2015 NPN SBIRT Power Session

Transcription

1 2015 NPN SBIRT Power Session Creating a prevention vital sign: Using Screening, Brief Intervention, and Referral to Treatment (SBIRT) to integrate substance abuse prevention into healthcare Mallori DeSalle is the Indiana SBIRT Outreach Coordinator in the School of Public Health at Indiana University-Bloomington. Ms. DeSalle is an undergraduate instructor and professional trainer for SBIRT, Motivational Interviewing and Substance Abuse Prevention Skills Training. Ms. DeSalle is listed on the National Registry of SBIRT trainers and is a member of the Motivational Interviewing Network of Trainers. She is a Licensed Clinical Mental Health Counselor, certified by the National Board of Certified Counselors and an internationally Certified Prevention Specialist. Kaitlyn Reho, MPH, is the Screening, Brief Intervention, and Referral to Treatment (SBIRT) Outreach and Training Specialist at Indiana University-Bloomington, School of Public Health. Kaitlyn is responsible for linking public health research to the workforce through research translation and the development of online trainings. Her expertise includes prevention science, SBIRT, and alcohol and drug topics. Kaitlyn is a part of the SBIRT primary care expansion process in Indiana.

2 SBIRT POWER SESSION NATIONAL PREVENTION NETWORK NOVEMBER 17-19, 2015 Mallori DeSalle, MA, LMHC, NCC, CCMHC, CPS Indiana SBIRT Outreach and Training Coordinator Member of Motivational Interviewing Network of Trainers Collaborator: Kaitlyn Reho, MPH Indiana SBIRT Training Specialist WHAT IS SBIRT? SBIRT stands for: Screening Brief Intervention Referral to Treatment

3 WHAT DOES A ALCOHOL PROBLEM LOOK LIKE? Image source: Often the terms risky drinker and alcoholic are thought to mean the same thing. DRINKING LEVELS IN US SOCIETY Both are considered alcohol problems 5% 20% Dependent At-risk or harmful drinkers 35% Low risk drinkers 40% Abstainers We now know that people can experience harm from alcohol use without: Being unable to limit their drinking or drinking in dangerous situations. We use new vocabulary ( risky and harmful ) to address other levels of drinking.

4 THE RANGE VIEW OF ALCOHOL USE Alcohol use viewed as a continuum based on level/frequency of use. ADULT ALCOHOL PREVENTION Tertiary Prevention 5% Secondary Prevention 20% Primary Prevention 35% 40%

5 WHERE IS SBIRT ON CONTINUUM OF CARE? Brief Intervention Referral to Treatment 7 LOCATING RISKY AND HARMFUL DRINKERS: THE BEGINNING OF SBIRT SBIRT is opportunistic. It can be integrated into existing systems. Contact with risky/harmful drinkers might occur in a variety of locations. These systems are ideal locations for screening.

6 USING SBIRT TO INTEGRATE SUBSTANCE ABUSE PREVENTION INTO HEALTHCARE 1. Regular visit to a health care provider. 2. Once a year answer a few questions. 3. Talk to a health care provider to review the screening. SUSTAINABILITY LONG TERM RELIABLE RESULTS Seed funding for: Primary Care FQHCs CHCs RHCs Expansion Strategies: State Level Policy Strengthen workforce development Model for successful SBIRT integration

7 SBIRT POLICIES AND PRACTICES: State Level Medicaid and Medicare billing Integrated Care credentialing Organizational Level Electronic Health Records Policy and Procedures STRENGTHEN SBIRT WORKFORCE SBIRT Training Curriculum Introduction to SBIRT SBIRT Implementation for Adults SBIRT Implementation for Youth Introduction to Motivational Interviewing Drug Overview-6 modules + Fidelity Reviews Online Trainings*

8 Online Training for Professionals Patient Education Brochures SBIRT Implementation Tools SBIRT EXPANSION PROJECT Seed funding for: Primary Care FQHCs CHCs RHCs

9 EVALUATION PROCESS & OUTCOME SBIRT Implementation Planning Feedback Feedback Active Implementation SBIRT Procedure Feedback ADJUSTING TO CHALLENGES Misunderstanding of SBIRT Administrative process changes Working process=team effort

10 SBIRT RESEARCH Campbell KP et al, eds. A Purchaser s Guide to Clinical Preventive Services: Moving Science into Coverage. Washington, DC: National Business Group on Health; Estee S et al. Medical Care 2010; 48: Fleming MF et al. Medical Care 2000; 26: Fleming MF et al. Alcoholism: Clinical and Experimental Research 2002; 26: Gentilello LM et al. Annals of Surgery 2005, 241: Quanbeck A et al. Wisconsin Medical Journal 2010; 109:9-14.

11 Indiana SBIRT Website: Resources include: Alcohol and Drug Screening Booklet Brief Intervention Step-by-Step Readiness Ruler Drug Effects Brochures Low-Risk Drinking Limits Business Cards Marketing Fact Sheet Provider Information Sheet SBIRT Brochure We Ask Everyone Poster SBIRT Implementation Webinar SBIRT Readiness Assessment Implementation Decisions Worksheet Billing Codes Fidelity Instruments Online Trainings: o o o Introduction to SBIRT in Primary Care Introduction to Motivational Interviewing Drug Overviews (Alcohol, Marijuana, Cocaine, Prescription Drugs, Heroin, Tobacco)

12 Substance Use Screening, Brief Intervention and Referral to Treatment SBIRT in Community Health Centers Screening- While in the waiting room, patients are screened to identify their level(s) of substance use using a validated instrument. Brief Intervention (BI)- Those patients whose screening indicates risky or harmful levels of use receive a BI, which is a minute conversation to motivate positive behavior change. Referral to Treatment (RT)- For those whose screening indicates heavy/dependent use, providers make a referral for further treatment. SBIRT is Effective A meta-analysis of randomized control trials concluded that heavy drinkers receiving BI services are twice as likely to reduce their drinking as heavy drinkers receiving no intervention. 1 Results of SAMHSA s SBIRT program in six states show reductions of 39% in heavy alcohol use, 68% in drug use, and improved levels of general and mental health at 6-month follow up. 2 In a study of low-income minority men and women, individuals receiving brief motivational intervention during routine medical visits were more likely to be abstinent for cocaine alone (22.3% vs. 16.9%), heroin alone (40.2% vs. 30.6%) and both drugs (17.4% vs. 12.8%). 3 SBIRT is Recommended The National Commission on Prevention Priorities ranked the top 25 preventive clinical services recommended by the U.S. Preventive Services Task Force (U.S.P.S.T.F.) on Rankings of 25 Preventive Clinical preventable burden (PB) and return on investment (ROI). On this Services Recommended by USPSTF list alcohol screening and intervention ranked #4, just lower # Service PB ROI than childhood immunizations and smoking cessation, and higher 1 Aspirin to prevent CVS 5 5 than screening for high blood pressure, cholesterol, STIs, disease osteoporosis, or breast, cervical or colon cancer. 4,5 2 Childhood 5 5 The World Health Organization, U.S.P.S.T.F, and the Committee immunizations on Trauma of the American College of Surgeons have endorsed 3 Smoking Cessation 5 5 routine SBIRT in primary health care settings and Level I Trauma 4 Alcohol screening and 4 5 Centers. intervention References PB & ROI scoring: 1 = lowest; 5 = highest 1. Wilk AI, Jensen NM, Havighurst TC. Meta analysis of randomized control trials addressing brief interventions in heavy alcohol drinkers. J Gen Intern Med. 1997;12(5): Madras BK, Compton WM, Avula D, Stegbauer T, Stein JB, Clark HW. Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites: comparison at intake and 6 months later. Drug Alcohol Depend. Jan 2009;99(1-3): Bernstein J, Bernstein E, Tassiopoulos K, Heeren T, Levenson S, Hingson R. Brief motivational intervention at a clinic visit reduces cocaine and heroin use. Drug and Alcohol Dependence. 2005;77(1): Maciosek MV, Coffield AB, Edwards NM, Flottemesch TJ, Goodman MJ, Solberg LI. Priorities among effective clinical preventive services: results of a systematic review and analysis. American journal of preventive medicine. 2006;31(1): Solberg LI, Maciosek MV, Edwards NM. Primary care intervention to reduce alcohol misuse: ranking its health impact and cost effectiveness. American journal of preventive medicine. 2008;34(2): e143 For more information go to indianasbirt.org