Amy Pepin, MSW, LICSW, CPS JSI Research & Training, Inc. - - PowerPoint PPT Presentation

Behavioral Health is Essential to Health Prevention Works | Treatment is Effective | People Recover

Amy Pepin, MSW, LICSW, CPS JSI Research & Training, Inc. December 2nd, 2015

New Hampshire

First in the Nation

“This is a disease, this is a chronic condition that has to be interrupted and treated and prevented if possible.” – Hillary Clinton “Nobody would know that, but New Hampshire has a huge heroin problem.” “You have to educate and you have to do something very strong, but it does have a big problem, I’ve been hearing it from everybody.” – Donald Trump

A Heroin Epidemic in New Hampshire Is Our Best Chance to Get Politicians to Talk About Addiction

“You talk about New Hampshire for a

• moment. One of the stories that has not

been as reported nationally, is the fact that many of the people who today are dependent on heroin, is because they became dependent on prescription

• piates,” Senator Marco Rubio

“New Hampshire’s got its issues, but so does New Jersey and so does Iowa, and places I’ve been visiting have all been experiencing the same thing. This is an epidemic in our country,” – Governor Chris Christie

Strategic Planning

• Funding - Vision and Leadership
• Conrad N. Hilton Foundation
• Policy - Advocacy and education
• Provider partners - 7 organizations
• 15 primary care sites
• Program - Training and Technical Assistance

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Funding Parameters

May be used to…

Prepare for and implement SBIRT:

– EMR modifications – Workflow improvements or enhancement – Cover staff time devoted to learning, business practice adjustments, and initial implementation

May not be used to…

Cover new or additional staff which will be devoted to ongoing SBIRT activities that will continue beyond the grant period

Participant Requirements

• Form an interdisciplinary Implementation Team that meets

regularly and participates in:

• 4-6 hour face-to-face meetings 2-3 times/year
• Monthly 1.5 - 2 hour webinars addressing SBIRT

implementation issues

• Share lessons learned
• EMR in place
• Integrated behavioral health/SUD services in place, or

commit to develop partnerships

• Quarterly data reporting

Participant Benefits

• Member of a Community of Practice
• Training and individualized TA
• Sharing across grantees

“Implementing SBIRT has not

• nly helped our patients, but

changed the way we practice: It has led to formalizing protocols and training and program evaluation agency-wide.” “It is really exciting to work on something like this that is so needed in a community like

• urs.”

Training and Technical Assistance

• Action Learning Collaborative
• Webinars
• Teleconferences
• Training
• Consultation
• Facilitation
• Presentations
• Annual Statewide Summit
• Playbook
• www.sbirtnh.org

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Open-Source Webinar Series

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Screening Tools

S2BI CRAFFT

Brief Intervention

• A brief intervention is a

short, motivating conversation in response to screening results - typically 3-7 minutes.

• BI utilizes motivational

interviewing techniques, you do not need to be an expert - primarily being done by primary care providers.

• BI is patient-centered –

your goal is dependent on each patient’s circumstances and preferences – change is a process over time.

• The patient has the best

idea in the room – listen.

Implementation Checklist

17

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Coverage

• 7 Provider organizations
• 15 primary care clinic sites
• Pediatric practices
• Family medicine practices
• FQHCs
• Screened 2,000 youth to date
• On track to meet goal of 10,000 by 2017

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Critical Success Factors & Challenges

• Team
• Patient Confidentiality
• Role of the Primary Care Provider

Team

• Buy in from key

leadership

• Representation across

disciplines and clinical flow

• Meet regularly for

learning and decision making

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• Perceived barrier
• Actual barrier
• Approaches
• Tools and resources

www.sbirtnh.org

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• Crucial to flow of process
• Ideally conducts BI
• Creates environment to

address alcohol and drug use as a health issue

• Follows up
• Screens across lifespan

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Evaluation

Components

• Metrics were designed in

collaboration with Abt Associates

• 9 metrics
• Patient Survey

Measure Numerator Denominator % of youth who screened as no current use total # of youth who completed screen during wellness checkup (or similar annual exam or visit) total # of youth aged 12-22 seen for wellness checkup (or similar annual exam or visit) % of youth who screened as no current use

• n CRAFFT, “no” to all

questions on Part A

• n S2BI, “never” to first

three questions # youth screened no current use # youth screened % of youth screened as being at risk

• n CRAFFT, any “yes”

answer on Part A

• n S2BI, any answer greater

than “never” on the first three questions # youth identified at risk through the screening process # youth screened % at risk youth who received BI/BA # at risk youth who received BI/BA # youth identified as being at risk % at risk who need referral

• CRAFFT score ≥2 on Part B
• S2BI, weekly use of any

substance # at risk youth who need referral for treatment # youth identified as being at risk (line 11) For organizations with internal behavioral health services: % who need a referral who received a referral # at risk youth who received a referral for treatment to internal behavioral health services # at risk youth who need referral for treatment (line 17) For organizations with internal behavioral health services % at risk who received a referral to external behavioral health services # at risk youth who received a referral to external behavioral health services # at risk who need a referral to treatment For organizations WITHOUT internal behavioral health services: % at risk who received a referral to external behavioral health services # at risk youth who received a referral for treatment to external # at risk youth who need referral to treatment (line 17) # At risk youth who received BI/BA were followed up by PCP N/A N/A # At risk youth referred for treatment who were followed up by PCP N/A N/A

Sustainability

Categories

• Social

– Organizational buy-in – Provider champions

• Environmental

– Flow Modifications – EMR Modifications – “It’s just what we do”

• Financial

– Reimbursement

Active SBIRT Initiatives in NH

Initiatives Target Population Sites Funders NH Youth SBIRT Initiative Youth and Young Adults (ages12-22) 7 grantees

• rganizations

x 15 sites NH Charitable Foundation Conrad N. Hilton Foundation Community Health Centers

• Adults (ages 18-65)
• Pregnant women

18 sites NH Bureau of Drug and Alcohol Services Inter- professional Education Collaborative (NH AHEC) Health professions students – nursing, social work, medical assistant, and doctor. 11 institutions SAMHSA

Questions?