Vermont SBIRT Outcomes & Lessons

Transcription

1 Vermont SBIRT Outcomes & Lessons Special Focus: Suicide Risk Screening Opportunities & Challenges Win C. Turner PhD, LADC VT Suicide Prevention Symposium Stoweflake Mountain Resort 1

2 Two Primary Questions for this quick presentation? How can we help Vermont s healthcare and educational providers successfully engage our youth, young adults & adults in strategies to identify, prevent and offset emerging suicidal concerns. Is it possible to create places of safety & trust so the most vulnerable needs are recognized and handled with compassionate care?

3 General Questions Discuss with your neighbor: one good thing about getting older? one bad thing about getting older?

4 Todays Journey Recognize Suicide risk as a complex outcome of personal, inter-personal, & social determinants. Review SBIRT Strategies including the PHQ screening tool & SBIRT data on AOD, Depression & suicide risk prevalence Introduce Opportunities & strategies for enhancing health and educational settings potential impact on their population s suicide risk

5 The opportunity to help is real? Schroeder, S (2007) We can do better improving the health of the American people. N Eng J Med 357(12):

6 Complexity & Prevalence 6

7 ACE Study Adverse Childhood Experiences Kaiser Permanente study ,000 people 10 questions re: childhood trauma 5 = personal trauma 5 = related to family members

8 ACE study results 2/3 had at least one ACE 87% had more than one 4 or more trauma responses to questions: 15% = women 9% = men

9 ACE Score of 4 or more increases risk Hepatitis = 240% Likelihood of COPD = 390% Depression = 460% Addictions = 500% Suicide = 1,222 %

10 Stopping the Inheritance of Suffering: Adverse Childhood Experiences

11 Trauma and SUD Conclusion Traumatic events leave their influential imprint on the brains & lives on those affected Disasters, terrorist attacks, and other generalized traumatic events may activate pre-existing PTSD or compound the effects of previous trauma If clinicians don t inquire about the effects of a traumatic event, many people will not discuss them

12 Our Behaviors are Killing Us - Literally Case & Deaton, 2015

13 Suicides are Increasing for Females in US CDC, 2016: Increase in Suicide in the United States,

14 VT prevalence (age 12 plus) of substance use disorder is about the same as compared to the U.S. average Percent of population who meet DSM-IV criteria for dependence or abuse % 15 8% Vermont U.S. Source: National Survey on Drug Use and Health, 2010 and 2012

15 Past Year Alcohol Use Treatment among Persons with Alcohol Use Disorder in VT ( Age 12 plus) 9% Did Not Receive Treatment Received Treatment 91%

16 Among those with a past year substance use disorder, 42.8 percent had an identified co- occurring mental illness. (NSDUH) Most people with co-occurring disorders receive no treatment 7% No Treatment 57% Past Year Mental Health and Substance Abuse Care for Adults with Co-Occurring Disorders 2011 Both Mental Health and and Substance Abuse Care Substance Abuse Only 4% Mental Health Care Only 32%

17 Reasons for Not Receiving Substance Use Treatment For Those Who Needed No Health Coverage and Could Not Afford Cost Not Ready to Stop Using Able to Handle Problem without Treatment 10.2 No Transportation/Inconvenient 9.7 Might Cause Neighbors/Community to Have Negative Opinion 8.3 Did Not Feel Need for Treatment at the Time 7.1` Percent Reporting Reason 40 Source: National Survey on Drug Use and Health,

18 Why Do We Need SBIRT? Because most people with substance use problems do not seek formal treatment. But they DO visit their general practitioner. Yet screenings and brief interventions for substance use are rarely performed in primary care. 18 Two-Thirds of individuals with substance use problems visit their general practitioner each year

19 Why Do We Need SBIRT? Because Psychosocial Vital Signs are recommended for universal screening measures: ü Race/Ethnicity ü Tobacco Use ü Alcohol Use (+ drug use, including opiate misuse) ü Residential Address ü Educational Attainment ü Financial Resource Strain ü Stress ü Depression/Suicide Risk ü Physical Activity ü Social Isolation ü Intimate Partner Violence ü Neighborhood MedianHousehold Income 19

20 Why Do We Need SBIRT? Because screenings and brief interventions work across settings and across populations. Ø Even a 5-minute intervention reduces risky substance use. Ø SBIRT in medical settings reduces costs, improves healthrelated diseases & consequences related to risky substance use. 20

21 What is SBIRT? A systematic & evidence based public health approach toward integrating medical and behavioral care in order to identify and intervene for Vermonters with substance, mood, and other behavioral risks affecting their lives. The heart and soul of all SBIRT interactions is to generate motivation toward seeking wellness. 21

22 SBIRT Offers a Systematized Approach Removes: 22 Introduces: Subjectivity + Predictability Inconsistency + Efficiency

23 The SBIRT Method BI Plus Referral Initial Screen + Positive USAudit-C 7 Men, 6 Women/65+ Positive Drug Screen & PHQ2 Secondary Screen + Positive USAudit 7/8 Women/Men Positive Drug > 1 Positive PHQ9 BI Plus BT BI

24 Vermont SBIRT Outcomes Over 107,000 screens completed Over 7000 interventions completed 18 Medical settings involved since 2014 Primary care clinics, Emergency Departments, Pediatric Clinics, Free Clinics, Student Health Services T 24

25 SBIRT Outcomes 25

26 SBIRT Outcomes 26

27 Decrease in Risky Behavior 27

28 Patient ratings of initial discussion at 6 month follow up interview I plan to make/made changes to my substance use because of my discussion with staff. 56% I know more about how my alcohol and/or drug use affects my physical health because of the discussion. The discussion with staff made me think differently about my alcohol and/or drug use. Staff made me feel comfortable talking about my use of alcohol and/or other drugs. Staff were respectful when talking with me about my alcohol/drug use. 74% 62% 96% 99% 0% 20% 40% 60% 80% 100% Percent of Patients Who Agreed or Strongly Agreed with Statement 28

29 Vermont SBIRT Outcomes for Depression & Suicide Risk There is an evolving landscape of integrated care in Vermont The opportunities for improvement are vast Based on the PHQ2 triage screen signaling the need for the additional PHQ-7 secondary screen 29

30 30

31 31 PHQ-9 Score Depression Severity Proposed Treatment Actions 0-4 None/Minimal Minimal 5-9 Mild Assessment Moderate Assessment Moderately Severe Immediate Referral Severe Immediate Referral

32 Suicide Risk Screening Q1. Depression Risk as per PHQ Q2. If positive for Depression Risk how many patients receive and/or answer Q9 Q3. How many endorse Suicide Ideation based on PHQ- Question 9 32

33 Answer: 34,982 patients at participating sites completed an initial screening for depression. 44% of those who score positive on the initial 2 PHQ questions received the full PHQ 9 PHQ -9 includes a more in depth look at depressive symptoms including question 9 on suicidal thinking 33

34 X2 (1) = 739; p<.001) AOD Risk & Higher Risk for Depression 16% of Vermonters screened scored positive for any risky alcohol and/or drug use 8% of Vermonters screened + for Depression Risk in Medical Settings 17% * of those with AOD risk also had depression compared to 6%* of those with no AOD risk.

35 Depression Risk Percent Risk 17% 6% No AOD Risk 35 AOD Risk

36 Depression & AOD = Suicide Risk 30% of those screened scored positive for suicide risk with no AOD present 34% of those screened scored positive for suicide risk with alcohol risk present 38% of those screened scored positive for suicide risk with drug risk present (88% of Drug risk = Cannabis Use )

37 Suicicde Risk 38% 34% 30% No AOD 37 Alcohol Risk Drug Risk

38 Suicide Risk Screening: Question What are the opportunities & Challenges? What are the recommendations? 38

39 Type% Patients% PHQ%:% screened% Depression% with%phq2% Risk% as%part%of% SBIRT% ED%(1)% 6854! PCP% (1)% PCP% (2)%! 39 4%!=!274! 1/16!(1/18! patients! 1474!! 6%!=!88! 10/16(!1/18! patients! 8628! 8%!=690! 5/14(7/16! patients! If%+%on% PHQ2%% Who% received% secondary% screen% 96%!=!263! patients! 40%!=!35! patients! 12%!=!82! patients! Positive%for% Suicide% Ideation%if% risk%for% depression% 39%!=!107! patients! 11%!=!4! patients! 7%!=!6! patients!!

40 Three lessons One we need to do a better job of more fully identifying the risk that could be right in front of us Two: we need to understand how to speak to our youth, young adults and adults in their times of need 40

41 Motivational Interviewing The spirit and skills of Motivational Interviewing are essential ingredients for addressing the growing concerns of our patients and ultimately creating the compassionate connections necessary to identify, engage and intervene. 41

42 How do the MI Spirit & Skills work? It s all about: Collaboration Compassion Patient Perspective & Choice Skills and & Strategies to Elicit Patient Motivation & Behavioral Activation 42

43 General Questions Discuss with your neighbor: one good thing about getting older? one bad thing about getting older? What s one thing you can do tomorrow to improve the health for the patients or communities where you work?