 3 years. Most respondents, 84.6%, agreed that it is the responsibility of SBHC providers to screen students for substance use using a standardized tool, and 96.2% agreed that it is the responsibility of the SBHC provider to assess for students' readiness to change. A majority reported self-efficacy in helping students achieve change in their alcohol use, illicit drug use, and prescription drug misuse: 73.1%, 65.4%, and 63.5%, respectively. Conclusions: These results suggest that SBIRT training for New Mexico SBHC providers is timely. The authors identified gaps between recommended SBIRT practices and SBIRT delivery as well as discrepancies between reported provider self-efficacy and actual implementation of the SBIRT model. Further study will determine the effectiveness of efforts to address substance use and implement SBIRT in SBHCs.

Consider the Setting: Challenges in Integrating Screening, Brief Intervention, and Referral to Treatment into Nursing and Social Work Students’ Clinical Practice

Objective: Substantial funds are being invested into training health professions students to provide screening, brief intervention, and referral to treatment (SBIRT) for substance use, but will the newly trained workforce be ahead of its future employers? The goal of this study was to explore implementation facilitators and barriers. Methods: This project educated 541 baccalaureate nursing (BSN), advanced practice nursing (NP), and master of social work (MSW) students through didactics, role plays, standardized patient practice, and clinical experience to help students achieve competency. One month after training, students were surveyed regarding their use of SBIRT in clinical practice and barriers/facilitators to their use of SBIRT. Results: Efforts to integrate SBIRT into students’ clinical experiences were met with numerous challenges. Follow-up surveys revealed a number of barriers to practicing SBIRT during clinical rotations, including feeling a lack of authority to implement, clinic policies not allowing SBIRT, clinic staff lacking SBIRT awareness and training, perceptions that SBIRT was inappropriate for the patient populations served, lack of time, and fear of patient reaction. Facilitators included faculty and supervisor support of SBIRT, clinic policies allowing SBIRT, acceptance of SBIRT by clinic staff, having a framework to discuss substance use, and having SBIRT practice as a course requirement. Conclusion: Without clinical site buy-in, students do not receive adequate opportunities to practice with patients. Therefore, clinical site attitudes and policies need to be considered prior to implementing student practice so students can sustain gains in knowledge, attitudes, and skills.

A new methodology for examining the efficacy of SBIRT protocols on reducing healthcare utilization and costs

Background There is increasing interest in deploying Screening, Brief Intervention, and Referral to Treatment (SBIRT) practices in emergency departments (ED). However, the current literature is inconclusive on whether or not SBIRT practices are cost effective and cost beneficial. In order to answer this question, new analytical methods need to be developed. The objective of the following study was to pilot a new experimental methodology modeling costs using a multilevel generalized linear model (GLM) for studying the impact of SBIRT on healthcare utilization and costs.

Adapting Screening, Brief Intervention, and Referral to Treatment for Alcohol and Drugs to Culturally Diverse Clinical Populations.

To review the literature on the screening, brief intervention, and referral to treatment (SBIRT) approach to alcohol and drug use with racial and ethnic subgroups in the United States and to develop recommendations for culturally competent SBIRT practice. Articles reporting on the use of SBIRT components (screening, brief intervention, referral to treatment) for alcohol and drug use were identified through a comprehensive literature search of PubMed from 1995 to 2015. A synthesis of the published literature on racial and ethnic considerations regarding SBIRT components (including motivational interviewing techniques) was created using evidence-based findings. Recommendations on culturally competent use of SBIRT with specific ethnic groups are also described. On the basis of the literature reviewed, SBIRT offers a useful set of tools to help reduce risky or problematic substance use. Special attention to validated screeners, appropriate use of language/literacy, trust building, and incorporation of patient and community health care preferences may enhance SBIRT acceptability and effectiveness. Providers should consider the implications of previous research when adapting SBIRT for diverse populations, and use validated screening and brief intervention methods. The accompanying case illustration provides additional information relevant to clinical practice.

South Texas Residency Screening, Brief Intervention, and Referral to Treatment (SBIRT) Training: 12-Month Outcomes

ABSTRACTBackground: Screening, brief intervention, and referral to treatment (SBIRT) is an efficacious and cost-effective skill set when implemented in primary care settings regarding hazardous alcohol use. This study assesses the impact of medical resident SBIRT training across 3 specialties and identifies predictors of change in trainee behavior, attitudes, and knowledge over 12 months. Methods: This program's substance use SBIRT training was developed and tailored to fit diverse curricular objectives and settings across an array of medical residency programs in South Texas. The 329 residents training in pediatrics, family medicine, and internal medicine during 2009–2012 constituted the trainee group reported in this analysis. Surveys assessing SBIRT-related knowledge, current practice, confidence, role responsibility, attitudes, beliefs, and readiness to change were completed by 234 (71%) trainees at 3 time points: pre-training, then 30 days and 12 months post-initial training. Results: SBIRT-related knowledge, confidence, and practice increased from pre-training to 12-month follow-up. Residents who reported the least amount of pre-training clinical and/or prior academic exposure to substance use reported the greatest SBIRT practice increases. When controlling for demographic and prior exposure variables, the largest contributor to variance in SBIRT practice was attributed to residents' confidence in their SBIRT skills. Conclusions: SBIRT training that employs diverse educational methodologies as part of customizing the training to residency specialties can similarly enhance SBIRT-related knowledge, confidence, and practice. Trainee report of limited prior clinical or academic exposure to substance use and/or low confidence regarding SBIRT skills and their professional role responsibilities related to substance use predicted trainee success and sustained SBIRT strategy application. When customizing SBIRT training, curriculum developers should consider leveraging and capacity building related to those factors predicting continued use of SBIRT practices.

Translation of alcohol screening and brief intervention guidelines to pediatric trauma centers

As part of the American College of Surgeons verification to be a Level 1 trauma center, centers are required to have the capacity to identify trauma patients with risky alcohol use and provide an intervention. Despite supporting scientific evidence and national policy statements encouraging alcohol Screening, Brief Intervention and Referral to Treatment (SBIRT), barriers still exist, which prevent the integration of SBIRT into clinical care. Study objectives of this multisite translational research study were to identify best practices for integrating SBIRT services into routine care for pediatric trauma patients, to measure changes in practice with adoption and implementation of a SBIRT policy, and to define barriers and opportunities for adoption and implementation of SBIRT services at pediatric trauma centers. This translational research study was conducted at seven US pediatric trauma centers during a 3-year period. Changes in SBIRT practice were measured through self-report and medical record review at three different study phases, namely, adoption, implementation, and maintenance phases. According to medical record review, at baseline, 11% of eligible patients were screened and received a brief intervention (if necessary) across all sites. After completion of the SBIRT technical assistance activities, all seven participating trauma centers had effectively developed, adopted, and implemented SBIRT policies for injured adolescent inpatients. Furthermore, across all sites, 73% of eligible patients received SBIRT services after both the implementation and maintenance phases. Opportunities and barriers for successful integration were identified. This model may serve as method for translating SBIRT services into practice within pediatric trauma centers.

A SBIRT Curriculum for Medical Residents: Development of a Performance Feedback Tool to Build Learner Confidence

ABSTRACT A major barrier to actualizing the public health impact potential of screening, brief intervention, and referral to treatment (SBIRT) is the suboptimal development and implementation of evidence-based training curricula for healthcare providers. As part of a federal grant to develop and implement SBIRT training in medical residency programs, the authors assessed 95 internal medicine residents before they received SBIRT training to identify self-reported characteristics and behaviors that would inform curriculum development. Residents’ confidence in their SBIRT skills significantly predicted SBIRT practice. Lack of experience dealing with alcohol or drug problems and discomfort in dealing with these issues were significantly associated with low confidence. To target these barriers, the authors revised their SBIRT curriculum to increase residents’ confidence in their skills and developed an innovative SBIRT Proficiency Checklist and Feedback Protocol for skills practice observations. Qualitative feedback suggests that, despite the discomfort residents experience in being observed, a proficiency checklist and feedback protocol appear to boost learner confidence.

Workplace Alcohol Screening, Brief Intervention, and Referral to Treatment (SBIRT): A Survey of Employer and Vendor Practices

Alcohol abuse and dependence is recognized as one of the leading causes of morbidity and mortality in the United States. Alcohol is the most widely used substance among working adults, and almost 80% of risky drinkers are employed. Health care costs associated with alcohol problems exceed major chronic diseases. Employers bear economic and other burdens from untreated alcohol problems: productivity losses, increased absenteeism, tardiness, and poor work quality. There is overwhelming scientific evidence of the effectiveness of alcohol screening, brief intervention, and referral to treatment (SBIRT) for detecting and treating people with alcohol problems in medical settings (e.g., emergency), a setting that presents numerous “teachable moments.” The effectiveness in nonmedical work-related settings (e.g., employee assistance, work–life) is unclear. A review of the literature suggests there has been little attention paid to adaptation of alcohol SBIRT for the workplace, a setting where millions of working adults spend most of their day. This research aims to identify and describe employer and vendor SBIRT practices and promising approaches feasible for adaptation and dissemination in a variety of work-related settings.