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

SBIRT training: how do social work students compare to medical learners?

ABSTRACT Background: SBIRT (Screening, Brief Intervention, and Referral to Treatment) is an effective early intervention approach for individuals with substance misuse. The purpose of this study was to determine if medical learners are more adept at learning a brief substance use intervention compared to non-medical learners (e.g., social work students). The dissemination of SBIRT training among many helping professions can increase service delivery for substance use problems. Methods: A total of 2,488 participants completed SBIRT training, representing 15 different disciplines and over 20 different institutions. General linear models and paired t-tests were used to investigate the effects of SBIRT training on changes in knowledge and attitude of alcohol and drug use and satisfaction. Results: There were no statistical differences in the change of satisfaction, knowledge, and attitude between medical and non-medical discipline participants. Both medical and non-medical participants had greater improvement in attitude and knowledge scores post-training. Similar improvements in attitude, knowledge, and satisfaction were observed in all the health-care discipline participants. Discussion: SBIRT skills may be transferable to disciplines including non-prescribing professionals (e.g., social work, nursing, physical therapy, rehabilitation science, and pharmacy). In an effort to expand treatment, health-care training institutions adopt SBIRT as a core competency for professional practice.

Outcomes of an interprofessional SBIRT training program: Knowledge attainment and perceived competence for practice

Background: One way to address substance misuse is to train health professional students in Screening, Brief Intervention, and Referral to Treatment (SBIRT), an early intervention strategy. This study evaluated a semester-long, 50-hour elective SBIRT training that blended online coursework with interprofessional experiences. Medicine, nursing, pharmacy, and social work students completed an interprofessional standardized patient experience and completed a minimum of two interprofessional SBIRT experiences at community agencies. Methods: We analyzed longitudinal data from 197 students using structural equation modeling to examine gains in knowledge and perceived competence, as well as to test if background variables predicted 30-day application of SBIRT knowledge and skills, 30-day satisfaction’ 12-month frequencies of care for performing SBIRT; and number of SBIRT clients/patients served directly. Results: Overall, student SBIRT knowledge and perceived competence both increased by more than a standard deviation during the course. Students who experienced larger gains in perceived competence rated the course significantly higher in terms of relevance and usefulness and, in turn, served significantly more SBIRT clients/patients during the following year. We did not find evidence that intra-individual growth in knowledge impacted the degree to which students ultimately applied SBIRT components. Finally, students who had more previous training and experience related to substance abuse ultimately reported greater application of SBIRT knowledge and skills. Interprofessional differences included: At baseline, medicine students had significantly lower substance abuse education knowledge as compared to the other disciplines. Pharmacy and social work students were more likely to have had previous experience with motivational interviewing. Baseline perceived competence in applying SBIRT was higher in social work and nursing. Upon completion, pharmacy and medicine students had lower satisfaction with the course. Conclusions: These findings suggest that SBIRT courses can increase knowledge and perceived competence; moreover, student background characteristics, work settings, and experiences may have important effects on learning SBIRT.

A Pilot Study of Peer-to-Peer SBIRT Simulation as a Clinical Telehealth Training Tool During COVID-19.

Screening, Brief Intervention and Referral to Treatment (SBIRT), is an evidence-based approach to screening and early intervention for those at risk of substance use disorders. With the ongoing health concerns related to COVID-19, there is an increased need for social workers who can competently deliver evidence-based interventions, such as SBIRT, via telehealth. Due to the COVID-19 pandemic, traditional SBIRT training approaches using face-to-face (FTF) instruction and FTF simulated practice may not be a safe or feasible way to develop students’ SBIRT- related skills. This study explores 35 social work graduate students’ experiences of learning SBIRT skills in a remote learning format and subsequently delivering a SBIRT intervention to a live “client” via a peer-to-peer simulated telehealth session. Overall, students reported that the shift from FTF to remote learning made learning SBIRT skills difficult, and that providing brief intervention and referral was the most difficult step of the simulated SBIRT telehealth intervention. Qualitative feedback indicates that overall, students found the simulated telehealth sessions a valuable learning experience, but also reported that richer educational experiences would have resulted from additional practice opportunities and real time feedback. Implications for future research, simulation-based education and clinical practice are discussed.

Reliability of the Clinical SBIRT Proficiency Checklist for Medical Students.

The Substance Abuse and Mental Health Services Agency (SAMHSA) recognizes Screening, Brief Intervention, and Referral to Treatment (SBIRT) as a comprehensive approach to identify individuals with or at risk of developing substance use disorders. Few studies have explored tools for assessing medical student SBIRT competencies. First-year medical students trained in SBIRT and Motivational Interviewing completed an Objective Structured Clinical Encounter (OSCE) with a standardized patient who presented with substance use. Six trained members of our research team reviewed 118 OSCE videos utilizing the Clinical SBIRT Proficiency Checklist (CSPC); additionally 30% (n = 37) were randomly selected for pair-review to examine interrater reliability. Interrater reliability was Cohen's kappa of 0.89 for the presence of SBIRT skills and 0.39 agreement for the absence of skills. Across the videos, the most commonly observed skill was screening for alcohol use (75.4%, 95%CI 66.5, 84.3), while organizing referral for treatment was infrequently observed (36.4%, 95%CI 22.0, 50.8). The CSPC is a reliable tool for assessing medical student SBIRT skills on an OSCE. These findings provide insights on medical student SBIRT knowledge and provides a practical tool for providing early clinically relevant feedback on these skills.

Distance Versus On-Site Educational Strategies for Competency-Based Screening, Brief Intervention, and Referral to Treatment Education.

Although the individual and public health consequences of alcohol and drug use are substantial, nursing education programs generally lack content on addiction. The goal of this evaluation was to compare the initial outcomes of on-site versus distance methods for training graduate nurse practitioner students in Screening, Brief Intervention, and Referral to Treatment (SBIRT) for substance use. A nonrandomized two-group pretest-posttest design was used to compare knowledge, attitudes, and skills learning outcomes between on-site (n = 45) and distance (n = 18) family or adult/geriatric Master of Science in Nursing nurse practitioner students receiving SBIRT training. Overall, students increased their knowledge, attitudes, and confidence about screening and intervening with patients who use substances; showed a high level of skills in conducting a brief intervention to motivate patients to reduce their substance use; and were highly satisfied with the education provided. Counseling confidence and gains in knowledge were similar across groups. Compared with distance students, on-site students reported significantly more positive attitudes about their role adequacy, role legitimacy, and role support for intervening with alcohol use and about their role support for intervening with drug use. On-site students had greater training satisfaction, but distance students' skills assessed through standardized patient interactions were significantly better. Both on-site and distance training were effective instructional methods to increase SBIRT knowledge and skills. However, differences in attitudes, training satisfaction, and skills demonstration should be taken into account when designing addiction training using distance technologies.

Alcohol and drug screening and brief intervention behaviors among advanced practice registered nurse (APRN) students in clinical settings

Previous research on training health professionals to identify and address unhealthy alcohol and drug use in patients through screening, brief intervention, and referral to treatment (SBIRT) has found that training increases knowledge about substance use and increases students' confidence in addressing substance use in patients. To date, however, there is little information on how health professional students integrate SBIRT into individual practice. Within a U.S. SBIRT training consortium, advanced practice registered nurse (APRN) students were required to practice SBIRT in clinical settings and complete assessment logs for each patient screened. Logs documented results from single item alcohol & drug screening questions; AUDIT or DAST responses; brief intervention (BI)/referral to treatment (RT) steps completed and patients' responses. 113 APRN students completed logs on 538 patients (mean age 44; SD 15.0; 53.5% female). Positive single question alcohol screens were more frequent than positive single question drug screens (55.3% vs. 25.5%). More than one third (36%) of the logs included high-risk AUDIT/DAST scores. The most utilized BI components were discussions regarding consequences of use (76%) and safe levels of use (70%), while the most utilized RT steps included referral to a mutual help group (15%) or a specialty treatment program (8%). Positive screening rates found by APRN students were higher than reported rates in most clinical settings. The logs also demonstrated that APRN students employed many of the SBIRT skills they were taught while also helping identify underutilized SBIRT steps, which may be addressed specifically in future SBIRT trainings.

Evaluation of Alcohol Screening, Brief Intervention, and Referral to Treatment (SBIRT) Training for Social Workers

Social work education is well positioned for workforce development initiatives that prepare practitioners to use Screening, Brief Intervention, and Referral to Treatment (SBIRT) with people at risk for alcohol use disorders. This article presents preliminary process and outcome evaluation data from the first year of a three-year grant which suggests that the training is acceptable and results in significant changes in trainees’ knowledge, attitudes, and self-perceived SBIRT skills. Training was embedded within the curricula of an urban school of social work, which includes a Bachelor of Social Work (BSW) program and a single-concentration clinical Master of Social Work (MSW). Trainees included social work students (n = 134) and field instructors (n = 38). More than 90% of students were very satisfied or satisfied with the training, and 100% of field instructors rated the training as excellent or good. Students demonstrated significant changes from pre- to posttraining in substance use knowledge, confidence in SBIRT skills, and attitudes about integrating SBIRT into practice. Field instructors reported increased confidence in screening. Integrating SBIRT training into social work curriculum is a promising method of developing a workforce that can effectively prevent and alleviate alcohol misuse.

SBIRT Training in Social Work Education: Evaluating Change Using Standardized Patient Simulation

A grand challenge for social work is addressing widespread public health problems of alcohol misuse. MSW students (n = 83) received Screening, Brief Intervention, and Referral to Treatment (SBIRT) training through didactic sessions, role plays, and pre–post videotaped standardized patient (SP) interactions. SBIRT knowledge, self-reported practice behaviors, and confidence were assessed at pretest, 30 days, and 6 months posttest. Videos were coded to assess intervention-adherent behaviors. General linear mixed models analyzed changes. Participants demonstrated increased adherence to SBIRT behaviors, and knowledge, skills, and confidence increased posttraining. Findings suggest SBIRT training increases students’ capacity to implement evidence-based interventions designed to reduce alcohol misuse.

Teaching residents screening, brief intervention, and referral to treatment (SBIRT) skills for alcohol use: Using chart-stimulated recall to assess curricular impact

ABSTRACTBackground: Screening, brief intervention, and referral to treatment (SBIRT) improves identification and intervention for patients at risk for developing an alcohol use disorder (AUD). Residency curriculum is designed to teach SBIRT skills, but resources are needed to promote skill implementation. The electronic health record (EHR) can facilitate implementation through integration of decision-support tools. The authors developed electronic tools to facilitate documentation of alcohol assessment and brief intervention and to reinforce skills from an SBIRT curriculum. This prospective cohort study assessed primary care internal medicine residents' use of SBIRT skills and EHR tools in practice using chart-stimulated recall (CSR). Methods: Postgraduate year 2 and 3 residents received a 5-hour SBIRT curriculum with skills practice and instruction on SBIRT electronic tools. Participants were then given a list of their patients seen in a 1-year period who were drinking at/above the recommended limit. Trainees selected 3 patients to review with a faculty member in a CSR. Faculty used a 24-item chart checklist to assess application of SBIRT skills and electronic tool use and met with residents to complete a CSR interview. CSR interview notes were analyzed qualitatively to understand application of SBIRT skills and EHR tool use. Results: Eighteen of 20 residents participated in the CSR, and 5 faculty reviewed 46 patient charts. Residents documented alcohol use (84.2% of charts) and assessment of quantity/frequency of use (71.0%) but were less likely to document assessment for an AUD (34%), an appropriate plan (50.0%), or follow-up (55%). Few residents used EHR tools. Residents reported barriers in addressing alcohol use, including lack of knowledge, patient barriers, and time constraints. Conclusions: More intensive training in SBIRT with opportunities for practice and feedback may be necessary for residents to consistently apply SBIRT skills in practice. EHR tools need to be better integrated into the clinic workflow in order to be useful.

Residents' experience of screening, brief intervention, and referral to treatment (SBIRT) as a clinical tool following practical application: A mixed-methods study

ABSTRACTBackground: Screening, brief intervention, and referral to treatment (SBIRT), an evidence-based validated system for providing early detection and brief treatment of substance use disorders, has been widely used in the training of medical residents across specialties at a number of sites. This article investigates the effectiveness of SBIRT training during short-term follow-up at Albany Medical Center, one of the initial Substance Abuse and Mental Health Services Administration (SAMHSA) grantees. Methods: Training outcomes were measured by training satisfaction following opportunities to apply SBIRT skills in clinical work, the rate at which these techniques were applied in clinical work, and the degree to which residents felt that the SBIRT training provided skills that were applicable to their practice. We examined differences in learning experience by postgraduate year and by program, and conducted a qualitative analysis in a convergent parallel mixed-methods design to elucidate barriers encountered by residents upon using SBIRT techniques in clinical practice. Results: Residents remained highly satisfied with the training at 4-month follow-up, with 80.1% reporting that they had used SBIRT skills in their clinical work. Use of SBIRT techniques was high at 6-month follow-up as well, with 85.9% of residents reporting that they regularly screened their patients for substance use, 74.4% reporting that they had applied brief intervention techniques, and 78.2% indicating that SBIRT training had made them overall more effective in helping patients with substance use issues. Differences in application rates and satisfaction were found by specialty. Qualitative analyses indicated that residents encountered patient readiness and specific contextual factors, such as time constraints, externally imposed values, and clinical norms, as barriers to implementation. Conclusions: Despite encountering obstacles such as time constraints and patient readiness, residents utilized many of the skills they had learned during SBIRT training in clinical practice and reported finding these skills useful in their management of patients with substance use issues.

Multispecialty screening, brief intervention, and referral to treatment (SBIRT) training in an academic medical center: Resident training experience across specialties

ABSTRACTBackground: The Substance Abuse and Mental Health Services Administration (SAMHSA) has recently begun to fund programs that train medical residents on how to utilize an evidence-based validated system known as screening, brief intervention, and referral to treatment (SBIRT) for providing early detection and brief treatment of unhealthy substance use. This paper investigates training outcomes of multispecialty SBIRT training at one such program at Albany Medical Center (AMC), one of the initial SAMHSA grantees. Methods: Training outcomes were measured across 3 domains of learning: trainee satisfaction, acquired knowledge, and perceived usefulness. The authors explored differences in learning experience by postgraduate year and by specialty. Results: Overall, residents were highly satisfied with the training, and learning outcomes met objectives. Residents' ratings of usefulness did not vary by program year. However, the results indicate that relative to residents in other programs, residents in psychiatry and pediatrics found the training components significantly more useful, whereas emergency medicine residents found training components to have less utility. Residents who found the training relevant to their daily work were more satisfied and more receptive to SBIRT training overall, which may help explain difference scores by program. Conclusions: Residents were highly satisfied with SBIRT skills training, although ratings of usefulness varied by residency program. Specialization by program and on-site modeling by senior faculty may enhance trainee satisfaction and perceived usefulness.

Advanced practice nursing students’ use of screening and brief intervention in the clinical setting

Introduction More than 30% of US adults are estimated to drink at risky levels or meet criteria for harmful or dependent alcohol use. Screening, brief intervention and referral to treatment (SBIRT) in primary care settings is recommended and nurses, particularly advanced practice nurses (nurse practitioners), are being called upon to perform SBIRT for alcohol. This study assessed if knowledge, attitudes, and beliefs about SBIRT, evaluated after a three-part, educational training, predicted whether 21 family nurse practitioner (FNP) students screened for alcohol use during subsequent patient encounters in their clinical practica. Objectives Learners will be able to: – describe the general purpose and procedures of SBIRT; – identify three strategies for integrating SBIRT into current practice setting. Aims To help in development of SBIRT skills, the Substance Abuse and Mental Health Services Administration expanded training grant opportunities in 2013, for education programs to multiple groups of medical professionals. Findings from this study are presented to show the effectiveness of the training for nursing professionals. Method Immediately following training, students completed a survey and then documented implementation of SBIRT during their clinical practica. Results Students who reported higher levels of perceived Competence in their post-training surveys were more likely to screen patients for alcohol use in their clinical practica settings. Conclusion Screening for alcohol use and identifying patients at risk for or engaged in hazardous drinking meet important NP practice competencies. Further research is needed to explore training programs that specifically emphasize activities to increase competence, knowledge, and comfort regarding SBIRT.

Impact of a multicomponent screening, brief intervention, and referral to treatment (SBIRT) training curriculum on a medical residency program

ABSTRACTBackground: Substance-related disorders are a growing problem in the United States. The patient-provider setting can serve as a crucial environment to detect and prevent at-risk substance use. Screening, brief intervention, and referral to treatment (SBIRT) is an integrated approach to deliver early intervention and treatment services for persons who have or are at risk for substance-related disorders. SBIRT training components can include online modules, in-person instruction, practical experience, and clinical skills assessment. This paper will evaluate the impact of multiple modes of training on acquisition of SBIRT skills as observed in a clinical skills assessment. Methods: Residents were part of an SBIRT training program, from 2009 through 2013, consisting of lecture, role-play, online modules, patient encounters, and clinical skills assessment (CSA). Differences were assessed across satisfactory and unsatisfactory CSA performance. Results: Seventy percent of the residents satisfactorily completed CSA. Demographics, type of components completed, and number of components completed were similar among residents who demonstrated satisfactory clinical skills compared with those who did not. All components of the training program were accepted equally across specialties and resident matriculation cohorts. Conclusion: The authors conclude that the components employed in SBIRT training do not have to be numerous or of a particular mode of training in order to see observable demonstration of SBIRT skills among medical residents. Thus, residency educators who have limited time or resources may utilize as few as 1 mode of training to effectually disseminate SBIRT skills among health care providers. As SBIRT continues to evolve as a promising tool to address at-risk substance-related disorders, it is critical to train medical residents and other health professionals.

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.

Online Versus In-Person Screening, Brief Intervention, and Referral to Treatment Training in Pediatrics Residents.

Pediatricians underestimate the prevalence of substance misuse among children and adolescents and often fail to screen for and intervene in practice. The American Academy of Pediatrics recommends training in Screening, Brief Intervention, and Referral to Treatment (SBIRT), but training outcomes and skill acquisition are rarely assessed. We compared the effects of online versus in-person SBIRT training on pediatrics residents' knowledge, attitudes, behaviors, and skills. Forty pediatrics residents were randomized to receive either online or in-person training. Skills were assessed by pre- and posttraining standardized patient interviews that were coded for SBIRT-adherent and -nonadherent behaviors and global skills by 2 trained coders. Thirty-two residents also completed pre- and postsurveys of their substance use knowledge, attitudes, and behaviors (KABs). Two-way repeated measures multivariate analyses of variance (MANOVAs) and analyses of variance (ANOVAs) estimates were used to assess group differences in skill acquisition and KABs. Findings indicated that both groups demonstrated skill improvement from pre- to postassessment. Results indicated that both groups increased their knowledge, self-reported behaviors, confidence, and readiness with no significant between-group differences. Follow-up univariate analyses indicated that, while both groups increased their SBIRT-adherent skills, the online training group displayed more "undesirable" behaviors posttraining. The current study indicates that brief training, online or in-person, can increase pediatrics residents' SBIRT skills, knowledge, self-reported behaviors, confidence, and readiness. The findings further indicate that in-person training may have incremental benefit in teaching residents what not to do.

Innovative approaches to integrating screening, brief intervention, and referral to treatment training into nursing education and practice in Colorado

Nurses play a critical role in integrating screening, brief intervention, and referral to treatment (SBIRT) services as standard of care in healthcare settings. Nurses are well positioned to deliver SBIRT services because of their extended patient contact and existing skill sets in health promotion, communication, and patient education. Patients consistently rate nurses in population-wide surveys to be the most trusted professional group in the United States. Data collected from SBIRT initiatives funded by the Substance Abuse and Mental Health Services Administration in the United States indicate the vast majority of SBIRT service providers are nurses, social workers, and counselors. While nurses are key to deliver SBIRT services, specific training and preparation is necessary. This presentation will review evidence and rationale that support nurse-implemented SBIRT and will describe three models employed by the SBIRT Colorado initiative to integrate SBIRT into nursing academic preparation as well as nursing practice across diverse settings. The models include: 1) in-person skills-based training; 2) rapid improvement activities; and 3) interactive, online e-learning technology called “SBIRT Substance Use NursingMentor™.” The online training uses computational linguistics, search and streaming media to teach SBIRT skills through engaging simulated interactions. The SBIRT Substance Use NursingMentor was developed as a collaborative effort between MedRespond, Peer Assistance Services, Inc., and NORC at the University of Chicago. Quantitative and qualitative data collected from nurse training participants will be described. Pilot test results from nurses who participated in the online training demonstrated an increase in knowledge, awareness, and understanding of risky drinking, illicit substance use, and related consequences. Data collected from metrics integrated into the online module launched in May 2013 will be analyzed to evaluate the use of e-learning technologies to provide skill-based SBIRT competency training. Presenters will discuss recommendations that indicate how to target and tailor training for nurses for effective SBIRT dissemination.

Evaluation of a Pilot Training Program in Alcohol Screening, Brief Intervention, and Referral to Treatment for Nurses in Inpatient Settings

Alcohol screening, brief intervention, and referral to treatment (SBIRT) is a set of clinical strategies for reducing the burden of alcohol-related injury, disease, and disability. SBIRT is typically considered a physician responsibility but calls for interdisciplinary involvement requiring basic SBIRT knowledge and skills training for all healthcare disciplines. The purpose of this pilot study was to design, implement, and evaluate a theory-driven SBIRT training program for nurses in inpatient settings (RN-SBIRT) that was developed through an interdisciplinary collaboration of nursing, medical, and public health professionals and tailored for registered nurses in the inpatient setting. In this three-phase study, we evaluated (1) RN-SBIRT's effectiveness for changing nurses' alcohol-related knowledge, clinical practice, and attitudes and (2) the feasibility of implementing the inpatient curriculum. In a quasi-experimental design, two general medical units at our facility were randomized to receive RN-SBIRT or a self-directed Web site on alcohol-related care. We performed a formative evaluation of RN-SBIRT, guided by the RE-AIM implementation framework. After training, nurses in the experimental condition had significant increases in Role Adequacy for working with drinkers and reported increased performance and increased competence for a greater number of SBIRT care tasks. Despite some scheduling challenges for the nurses to attend RN-SBIRT, nurse stakeholders were highly satisfied with RN-SBIRT. Results suggest that with adequate training and ongoing role support, nurses in inpatient settings could play active roles in interdisciplinary initiatives to address unhealthy alcohol use among hospitalized patients.

Training health-care practitioners in screening, brief intervention, and referral to treatment using standardized approaches and expert coaching

Skill acquisition and maintaining fidelity to a practice requires ongoing monitoring and performance feedback in addition to initial training. This paper describes an evaluation of a training and coaching model employed for the Texas and Georgia screening, brief intervention, and referral to treatment (SBIRT) programs, funded by the US Substance Abuse and Mental Health Services Administration. Both programs were both implemented in large community medical settings that included hospital emergency departments, trauma and inpatient services, and primary care. We describe the specialist training processes with an emphasis on our web- and phone-based expert coaching model and standardized training programs. Specialists who received the multifaceted training package demonstrated significant improvements in SBIRT skills during a half-day standardized patient activity and over 12 months of coaching as measured by the Motivational Interviewing Treatment Integrity (MITI) coding system and coaching evaluations. Videotaped recordings of four standardized patient training sessions for 20 randomly selected trainees were coded by an expert external coder using the MITI-3 coding system. Trainees made significant improvements in evocation (p = 0.004), collaboration (p = 0.003), direction (p = 0.030), empathy (p = 0.029), spirit (p = 0.008), and in percentage of MI-adherent speech (p = 0.035). Further, 148 quarterly reports were examined for those trainees who received at least 12 months of coaching. Thirty-seven trainees (17 from Texas and 20 from Georgia) were included in these analyses. Trainee global ratings on spirit (Texas, p = 0.026; Georgia, p = 0.002) and empathy (Texas, p = 0.012; Georgia, p = 0.001) improved during the four quarters. In addition, MI-behavior ratings for both sites showed improvement at some point over the four quarters analyzed (p < 0.05). This study adds evidence to previous findings indicating that progressive feedback and coaching enhance SBIRT skill development.

Web-Based SBIRT Skills Training for Health Professional Students and Primary Care Providers

ABSTRACT The authors have developed and assessed 2 innovative, case-based, interactive training programs on substance abuse, one for health professional students on alcohol and one for primary care providers on screening, brief intervention, and referral to treatment (SBIRT). Both programs build skills in substance abuse SBIRT. Real-world effectiveness trials involving medical students (n = 10) and nursing students (n = 60) were completed; trials involving primary care providers (n = 65) are in progress during 2011. Medical students and nursing students had similarly low baseline scores on assessments that benefited from training: knowledge, confidence, and clinical performance measured via an online standardized patient case and encounter note all improved post-training. Preliminary results indicate that practicing providers improved on knowledge, attitude, and brief intervention skill performance after a similar training. Results suggest that SBIRT skills can be improved with this model for case-based interactive training programs, and thus, that this training has the potential to impact patient outcomes.

Pennsylvania SBIRT Medical and Residency Training: Developing, Implementing, and Evaluating an Evidenced-Based Program

ABSTRACT Medical residents do not receive adequate training in screening, brief intervention, and referral to treatment (SBIRT) for alcohol and other drug use disorders. The federally funded Pennsylvania SBIRT Medical and Residency Training program (SMaRT) is an evidence-based curriculum with goals of training residents in SBIRT knowledge and skills and disseminating the curriculum throughout the medical residency programs. The SMaRT program collaborates with 4 hospital systems and 7 residency sites, with a target of 1147 residents to be trained. This brief report describes the design of the SMaRT program curriculum, implementation across settings and programs, and its evaluation methods.