IMPLEMENTING SBIRT IN Webinar Facilitator HEALTH CENTERS: EXAMPLES - PDF document

2/17/15 ¡ IMPLEMENTING SBIRT IN Webinar Facilitator HEALTH CENTERS: EXAMPLES FROM THE Tracy McPherson, PhD FIELD Senior Research Scientist Substance Abuse, Mental Health and Criminal Justice Studies NORC at the University of Chicago Presented By: 4350 East West Highway 8th Floor, NAADAC, THE BIG Initiative, National SBIRT Bethesda, MD 20814 ATTC, NORC at the University of Chicago, esap1234@gmail.com National Council, and SAMHSA February 18, 2015 Produced in Partnership… 2015 SBIRT Webinar Series 2/18/15 - Implementing SBIRT in Health Centers: ¨ Examples from the Field 3/18/15 - SBIRT: A Brief Clinical Training for ¨ Adolescent Providers 4/15/15 - All About SBIRT for Teens ¨ 4/29/15 - Understanding the Affordable Care Act ¨ (ACA) and SBIRT 5/13/15 - SBI in Primary Care and Senior Care ¨ Facilities for Older Adults at Risk for Possible Substance Use Disorders and/or Depression 6/10/15 - A Military Culture Approach to SBIRT for ¨ Veterans & Active Duty Personnel 7/22/15 - Drugs are a Local Phenomenon for ¨ LGBTQ Populations: Implications for SBIRT 8/19/15 - Integrating SBI for Alcohol & Other ¨ Drugs in Behavioral Health Settings Serving College Students ¨ hospitalsbirt.webs.com/webinars.htm Access Materials Ask Questions Ask questions ¨ PowerPoint Slides through the “Questions” ¨ CE Quiz Pane ¨ Recording Will be ¨ Free CEs answered live at the end hospitalsbirt.webs.com/health-centers-sbirt 1 ¡

2/17/15 ¡ Technical Facilitator Part One Misti Storie, MS, NCC Director of Training & SBIRT with National Council Professional Development NAADAC, the Association for Addiction Professionals misti@naadac.org The Coalition for Drug Free Greater Presenter #1 Cincinnati Experience • Grant funded 6 month technical assistance project Aaron M. Williams, MA • Initial SBIRT training plus one on one follow-up Director of Training and • Agencies implementing SBIRT in various settings: Technical Assistance for – Schools Substance Abuse – FQHC SAMHSA/HRSA Center for – Community anti-drug coalition Integrated Health Solutions • Through this and several other projects came a number National Council of points of consideration in implementation aaronw@thenationalcouncil.org Workforce Considerations Core Areas of Consideration Understanding of roles and responsibilities within the care team is critical to success. Considerations include: • Workforce § Type of providers (Drs’, nurses, behavioral health • Referral/Partnership building specialist etc..) providing the services • Workflow Development § Licensure and credentialing of staff ü Can they bill for services § Skill and comfort level of team members providing each services § Knowledge of the relationship between substance use and other health conditions 2 ¡

2/17/15 ¡ Partnership Development Workflow Development Considerations § Identify how best to integrate § Availability of resources for treatment SBIRT in existing operation of ü Who is in your network? the health center by conducting a ü What services are provided? walk-through and discuss how ü Do you need other services? clients flow through the daily § Staff knowledge of available resources operations § Who will coordinate care between your organization § Develop flow charts documenting and outside resources existing flow § What is the communication loop between your agency and outside resources ü How is information shared? Implementation Planning Process Continuous Quality Improvement Steps § Assemble a planning team Ø Select screening instruments “If the plan doesn't work change the plan but never the Ø Consider referral/system of care needs goal.”-Unknown Ø Conduct a workflow analysis Ø Address/communication and documentation concerns Ø Consider data collection methods Ø Develop comprehensive policies and procedures Ø Design training for staff Ø Discuss billing financial implications Presenter #2 Part Two Marcy Rosenbaum, LCSW, SBIRT at Southwest Virginia Community Health CSAC Systems Behavioral Health Director Southwest Virginia Community Health Systems, Inc. mrosenbaum@svchs.com 3 ¡

2/17/15 ¡ Primary Care and Behavioral Southwest Virginia Community Health Care Integration Healthcare Systems, Inc. — 2011 nominee by HRSA ’ s (Health Resources Service Delivery System Services Administration) Office on Rural Health Policy as one of the best practices in the nation for providing integrated behavioral health/ primary care services. Behavioral Physical — Composed of 4 PCP clinics and one dental clinic in Healthcare Healthcare SWVA staffed with behavioral health providers (4 LCSWs), psychiatrist, dentist, eye doctor, PCPs, and Migrant Health Outreach Workers. Why integrate behavioral and Why Integrate physical care? Behavioral Better and outcomes Most psychiatric treatment is provided by non-psychiatric Physical medical providers. Healthcare Improves 70% of primary care appointments are related to psychosocial Funding issues. and access Approx. 1 out of 4 patients will make it to a behavioral health appointment referred to a setting outside of PCP office. Reduces burden of care Less stigma and discrimination to go to PCP office for care. Adults with any mental illness are more likely than adults without a mental illness to have chronic health conditions. Complexity of Intersecting Integrated SA and PC Services Diagnoses in Integrated Care improve Quality of Treatment High blood pressure Screening identifies high risk SA behaviors to target prevention of SA disorders. Alcohol Xanax abuse abuse Integrated treatment is a preferred and evidenced based model of care. Brings SA expert into treatment plan quickly. PTSD Depression (exam room consults) Specifically identify withdrawal or overdose issues Hepatitis that may need outpatient or inpatient treatment. 4 ¡

2/17/15 ¡ Benefits of Integration for Purpose of SBIRT Patients A model of service delivery, not a specific Reduce psychosocial distress technique or program Prevent further illness or slow progression An early intervention approach “One stop shop” Identify BH issues and diagnoses Aimed at people who may not meet diagnostic level of abuse/dependence Less stigma Use evidenced based practice to identify, reduce, Timely access to services and prevent problematic substance use Improve overall health Screening Tools How do we use SBIRT? AUDIT C CAGE AID Screening DAST Drug screens and alcohol testing Brief Intervention Medical assessment for substance abuse related medical issues Biopsychosocial assessment SASSI (Substance Abuse Supplemental Screening Instrument) Referral to Treatment ASAM-PPC (American Society Addiction Medicine Patient Placement Criteria) Example of use in an FQHC’s integrated primary and behavioral health program Must use at least a standardized assessment or screening instrument AUDIT C Snapshot of Initial BH Screening In the past year, how often do you have a drink containing Nurse does PHQ2 and alcohol? never(0), monthly(1), weekly(2), some days each Audit C screens week(3), most days each week(4) How many drinks did you have on a typical day when you Screens Screen were drinking? 1or2(0), 3or4(1), 5or6(2), 7-9(3), more than both POSITIVE NEGATIVE 10(4) How often did you have six or more drinks on one occasion? PCP examination never(0), <monthly(1), monthly(2), some days a week(3), most days each week(4) Recommend Patient see Any Behavioral Health indication of Positive screen for hazardous or abuse of alcohol: Consultant BH issue Men > 4 Women > 3 5 ¡

2/17/15 ¡ Best practice for referral from Brief Intervention Tools PCP to BHC: THE WARM HANDOFF Cognitive Motivational Relaxation Behavioral Interviewing Training Therapy — In the exam room the PCP introduces BHC to the patient as part of the treatment team and the expert on BH. Relapse Transtheoretical Harm Prevention Model of Reduction Planning Change — PCP leaves the room and BHC conducts consultation — Best referral method for integrated care when schedule allows. Others Referral to Treatment Meet person “where they are at” — Made if patient ’ s needs are greater than Keep person’s goal in mind can/should be provided by practitioner. Examples include: Reduce risky SA behaviors ◦ CSB for intensive outpatient, SA group therapies, and case management services ◦ Inpatient treatment, often for detox or to begin Improve mental and physical health recovery in supportive environment ◦ Local support groups such as AA, NA, Al-anon Use any evidence based intervention ◦ Psychiatrist ◦ Alternative therapies such as massage therapy, acupuncture, methadone/suboxone Harm Reduction Approach Building the SBIRT Team Building the SBIRT Team All our practice decisions flow from the Licensed or certified to provide mental health or substance abuse services (includes physician, PA, NP, CNS, CP, CSW, medical home model of care. CSAC) The medical home is best described as a model Screenings can be done by non-licensed, paraprofessional healthcare providers. Must be supervised and or philosophy of primary care that is patient- recommended by a PCP (specific Medicaid requirement) centered, comprehensive, team-based, coordinated, accessible, and focused on quality At SVCHS: Initial screening by PCP/RN, further screening and safety. by BHC, Interventions by BHC/PCP/RN, referrals by BHC (From the Patient-Centered Primary Care Collaborative) Check with payer for specific qualifications 6 ¡