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

Cross-Site Evaluation of Alcohol Screening and Brief Intervention Implementation Programs in Healthcare Systems Serving Individuals of Reproductive Age.

With US Centers for Disease Control and Prevention funding, from 2018 to 2022, 4 large healthcare systems (n = 53 health centers across 7 states) serving people of reproductive age trained staff and provided implementation support for alcohol screening and brief intervention (SBI). This cross-site evaluation explores each healthcare system's implementation approach to implement SBI, reduce excessive alcohol use, and prevent prenatal alcohol exposure (PAE) and fetal alcohol spectrum disorders. The SBIRT (Screening, Brief Intervention, and Referral to Treatment) Program Matrix framed the multilevel strategies to implement alcohol SBI programs from 2018 to 2022. Qualitative and quantitative data sources examined outcomes, guided by one logic model, through systems-level process data and provider-level performance metrics. Data analyses utilized frequencies and means for quantitative data and themes for qualitative data according to an established framework. Successful approaches within systems included using electronic health records, flexible implementation and workflow protocols, customized training and technical assistance programs, quality assurance feedback loops, and stakeholder buy-in. Centralized management structures were efficient in standardizing implementation across health centers. Decentralized management structures used tailored approaches, enhancing provider/staff SBI acceptance. Across systems, 1259 staff (eg, clinicians, medical assistants) were trained to provide alcohol SBI services and reported pre-post training increases in self-efficacy in performing brief intervention; skills in PAE counseling; and confidence in screening. Fifty-three (48 providing data) health centers implemented alcohol SBI, screening 106 826 patients over the study period with most of the 10 087 patients who screened positive for excessive alcohol use receiving a BI. Maximizing the use of technology, employing flexibility in program delivery, and institutionalizing processes and protocols improved workflow, efficiency, and program reach. Ongoing partnership and stakeholder communication identify areas for ongoing improvement, engagement, and best practices for sustainability around substance use screening, which are essential with increases in substance use since the pandemic.

Family support and treatment completion for unhealthy alcohol use in a SBIRT program

ABSTRACT Screening, Brief Intervention, and Referral to Treatment (SBIRT) research indicates that substance use severity is a predictor of readiness to change, which is in turn associated with positive treatment follow-through. Using a strengths-based approach, family support is hypothesized to be a protective factor related to treatment completion; yet additional research is needed to substantiate the role of this construct when considering other pre-treatment factors. This study used a SEM equation to examine whether self-reported family support mediated the relationship between substance use severity and treatment completion. Service user demographics and pre-treatment characteristics were collected from service users in a primary care setting who were referred to treatment in a statewide implementation of SBIRT. The results provide additional evidence that family support mediates the relationship between symptom severity and substance use treatment completion. The authors conclude with a discussion on how family support can be integrated in SBIRT models for both enhancing the screening process and referrals to treatment.

School-Based Screening and Brief Intervention for Adolescent Substance Use With Telehealth-Delivered Case Consultation and Education.

Screening, brief intervention, and referral to treatment (SBIRT) is a public health framework for addressing adolescent substance use. Implementation of SBIRT in schools carries the potential to improve substance use treatment access and service acceptance for students, but faces barriers related to knowledge deficits, low comfort, and lack of training in screening and brief interventions among school-based mental health (SBMH) providers. This report describes the development and acceptability evaluation of a school-based SBIRT program designed to overcome common implementation barriers of SBIRT related to provider confidence, knowledge, and training deficits by supplementing the traditional model with telehealth-delivered addiction consultation and education (ACE). Program components include core SBIRT trainings, telehealth-delivered ACE sessions, and outreach support for SBMH providers. Each ACE session included a didactic expert presentation on a clinical topic and a provider-presented patient case with discussion. Sessions were delivered using a Project ECHO-based hub-and-spoke format with monthly 1-hour virtual meetings. Interviews and surveys with SBMH providers on substance use screening and intervention practices and perceived barriers were used to inform program design choices and tailor the curriculum. Acceptability data were collected at 9 months. SBMH provider participants reported increased confidence, knowledge, and evidence-based screening and early intervention practices, and high acceptability, satisfaction, and benefit from the program. Ongoing barriers to referral to treatment were reported. This pilot study suggests that supplementing traditional SBIRT with telehealth-delivered ACE sessions can address common implementation barriers and serve as a scalable model to improve SBIRT adoption in schools.

Rates, Patterns, and Predictors of Follow-up Care for Adolescents at Risk for Substance Use Disorder in a School-Based Health Center SBIRT Program

PurposeTo examine rates, patterns, and predictors of follow-up care for adolescents screened as being at risk for substance use disorder (SUD) in a school-based health center (SBHC) Screening, Brief Intervention and Referral to Treatment (SBIRT) program. MethodsElectronic health records were extracted of adolescents who received health care services from one of three high school-based health centers implementing SBIRT. Patterns and predictors of engagement in follow-up care within 8 weeks following the week of a positive SUD risk screen were analyzed using item response theory (IRT) modeling. ResultsOut of 1,327 adolescents receiving SBHC services, 81.2% completed a health screening questionnaire. Of screened adolescents, 17.7% were positive for SUD risk. Across the 8-week follow-up period, 65.4% of adolescents at risk for SUD received at least one follow-up visit. IRT modeling indicated that high levels of engagement in follow-up care were characterized by contact with a behavioral health care (BHC) provider. The percentage of adolescents having follow-up contact with a BHC provider increased significantly after the onset of the COVID-19 pandemic. Engagement in follow-up care was predicted by risk for depression, history of suicidal behavior, being female, and previous sexual activity. DiscussionSBHCs provide a favorable setting for screening and detecting adolescents at risk for SUD. Adolescents at risk for SUD should receive follow-up contact with a BHC provider. Enhanced follow-up engagement efforts may be warranted for adolescents at risk for SUD without risk for depression or suicidal history, as well as for females and those with previous sexual activity.

The effect of inpatient addiction screening and intervention on readmissions

AimThe number of individuals in the United States (US) needing treatment for substance use disorder (SUD) but not receiving treatment at a specialty facility was reported to be almost 18 million in 2019. This study measured the difference in subsequent hospital visits between groups, one receiving screening, brief intervention, and referral to treatment (SBIRT) and one receiving usual care. BackgroundThere are studies that discuss SBIRT in terms of process evaluation, staff training, reduced readmission rates, and self-reported reductions in substance use. However, the interrelationship between components of SBIRT implementation, such as feasibility, cost, and sustainability need additional investigation. This study compared readmissions between groups receiving SBIRT counseling (n = 101) and those receiving usual care (n = 99). ResultsThe overall total number of subsequent visits for SUD for the group receiving SBIRT (53) was significantly lower than for the group receiving usual care (128). The overall total number of non-SUD subsequent visits was not significantly different between groups. The study also identified differences between sexes that require further investigation. ConclusionsThe findings of this study demonstrate a measure of difference based on SBIRT intervention. The SBIRT program can be incorporated into daily practice in the acute care setting through nursing education and utilization of the electronic health platform.

Effectiveness of E-SBIRT intervention in community healthcare institution in China: study proposal for a randomised controlled trial

BackgroundMany studies have demonstrated the effectiveness of Screening, Brief Intervention and Referral to Treatment (SBIRT) in addressing substance use problem. However, owing to the shortage of counsellors, it has not...

Substance Use Screening Protocol: Implementation of a System for Patients With Cancer

Substance use by patients with a cancer diagnosis may have a detrimental effect on short- and long-term outcomes. Screening, brief intervention, and referral to treatment (SBIRT) has been recommended for all patients in primary care and emergency medicine. The purpose of this quality improvement project was to train clinical providers and to implement an effective SBIRT program in a radiation oncology clinic in a comprehensive cancer center. An interprofessional task force developed a staff training protocol that incorporated oncology-specific content. The team then piloted an SBIRT program in the outpatient clinic. Staff training results were mixed, with only a few evaluation items showing significant improvement. Despite these results, staff training and the implementation of an SBIRT may be valuable in improving substance use screening in this vulnerable population.

Student Experience of School Screening, Brief Intervention, and Referral to Treatment.

Screening, Brief Intervention and Referral to Treatment (SBIRT) is a clinical guideline that can help delay, prevent or reduce substance use behaviors in youth. We aimed to describe the experiences of middle and high school (MS and HS) students attending a school with an SBIRT program. This was a survey study conducted in 2 school districts that implemented SBIRT programs prior to statewide roll-out of mandatory school SBIRT in Massachusetts, in which students were asked about past-year substance use and then received brief counseling by a school professional. Students in grades that received SBIRT were subsequently invited to complete an electronic questionnaire about their SBIRT experience. A total of 890 students were included in the study (63.7% MS, 36.3% HS). Experiences of school SBIRT were predominantly positive: 74.0% of participants reported that the information received was useful. Students who reported having used substances were less likely to agree that "schools should screen for substance use" than students who did not report substance use (AOR: 0.39, 95%CI: 0.29-0.53). Most respondents found SBIRT of value, though students with past-year substance use were less positive about the experience. More research is needed to optimize SBIRT delivery in schools.

Successful Implementation of an Alcohol Screening, Brief Intervention, and Referral to Treatment Program.

Devastating effects of alcohol are well established in trauma. To address this, thve American College of Surgeons Committee on Trauma (ACS-COT) requires ACS-verified Level 1 trauma centers to have an active screening, brief intervention, and referral to treatment (SBIRT) program. In 2015, NewYork-Presbyterian/Queens successfully implemented an SBIRT program. Previous studies indicate difficulty in achieving a high level of SBIRT compliance. We explored the effects of a multidisciplinary approach in implementing a standardized screening protocol for every trauma-activated patient 15 years or older. A multidisciplinary team developed a standardized approach to identifying trauma patients for our SBIRT program. Social workers were trained in performing brief interventions and referral to treatment at a New York State-level training course prior to starting our SBIRT program. Blood alcohol levels were obtained in every trauma activation. Trauma patients who had a blood alcohol level greater than 0.02% were identified and tracked by the trauma service. These patients were referred to social workers, underwent brief intervention, and evaluated for referral to treatment if determined to be a high-risk alcohol user. Over the 8-month implementation period, we evaluated 693 trauma patients. A blood alcohol level was obtained on most trauma patients (n = 601, 86.6%). Patients with a blood alcohol level greater than 0.02% were referred to a social worker (n = 157, 22.6%). Social workers performed a brief intervention and evaluation for referral/treatment services for 129 of the trauma patients with elevated blood alcohol levels. Overall, 82% of intoxicated trauma patients underwent brief intervention, which identified 22 patients who were referred for treatment programs. An inclusive multidisciplinary approach to the implementation of an SBIRT program achieves a high level of compliance.

Effectiveness of a Specialized Brief Intervention for At-risk Drinkers in an Emergency Department: Short-term Results of a Randomized Controlled Trial.

Screening, Brief Intervention, and Referral to Treatment (SBIRT) programs have been developed, evaluated, and shown to be effective, particularly in primary care and general practice. Nevertheless, effectiveness of SBIRT in emergency departments (EDs) has not been clearly established. We aimed to evaluate the feasibility and efficacy of an SBIRT program conducted by highly specialized professionals in the ED of a tertiary hospital. We conducted a randomized controlled trial to study the feasibility and efficacy of an SBIRT program conducted by alcohol specialists for at-risk drinkers presenting to the ED, measured with the three-item version of the Alcohol Use Disorder Identification Test (AUDIT-C). Patients were randomized to two groups, with the control group receiving two leaflets-one regarding alcohol use and the other giving information about the study protocol. The intervention group received the same leaflets as well as a brief motivational intervention on alcohol use and, where appropriate, a referral to specialized treatment. The primary outcomes were the proportion of at-risk alcohol use measured by AUDIT-C scale and the proportion of patients attending specialized treatment at 1.5 months. Of 3,027 patients presenting to the ED, 2,044 (67%) were potentially eligible to participate, 247 (12%) screened positive for at-risk drinking, and 200 agreed to participate. Seventy-two percent of the participating sample were men, and the mean (±SD) age was 43 (±16.7) years. Follow-up rates were 76.5%. At 1.5 months, the intervention group showed greater reductions in alcohol consumption and fewer patients continuing with at-risk alcohol use (27.8% vs. 48.1%; p = 0.01). The SBIRT program also increased the probability of attending specialized treatment, compared to the control condition (23% vs. 9.8%, p = 0.0119) CONCLUSION: The SBIRT program in the ED was found to be feasible and effective in identifying at-risk drinkers, reducing at-risk alcohol use, and increasing treatment for alcohol problems.

The SBIRT program matrix: a conceptual framework for program implementation and evaluation

Screening, Brief Intervention and Referral to Treatment (SBIRT) is a comprehensive, integrated, public health approach to the delivery of services to those at risk for the adverse consequences of alcohol and other drug use, and for those with probable substance use disorders. Research on successful SBIRT implementation has lagged behind studies of efficacy and effectiveness. This paper (1) outlines a conceptual framework, the SBIRT Program Matrix, to guide implementation research and program evaluation and (2) specifies potential implementation outcomes. Overview and narrative description of the SBIRT Program Matrix. The SBIRT Program Matrix has five components, each of which includes multiple elements: SBIRT services; performance sites; provider attributes; patient/client populations; and management structure and activities. Implementation outcomes include program adoption, acceptability, appropriateness, feasibility, fidelity, costs, penetration, sustainability, service provision and grant compliance. The Screening, Brief Intervention and Referral to Treatment Program Matrix provides a template for identifying, classifying and organizing the naturally occurring commonalities and variations within and across SBIRT programs, and for investigating which variables are associated with implementation success and, ultimately, with treatment outcomes and other impacts.

Screening, Brief Intervention and Referral to Treatment (SBIRT): rationale, program overview and cross‐site evaluation

Since 2003, the US Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment (SAMHSA, CSAT) has awarded 32 Screening, Brief Intervention and Referral to Treatment (SBIRT) grants to states, territories and tribal organizations to enhance services for persons with, or at risk for, substance use disorders. The grants supported an expansion of the continuum of care to include screening, brief intervention, brief treatment and referral to treatment in general medical and community settings. This paper describes the SAMHSA SBIRT program in the context of the scientific research that motivated its development, as well as the two cross-site evaluations that are the subject of subsequent papers in this Supplement. A narrative review of research evidence pertaining to SBIRT and of the cross-site evaluation design that made it possible to determine whether the SAMHSA SBIRT grant program achieved its intended aims. The 11 programs within the two cohorts of grant recipients that were the subject of the cross-site evaluations are described in terms of SBIRT service components, performance sites, providers, management structure/activities and patient/client characteristics. The US SAMHSA SBIRT program is an effective way to introduce a variety of new services that extend the continuum of care for substance-involved individuals, ranging from early intervention with non-dependent substance users to referral of more serious cases to specialized substance abuse treatment.

Financial sustainability of screening, brief intervention, and referral to treatment programs in emergency department settings (part of Economics of SBI symposium)

Background Substance misuse is a leading public health concern in the United States. Emergency departments (EDs) are thought to be an efficient environment in which to deliver screening, brief intervention, and referral to treatment (SBIRT) because a relatively high proportion of patients present with substance misuse. We developed a discrete event simulation model to track SBIRT program costs and revenues in an ED. The results inform the extent to which SBIRT can be sustained by insurance reimbursement in EDs.

Screening, Brief Intervention, and Referral to Treatment Education for Emergency Nurses in 5 Hospitals: Implementation Steps and Hurdles

The World Health Organization reported that mental and substance use disorders will surpass all physical diseases by 2020. 1 World Health Organization Promoting mental health: concepts, emerging evidence, practice. http://www.who.int/mental_health/evidence/en/promoting_mhh.pdf Google Scholar More than 23.5 million individuals (9.4%) aged 12 years or older have been identified as needing treatment for substance use problems, yet only 2.3 million (<10%) received care. 2 Leading change: a plan for SAMHSA’s roles and actions 2011–2014. http://store.samhsa.gov/product/SMA11-4629 Google Scholar , 3 Office of Applied Studies. Results from the 2008 national survey on drug use and health: national findings. NSDUH Series H-36, HHS Publication No. SMA 09–4434. Substance Abuse and Mental Health Services Administration Web site. http://www.oas.samhsa.gov. Published 2009. Accessed May 9, 2014. Google Scholar Furthermore, the total estimated societal costs of substance abuse in the United States amount to approximately $510.8 billion annually. 2 Leading change: a plan for SAMHSA’s roles and actions 2011–2014. http://store.samhsa.gov/product/SMA11-4629 Google Scholar , 4 Miller T Hendrie D Substance Abuse Prevention Dollars and Cents: A Cost-Benefit Analysis. Center for Substance Abuse Prevention, Substance Abuse and Mental Health Services Administration, Rockville, MD2009 Google Scholar Such alarming statistics regarding alcohol and other drug (AOD) problems are compounded by the untold deleterious impact of substance misuse on the lives of individuals, families, communities, and society. Excessive alcohol use accounted for approximately 88,000 deaths per year from 2006 to 2010 and accounted for 1 in 10 deaths among adults aged 20 to 64 years. 5 CDC features, data & statistics Alcohol deaths. http://www.cdc.gov/features/alcohol-deaths Google Scholar This impact has garnered the attention of health professionals who are escalating assessment skills and services to individuals regarding harmful AOD use. 6 Hankin A Daugherty M Bethea A Haley L The emergency department as a prevention site: a demographic analysis of substance use among ED patients. Drug Alcohol Depend. 2013; 130: 230-233 Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar , 7 Ong-Flaherty C Screening, brief intervention, and referral to treatment: a nursing perspective. J Emerg Nurs. 2012; 38: 54-56 Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar , 8 Désy P Perhats C Alcohol screening, brief intervention, and referral in the emergency department: an implementation study. J Emerg Nurs. 2008; 34: 11-19 Abstract Full Text Full Text PDF PubMed Scopus (52) Google Scholar , 9 Désy P Howard PK Perhats C Li S Alcohol screening, brief intervention, and referral to treatment conducted by emergency nurses: an impact evaluation. J Emerg Nurs. 2010; 36: 538-545 Abstract Full Text Full Text PDF PubMed Scopus (54) Google Scholar , 10 Barnard S Implementing an SBIRT (screening, brief intervention, and referral to treatment) program in the emergency department: challenges and rewards. J Emerg Nurs. 2009; 35: 561-563 Abstract Full Text Full Text PDF PubMed Scopus (6) Google Scholar , 11 Vadlamudi RS Adams S Hogan B Wu T Wahid Z Nurses’ attitudes, beliefs, and confidence levels regarding care for those who abuse alcohol: impact of educational intervention. Nurse Educ Pract. 2008; 8: 290-298 Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar , 12 Gonzalez Castro F Garginkel J Critical issues in the development of culturally relevant substance abuse treatments for specific minority groups. Alcohol Clin Exp Res. 2003; 27: 1381-1388 Crossref PubMed Scopus (42) Google Scholar Irene Kane is Associate Professor of Nursing, University of Pittsburgh School of Nursing, Pittsburgh, PA. Ann M. Mitchell is Professor of Nursing, University of Pittsburgh School of Nursing, Pittsburgh, PA. James Aiello is Project Associate, Institute for Research, Education and Training in Addictions, Pittsburgh, PA. Holly Hagle is Director, National SBIRT Addiction Technology and Transfer Center and Institute for Research, Education and Training in Addictions, Pittsburgh, PA. Dawn Lindsay is Director of Evaluation Services, Institute for Research, Education and Training in Addictions, Pittsburgh, PA. Kimberly S. Talcott is ELITE and SBIRT Project Manager, University of Pittsburgh School of Nursing, Pittsburgh, PA. Lynn Boucek is SBIRT Project Associate, University of Pittsburgh School of Nursing, Pittsburgh, PA.

An examination of the workflow process of the screening, brief intervention, and referral to treatment program

Background Substance abuse and dependence are widely recognized as widespread societal problems, and most people who engage in risky substance use do not recognize it as a problem. The Substance Abuse and Mental Health Services Administration (SAMHSA) launched the Screening, Brief Intervention, and Referral to Treatment (SBIRT) grant program in 2003 to identify, reduce, and prevent problematic use, abuse, and dependence on alcohol and illicit drugs among individuals who would not typically seek treatment. Following the evidence base, SBIRT programs were implemented in general health-care settings, with the aim of integrating behavioral health services in locations that provide an opportunity to identify risky patients and provide them with an appropriate level of treatment. In 2008, SAMHSA sponsored an evaluation of the SBIRT program among its third cohort of grantees. A key focus of the evaluation was to understand the SBIRT workflow process, or the process by which clients interact with health-care personnel to obtain SBIRT services. SBIRT has been implemented in many treatment settings, and each setting has adjusted the workflow process to meet its respective needs. This study focuses on the overall workflow process, adaptations, and key observations in emergency departments and ambulatory clinics.

Using process indicators to optimize service completion of an ED drug and alcohol brief intervention program

ObjectiveThe strongest evidence for effectiveness of screening, brief intervention, and referral to treatment (SBIRT) programs is in primary care settings. Emergency department (ED) studies have shown mixed results. Implementation of SBIRT into ED settings is complicated by the type of patients seen and the fast-paced, high-throughput nature of the ED environment that makes it difficult to reach patients flagged for SBIRT services. This study uses data from an ED-based SBIRT program to examine the relationship between screen-positive rate, ED patient flow, and SBIRT service delivery. MethodsData for the study (N = 67137) were derived from weekly reports extracted directly from one hospital’s electronic health record. Measures included time and day of patient entry, drug/alcohol screen result (positive or negative), and whether the patient was reached by SBIRT specialists. Factorial analysis of variance compared variations in screen-positive rates by day and time and the percentage of patients reached by SBIRT specialists during these periods. ResultsOverall, 56% of screen-positive patients received SBIRT services. Only 5% of patients offered SBIRT services refused. Day and time of entry had a significant interaction effect on the reached rate (F12,14166 =3.48, P < .001). Although patient volume was lowest between 11 pm and 7 am, screen-positive rates were highest during this period, particularly on weekends; and patients were least likely to be reached during these periods. ConclusionsWhen implementing an ED-based SBIRT program, thoughtful consideration should be given to patient flow and staffing to maximize program impact and increase the likelihood of sustainability.

Utilization of Pastoral Care Services for a Screening, Brief Intervention, and Referral-to-Treatment Program at an Urban Level I Trauma Center

Excessive alcohol consumption is currently the third leading cause of preventable death within the United States, accounting for roughly 80,000 deaths each year. 1 Maier RV Controlling alcohol problems among hospitalized trauma patients. J Trauma. 2005; 50: S1-S2 Crossref Scopus (19) Google Scholar Excessive alcohol consumption also takes a toll on hospitals and health care centers, specifically emergency departments and trauma units. Each year, over 20 million adults in the United States sustain injuries requiring emergency care, and 15% to 20% screen positive for alcohol. 2 Rockett IH Putnam SL Jia H et al. Assessing substance abuse treatment need: a statewide hospital emergency department study. Ann Emerg Med. 2003; 41: 802-813 Abstract Full Text Full Text PDF PubMed Scopus (84) Google Scholar , 3 Teplin LA Abram KM Michaels SL Blood alcohol level among emergency room patients: a multivariant analysis. J Stud Alcohol. 1989; 50: 441-447 PubMed Google Scholar , 4 Soderstrom CA Session 2: substance-abuse interventions—setting the stage for discussion. J Trauma. 2005; 59: S77-S79 Crossref PubMed Scopus (8) Google Scholar , 5 Hungerford DW Recommendations for trauma centers to improve screening, brief intervention, and referral to treatment for substance abuse disorders. J Trauma. 2005; 59: 537-542 Google Scholar These figures increase further within the trauma department, where up to half of all trauma accidents are linked to alcohol use (25%-50%). 4 Soderstrom CA Session 2: substance-abuse interventions—setting the stage for discussion. J Trauma. 2005; 59: S77-S79 Crossref PubMed Scopus (8) Google Scholar , 5 Hungerford DW Recommendations for trauma centers to improve screening, brief intervention, and referral to treatment for substance abuse disorders. J Trauma. 2005; 59: 537-542 Google Scholar , 6 Babor TF McRee BG Kassebaum PA Grimaldi PL Ahmed K Bray J Screening, Brief Intervention, and Referral to Treatment (SBIRT): toward a public health approach to the management of substance abuse. Subst Abus. 2007; 28: 7-30 Crossref PubMed Scopus (673) Google Scholar Tiffany L. Overton is Trauma Research Associate, JPS Health Network, Fort Worth, TX. Gary Williams is SBIRT Program Coordinator, JPS Health Network, Fort Worth, TX. Shahid Shafi is Consultant, JPS Health Network, Fort Worth, TX. Rajesh R. Gandhi is Trauma Medical Director, JPS Health Network, Fort Worth, TX.

Do we need an SBIRT program?

Drug use has an impact on physical and mental health. Quite often, patients attend accident and emergency (A&E) departments due to drug-use-related disorders, and this is why screening and brief intervention for substance use disorders are relevant in emergency room settings. Studies have shown that screening, brief intervention, and referral to treatment (SBIRT) programmes are effective in several medical settings, including A&E departments. Since most of the evidence has been gathered in the US, this study tries to identify the relevance of substance use disorders in a large Spanish A&E Department and the possible need to implement a SBIRT programme. All medical doctors on duty in a given day were asked prospectively about ward consultations attended during their 16 hours-shift. The questionnaire included information on patients’ substance use and if this was related to the medical visit, whether or not they thought the patient needed referral to an addiction specialist and their opinion on what may help them to improve the management of those patients. 194 patients were attended. 22 patients (11.3%) were reported as substance users. Only 2 were visited by the psychiatrist (1%). Alcohol (n=10), cannabis (n=3) and benzodiazepines (n=4) were the most reported drugs (n=10). Practitioners considered that support from an addiction specialist (8, 7/10) and specific training in the management of substance users (8, 2/10) as the most valuable aids. Availability of screening tools was somewhat less valued (7, 2/10). The number of patients who present to the A&E department with a drug related-problem is large, yet these patients are scarcely seen by the psychiatrist. Practitioners see training opportunities in the management of substance users and the availability of addiction specialists as the most valued aids. Regardless, the rate of patients presenting with substance use related disorders warrants further research and suggests the convenience to implement SBIRT programmes in A&E department settings.

Screening, brief intervention, and referral to treatment (SBIRT) implementation models and work flow processes: commonalities and variations

The Substance Abuse and Mental Health Services Administration (SAMHSA) sponsored a cross-site evaluation of the grantees of their Screening, brief intervention, and referral to treatment (SBIRT) program for alcohol and other drugs funded in 2008. As part of this evaluation, the cross-site evaluation team was tasked with understanding the implementation and service delivery protocols and work flow processes related to SBIRT service delivery. SBIRT programs have been implemented in a variety of different settings and performance sites, and each has adjusted the flow of SBIRT services to meet the needs of the particular setting. This presentation will focus on the variations in SBIRT program activities and work flow by three performance site types: (1) Emergency Departments; (2) Inpatient Hospitals; and (3) Outpatient Clinics. Descriptions of the service providers involved in the various SBIRT service components are presented.

Funding Medicaid codes for screening and brief intervention services: lessons learned

There is a growing body of evidence that screening, brief intervention, and referral to treatment (SBIRT) is effective in reducing drinking and substance use problems. Based on the outcomes from MOSBIRT, Missouri’s Substance Abuse and Mental Health Services Administration (SAMHSA)-funded SBIRT program, individuals receiving brief interventions show reductions in risky use, along with improvements in employment, housing, legal involvement and physical and mental health. As numerous studies indicate a cost savings of $3.81 to $5.60 for each dollar invested in screening for risky use, the most promising approach to sustaining SBIRT services in Missouri after SAMHSA support expires is to fund the state Medicaid codes already on the state’s fee schedule, thereby allowing for reimbursement of SBI services. To that end, an analysis of the Medicaid fee schedules of the 50 states and DC was conducted to determine which states currently have SBI Medicaid codes H0049 and H0050, as well as the American Medical Association’s Common Procedural Terminology (CPT) codes 99408 and 99409, on their schedules. The analysis indicated that 22 states have either the Medicaid or CPT codes with associated billing amounts on their Medicaid fee schedules. The average billing rate for screening is about $25 per unit, with rates of around $40 per unit for brief interventions. This information was presented to the Missouri governor’s budget office and resulted in rate setting and coverage of SBI services at federally qualified health centers and community mental health centers across the state. A rationale for supporting SBI services nationally is provided, along with recommendations for petitioning state budget offices to fund the Medicaid codes based on lessons learned from the MOSBIRT project.