Screening for substance use during pregnancy using an SBIRT framework

Gratefully reproduced with permission from Northern New England Perinatal Quality Improvement Network http://www.nnepqin.org/a-toolkit-for-the-perinatal-care-of-women-with-opioid-use-disorders/

reviewed: 5/8/2018

Patient instructed by to complete electronic

screening tool on tablet / laptop

Support staff leaves clinic room during electronic

screening

Patient takes brief

screen

Support staff uploads result in electronic

medical record

Electronic screening tool automatically

administers full screen

Screen negative

AUDIT ≥ substantial level and/or DAST ≥ moderate level

AUDIT moderate level and/or DAST low level

Process Map for SBIRT at Initial OB VisiteprocessduDuri General orientation to

practice, includes substance use policy

At one point during visit, staff ensures patient is

seen privately for confidential screening

Support staff leaves clinic room during electronic

screening

Patient arrives for initial prenatal visit

Prenatal visit with provider begins, BI

and RT are not indicated

Substance use screening

questionnaire

Patient takes brief

screen

Warm handoff to provider

Screen negative

Patient completes

screen

Electronic screening tool automatically

administers full screen

Warm handoff to provider

Screen positive

Follow up questionsBI by provider

Referral to behavioral health

for counseling

Routine prenatal care; education;

encourage abstinence

Occasional use only

Substance use

severity

Referral to addiction provider for further

evaluation and treatment

Moderate to Severe Substance Use

Disorder Suspected

Low to Moderate Substance Use

Suspected

BI=Brief intervention RT= Referral to treatment

Screening for substance use during pregnancy using an SBIRT framework

Gratefully reproduced with permission from Northern New England Perinatal Quality Improvement Network http://www.nnepqin.org/a-toolkit-for-the-perinatal-care-of-women-with-opioid-use-disorders/

reviewed: 5/8/2018

II. SBIRT Process: SCREENING

All pregnant women should be screened using a validated instrument.

• All pregnant women should be informed about the health system’s policy on prenatal drug,tobacco, and alcohol use at the first prenatal encounter, as part of their orientation to thepractice (see example patient letter)

• Screening for substance use should be conducted while a woman is alone or accompanied onlyby young children

• Creating space for confidential screening allows providers to ask questions about other sensitivetopics such as their reproductive health history, and to safely screen women for domesticviolence

• If a woman cannot be confidentially screened, screening should be deferred

• Timing of screening• Screening should be done at initiation of prenatal care, and repeated in the third

trimester• Screening should also be repeated on admission for delivery

• A number of substance use screening tools have been validated for use during pregnancy. Thebest tool is the one which is easy to use in a given context

• A positive screen does not equate to a diagnose a substance use disorder, but rather to theneed for further exploration about risk of substance exposure during pregnancy