The National Center on Addiction and Substance Abuse (CASA) New York State Office of Alcoholism and Substance Abuse Services (OASAS)
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1 Can SBIRT Become Part of Routine Healthcare Delivery? Lessons Learned at Northwell Health Prevention, Treatment and Recovery: Innovation in Substance Use Disorders 11/17/17 Jonathan Morgenstern, PhD Director, Addiction Services Northwell Health Professor of Psychiatry Zucker School of Medicine S B I R Northwell Health Northwell Health Center for Addiction Services and Psychotherapy Interventions Research (CASPIR) Division of General Internal Medicine Department of Emergency Medicine Department of Psychiatry & Behavioral Health The National Center on Addiction and Substance Abuse (CASA) New York State Office of Alcoholism and Substance Abuse Services (OASAS) Substance Abuse and Mental Health Services Administration (SAMHSA)
2 SBIRT Northwell Health Westchester Medical Center Lenox Health Greenwich Village Peconic Bay Emergency Department Internal Medicine Practice Future ED Sites (2017) Inpatient Pilot Educational Efforts To identify and effectively intervene with those who are at moderate or high risk for psychosocial or health care problems related to their substance use Physicians PA Nursing NP Medical Assistant Health Coach Patient Dietician SUD Providers Psychologist SW Pharmacist
3 Motivate a Shift in our Clinical Culture Substance Use/Misuse is truly a Healthcare Issue Core Mission Enhancing Awareness, Skills, and Comfort 2-3 dedicated to educational training on substance use/addictions during residency Compared to 1 in 25 Americans who first drank, smoked or used other drugs at age 21 or older Azari S, et al. MedEdPORTAL Publications Major source of referrals to treatment are NOT healthcare providers only 6.6% SAMHSA (2011) National Survey on Drug Use and Health
4 Rethinking Substance Type 2 Use our Diabetes Continuum Approach Overweight Obese Prediabetes Type II DM High Risk Normalize the Process/Conversation Key Implementation Pieces Building Champions and Change Teams Training Assess setting and tailor protocols Performance Monitoring Process Improvement
5 EHR Integration PreScreen Questions and Scoring Algorithm Automatic Tasking, Flagging, and Icons SBIRT Health Coach Documentation Note Data Collection Automated Reports PreScreen Data Demographics Date/Time of Service Data Transfer IBEX AllScripts EHR (AEHR) AllScripts EDIS Sunrise Emergency Care (SEC) Post-Implementation: Ongoing Needs Performance Monitoring and Evaluation Training/Supervision/ Fidelity PDSA Champion Building Maintenance and Sustainability
6 Services Delivered *During SBIRT Health Coach Hours* Dec2013 October2017 Completed PreScreens PreScreen Positive Brief Interventions Eligible for Referrals to Treatment 264,164 10% 9,474 4,143 Preliminary Evaluation Results Six months after receiving brief intervention, patients are showing positive changes:
7 Preliminary Evaluation Results Six months after receiving brief intervention, patients are showing positive changes: Lessons Learned Team-Based approach necessary for: Implementation Delivery of Care Maintenance Closing loops of feedback from stakeholders, will go a long way! Efforts do not stop at implementation ongoing attention needed Fidelity to screening and BI practices challenging Data collection/monitoring essential Sustainability through technology solutions Just BIG enough, and just SMALL enough to use as a Pioneer Project to further integration
8 - Call for Action - Standing Together to Align a Community of Potential Solutions SBIRT Naloxone Saturation Prescriber Guidelines Treatment Care Mgmt/Navigation Follow-up Expanding the NYSBIRT-II Footprint: Ongoing and Next Steps Education and Training Service Delivery System and Community Level Collaborations State Level Collaborations Technology Solutions
9 Thank You. Jonathan Morgenstern, PhD Director, Addiction Services Northwell Health Professor of Psychiatry Zucker School of Medicine For more information
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