Expand SBIRT Program

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Background

Screening, Brief Intervention and Referral to Treatment (SBIRT) is used to provide care for substance users across the spectrum from early intervention to extensive specialized treatment. This represents a paradigm shift in substance-abuse treatment, which has historically focused on people that meet the criteria for substance abuse or dependence as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.

The SBIRT model screens all patients regardless of an identified disorder, allowing healthcare professionals in a variety of settings to address a patient's behavioral health even when that patient is not actively seeking treatment or care for their behavioral health problems. While SBIRT is well-established as an effective intervention for risky alcohol use researchers and clinicians are just beginning to explore it as an intervention for risky drug use.[1]

By expanding the use of SBIRT and improving SBIRT practices, communities should be able to reduce the number of people who develop a dependency on opioids or Opioid Use Disorder. It should provide pathways for people to get appropriate help sooner--which reduces the potential negative impact of using opioids. SBIRT can be done in many different settings, and there are a variety of ways to do each element of SBIRT. This creates many opportunities to expand and improve SBIRT practices.

 

Research on the Effectiveness of SBIRT

While the strongest evidence for the effectiveness of SBIRT relates to using it to address alcohol misuse, there is growing evidence in its effectiveness in accelerating people getting help with misuse of opioids.
  This 2017 report summarizes five years of research on SBIRT
  The research covered eleven multi-site programs in two cohorts of SAMHSA grant recipients were each funded for 5 years to promote the use and sustained implementation of SBIRT. They screened more than 1 million people. The programs used substance use specialists instead of medical generalists to deliver services.

 

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


Four factors influenced SBIRT sustainability:

  • Presence of a program champion
  • Availability of funding
  • Systematic change
  • Effective management of SBIRT provider challenges


Key Findings:

  • SBIRT was adapted successfully to the needs of early identification efforts for harmful use of alcohol and illicit drugs
  • SBIRT is an innovative way to integrate management of substance use disorders into primary care and general medicine
  • SBIRT improved treatment system equity, efficiency, and economy

 

Promising Programs

SBIRT in Schools

Some states, like Massachusetts have been moving to significantly expand SBIRT in schools. [2]
  A research report shared early findings: [3]
  Training on using SBIRT in schools to address alcohol use: [4]
  This article has encouraging updates and resources on using SBIRT in School-Based Health Clinics:[5]
 

 

SBIRT in Emergency Room Settings

Add information here

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

 

SBIRT in Community Clinics & FQHCs

Add information here.
 

 

SBIRT in Mental Health Settings

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

SBIRT in Dental Settings

Add information here

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

Expanding and Enhancing SBIRT Skills

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).

 

Funding

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

 

  1. Conrad N. Hilton Foundation[6]
  2. Substance Abuse and Mental Health Service Administration[7]
  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

Screening

More information about screening and testing for misuse.

 

Brief Intervention

Models for brief treatment recommended by SAMHSA[8] 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[5] , commonly used models for brief treatment include:

 

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

Scorecard Building

Potential Objective Details
Potential Measures and Data Sources
Potential Actions and Partners

Tools & Resources

TR - Expand SBIRT Program

Resources to Investigate

More RTI on SBIRT

PAGE MANAGER: [insert name here]
SUBJECT MATTER EXPERT: [fill out table below]

Reviewer Date Comments
     

 

Sources

  1. http://store.samhsa.gov/shin/content/SMA13-4741/TAP33.pdf
  2. http://www.masbirt.org/schools
  3. https://www.integration.samhsa.gov/Translating_SBIRT_Curtis_etal.pdf
  4. https://neushi.org/student/programs/attachments/SBIRTHandouts.pdf
  5. http://www.sbh4all.org/current_initiatives/sbirt-in-sbhcs/
  6. https://www.hiltonfoundation.org/grants?priority=substance-use-prevention#filters
  7. https://www.samhsa.gov/sbirt/grantees
  8. http://store.samhsa.gov/shin/content/SMA13-4741/TAP33.pdf
  9. http://store.samhsa.gov/shin/content/SMA13-4741/TAP33.pdf
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