Expand SBIRT Program

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Screening, Brief Intervention and Referral to Treatment, or SBIRT, provides a spectrum of care for people with substance use disorder from early intervention to  treatment.

 

How does SBIRT work?

It is a popular model because all patients are screened regardless of an identified disorder. This allows healthcare professionals to reach a wider range  of people - not just those who are seeking treatment for SUD or behavioral health. This is especially critical for those who may be at risk for substance use disorder but may not meet established criteria.  Additionally, SBIRT screens for all types of substance use, not just dependencies.

This evidence based, public health approach is a paradigm shift in substance-use  treatment. Routine screening helps identify and intervene with patients whose use puts them at risk for health issues.

SBIRT places risky substance use where it belongs—in the realm of healthcare. It focuses on identifying risky substance use to help prevent the onset of the more costly disease of addiction. Similar to preventive screenings for chronic diseases such as cancer, diabetes, and hypertension, SBIRT is an effective tool for identifying risk levels related to substance use and for providing the appropriate intervention.

By expanding the use of SBIRT and improving SBIRT practices, it can provide critical pathways for people to access treatment earlier.

Research on the Effectiveness of SBIRT

A growing body of evidence demonstrates SBIRT’s  effectiveness in creating positive outcomes for those with substance use disorder.  A  2017 report studied eleven multi-site programs of SAMHSA grant recipients each funded for 5 years to promote the use and  implementation of SBIRT. They screened more than 1 million people and reviewed five years of SBIRT research, concluding that its  implementation was associated with improvements in treatment system equity, efficiency and economy, including:

• Greater intervention intensity was associated with larger decreases in substance use.
• Brief intervention and treatment had positive outcomes, brief intervention was more cost effective for most substances.

Key Findings about SBIRT:

• Adapted successfully to the needs of early identification efforts for harmful use of alcohol and illicit drugs
• Integrates management of substance use disorders into primary care and general medicine
• Improves treatment system equity, efficiency, and economy

The 6 Characteristics of a Behavioral Health SBIRT Model

SAMHSA supports a research based comprehensive behavioral health SBIRT model which reflects the six following characteristics:

1. It is brief. The initial screening is accomplished quickly (about 5-10 minutes) and the intervention and treatment components indicated by the screening results are completed in significantly less time than traditional substance abuse specialty care. 

2.Screening is universal. The patients, clients, students, or other target populations are all screened as part of the standard intake process.

3.One or more specific behaviors are targeted. The screening tool addresses a specific behavioral characteristic deemed to be problematic, or pre-conditional to substance dependence or other diagnoses. 

4.The services occur in a public health, or other non-substance use treatment setting.  

5.It is comprehensive. The program includes a seamless transition between brief universal screening, a brief intervention and/or brief treatment, and referral to s care. 

6. Strong research or substantial experiential evidence supports the model. At a minimum, programmatic outcomes demonstrate a successful approach.

SBIRT Related Training

General Training

How can communities expand Screening and SBIRT tools? One way is to increase public awareness of the SBIRT approach and the value of identifying people who are at high or may be using substances. 

• NORC at the University of Chicago Hosted Webinars on Screening, Brief Intervention, and Referral to Treatment (SBIRT) Initiatives:   NORC Training Resources for professionals, adolescent SBIRT, workplace/EAP, community stakeholders, and other addiction or behavioral professionals are available at  http://www.sbirteducation.com. Upcoming free webinars can be found at https://hospitalsbirt.webs.com/webinars.htm
• NORC and the Conrad Hilton Foundation also offers a curriculum focused specifically on skills-based education for Adolescent SBIRT.  https://sbirt.webs.com/webinars

Screening and Intervention Training

How can communities expand SBIRT?  According to SAMHSA, one of the benefits of the SBIRT approach is that it is easy to learn relative to other behavioral treatment techniques that may require lengthy specialized training. As such, it can be implemented by diverse health professionals who work in busy medical settings such as physicians, nurses, social workers, health educators and paraprofessionals.

Accordingly, if a community wants to  expand SBIRT it may  require  training of a large number of people. One  cost effective option to accomplish this is through the use of technology.

• Kognito offers and accredited technology-based training on Screening and Brief Intervention for youth using innovative simulations to provide training and evaluate the skills of those taking the training. The program was developed in collaboration with NORC at the University of Chicago and adopted by more than 40 schools of health professions and state agencies.  Additionally, the Kognito Conversation Platform has an innovative behavior change model that integrates several evidence-based models and techniques, game mechanics, and learning principles. Kognito is listed in the National Registry of Evidence-based Programs and Practices (NREPP).
• SAMHSA offers a wide list of general resources for SBIRT with links to technical assistance, online apps, and other research #REDIRECT https://www.integration.samhsa.gov/clinical-practice/sbirt

 

Screening 

Effective Screening Tools

Communities can also enhance SBIRT by incorporating technology through new screening tools. These tools make it easier for health professions to expand initial screenings  while opening up a new avenue to engage patients and individuals. Screening tools may include phone apps, tablet-based screening, computer administered screening (available in Spanish ) interactive voice response, web based or even text based.

• SBIRT Oregon App:   The Department of Family Medicine at Oregon Health and Science University designed online resources and an SBIRT app for primary care and emergency medicine settings in Oregon and the U.S.   The patient uses web-based screening app for tablet, phone, or desktop, which quickly screens and assesses patients for substance use and depression, converts answers into chart-ready notes, reads questions out loud for patients with low literacy, and delivers screening tools in English or Spanish.
• Screen for Opioid Abuse Risk (SOAR in Ohio, formerly known as OARS)  was developed as a comprehensive self-administered measure of potential risk that includes a wide range of critical elements noted in the literature to be relevant to opioid risk.[2] This 43-question assessment is administered using a tablet and takes about 10 - 12 minutes to complete. It is HIPAA compliant, EMR supported, and has high reliability, validity and predictability scores. The assessment is instantly scored and a report is available to the prescribing physician that provides a summary opioid risk profile and a multidimensional assessment of risk factors. SOAR  also provides depression and anxiety scores that can be used for SBIRT assessments and wellness visits.

Referral to Brief Intervention or Referral to Treatment

Screening is the first component of SBIRT.  Next, the individual may be referred for a      Brief Intervention (BI), where a healthcare professional engages a patient showing risky substance use behaviors in a short conversation, providing feedback and advice.

According to SAMHSA[4] , commonly used models for brief interventions treatment include:

• Cognitive-Behavioral Therapy (CBT)
• Motivational Enhancement Therapy
• Community Reinforcement Approach
• Solution-focused Therapy
•  Models for brief treatment recommended by SAMHSA[3] include:
• Brief Negotiated Interview
• Brief counseling
• Feedback, Responsibility, Menu of options, Empathy, Self-efficacy (FRAMES)
• Motivational Interviewing (MI) techniques

If the patient requires additional services, the healthcare professional may recommend a Referral to Treatment  (RT)— brief therapy or additional treatment to patients who screen in need of additional services.

SAMHSA recommends that referral to treatment is a critical component of the SBIRT process. It involves establishing a clear method of follow-up with patients that have been identified as having a possible dependency on a substance or in need of specialized treatment. The referral to treatment process consists of assisting a patient with accessing specialized treatment, selecting treatment facilities, and helping navigate any barriers such as treatment cost or lack of transportation that could hinder treatment in a specialty setting. 

Integrate SBIRT into Other Settings  

Besides typical healthcare settings, here are many other places where professionals come into contact with people who may be at risk of substance use disorder.   

Hospitals  and Emergency Rooms

Individuals with SUDs or just occasional use regularly access emergency care.  Utilizing the SBIRT approach with individuals seeking care can be beneficial.  A 2018 study examined an SBIRT program in Allegheny County, Pennsylvania emergency rooms.  The study concluded that SBIRT showed the potential to reduce healthcare costs and utilization as measured by Medicaid claims data, and that SBIRT use in the ED can be readily incorporated into existing practice settings.

Community Health Centers and Clinics

Community settings provide excellent opportunities for early intervention with at-risk substance users and for intervention for persons with substance use disorders.  

 Agencies and Programs Addressing Mental Health

 

Promising Programs

There are many promising programs that seek to expand SBIRT into places where professionals come into contact with people who have started to misuse substances.  Several programs have focused on populations that have co-occuring mental health issues, which often leads to self-medication and abuse.

Healthcare Settings

Healthcare professinals often come into contact with patients who may have substance misuse issues.  

Hopsitals and Emergency Rooms

https://www.bu.edu/bniart/files/2011/02/SBIRT-emergency-care-setting.pdf

Dentists and Oral Surgeons

The Journal of the American Dental Association, Volume 142, Issue 7, July 2011, Pages 800-810  https://www.sciencedirect.com/science/article/pii/S0002817714622649

The Journal of the American Dental Association, Volume 144, Issue 6, June 2013, Pages 627-638 https://www.sciencedirect.com/science/article/pii/S0002817714607674

 

Agencies and Programs Addressing Mental Health

Add information here
https://ireta.org/resources/what-i
s-sbirt-and-why-might-it-fit-well-in-mental-health-settings-the-research-is-just-beginning/

Schools

Some states, like Massachusetts have been moving to significantly expand SBIRT in schools.
A research report shared early findings: 
Training on using SBIRT in schools to address alcohol use: 
This article has encouraging updates and resources on using SBIRT in School-Based Health Clinics:
 

Integration of SBIRT into Electronic Health Records

One way to enhance the impact of SBIRT is to integrate information from the process into the Electronic Health Record (EHR).  "Modifying your organization's electronic health record to support SBIRT can accelerate your patient flow, reduce the burden of data collection, and allow you to monitor and measure the success of your SBIRT implementation."

An overview on this topic, and links to recorded webinars can be found in the SBIRT and Electronic Health Records Toolkit: https://ireta.org/resources/electronic-health-record-toolkit/

This recorded webinar, provided by IRETA and the Addiction Technology Transfer Center Network, provides a good overview on implementing the integration of SBIRT data into EHRs. 

Funding

The following organizations are currently funding research and initiatives to expand SBIRT:

1. Conrad N. Hilton Foundation
2. Substance Abuse and Mental Health Service Administration
3. A report by Catalyst shares several innovative ways to fund SBIRT in schools  
   Funding Screening, Brief Intervention, and Referral to Treatment (SBIRT) in Public Schools

Tools & Resources

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