Expand SBIRT Program

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WHAT IS SBIRT?

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.

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

1. 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.

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

 

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

One of the keys to expanding the use of Screening and SBIRT tools is to increase the general awareness of the SBIRT approach and the value of identifying people who are misusing substances (or at risk of misusing substances) as soon as possible. 

This set of Webinars provides valuable background and could be shared with many different community stakeholders:  https://sbirt.webs.com/webinars

More SBIRT Training Resources are available at  http://www.sbirteducation.com 

Screening and Intervention Training

Efforts to significantly expand SBIRT in a region will require significant training of a large number of people. One option to accomplish this is through the use of technology.

Kognito offers and accredited technology-based training on Screening and Brief Intervention for youth that use 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. It helps improve patient-provider communication and supports the integration of substance use SBI in primary care settings. It is a cost-effective way to train large numbers of people.

The Kognito Conversation Platform has an innovative behavior change model integrates several evidence-based models and techniques, game mechanics, and learning principles. In these simulations, users enter a virtual environment and engage in role-play conversations with emotionally-responsive virtual humans. Through practice and receiving personalized feedback, users learn and assess their competency to lead similar conversations in real life. Kognito is the only company with health simulations listed in the National Registry of Evidence-based Programs and Practices (NREPP).

Screening 

Effective Screening Tools

One of the most promising ways to enhance SBIRT is to use some of the new screening tools that are based on new science and that use new technology.  The use of tools make it easier for screenings to be done, and the results of the screenings shoudl be more detailed and valuable.   Also, in many cases, the screening is a billable event, and if it is done using technology, then it will minize the burden on the healthcare professionals. 

OARS
Opioid Abuse Risk Screener (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. This 43-question assessment is administered using an iPad (tablet) and takes about 10 - 12 minutes to complete. It is HIPAA compliant, EMR supported, and has high reliability, validity and preditablity 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. The OARS also provides depression and anxiety scores that can be used for SBIRT assessments and wellness visits, including scores for the PHQ-9 and the GAD-7. All information is provided in a compressive easy to read report which clearly identifies aberrant behavior and risk factors for followup by the provider with the patient during the visit.

The OARS is reimbursable with an average rate of $40/screening. Providers can get reimbursed in most cases with the CPT Code 96103 or the SBIRT codes while taking important steps to identify individuals that may be at risk for opioid misuse or abuse.

InteraSolutions, the company that developed OARS, received a 2018 recipient of the State of Ohio's Opioid Science Challenge that seeks to identify and support scientific breakthroughs that help to address the opioid crisis. The OARS screening tool was recognized as one of those important breakthroughs. 

More information on the Opioid Abuse Risk Screener (OARS)

Brief Intervention

Models for brief treatment recommended by SAMHSA include:

1. Brief Negotiated Interview
2. Brief counseling
3. Feedback, Responsibility, Menu of options, Empathy, Self-efficacy (FRAMES)
4. Motivational Interviewing (MI) techniques

Referral to Treatment

According to SAMHSA , commonly used models for brief treatment include:

1. Cognitive-Behavioral Therapy (CBT)
2. Motivational Enhancement Therapy
3. Community Reinforcement Approach
4. Solution-focused Therapy

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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