NEVER HAVE I EVER EVIDENCE-BASED STRATEGIES FOR DISCUSSING TEEN SUBSTANCE USE

NEVER HAVE I EVER EVIDENCE-BASED STRATEGIES FOR DISCUSSING TEEN SUBSTANCE USE

The mission of the American School Health Association is to transform all schools into places where every student learns and thrives. The American School Health Association envisions healthy students who learn and achieve in safe and healthy environments nurtured by caring adults functioning within coordinated school and community support systems.

92 ND ANNUAL CONFERENCE INDIANAPOLIS, INDIANA OCTOBER 4-6, 2018

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TODAY S PRESENTER: Mallori DeSalle, MA, LMHC, NCC, CCMHC, MATS, CPS

Never Have I Ever. Evidence-Based Strategies for Discussing Teen Substance Use

Your Trainer Mallori DeSalle, MA, LMHC, NCC, CCMHC, MATS, CPS Indiana SBIRT Outreach and Training Coordinator Member of Motivational Interviewing Network of Trainers

What do you think of?

Today s Agenda Rationale and Research for SBIRT Screening Tools Brief Intervention Overview Referral to Treatment Outcomes of SBIRT

What is SBIRT?

What is SBIRT? SBIRT stands for: Screening Brief Intervention Referral to Treatment

Poll #1 What do you already know about SBIRT?

SBIRT

What is a Substance/Alcohol Use Problem?

Unitary View of Alcohol/Drug Problems Often the terms risky drinking and alcohol abuse are thought to mean the same thing: Image source: http://www.posterplanet.net/simpsonshomerbeerposter.htm

The Range View of Alcohol Use Alcohol use viewed as a continuum based on level/frequency of use.

Drinking Levels in US Society Both are considered alcohol problems 5% Dependent 20% At-risk or Harmful Dependent At-risk or harmful drinkers 35% At-risk drinkers haven t had any problems Low risk drinkers 40% Harmful drinkers have problems that are relatively Abstainers small, maybe isolated and questionably related

Range of Risk for Youth that Consume Alcohol Ages 12-15 Ages 16-18 50% 50% 30% 20% 50% This continuum based on Age/Level/Frequency of use.

Past Year drinking: (more than one or two sips) 1 in 15 12 year olds 1 in 4 14 year olds 1 in 2 16 year olds 2 in 3 18 year olds

Adolescent Binge Drinking One Standard Drink

The Range View of Risk Most interventions focus here. Image source: http://thenestingplace.blog.com/2011/08/%e2%80%9 Cepidurals-a-guide-for-partners-wanting-to-get-itright%E2%80%9D/ The range view emphasizes risky and harmful use as well.

Substance Misuse in Context There is significant overlap between substance misuse (including risky or harmful drinking) and other problems. Image source: http://www.chcounselling.co.uk/reasons/substancemisuse.html

Two Levels of Screening Pre-screen: For Everyone/Universal One or two questions to help filter the individuals that will be most likely to screen positive on a full screening. Time saving measure for increasing efficiency with time is limited. A positive pre-screen indicates the need to complete the full screening. Full Screening: After Positive Pre-screen The full screening tool informs the professional about the client s level of substance use risk and the appropriate next steps: Brief Intervention or Referral to Treatment.

Pre-screening Process: Positive pre-screen = 1 or more questions answered positively. Negative pre-screen = all negative responses Negative Question 1: C Negative SBIRT Complete 3-Question Pre-screen Positive Positive CRAFFT (6 questions)

Inconsistent Adolescent Full Screening

Scoring the CRAFFT CRAFFT Score 0 Modality Education and Positive Reinforcement 1-2 Brief Intervention NA 3< Brief Treatment Referral to Treatment

SBIRT Process Overview 3-Question Pre-screen Negative Negative Question 1: C Positive Positive CRAFFT (6 questions) SBIRT Complete No Risk Risky Dependent Education and Reinforcement Brief Intervention Only Brief Intervention and Referral to Treatment

Actions Following Screening Education Pass out brochures, provide positive reinforcement, answer questions. Materials available at www.indianasbirt.org. Brief Intervention Brief conversation focused on motivating behavior change. Brief Treatment Optional level between BI and RT. BI + a series of follow-up visits with a mental health specialist. Referral to Treatment BI + refer patient to outside specialty care, such as to an addiction treatment center.

Brief Interventions: The Next Step o Short conversation or counseling session (5-15 minutes). o Often focuses on barriers to changing behavior and benefits to changing. Image source: http://pubs.niaaa.nih.gov/publications/aa66/aa66.htm o Assess readiness to change behavior. Image source: http://cooldesktopbackgroundsx.com/abstractbackgrounds/season-change-desktop-background/

Motivational Interviewing (MI) Versus Education only? Image source: http://www.careercast.com/career-news/my-boss-has-no-people-skills

Poll # 2 What aspect of SBIRT/MI feels comfortable?

SBIRT Conversations Establish Rapport Raise the subject; Ask permission Thoughts and Feedback Enhance Motivation Negotiate a Plan Discuss results; Pros and cons; Determine the appropriate health education when it is needed Ideas for change; Determine the barriers to change; Validate control over decision Set goals; Discuss follow-up as needed

Brief Intervention

Brief Intervention Video Example

Referral to Treatment Screening locates someone on the range of alcohol use. Usually, a BI is used for risky/harmful use. Referral to treatment occurs when a patient is a heavy or dependent drinker, or when a BI reveals more serious use.

Where Could We See SBIRT?

Number of Adolescents Aged 12-17 Admitted to Publicly Funded Substance Abuse Treatment Facilities on an Average Day, by Principal Source of Referral Treatment Episode Data Set, 2008

Poll # 3 Where in your school/district could you see SBIRT?

SBIRT Outcomes http://web.iit.edu/sites/web/files/field_uploads/slideshow/full-body-slide/2015/main_home1_770x350.jpg

Outcomes of Brief Interventions Screening and Brief Interventions reduce Drinking and illicit drug use; Emergency room costs; Injuries and emergency dept. visits; Length of hospital stays, sick days & mortality; Unnecessary risks (e.g. driving under the influence, legal consequences, physical injury).

Questions Image source:https://innorobo.com/wp-content/uploads/2015/02/startup.jpg

References Campbell KP et al, eds. A Purchaser s Guide to Clinical Preventive Services: Moving Science into Coverage. Washington, DC: National Business Group on Health; 2006. Estee S et al. Medical Care 2010; 48:18-24. Fleming MF et al. Medical Care 2000; 26:36-43. Fleming MF et al. Alcoholism: Clinical and Experimental Research 2002; 26: 36-43. Gentilello LM et al. Annals of Surgery 2005, 241:541-550. Quanbeck A et al. Wisconsin Medical Journal 2010; 109:9-14. DiClemente, D, Corno,C, Graydon, M, Wiprovnick, A, Knoblach, D. Motivational Interviewing, Enhancement and Brief Interventions Over the Last Decade: A Review of Reviews of Efficacy and Effectiveness. Psychology of Addictive Behaviors. 2017:31(8):862-887.

References (Continued) 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):52-61. 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):143-152. Motivational Interviewing: Helping People change (3 rd Edition), William Miller and Stephen Rollnick, Guilford Press. Motivational Interviewing in Health Care: Helping Patients Change Behavior, Stephen Rollnick, William Miller and Christopher butler, Guilford Press. Hunter, C.L., Goodie, J.L., Oordt, M.S., & Dobmeyer, A.C.(2009).Integrated behavioral health in primary care: Step-by-step guidance for assessment and intervention. Washington, DC: American Psychological Association. Centers for Disease Control and Prevention (CDC). (2012). Summary health statistics for U.S. Adults: National Health Interview Survey, 2011. Vital and Health Statistics, 10, 1-208.

References (Continued) Wilk AI, Jensen NM, Havighurst TC. Meta analysis of randomized control trials addressing brief interventions in heavy alcohol drinkers. Journal of General Internal Medicine. 1997;12(5):274-283. 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):280-295. 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):49-59.

Contact Us! www.indianasbirt.org Mallori DeSalle: mdesalle@indiana.edu THANK YOU!

Q&A

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SAVE THE DATE! 92 ND ANNUAL CONFERENCE INDIANAPOLIS, INDIANA OCTOBER 4-6, 2018