University of Texas Health Science Centerat San Antonio

®

Project S-START

Project Aim:

To improve knowledge, attitudes and SBIRT practices of South Texas resident physicians

in six medical specialties, with sustained curricular use and clinical practices

Project S-START

• Key Personnel:Project Director: Janet F. Williams, M.D. – Dept PediatricsProject Co-Director: Sandra Burge, Ph.D. – Dept Family MedicineProject Coordinator: Suyen Schneegans, M.A. - Dept PediatricsDirector of Evaluation: Nancy Amodei, Ph.D. – Dept Pediatrics

• Key Policy Organizations:Medical School Dean & Former Dean/Current UTHSCSA PresidentGraduate Medical Education Deans Council of Residency SBIRT Trainers (CRST):

• Pediatrics (UTHSC; BAMC military) • OB-Gyn• Family Medicine (UTHSC; South TX, Fort Hood, Santa Rosa) • Psychiatry (Adult & Child)• Internal Medicine (UTHSC; South TX) • Surgery

Program Structure & Start-upResources for all Departments

Thea Lyssy, Website & Curriculum Developer

Pediatrics• Janet F. Williams• Noemi Adame• Lizette Gomez• Sylvia Leal-Castenon• Juan Parra

FCM - UT• Sandra Burge• Nida Emko• Alexandra Loffredo• Manuel Oscos-Sanchez

Internal Medicine

• Patricia Wathen• George Crawford• Michelle Conde • Sean Garcia

OB-GYN• Erin Nelson• Gabriel Medrano • Elly Xenakis

Psychiatry• Michael Dawes• Brenda Talley • Vivek Singh • Jason Schillerstrom

Internal Medicine

(S. TX)• Gary Souffrant • James Hanley • Rosita Frazier

Surgery• Daniel Dent• Ronald Stewart • Ross Willis • Shannon Lopez• Rochelle Cortes

FM – Fort Hood

• Doug Maurer• Drew Baird • Dena George • Zaal Paymaster

FM – Santa Rosa

• Tamara Armstrong

FM-McAllen

• James Tysinger• Sunand Kallumadanda

YR 01

YR 02

YR 03

Adolescent Medicine (BAMC)

• Elisabeth Stafford• Dale Ahrendt• Jesse Barondeau

Site Locations

Family Medicine – Fort Hood

UTHSC- SA Brooke Army Medical

Center (BAMC) CHRISTUS Santa Rosa Family Medicine –

McAllen Internal Medicine –

(RAHC) Regional Academic Health Center

Program Model

No further questions

1) Ask pre-screening questions

Begin Screening

Low to Moderate

Risk

Moderate to High Risk

High to Very High Risk

Brief Intervention

Brief Intervention & Referral to

Treatment

Referral to Treatment

If “negative”

If “positive”

• Evidence-based algorithm is tailored to each department• Goal: sustainability & to find ways to reinforce it in the program and the resident’s practice

Praise

Faculty Training

Used the Train the Trainer model to train SBIRT faculty in:PediatricsFamily & Community Medicine - UTHSCSAFamily Medicine – Fort HoodFamily Medicine – CHRISTUS Santa Rosa

Other Methods:Personal consultationCRIT (IM Chief Resident Immersion Training in SBIRT)Sharing resources via project websiteCouncil of Residency SBIRT Trainers (CRST) NewsletterEmail correspondence

Length of the training program:Training is longitudinal, infused through the length of each

training program - 3 to 5 years

8 proposed training modules:1. Cultural Competency approaches to SBIRT services2. Medical Conditions linked to Substance Abuse3. Use of Pre-Assessment & Screening Tools4. Brief Interventions & Referrals to Treatment procedures5. Pharmacotherapy for relapse prevention, maintenance, & other

prescribing drugs6. Outpatient Medical Management & Integrated Provider System7. Electronic Medical Health Records8. Administrative Issues

Curriculum Description – page 1

Curriculum Description – page 2

Screening tools used in the curriculum: CRAFFT, CAGE, CAGE-AID, TACE, ASSIST, BNI-ART

Brief Intervention (BI) procedures: BI spectrum of skills: positive feedback, build strengths, dispel

myths, brief directed advice, range of intervention strategies from brief to multisession discussions.

Motivational interviewing/ Motivational enhancement techniques

Referral to Treatment (RT) Support Online Bexar County Substance Abuse Resources Directory SAMHSA Treatment Locator Resources Mid-Coast Family Services (regional referral service)

Methods of Curriculum Delivery

Training workshops

Lecture/discussion

Objective-driven learning modules/discussion

Grand Rounds

Video library

Project S-START Website

• Revised Medical Record templates

• Pocket Card Assignments

• Pocket Card Reminders

• Self-directed/monitored online learning (Blackboard modules)

• OSCE (Observed Standardized Clinical Exams)

SBIRT Curricular Strategies by Specialty

  Pediatrics

OB-GYN

Psychiatry

Internal 

Medicine

IM - ERAH

C

FCM

FM –McAlle

n

FM -Fort Hood

FM -Santa Rosa

Surgery

Large Group Didactic Lecture

+   + + + +  + + +  +

Small Group Discussion

 +   + + +     + + +

Skill-Building Workshops

    + + + +

Reading Assignments

+ +   + +

Screening Questions In Medical  Records

+ + + + + + + + + + (likely but not in place

yet)

Reminder Pocket Cards

 +  + +   +      

Screening Assignments*

         +  +  +

Inpatient Clinical Supervision

 +     +  +  +   + +

Outpatient Clinical Supervision

 +  + + (child psych only)

+ +  +  +  + +

Independent Study Module (Blackboard)

 +       +  +     +

OSCE (Observed Standardized Clinical Exams)

      +       +

Dissemination Model – page 1

Posters AMERSA, 2009 Society for Adolescent Medicine, 2010 6th Annual Innovations in Health Science Education, 2010 Annual Research Day at Fort Hood, 2010 Pediatrics Research Day, 2010 American Academy of Family Physicians, 2010 Texas Academy of Family Physicians, 2010 AAMC/ CDC Public Health in Medical Education Conference,

2010 AMERSA, 2010 (2) North American Primary Care Research Group, 2010 Society for Adolescent Health and Medicine, 2011 Innovations in Health Science Education, 2011 (2) AMERSA, 2011 (2)

Dissemination Model – page 2

Oral PresentationsAMERSA, 2009 (2)Society of Teachers of Family Medicine (45 min x

2), 2010World Organization of Family Doctors, 2010American Academy of Addiction Psychiatry, 2010Southern Society of Pediatric Research, 2011Society of Teachers of Family Medicine, 2011Society for Adolescent Health & Medicine

(workshop), 2011Pediatric Academic Societies (workshop), 2011INebria conference, (workshop), 2011AMERSA (workshop), 2011

Dissemination Model – page 3

Invited PresentationsTexas Medical Association, 2009 (3)Texas Pediatric Society, 2009 ONDCP US-Mexico Binational Drug Demand

Reduction Policy Meeting , 2010Society for Pediatric Anesthesiology (keynote),

2010Pediatrics for the Practitioner, 2010Northside Independent School District, 2010

EditorialJournal of Adolescent Health, March 2011 issue

Social MediaBlog on ONDCP website, 2010

Dissemination: CRST Meetings

Council of Residency SBIRT Trainers (CRST) MeetingsDate Pediatrics BAM

CFCM

Internal Medicine

Psychiatry

OB-Gyn

FM – Fort Hood

FM – Santa Rosa

Trauma

Nursing

1.29.09

2 1 1 - 2 1 - - 1 -

1.30.09

2 - 2 2 - - - - - -

9.29.09

4 2 1 2 2 - - - 3 -

12.08.09

5 1 2 1 1 1 - - - 1

3.09.10

7 1 1 - 1 - 1 1 - 1

8.17.10

4 2 2 2 1 1 - - - -

2.15.11

5 - 2 1 - - - - 1 -

6.28.11

2 - 2 - - 1 - - - -

7.19.11

5 - 2 1 1 - - - 3 -

Dissemination: Newsletters

CRSTy Times Newsletter6 Editions

July 2009 September 2009 January 2010 July 2010 December 2010 July 2011

Resident NewsletterWill be sent out quarterlyWill serve as a reinforcement for SBIRT and evaluation

reminder

Dissemination: Project Website

Project S-START website

http://familymed.uthscsa.edu/sstart/

Total number of hits & views

Timeframe: 1.06.09 to 7.31.11

Total # of hits = 28,510 Avg. hits per day = 30

Total page views = 10,089 Avg. page view per day

= 10

Dissemination: Substance Abuse Resource Directory

Bexar County Substance Abuse Resource Directoryhttp://bexarlist.com

Dissemination: Publication Committee

Writing Group Meetings – work on SBIRT publicationsHave had 3 meetingsSubmissions to the Substance Abuse journal

1. Lessons from the field: Challenges in implementing cross-disciplinary SBIRT residency training curricula

2. Opportunities and challenges: Implementing a brief assessment and a brief intervention in substance abuse consults in the South Texas veteran’s health care system

3. Implementing adolescent SBIRT education in pediatric residency curricula

Sustainability Model: Electronic Health Record

Example of EHR changes – UTHSC FCM

Alcohol Other drugs Tobacco

* Screenshot from Sunrise

Sustainability Model: Medical Health Records

Acute Care Encounter

Example of Paper HR change – Pediatrics

Alcohol Other drugs Tobacco

New Pediatric iPad Project:

All residentsSBIRT Algorithm & Pocket Cards

Sustainability Model: MHR in Pediatrics

Child Health Record (11-20 years-old)

Sustainability Model: State SBIRT Project

Proposed 5 year SAMHSA-CSAT grant: Texas SBIRT ProjectCollaborated with the Texas Department of State Health

Services (DSHS) DSHS will develop an integrated model of care to provide SBIRT within primary care settings UTHSCSA will serve as a centralized web-based clearinghouse to:

disseminate SBIRT related information link people with SBIRT tools and resources pair new providers with an experienced mentor develop an SBIRT mobile application find speakers to promote SBIRT provide training at professional conferences and meetings