Implementing SBRT in Rural Clinics: A How to Guide

Transcription

1 Implementing SBRT in Rural Clinics: A How to Guide Dr. Christine Chasek January 9, 2019

2 Samson Teklemariam, MA, LPC Director of Training and Professional Development NAADAC, the Association for Addiction Professionals

3 Produced By NAADAC, the Association for Addiction Professionals

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6 Cost to Watch: Free CE Hours Available: 1 CEs CE Certificate for NAADAC Members: Free CE Certificate for Non-members: $15 CE Certificate To obtain a CE Certificate for the time you spent watching this webinar: 1. Watch and listen to this entire webinar. 2. Pass the online CE quiz, which is posted at 3. If applicable, submit payment for CE certificate or join NAADAC. 4. A CE certificate will be ed to you within 21 days of submitting the quiz.

7 Using GoToWebinar (Live Participants Only) Control Panel Asking Questions Audio (phone preferred) Polling Questions

8 Webinar Presenter Dr. Christine Chasek LIMHP, LADC, MAC Associate Professor 1615 W. 24 th Street Kearney, NE Your University of Nebraska at Kearney Behavioral Health Education Center of Nebraska

9 Health Disparity Project Partners Dr. Shinobu Watanabe-Galloway Associate Professor, UNMC Jason Dillard, PLMHP, PLADC Plum Creek Medical Group Sarah Bradley, UNK Graduate Student Your University of Nebraska at Kearney Behavioral Health Education Center of Nebraska University of Nebraska Medical Center

10 Webinar Learning Objectives Participants will learn the components of a SBIRT practice to implement in rural clinics. Participants will identify the barriers and opportunities in implementing SBIRT in rural clinics. Participants will have an outline of steps to complete when implementing an SBIRT program.

11 Why SBIRT in Rural Clinics? Many healthcare providers report that addressing alcohol and other drug problems is one of the most challenging areas of their practice. Providers are unsure how to address these issues and yet they are in a prime position to reduce the negative outcomes related to substance misuse. Substance use counselors can partner with these providers to implement cost-effective screening, brief intervention, and referral practices that help identify and get patients the services they need. This is a win, win, win situation for the healthcare provider, substance use counselor, and mostly importantly the patient.

12 Agenda Identify and Examine the components of SBIRT practices Barriers to implementing SBIRT Opportunities Outline of steps to implementing

13 SBIRT Core Components

14 Societal Definition of Addiction

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16 ASAM Definition of Addiction (2013) Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits, leads to characteristic biological, psychological, social, and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors. Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.

17 How Pervasive is the Problem? An estimated 21.0 million people aged 12 or older needed substance use treatment (2016) 1 in 13 need treatment 1 in 7 age need treatment Only 10% of people aged 12 or older who needed substance use treatment received it (National Survey on Drug Use and Health, 2017)

18 Adult Behavioral Issues in Primary Care 50% - 70% of physical complaints have no identifiable physical cause Anxiety Pain Depression Substance Abuse Between 2004 and 2009, drug-related ER visits increased 81% from 2.5 million to 4.6 million. ER visits caused by non-medical use of prescription drugs increased more than 98% between 2004 and 2009 Less than 5% with substance abuse problems receive minimally adequate treatment in primary care Less than 20% of primary care physicians believe they are prepared to identify or treat substance abuse disorders Kennedy Forum and DAWN

19 SBIRT is an evidenced-based practice used to identify, reduce, and prevent problematic use, abuse, and dependence on alcohol and illicit drugs. Easy to implement in medical settings Endorsements: Institute of Medicine Medicare and Medicaid American Medical Association SAMHSA-HRSA Center for Integrated Health Solutions

20 Polling Question #1 I have used screening tools in my practice. Yes, No, Not Sure

21 Screening Process and Tools ASSIST AUDIT DAST

22 SBIRT: Core Components Screening quickly assesses the severity of substance use and identifies the appropriate level of treatment. Brief intervention focuses on increasing insight and awareness regarding substance use and motivation toward behavioral change. Referral to treatment provides those identified as needing more extensive treatment with access to specialty care.

23 Screening Tools

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25 ASSIST

26 Other Screening Tools AUDIT

27 Other Screening Tools DAST

28 Scores and Intervention

29 Scores Low Risk: Positive Reinforcement Moderate: Brief Intervention High: Referral to Treatment

30 Brief Interventions FRAMES F = feedback of personal risk, e.g. that use may contribute to medical problem such as hypertension or psychosocial problems, e.g. relationship problems or work problems R = responsibility of the patient and the patient/client has personal control A = advice to change, e.g. to stop using or reduce reduce drinking to safe levels, treatment, ect. M = menu of alternative goals and strategies to reduce substance use E = empathic counseling style is more effective than confrontation S = self-efficacy; encourage patients /clients optimism that the chosen goals can be achieved.

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33 Least restrictive to most restrictive Treatment Options Education/substance awareness class: 6 hours Individual/family outpatient: 1 hour weekly ongoing Group outpatient: 1-2 hours weekly Intensive outpatient program: 9 hours a week Partial care: 4-8 hours a day 3-5 days a week Detoxification: 1-7 days Short term Stabilization Inpatient treatment/hospitalization: 1-7 days Residential: Short Term: days Long Term: days

34 Polling Question #2 I am considering implementing screening in my practice. Yes, No, Unsure

35 Barriers Encountered HealthCare providers reactions Paperwork concerns Billing Issues

36 Opportunities Cost Savings Patients get to level of care needed Savings of time in clinic Referrals for Substance Use Counselors

37 The Office of National Drug Control Policy estimated that substance use costs society around $193 billion in Reduced Healthcare Costs SBIRT has been shown to result in healthcare cost savings that range from $3.81 to $5.60 for every $1.00 spent. Decreased severity of AOD use SBIRT Decreased risk of physical trauma

38 Funding opportunities Implementation plan Training Scripts for implementation

39 Many ways to implement Engage the nursing staff Need a Champion!

40 Contact Information Dr. Christine Chasek Licensed Mental Health Practitioner (LIMHP) Licensed Drug and Alcohol Counselor (LADC) Master Addiction Counselor (MAC) Associate Professor, University of Nebraska at Kearney BHECN-Kearney, Director Local Address: UNK campus (Kearney, NE)

41 References American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5 th ed.). Washington DC: American Psychiatric Publishing. American Psychiatric Association (1968). Diagnostic and statistical manual of mental disorders (2nd ed.). Washington DC: American Psychiatric Publishing. Babor, T. F., Del Boca, F. & Bray, J. W. (2017). Screening, brief intervention, and referral to treatment: Implications of SAMHSA s SBIRT initiative for substance abuse policy and practice. Addiction, 112, Mee-Lee, D. (2013). The ASAM criteria: Treatment criteria for addictive, substance-related, and cooccurring conditions. Nevada: The Change Companies: Nevada. National Survey on Drug Use and Health. (2017). Key Substance Use and Mental Health Indicators in the United States: Results from the 2016 National Survey on Drug Use and Health. Retrieved from NIH (2004). Helping patients with alcohol problems: A health practitioner s guide. Evidence based practices for substances use disorders. Retrieved from cessno=5&rf=full+display&df=full+display&np=3&rl=1&dl=0&xc=/dbtwwpd/exec/dbtwpub.dll&ac=qbe_query&cs=0 SAMHSA. (2015). Screening, brief intervention, and referral to treatment. Retrieved from SAMHSA. (2018). SAMHSA-HRSA Center for Integrated Health Solutions. Retrieved from Thombs, D. L. (2006). Introduction to addictive behaviors. New York: The Guildford Press. World Health Organization. (2017). The Assist Project. Retrieved from Zorland, J. L., Gillmore, D Kuperminc, G.P. (2018). Effects of substance use screening and brief intervention on health related quality of life. Quality of Life Research,

42 Thank You! Dr. Christine Chasek LIMHP, LADC, MAC Associate Professor 1615 W. 24 th Street Kearney, NE Your University of Nebraska at Kearney Behavioral Health Education Center of Nebraska

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44 Cost to Watch: Free CE Hours Available: 1 CEs CE Certificate for NAADAC Members: Free CE Certificate for Non-members: $15 CE Certificate To obtain a CE Certificate for the time you spent watching this webinar: 1. Watch and listen to this entire webinar. 2. Pass the online CE quiz, which is posted at 3. If applicable, submit payment for CE certificate or join NAADAC. 4. A CE certificate will be ed to you within 21 days of submitting the quiz.

45 Upcoming Webinars January 23, 2019 February 27, 2019 Living in a Cloud: Adolescent Nicotine Used By Beth Donnellan, M.Ed, ABD, CCTP, CATP Addressing the Opioid Crisis via Community- Based Technical Assistance by Holly Hagle, PhD February 13, 2019 March 13, 2019 Finding Ambivalence and 10 other Things about Motivational Interviewing by Richard Choate, LADC, CADC II Hunger for Healing: Evidence-Based Practice for Binge Eating Disorder by Michael Bricker, MS, CADC-II, NCAC-2, LPC

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47 WEBINAR SERIES Over 145 CEs of free educational webinars are available. Education credits are FREE for NAADAC members. MAGAZINE ARTICLES In each issue of Advances in Addiction & Recovery, NAADAC's magazine, one article is eligible for CEs. FACE-TO-FACE SEMINARS NAADAC offers face-to-face seminars of varying lengths in the U.S. and abroad. INDEPENDENT STUDY COURSES Earn CEs at home and at your own pace (includes study guide and online examination). CONFERENCES NAADAC Annual Conference, September 28 October 2, 2019 Orlando, Florida CERTIFICATE PROGRAMS Demonstrate advanced education in diverse topics with the NAADAC Certificate Programs: Recovery to Practice Conflict Resolution in Recovery National Certificate in Tobacco Treatment Practice

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