sbirt practical prevention tool
Post on 21-Oct-2014
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prepared for
Michigan Primary Care Association
Peer Assistance Services, Inc.
Dedicated to quality, accessible prevention and intervention services in workplaces and communities, focusing on substance abuse and related issues.
Incorporated in 1984
Programs
• Peer Health Assistance Programs (Dental, Pharmacy, Nursing, and other professions)
• Colorado TASC (Treatment Accountability for Safer Communities)
• Workplace Prevention Services (WPS)
• Prescription Drug Abuse Prevention Program
• SBIRT (Screening, Brief Intervention, and Referral to Treatment)
Acknowledgements
Objectives
• Discuss evidence that supports SBIRT• Identify core components of SBIRT• Describe lessons learned from SBIRT Colorado • Review solutions to commonly perceived barriers
Why SBIRT?
“The administration will continue to promote the integration of SBIRT in to mainstream health care, disseminate information
about SBIRT to a wide variety of health care settings, highlight model programs that are using SBIRT, and encourage training
opportunities for the allied health professions.”
-2012 National Drug Control Strategy
Support for SBIRT
• The Joint Commission• The American College of Surgeons Committee on Trauma• The U.S. Preventive Services Task Force• The American Congress of Obstetricians and Gynecology • The Emergency Nurses Association• The Office of National Drug Control Policy• The Centers for Medicare and Medicaid Services • The Center for Substance Abuse Treatment• Health Resources and Services Administration • National Institute on Alcohol Abuse and Alcoholism• National Institute on Drug Abuse
Prevention Priorities
Billing CodesPayer Code Description FeeCommercial CPT 99408
CPT 99409
Alcohol and/or substance abuse structured screening and brief intervention services; 15 to 30 minutes
Alcohol and/or substance abuse structured screening and brief intervention services; greater than 30 minutes
$33.41
$65.51
Medicare G0396
G0397
Alcohol and/or substance abuse structured screening and brief intervention services; 15 to 30 minutes
Alcohol and/or substance abuse structured screening and brief intervention services; greater than 30 minutes
$29.42
$57.69
Medicaid H0049
H0050
Alcohol and/or drug screening
Alcohol and/or drug service, brief intervention, per 15 minutes
$24.00
$48.00
SBIRT Colorado
History of SBIRT in Colorado
County Population Density 2000
Brief Therapy
2%
Referral to
Treatment
3%
Brief
Intervention
35%
Screening only
60%
0
2
4
6
8
10
12
14
16
Intake 6 mth follow-up
Alcohol
Marijuana
Illicit drugs
Screening, Brief Intervention and Referral to Treatment
The SBIRT Process
•Introducing SBIRT
•Brief Screen
•Screening
•Brief Intervention
•Referral to Treatment and Follow-Up
Introduction and Consent
Purpose of Screening
Brief Screen
1.How many drinks do you have per week?2.When was the last time you had 4/5 or more drinks in one day?3.In the past year, have you used or experimented with an illegal drug or prescription drug for nonmedical reasons?4.Do you currently smoke or use any form of tobacco products?
Moderate Drinking Guidelines
What is a standard drink?
Screening Instruments
Use for follow-up in those who test positive on the brief screen:
• ASSIST: Alcohol, Smoking, and Substance Involvement Screening Test
• AUDIT: Alcohol Use Disorders Identification Test
• DAST-10: Drug Screening Test (not including alcohol)
• CRAFFT: Adolescent drug and alcohol screening
Brief Intervention
What is Brief Intervention?
• A brief motivational conversation • Single 3-5 minute to multiple 15-30 minute sessions
have led to decreased use • Most effective with at-risk clients who are not
addicted • Educating clients about the health risks of their
substance use has led to behavior change • BIs are low cost, quick, client friendly, easy to do
Motivational Interviewing
William Miller and Steven Rollnick
Ambivalence as central construct
Persuasion elicits resistance
Alternative to direct persuasion and it works!
Source: William Miller (2002)
Examples of MI Strategies
Open-ended questions
Affirmation
Reflective listening
Summarizing
Goal is to elicit change talk!!!
Don’t Assume
• Patient ought to change• Patient wants to change• Patient’s health motivates him/her• Now is the right time for patient to change• Tough approach is best
Brief Intervention
Step 1: Raise the Subject
Step 2: Provide Feedback
Step 3: Enhance Motivation
Step 4: Negotiate and Advise
Step 1: Raise the Subject
Raise the subject of substance use
“Would you mind taking a few minutes to talk with me about your substance use?”
Step 2: Provide FeedbackDiscuss health risks of alcohol and other substances
“At this level of consumption, you are at increased risk for health and other consequences such as…”
Review drinking guidelines“The recommended guidelines for healthy women/men
are…
Pre-Contemplation
Contemplation
Maintenance
Action
Preparation
Step 3: Enhance Motivation
Step 4: Negotiate and AdviseElicit response: “What are some of your thoughts regarding
our discussion?
Negotiate a goal: “Why are you a 5 and not a 7?” and “What are some steps you could take?”
Assist in developing a plan: “What will be challenging for you to meet this goal? What is your plan for overcoming these challenges?”
Summarize: “What I heard you say is…”
Closing the Intervention
Show appreciation to your client
Affirm positive behaviors
Respect client’s decisions
Offer information
Arrange for follow up
Referral to Brief Therapy and Treatment
• If patient scores high on assessment
• What is brief therapy?
• Know your resources!
Sustainability
• Identify an internal champion
• Flexibility in how SBI can be implemented
• Best to combine with other health screening and education to enhance integrated care
• Involve the entire team
• Train nursing students and residents to establish SBI as a routine practice
References
• The National Center on Addiction and Substance Abuse at Columbia University. The Cost of Substance Abuse to America’s Health Care System. Report 2: Medicare Hospital Costs. May 1994. Available at http://www.casacolumbia.org/articlefiles/379-Cost%20of%20Substance%20Abuse%20Report%202.pdf.
• Mokdad A, Marks J, Stroup D, Gerberding J. Actual causes of death in the United States, 2000. JAMA 2004;291:1238--45.
• Substance Abuse and Mental Health Services Administration. (2006) Results from the 2005 National Survey on Drug Use and Health: National findings Rockville (MD): Office of Applied Studies.
• Maciosek, MV, Coffield, AB, Edwards, MS, et al. Priorities Among Effective Clinical Preventive Services. Results of a Systematic Review and Analysis. Am J Prev Med 2006; 31 (1) 52-61. Available at http://www.prevent.org/data/files/initiatives/prioritiesamongeffectiveclinicalpreventivesvcsresultsofreviewandanalysis.pdf .
• D’Onofrio G, Pantalon MV, Degutis LC, et al. The Yale Brief Negotiated Interview Manual. Yale University School of Medicine. 2005. Available at http://www.ihs.gov/nonmedicalprograms/nc4/documents/appendix_a_yale_bni_manual.pdf.
• William Miller, Rollnick Steven. Motivational Interviewing, Second Edition: Preparing People for Change. 2002.
www.improvinghealthcolorado.orgwww.healthteamworks.org