SBIRT Opportunities Holly Hagle, PhD Behavioral Health is Essential - - PowerPoint PPT Presentation

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

SBIRT Opportunities

Holly Hagle, PhD

What is SBIRT?

• SBIRT is a comprehensive, integrated, public health

approach to the delivery of early intervention and treatment services for people with substance use disorders and those at-risk of developing them.

• Primary care, trauma and emergency departments,

hospital inpatient, workplace/EAP, community health

• ther settings provide opportunities BEFORE more

severe consequences occur.

Source: Substance Abuse and Mental Health Services Administration. (2011). White paper: Screening, Brief Intervention and Referral to Treatment (SBIRT) in Behavioral Healthcare. Available at: http://www.samhsa.gov/prevention/sbirt/SBIRTwhitepaper.pdf.

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

Why we need SBIRT: Overview

10 Leading Risk Factors for Disease In Developed Countries

Percent of disability-adjusted life years

Northwest ATTC iThur presentation: (2012) The World Health Report 2002

Source: SAMHSA webinar Health Care Reform: Implications for Behavioral Health Providers http://www.youtube.com/watch?v=D0z1T3CRh_8

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Full screen

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Source: Northwest ATTC iThur presentation: (2012)

Screen Target Population # Items Assessment Setting (most common) Type

ASSIST (WHO)

• Adults
• Validated in

many cultures and languages 8 Hazardous, harmful, or dependent drug use (including injection drug use) Primary Care Interview AUDIT (WHO)

• Adults and

adolescents

• Validated in

many cultures and languages 10 Identifies alcohol problem use and

• dependence. Can be used as a pre-

screen to identify patients in need of full screen/brief intervention

• Different

settings

• AUDIT C-

Primary Care (3 questions) Self-admin, Interview, or computerized DAST-10 Adults 10 To identify drug-use problems in past year Different settings Self-admin or Interview CRAFFT Adolescents 6 To identify alcohol and drug abuse, risky behavior, & consequences of use Different settings Self-admin CAGE- AID Adults and youth >16 4

• Signs of dependence, not risky use

Primary Care Self-admin or Interview TWEAK Pregnant women 5

• Risky drinking during pregnancy.

Based on CAGE.

• Asks about number of drinks one

can tolerate, alcohol dependence, & related problems Primary Care, Women’s

• rganizations,

etc. Self-admin, Interview, or computerized

Source :Pacific Southwest ATTC (2012) SBIRT Curriculum

Screening

What is Motivational Interviewing?

• Brief counseling that raises awareness of risks and motivates

client toward acknowledgement of problem.

• Matching the brief intervention to the persons readiness to

change through motivational interviewing techniques

• Approach to behavior change that assumes that motivation is

fluid and can be influenced

• Motivation is influenced in the context of a relationship
• Principle tasks are to work with ambivalence and resistance
• Goal is to evoke and strengthen personal motivation for change

Brief Intervention

Referral to Treatment

• Meaningful and real
• A referral that the patient is likely to utilize
• Best when made to a known and trusted

provider

• Local resources
• Referral to treatment

Referral and treatment

SBIRT for Quality Improvement

• SBIRT for ATODs utilizing brief

interventions, especially brief, multi- contact interventions using motivational interviewing to move patients toward behavior change;

• Identifying resources and referring patients

if they are in need of specialty care

SBIRT for Quality Improvement

• Behavioral counseling interventions

improve behavioral outcomes for adults with risky/hazardous drinking.

• The best evidence of effectiveness is for

brief multicontact interventions.

Brief Intervention

• SAMHSA defines brief intervention as “a

single session or multiple sessions of motivational discussion focused on increasing insight and awareness regarding substance use and motivation toward behavioral change.

Brief Intervention Multicontact

• Range from very brief interventions within a primary care

visit to multicontact interventions that entail multiple,

• ften more lengthy, visits and nonvisit contacts over an

extended period.

• BI:

– very brief (up to 5 minutes, single contact), – brief (more than 5 and up to 15 minutes, single contact), – extended (beyond 15 minutes, single contact), – brief multicontact (each contact up to 15 minutes), – extended multicontact (some contacts beyond 15 minutes).

Brief Intervention

• Can include the following elements:

– advice, – feedback, – motivational interviews of varying length and number, or – cognitive behavioral strategies (e.g., self- completed action plans, written health education or self-help materials, drinking diaries, problem-solving exercises to complete at home

SBIRT Cost Benefits

• Medicaid costs for working age, disabled clients were

$366 lower per member per month for those who received at least a brief intervention compared to a statistically matched sample of clients who were treated in an emergency department but did not get a brief intervention through WASBIRT.

• The primary factor contributing to reduced costs

appeared to be a reduction 0.12 per member per month inpatient hospital days for stays that originated in an ER

• visit. (Estee et al., 2010)

SBIRT Cost Benefits

• The study calculated a medical care

savings of $712 per patient, which resulted from differences in emergency room visits and hospitalizations between groups.

SBIRT Cost Benefits

• A simulation model generated from a

review of U.S. based studies on screening and healthcare utilization costs showed an estimated cost savings of $89 per injured patient screened and $330 for each patient offered a brief intervention.

Questions/Discussion

• Visit: nsbirtattc.org
• Email: holly@ireta.org