Expand SBIRT in Maternity Care Clinics

Introductory Paragraph

SBIRT (Screening, Brief Intervention, Referral to Treatment) is "a comprehensive, integrated, public health approach to the delivery of early intervention and treatment services for persons with substance use disorders, as well as those who are at risk of developing these disorders" and has been widely acknowledged as an evidenced-based practice. It helps identify the level of risk associated with alcohol or substance use.

Key Information

Early identification of substance use allows for early intervention and treatment which minimizes potential harms to the mother and her pregnancy. Selective screening based on “risk factors” perpetuates stigma and misses most women with problematic use.

The goals of SBIRT include:

• Educate people about the risks of alcohol and other drugs
• Make people aware of their use and whether it may be creating health risks for them
• Decrease general use so as to reduce the societal risk and burden of the effects of overuse
• Identify individuals who have dependence and provide rapid access to care

Promising Practices

1. Use non-judgmental and caring tone - Patients are usually not offended by questions about substance use if asked in caring and nonjudgmental manner.

      2. Normalize questions:
          – Embed them in other health behavior questions
          – Preface questions by stating that all patients are asked about substance use
     3. Ask permission
          – “Is it OK if I ask you some questions about smoking, alcohol and other drugs?
     4. Avoid closed-ended questions
          – “You don’t smoke or use drugs, do you?”

Increase Uptake of SBIRT

• Embed it in standard of care
  • Staff-wide trainings
  • EMR
  • Routine part of QA Evaluation
• Don't rely exclusively on physicians
  • Physicians (especially primary care physicians) are overburdened by time and an increasing load of screenings
  • Think creatively about staff, screening and brief interventions
• Expand types of screening
  • Patient completed
  • Nurse/staff administered
  • Computer-assisted
• Expand types of intervention
  • Computer-based
  • Peer-based
  • Other staff

Promising Programs

Ultrasound Feedback

One study showed that real-time ultrasound feedback focused on the potential effects of smoking on the fetus may be an effective treatment adjunct to improve smoking outcomes. This could be adapted and used to treat women with other types of SUDs as well.

Educating Medical Students

A 2012 study of medical students in an obstetrics and gynecology rotation found that when students are placed in a residential treatment center for pregnant women (i.e. specialized training) they showed greater comfort in assessing and educating patients about substance abuse during pregnancy compared to those in a regular rotation.

 

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