angela mcclellan, ocps i director coalition for a drug-free mahoning county september 5, 2013
TRANSCRIPT
SBIRT
Angela McClellan, OCPS IDirectorCoalition for a Drug-Free Mahoning County
September 5, 2013
A Wise Judge Once Told Me…
http://pointsadhsblog.wordpress.com/2013/05/20/9832/
Continuum of care
Source: http://www.jmir.org/2010/5/e60/, http://captus.samhsa.gov/prevention-practice/prevention-and-behavioral-health/behavioral-health-lens-prevention/3
Prevention Continuum of Care Taxonomy: Problem ID & Referral
Problem Identification and Referral is an AOD prevention
strategy that refers to intervention oriented prevention
services that primarily targets indicated populations to
address the earliest indications of an AOD problem. Services
by this strategy focus on preventing the progression of the
problem.
This strategy does not include clinical assessment and/or
treatment for substance abuse and dependence.Source: Ohio Department of Mental Health and Addiction Services Prevention Continuum of Care Taxonomy
Problem ID & Referral: Direct Services Interventions that directly serve the customer and allow for two-way interaction at that instance.
Intervention, Brief Screening and Referral Services Drug-Free Workplace Programs/EAP Programs Student Assistance Program Services Support Groups Consumer Advocacy and Linkage Risk Reduction Activities
Source: Ohio Department of Mental Health and Addiction Services Prevention Continuum of Care Taxonomy
The Current Model:A Continuum of Substance Use
6
Abstinence
Dependence
Responsible Use
Source: Jim Aiello, MA, Med, Institute for Research, Education and Training in Addictions (IRETA), (www.ireta.org)
The outdated model defines a substance use problem as…
Dependence
7Source: Jim Aiello, MA, Med, Institute for Research, Education and Training in Addictions (IRETA), (www.ireta.org)
8
The SBIRT model defines a substance use problem as…
Excessive Use
Source: Jim Aiello, MA, Med, Institute for Research, Education and Training in Addictions (IRETA), (www.ireta.org)
The SBIRT ModelA Continuum of Substance Use
9
Abstinence
Experimental Use
Social Use
Binge Use
Abuse
Dependence
Source: Jim Aiello, MA, Med, Institute for Research, Education and Training in Addictions (IRETA), (www.ireta.org)
10
Drinking Behavior Intervention Need
4%
25%
71%
Dependent
HazardousHarmfulSymptomatic
Low Risk orAbstinence
No Intervention; screening and feedback only
Brief Intervention orBrief Treatment
Brief Intervention and Referral for additional Services
Source: Jim Aiello, MA, Med, Institute for Research, Education and Training in Addictions (IRETA), (www.ireta.org)
What Is SBIRT?
SBIRT is a comprehensive, integrated, public health approach to the
delivery of early intervention and treatment services for persons with
substance use disorders, as well as those who are at risk of
developing these disorders.
Primary care centers, hospital emergency rooms, trauma centers, and
other community settings provide opportunities for early intervention
with at-risk substance users before more severe consequences occur.
Source: http://www.samhsa.gov/prevention/sbirt/
What is it REALLY?
SBIRT is a tool to detect risky or
hazardous substance use before
the onset of abuse or dependence,
early intervention, and treatment
for people who have problematic or
hazardous [alcohol] problems.
http://www.samhsa.gov/prevention/sbirt/SBIRTwhitepaper.pdf
Why SBIRT?
Screening quickly assesses the severity of substance use and identifies the appropriate level of treatment.
Brief intervention focuses on increasing insight and awareness regarding substance use and motivation toward behavioral change.
Referral to treatment provides those identified as needing more extensive treatment with access to specialty care.
Source: http://www.samhsa.gov/prevention/sbirt/
Six Characteristics of SBIRT
1. It is brief (e.g., typically about 5-10 minutes for brief interventions; about 5 to 12 sessions for brief treatments).
2. The screening is universal.
3. One or more specific behaviors are targeted.
4. The services occur in a public health or other non-substance abuse treatment setting.
5. It is comprehensive (comprised of screening, brief intervention/treatment, and referral to treatment).
6. Strong research or experiential evidence supports the model’s effectiveness.
http://www.samhsa.gov/prevention/sbirt/SBIRTwhitepaper.pdf
EFFECTIVENESS OF SBIRT AND ITS COMPONENTS FOR BEHAVIORAL HEALTH CONDITIONS Screening Brief
Intervention ¹ Brief
Treatment ² Referral to Treatment
Evidence for Effectiveness of
SBIRT Alcohol Misuse/Abuse √ √ √ √ Comprehensive
SBIRT effective (Category B
classification, USPSTF)
Illicit Drug Misuse/Abuse √ * * √ Growing but
inconsistent evidence
Tobacco Use
√
√
√
√
Effective brief approach consistent with SBIRT (USPSTF;
2008 U.S. Public Health Service (PHS)
Clinical Practice Guideline
Depression
√ - √ √ No evidence to date for depression
Trauma/Anxiety
Disorders
√
*
-
√
No evidence to date for trauma/anxiety
disorders
Key: √ Evidence for effectiveness/utility of component
* Component Demonstrative to show Promising Results
- Not Demonstrated and/or Not Utilized
¹Brief intervention as defined by the SAMHSA SBIRT program involved 1-5 sessions lasting 5 minutes to an hour. Among SBIRT grantees funded by SAMHSA, about 15% of patients receive scores that indicate a brief intervention. ²Brief treatment as part of SBIRT involves 5-12 sessions, lasting up to an hour. Amount State SBIRT grantees funded by SAMHSA, about 3% of patients receive a score that dictates a brief treatment.
1. Use of Brief, Validated, Universal Pre-Screening / Screening Tools
AUDIT Alcohol Use Disorders identification Test
AUDIT-C Alcohol Use Disorders Identification Test - Consumption
DAST Drug Abuse Screening Test
ASSIST Alcohol, Smoking, Substance, Involvement, Screening Test
CAGE Cut Down, Annoyed, Guilty, Eye Opener
* Also Single Question Method has been found to be effective.
2. Relatively Easy to Use By Diverse Providers
The SBIRT approach is easy to learn relative to other behavioral treatment techniques
It can be implemented by diverse health professionals, e.g. Physicians, Nurses, Social Workers, Health Educators, Prevention Specialists, Paraprofessionals, etc.
3. Incorporation of strong referral linkages to specialty treatment
The goal is to provide a quick hand off to specialty treatment if the Primary Care site cannot provide more intensive service.
Close tracking to confirm patient compliance with treatment is critical to good health care provision.
SBIRT Flow Chart
Screening
Low Risk
No Further Intervention
Moderate Risk
Brief Intervention
Moderate to High Risk
Brief Intervention
Severe Risk to Dependency
Referral to Specialty Treatment
It Starts With One Person
Doug Wentz, M.A., O.C.P.S. IICommunity Services Director
One Health Ohio
Federally Qualified Healthcare Center Began SBIRT with patients at one site in Youngstown, OH. (Five other sites in region serve as control group).
Social Worker/Prevention Specialist (former CDCA) to screen Preliminary results:
99% of clients voluntarily participate in the screening 70% of 1-Question screens are positive for AOD or depression
Diagnostic rates more than doubled (vs. increase of 1.6% at control location)
“So what does this have to do with my coalition?”
We have the Know How! Coalitions have connections in all twelve sectors
“New” definition of problem has been our definition all along
Families
Service Organiza-
tions
Social Services
Youth
Faith Commu-
nity
BusinessesEducation
Media
Government
Medical Services
Law En-forcement
Senior Citizens
“So what does this have to do with my coalition?”
Information Dissemination Training Networking Bringing new faces to the table Grants and other Funding Training Revenue
The Truth Fairy
FAQs How do we pay for this? No, seriously, how do we pay for this? So what, this isn’t our target substance? Have you ever tried to get doctors to attend anything? <<sarcasm font>>
How can we/our collaborative partners get paid for this?
How do we get trained to be trainers? Where can I find resources?
SBIRT Resources www.ireta.org www.attcnetwork.org/sbirt www.sbirtonline.org www.niaa.nih.gov www.HealthTeamWorks.org www.drugabuse.gov www.samhsa.gov/prevention
/sbirt
Angela McClellan, OCPS IDirectorCoalition for a Drug-Free Mahoning [email protected](ofc) 330.953.3212 (cell) 330.771.7732
Doug Wentz, MA, OCPS IICommunity Services DirectorNeil Kennedy Recovery [email protected](ofc) 330.792.4724 x 7128 (cell) 330.509.3650