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January 25th 2018 Presentation

Depression Screening & SBIRT (Screening, Brief Intervention and Referral to Treatment)

DSRIP Calendar

DY3

April 1, 2017 – March 30, 2018

MY4

July 1, 2017 – June 30, 2018

Demonstration Year (DY) Measurement Year (MY)

MPA Period

April 1, 2017 – June 30, 2018

Substantiation Algorithm Best Practice

Depression Screening agenda

Millennium MPA - Depression

Substantiation

MCC shall conduct initial medical review

• audit. If original findings by MCC indicate

less than 75% documentation accuracy, then MCC will re-audit again at a later time.

Activity

Provide evidence

• f

appropriate documentation and at least 75% documentation accuracy

• f

depression screen with follow-up

Millennium MPA – Major Depression

Substantiation

Sign-in sheets for education and training sessions. Produce baseline reports Provide evidence of improvement by 10%, 15% or 20% over baseline

Activity

Participate in MCC-facilitated education and training on depression best practices Develop and implement practice workflow to care manage patients diagnosed with Major Depression Produce baseline reports of patients that received an initial Dx of Major Depressive Disorder in the primary care office that had a F/U visit w/in 12 wks. of diagnosis. Improve F/U w/patients receiving an initial Dx of Major Depression in the PCP office w/in 12 weeks of diagnosis

Depression Algorithm

BH Best Practice

Millennium MPA - SBIRT

Substantiation Demonstrate completion of training (i.e. certificates or sign-in sheets) Provide workflows and quarterly reporting on number of screenings Activity Train at least one key clinical member per site Implement SBIRT

But not in that particular order…

WHY is the issue of Substance Abuse Important for Primary Care Providers?(WHERE)

It is a common problem There are health implications It affects the person, family & society WE CAN DO SOMETHING ABOUT IT!!!

 Patient resistance  Sensitive topic  High failure rates  Inadequate training  Difficulty w/ linkages  Work overload  Staff frustration

Why not?

Prevalence of Substance Use

Prevalence for Alcohol Use and Abuse

 Most damage from misuse and/or binge drinking  Early Intervention is KEY!

Builds on medical principles

WHAT is SBIRT? And HOW can we do a better job?

Screening Brief Intervention and Referral to Treatment

1 Screen

Initial triage for level of severity of problem

2 Brief Intervention

Optimize level of recognition and motivation to change, if needed 1-3 sessions

3 Referral to Treatment

Severity, co-morbidity, on-site capacity, routine follow-up recommended

Patient Acceptance is high It is evidence-based (with long-term benefits) Ease of implementation by using existing staff Time-efficient and cost-effective Can generate additional revenue

Benefits of SBIRT (WHY)

SBIRT Algorithm

How can we do a better job?

SCREENING: WHEN? and WHO?

KEYS Routinely screen ALL patients over age 12 annually at well visit – also screen if relevant to primary complaint Use OASAS standardized instruments

 Triage patient information

• Non-Risky
• Risky
• Substance Use Disorder

 WHO screens? Self-administered or by trained staff  If positive screen – next steps may require further information (BH dx, blood pressure, blood sugar)

Approved Screening Tools

**Remember to PRE-SCREEN FIRST!!

Establish a preliminary substance use diagnosis Severity of problem Incorporate co-morbidity Identify strengths Performed in primary care office setting

ASESSMENT (if patient screens positive)

NON RISKY

Assessment Feedback to Patient Non Risky Reinforce current behaviors

Rescreen annually

BRIEF INTERVENTION

Risky Substance Use Disorder Brief Intervention and follow-up over time Follow-up Encourage linkage to treatment and monitor over time Follow-up

Build on patients’ concerns & motivation based on their goals Listen, show empathy, be non-judgmental Involve patient in joint decision making Compared to standard medical advice; this is non- confrontational; clear but not directive Can be completed in about 5-7 minutes Can be administered by PCP, NP, PA, RN, MSW, etc.

Keys to Brief Intervention*

*This is NOT an intervention as seen on TV

REFERRAL TO TREATMENT

Provide LINKAGES and NOT just phone #’s Establish bi-directional methods of communication to ensure progress of patient Can be referred on site to qualified Behavioral Health professional OR off site to licensed Behavioral Health facility

http://youtu.be/fX90j4jD9Sc Teen Example http://youtu.be/ebsqETBWEdQ Adult Example

Brief Intervention Examples

• Many Resources

available – packets will be distributed to sites

• New York State SBIRT

Publications: contact

Communications@oasas.ny.gov

to order additional publications

Continue quarterly Patient Engagement-including SBIRT screens Create or update workflows to include SBIRT processes Provide certification from 4 hours SBIRT training for at least 1 key clinician from each site

Next Steps

MILLENNIUM LINK TO 4 HOUR CERTIFICATION COURSE https://www.hwapps.org/dsrip/new-york/mcc/training- center/courses/?task=search_course&st=sbirt&partner_type=&project=&c _require=&credit_type=&=Find+Courses OASAS APPROVED Certification Courses https://cumc.co1.qualtrics.com/jfe/form/SV_1MLQ2Ub4uMqzV mB https://www.sbirttraining.com/ http://www1.nyc.gov/site/doh/providers/health-topics/sbirt-

• nline-learning.page

Training Videos

What –PAM/CFA/LNU When- February Where- Webinar format

Next Webinar

QUESTIONS?

Contact your Millennium Collaborative Care Relationship Manager

References

WHY

• A. L. Bahorik, D. D. Satre, A. H. Kline-Simon, C. M. Weisner and C. I. Campbell Alcohol, Cannabis,

and Opioid Use Disorders, and Disease Burden in an Integrated Health Care System https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5291754/ REVIEWS

• B. Shapiro, D. Coffa and E. F. McCance-Katz A Primary Care Approach to Substance Misuse

https://www.aafp.org/afp/2013/0715/p113.pdf SAMSHA Substance Use Disorders https://www.samhsa.gov/disorders/substance-use NIDA Screening for Drug Abuse in General Medical Settings: A Resource Guide For Providers https://www.drugabuse.gov/sites/default/files/resource_guide.pdf D. E. Jonas and J. C. Garbutt Screening and Counseling for Unhealthy Alcohol Use in Primary Care Settings https://www.ncbi.nlm.nih.gov/pubmed/28577629 IRETA Why Mainstream Healthcare Can't Ignore Substance Use http://ireta.org/2014/05/28/infographic-why-mainstream-healthcare-cant-ignore-substance-Use/?utm_

OB_GYN

• T. E. Wright, M. Trepan, S. J. Undersea, C. Boyce, K. Yonkers, G. Chang and A. A. Cringe The role of screening, brief intervention,

and referral to treatment in the perinatal period. https://www.ncbi.nlm.nih.gov/pubmed/27373599

• A. L. Suit Behavioral and Pharmacotherapy Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Women:

U.S. Preventive Services Task Force Recommendation Statement http://annals.org/aim/fullarticle/2443060/behavioral- pharmacotherapy-interventions-tobacco-smoking-cessation-adults-including-pregnant-women Pediatrics American Academy of Pediatrics . Prevention Substance use Screening, Brief intervention and Referral to Treatment . 2016 http://pediatrics.aappublications.org/content/pediatrics/138/1/e20161210.full.pdf

• D. J. Pilowsky and L.-T. Wu Screening instruments for substance use and brief interventions targeting adolescents in primary care:

A literature review http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3623552/

• S. J. Levy and J. F. Williams Substance Use Screening, Brief Intervention, and Referral to Treatment

http://pediatrics.aappublications.org/content/pediatrics/138/1/e20161210.full.pdf

• K. Harris, J. Louis-Jacques and J. R. Knight Screening and brief intervention for alcohol and other abuse

American College of Obstetrics and Gynecology. At Risk Drinking and Alcohol Dependence https://www.acog.org/- /media/Committee-Opinions/Committee-on-Health-Care-for-Underserved- Women/co496.pdf?dmc=1&ts=20180115T1719535250L.

References (OBGyn and Pediatrics)

American College of Obstetrics and Gynecology. At Risk Drinking and Alcohol Dependence https://www.acog.org/- /media/Committee-Opinions/Committee-on-Health-Care-for-Underserved- Women/co496.pdf?dmc=1&ts=20180115T1719535250L. D'Souza-Li and S. K. Harris The future of screening, brief intervention and referral to treatment in adolescent primary care: research directions and dissemination challenges https://www.ncbi.nlm.nih.gov/pubmed/27152620 American Academy of Pediatrics Youth Screening Pocket Guide https://pubs.niaaa.nih.gov/publications/Practitioner/YouthGuide/YouthGuidePocket.pdf

• K. C. Winters Brief Interventions for Adolescents

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4864856/pdf/nihms780140.pdf

• N. National Guideline Clearinghouse Primary care behavioral interventions to reduce illicit drug and nonmusical

pharmaceutical use in children and adolescents: U.S. Preventive Services Task Force recommendation statement. http://www.guideline.gov/content.aspx?id=47882&search=bipolar+disorder+and+child+abuse

• J. E. Glass, A. M. Hamilton, B. J. Powell, B. E. Perron, R. T. Brown Specialty substance use disorder services following

brief alcohol intervention: a meta-analysis of randomized controlled http://onlinelibrary.wiley.com/doi/10.1111/add.12950/abstract

• S. W. Feldstein Ewing, J. M. Houck, U. Yezhuvath, E. S. Kojori, D. Truitt and F. M. Filbey The impact of therapist's words
• n the adolescent brain: In the context of addiction treatment http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4704857/

References (Pediatrics)

• J. Vendetti, A. Gmyrek, D. Damon, M. Singh, B. McRee and F. Del Boca Screening, brief intervention and referral to

treatment (SBIRT): implementation barriers, facilitators and model migration http://dx.doi.org/10.1111/add.13652 DO - 10.1111/add.13652 Zhang, S. T. Li, Q. K. Lee, K. H. Chan, J. H. Kim, B. H. Yip, R. Y. Chung, A. H. Wong, Y. Fang, M. Liang and M. C. Wong Systematic Review of Guidelines on Managing Patients with Harmful Use of Alcohol in Primary Healthcare Settings https://www.ncbi.nlm.nih.gov/pubmed/28591801

• K. A. Tansil, M. B. Esser, P. Sandhu, J. A. Reynolds, R. W. Elder, R. S. Williamson, S. K. Chattopadhyay, M. K. Bohm, R. D.

Brewer, L. R. McKnight-Eily, D. W. Hungerford, T. L. Toomey, R. W. Hingson and J. E. Fielding Alcohol Electronic Screening and Brief Intervention: A Community Guide Systematic Review https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5082433/ SAMSHA Center for Health Integration. Solutions Shared Decision Making http://www.integration.samhsa.gov/clinical- practice/shared-decision-making Center for Medicare and Medicaid Services- SBIRT billing information https://search.cms.gov/search?utf8=%C3%A2%C5%93%E2%80%9C&affiliate=cms- new&dc=&query=SBIRT&commit=Search

• C. D. Pat node, J. T. Henderson, J. H. Thompson, C. A. Singer, S. P. Forman and E. P. Whitlock Behavioral Counseling

Interventions Expert Forum: Overview and Primer on U.S. Preventive Services Task Force https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0079361/

References (Implementation)

OASAS overview of SBIRT and approved screening tools. https://www.oasas.ny.gov/AdMed/sbirt/index.cfm NIDA Chart of Evidence Based Screening Tools fore Adults and Adolescents https://www.drugabuse.gov/nidamed-medical-health-professionals/tool-resources-your- practice/screening-assessment-drug-testing-resources/chart-evidence-based-screening-tools- adults?utm_source=all+IRETA+communications&utm_campaign=fc23f1c411-EMAIL_C NIDA Modified Assist-Quick Screening tool for Drug Use in General Medical Settings- computerized https://www.drugabuse.gov/nmassist/ NIDA Clinician's Screening Tool for Drug Use In General Medical Settings https://www.drugabuse.gov/nmassist/ NIAAA Patient and Clinician Educational https://pubs.niaaa.nih.gov/publications/Practitioner/CliniciansGuide2005/clinicians_guide13_p_m ats.htm

References (Screening Tools)

• B. J. Turner and C. W. Mathias Increasing Prevalence of Alcohol Use Disorders: Meeting the Challenge in

Primary Care 10.1007/s11606-017-4226-4 https://link.springer.com/content/pdf/10.1007%2Fs11606-017- 4226-4.pdf

• B. F. Grant, T. D. Saha, W. J. Ruan, R. B. Goldstein, S. P. Chou, J. Jung, H. Zhang, S. M. Smith, R. P. Pickering,
• B. Huang and D. S. Hasin Epidemiology of DSM-5 Drug Use Disorder: Results From the National Epidemiologic

Survey on Alcohol and Related Conditions-https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2300494

• W. M. Compton, C. Blanco and E. M. Wargo Integrating Addiction Services Into General Medicine

https://jamanetwork.com/journals/jama/fullarticle/2474414 CDC Fact Sheet-Binge Drinking https://www.cdc.gov/alcohol/fact-sheets/binge-drinking.htm

• L. T. Wu, J. McNeely, G. A. Subramaniam, K. T. Brady, G. Sharma, P. VanVeldhuisen, H. Zhu and R. P. Schwartz

DSM-5 substance use disorders among adult primary care patients: Results from a multisite study http://www.drugandalcoholdependence.com/article/S0376-8716(17)30327-7/pdf World Health Organization The ASSIST project-Alcohol, Smoking and Substance Involvement Screening http://www.who.int/substance_abuse/activities/assist/en/

References (Epidemiology)

• V. H. Murthy Surgeon General's Report on Alcohol, Drugs, and Health

https://jamanetwork.com/journals/jama/fullarticle/2587685

• B. K. Madras, W. M. Compton, D. Avula, T. Stegbauer, J. B. Stein and H. W. Clark Screening, brief interventions, referral to

treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites: comparison at intake and 6 months later https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2760304/

• S. J. Levy and P. K. Kokotailo Substance use screening, brief intervention, and referral to treatment for pediatricians

http://pediatrics.aappublications.org/content/pediatrics/128/5/e1330.full.pdf

• M. Khara The 5A's in practice: Role Play for a Brief Intervention in Smoking

https://www.youtube.com/watch?v=yzWfgjXsgr4

• E. F. Kaner, F. Beyer, H. O. Dickinson, E. Pienaar, F. Campbell, C. Schlesinger, N. Heather, J. Saunders and B. Burnand

Effectiveness of brief alcohol interventions in primary care populations http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004148.pub3/abstract;jsessionid=6BC1C0572C3F3966DDC2F0746E33 0ED4.f01t04

• D. E. Jonas, J. C. Garbutt, H. R. Amick, J. M. Brown, K. A. Brownley, C. L. Council, A. J. Viera, T. M. Wilkins, C. J. Schwartz, E.
• M. Richmond, J. Yeatts, T. S. Evans, S. D. Wood and R. P. Harris Behavioral counseling after screening for alcohol misuse in

primary care: a systematic review and meta-analysis for the U.S. Preventive Services Task Force http://annals.org/aim/fullarticle/1361859/behavioral-counseling-after-screening-alcohol-misuse-primary-care-systematic-review

• J. E. Glass, K. M. Bohnert and R. L. Brown Alcohol Screening and Intervention Among United States Adults who Attend

Ambulatory Healthcare https://www.ncbi.nlm.nih.gov/pubmed/26862079

• M. Fiore and e. al Update Clinical Practice Guideline for Nicotine Dependence

https://www.ncbi.nlm.nih.gov/books/NBK63952/ Crum and Z. B Changing mindsets to enhance treatment effectiveness http://dx.doi.org/10.1001/jama.2017.4545

References (Outcomes)

References (Outcomes)

• D. B. Clark, A. J. Gordon, L. R. Ettaro, J. M. Owens and H. B. Moss Screening and brief intervention for underage drinkers

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2848426/ F . W. Chi, C. M. Weiner, J. R. Mertens, T . B. Ross and S. A. Sterling Alcohol brief intervention in primary care: Blood pressure

• utcomes in hypertensive patients http://dx.doi.org/10.1016/j.jsat.2017.03.009
• J. F

. Bobb, A. K. Lee, G. T . Lapham, M. Oliver, E. Ludman, C. Achtmeyer, R. Parrish, R. M. Caldeiro, P . Lozano, J. E. Richards and K.

• A. Bradley Evaluation of a Pilot Implementation to Integrate Alcohol-Related Care within Primary Care

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5615567/

• C. Barbosa, A. Cowell, W. Dowd, J. Landwehr, A. Aldridge and J. BrayThe cost-effectiveness of brief intervention versus brief

treatment of Screening, Brief Intervention and Referral to Treatment (SBIRT) in the United States http://dx.doi.org/10.1111/add.13658 DO - 10.1111/add.13658

• M. A. Bachhuber and K. A. Bradley Evidence-Based Care for People with Unhealthy Alcohol Use-Still Elusive

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4907961/

• C. Angus, N. Latimer, L. Preston, J. Li and R. Purshouse What are the Implications for Policy Makers? A Systematic Review of the

Cost-Effectiveness of Screening and Brief Interventions for Alcohol Misuse in Primary Care https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4150206/

• A. Aldridge, R. Linford and J. Bray Substance use outcomes of patients served by a large US implementation of Screening, Brief

Intervention and Referral to Treatment (SBIRT) Addiction: Vol 112 p43-53. http://onlinelibrary.wiley.com/doi/10.1111/add.13651/abstract;jsessionid=E3E4720DFD5598094880283B641A4B03.f03t03

• J. Paltzer, R. L. Brown, M. Burns, D. P

. Moberg, J. Mullahy, A. K. Sethi and D. Weimer Substance Use Screening, Brief Intervention, and Referral to Treatment Among Medicaid Patients in Wisconsin: Impacts on Healthcare Utilization and Costs https://www.ncbi.nlm.nih.gov/pubmed/27221694