Expand SBIRT in Maternity Care Clinics

Introductory Paragraph

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.

This article builds upon information provided in the SAFE Solutions article titled "Expand SBIRT Program."

Key Information

Where to Integrate SBIRT. Besides typical healthcare settings, there are many other places where professionals come into contact with people who may be at risk of substance use disorder. Individuals with SUDs or just occasional use regularly access hospitals and emergency care. Utilizing the SBIRT approach with individuals seeking care can be beneficial. Community health Centers and clinics offer excellent opportunities for early intervention with at-risk substance users and intervention for persons with SUDs and mental health issues.

Relevant Research

This SAMHSA White Paper discusses the evidence supporting the effectiveness of SBIRT as a comprehensive approach and individual components of SBIRT for different non-medical behavioral health conditions. The report includes a literature review and addresses the question of what a model SBIRT program is, compared to programs which include or adapt components of the comprehensive SBIRT approach.

NIDA Study. The National Institute on Drug Abuse funded research on SUMMIT (Substance Use, Motivation, Medication and Integrated Treatment). It looked at ways to implement MAT and behavioral treatment for patients with opioid and alcohol use disorders in a community health clinic. The project helped the clinic implement SBIRT and evaluated whether integrated collaborative care helped patients get the care they needed. The manual titled, “SUMMIT Study Protocol: Step-by-Step Procedures for Providing Screening, Brief Intervention, and Treatment Services to Primary Care Patients with Opioid or Alcohol Use Disorders,” is useful for researchers, primary care clinics, and policymakers providing treatment in primary care settings. The introduction provides a general overview of the study for readers, and the remainder of the manual is presented in the step-by-step instructional format used during the study.

Impactful Federal, State, and Local Policies

SAFE Solutions is an ever-growing platform. Currently limited information is readily available for this section. SAFE Project is dedicated to providing communities with the most relevant and innovative materials. We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration. Please check back soon.

Available Tools & Resources

National Association of Addiction Professionals (NAADAC) provides a webinar that outline a plan on how to work collaboratively with clinics in rural settings to build a SBIRT practice.

Massachusetts Toolkit. This is a step-by-step guide for implementing SBIRT.

SAFE Project has a more detailed wiki page titled "Expanding SBIRT Program" with additional tools and resources.

Promising Practices

• New Hampshire was an early adopter of SBIRT in a community setting. By incorporating SBIRT, New Hampshire found that universal screening lowers the barriers to early intervention and treatment, integrated care, and increased positive outcomes for patients.

• Pennsylvania. This study examined an SBIRT program in Allegheny County emergency rooms. It concluded that SBIRT had the potential to reduce healthcare costs and utilization, as measured by Medicaid claims data and that SBIRT use in the emergency department can be readily incorporated into existing practice settings.

• Ultrasound Information. 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.

• Medical students. This study in an obstetrics and gynecology rotation documents the benefits of placing students in a residential treatment center for pregnant women. The results of their specialized training showed improvements in assessing and educating patients about substance abuse during pregnancy compared to those in a regular rotation.

 

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