Culturally Competent SBIRT: An Evidence-Informed

Clinical Case StudyKhanh Ly, BS

Derek Satre, PhDJennifer Manuel, PhDSandra Larios, PhDScott Steiger, MD

*Jason Satterfield, PhDUniversity of California

San Francisco

Roadmap SBIRT overview: Summary of

recommendations Literature review: Cultural Competence Notions of “competence” Clinical case presentation

Illustrations of adaptations

Funding: SAMHSA/CSAT grant #1U79TI025404-01 awarded to Dr. Satterfield

No Conflicts of Interest to Report

Learning Objectives To understand how cultural

considerations can impact SBIRT delivery in primary care.

To illustrate specific SBIRT adaptations to better serve diverse patients.

To explore cultural factors such as family and community values that may influence motivation to reduce substance use.

SBIRT Recommendations USPSTF recommends annual, universal

screening for alcohol in adult primary care (Whitlock et al., 2004)

Positive screen followed by more in depth assessment for severity and possible diagnosis

Brief intervention and/or referral to treatment with scheduled F/U

SBIRT and Diverse Patients?

Screening: n=13 studies Language, literacy Stigma, privacy, power AUDIT has broad support, available in the

most languagesSensitivity remains high but specificity is

lowered especially some Chinese translations

ASSIST – internationally developed (WHO)

SBIRT and Diverse Patients?

BI: n=8 studies (usually 1-2 brief discussions) Motiv Interviewing (or MI “spirit”) most

commonly used. Meta-analysis: Hettema et al., 2005

BNI – ED settings (e.g. Bernstein; D’Onofrio)+ results for cocaine, opioids, alcohol

+/- for PC illicit drugs (Saitz, Roy-Bryne, Gelberg)

Culture, Social and Structural Contexts

Culture Characteristics Language, beliefs, customs, food, music,

communication style, health practices Education

Literacy, health literacy Geography, neighborhoods Resources, “structures” that influence the

experience of health, illness, and health interventions

Notions of “Competence” Early approaches to cultural

competence The checklist approach

Middle approaches General skills

Current approaches Structural competence (Hansen) Critical consciousness (Lypson)

Clinical Case: Ronaldo(Satre et al., 2015)

47yo married man seeing PCP HPI: Back pain after alcohol-related fall Soc Hx: Born in Honduras, bilingual, HS

education + trade school, 2 adult daughters, social pressure to drink

Screening and Assessment AUDIT = 17 (at risk/hazardous) Motiv Interviewing, DSM Dx = SUD, mild?

SUD and Tx Epidemiology Some studies suggest substance use

disorders are over-represented in Latino men (SAMHSA, 2013)

SUD treatment is underutilized(by everyone) but especially by racial and ethnic minorities (Cook & Alegria, 2011)

Hispanic men have more problems related to alcohol compared to whites (Caetano, 2003)

Notions to keep in mind First – language and literacy Second – power, trust, respect Third – culturally tied considerations

familismo espiritismo machismo respeto

Clinical Case Conclusion What did Ronaldo’s PCP do? She assessed acculturation and patient

preferences re interview language and style.

She used familismo, respeto, and machismo to facilitate discussion of material and build motivation

Negotiated a reduction in drinking and approach to managing pain

Culturally “Competent” SBIRT?

Cultural and structural sensitivity seem achievable for screening and BI

There are few studies on exactly how to adapt/improve interventions

Better attention to cultural and structural factors may be a missing “active ingredient” for BI’s

Thank YouJason.Satterfield@ucsf.edu

UCSF Collaborative Education Project Kathy Julian Sandra Larios Khanh Ly Jennifer Manuel Ellie McCance-Katz Gina Moreno-John

Pat O’Sullivan Derek Satre Scott Steiger Janice Tsoh Maria Wamsley Patrick Yuan