Webinar Moderator PROMOTING SBIRT IN AN INTERPROFESSIONAL SETTING - - PDF document

4/5/17 1 PROMOTING SBIRT IN AN INTERPROFESSIONAL SETTING WITH VULNERABLE POPULATIONS

PRESENTED BY: THE BIG SBIRT INITIATIVE, NATIONAL SBIRT ATTC, and NORC at THE UNIVERSITY OF CHICAGO

April 6, 2017

Webinar Moderator

Tracy McPherson, PhD

Senior Research Scientist Public Health Department NORC at the University of Chicago 4350 East West Highway 8th Floor, Bethesda, MD 20814 esap1234@gmail.com

Produced in Partnership

www.sbirteducation.com www.cswe.org

2017 SBIRT Webinar Series

¨ 1/19/17 - Strategies for Incorporating Universal Education

about Healthy Relationships into Clinical Practice to Reduce Substance Use and Intimate Partner Violence

¨ 2/16/17 - Using SBIRT when Intimate Partner Violence has

been Disclosed

¨ 3/2/17 - WINGS: An Evidence-based SBIRT Intervention for

Addressing Partner Violence Among Young Women Who Use Drugs or Alcohol

¨ 3/16/17 - When One Size Does Not Fit All: Addressing Issues

Throughout an SBIRT Project Life Cycle

¨ 4/6/17 - Promoting SBIRT in an Interprofessional Setting with

Vulnerable Populations

¨ 5/4/17 - SBIRT in Various Settings: Differences & Common

Threads

¨ 6/15/17 - Using SBIRT for Problem Gambling in the Military

hospitalsbirt.webs.com/webinars.htm

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Access Materials

http://hospitalsbirt.webs.com/vulnerable-populations

¨ PowerPoint Slides ¨ Materials and

Resources

¨ Recording ¨ Certificate of

Completion

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4/5/17 2

Technical Facilitator

Misti Storie, MS, NCC

Technical Consultant misti.storie@gmail.com www.mististorie.com

Webinar Presenter #1

Molly Everett Davis, EdD, MSW Department of Social Work College of Health and Human Services George Mason University Mason SBIRT Team Curriculum Coordinator mdavi7@gmu.edu

Webinar Presenter #2

Shauna P. Acquavita, PhD, MSW

Assistant Professor School of Social Work College of Allied Health Sciences University of Cincinnati PI for Interprofessional SBIRT SAMHSA grant acquavsa@ucmail.uc.edu

Objectives

1.

Participants will be able to understand factors that impact the implementation of SBIRT in different interprofessional settings and the role of faculty and students in supporting this endeavor.

2.

Participants will be able to identify different considerations in implementing SBIRT with vulnerable populations with diverse characteristics.

3.

Participants will explore strategies to promote an increase in interprofessional competencies through the implementation of SBIRT.

4.

Participants will highlight challenges and unique training

• pportunities in implementing SBIRT within interprofessional

settings with vulnerable populations.

What is Interprofessional Collaboration?

When multiple health workers from different professional backgrounds work together with patients, families, [careers], and communities to deliver the highest quality

• f care.” (WHO 2010)

Interprofessional Education

Interprofessional education: “When students from two or more professions learn about, from

and with each other to enable effective collaboration and improve health outcomes.” (WHO 2010)

4/5/17 3

University of Cincinnati George Mason University

Our SBIRT Interprofessional Settings

• Medicine
• Nursing
• Pharmacy
• Allied Health

Sciences § Social Work

University of Cincinnati: The Academic Health Center

SBIRT Interprofessional Training Program at UC

Medicine Nursing Pharmacy Social Work

SBIRT

Support for the University of Cincinnati’s Interprofessional SBIRT Program provided by SAMHSA (1H79TI025942)

University of Cincinnati: Using Community Agencies to Inform SBIRT Practice

¨ Provide SBIRT trainings to all staff agencies if

needed and booster sessions.

¨ Meet with agencies before and after each semester

to discuss any concerns, questions, thoughts about clinical experiences.

¨ Board of Directors for UC’s SBIRT Grant ¤ Include representatives from two community agencies

Three Part Student Training for Course

Online Education Standardized Patient Experience Clinical Experience

<a href='http://www.freepik.com/free-vector/theater-courtains_763673.htm'>Designed by Freepik</a>

Men’s and Women’s Homeless Shelter Food Bank Hospital Federally Qualified Health Center

George Mason University

4/5/17 4

College of Health and Human Services

Nursing, Social Work, Global Health, Health ,Policy, Nutrition, Rehabilitation Science, Public Health, Health Informatics

¨ Cultivating SBIRT Champions

Training All Behavioral Health and Health Care Professionals to Ask About Substance Use!

¨ http://chhs.gmu.edu/sbirt/

MASON SBIRT: TEAMS- UP

¨ We foster interprofessional collaboration and

education while utilizing a three-pronged approach to SBIRT dissemination:

¨ Curriculum Infusion-Classroom and

Practica/Clinicals

¨ Experiential Training-Innovating SBIRT Training

Models

¨ Community Engagement- Training and Building

SBIRT Community capacity

Mason and Partners (MAP) Clinics

Fr Free Clinics for the Uninsured Cl Clini nicas Gr Gratis Só Sólo At Atendemos Pa Pacientes SI SIN N Seg Segur uro

Interprofessional Clinics Serving:

• Uninsured
• Immigrants
• Refugees

Services Offered:

• Acute Primary Care Visits
• School Physicals
• Depression Screening
• Initial treatment for diabetes,

hypertension, asthma, hearing and vision

• SBIRT Screening

Primary Health and Behavioral Health

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Interprofessional Setting

Nursing Pharmacy Social Work Psychology Health Informatics Public health Nutrition Community Health Workers ¨ Primary Health ¨ Behavioral Health ¨ Community Partnerships

Defining Vulnerable Populations WHO ARE THEY?

SBIRT and Vulnerable Populations

Defining Vulnerable Population

¨ Groups of people who are disadvantaged or at risk in some

way due to potential harm based upon their social, economic, physical, legal or psychological condition.

¨ Vulnerability is based upon susceptibility or risk for harm ¤ Environmental conditions ¤ Economic factors ¤ Individual characteristics ¤ Social Conditions ¤ Life challenges ¤ Health conditions ¤ Mental Health conditions ¤ Culture

Developing a Vulnerability Profile

¨ Develop a demographic profile of

your target population. Consider

Population Groups Based Upon: Race Ethnicity Age Gender Socioeconomic status Immigrant Status Education Attainment/literacy Disability Homelessness Health Risk Geographic Residence Language Proficiency Sexual Orientation Access to Resources(uninsured) Employment Status

Data Mining Results (MAP clinic data)

¨ Ethnicity(Hispanic

Latino/Black/Arabic/Asian)

¨ Diverse languages ¨ Mixed Gender ¨ Diverse mixture of primary health and

behavioral health issues

¨ Diagnosis often linked to pain and

delayed medical treatment

¨ Both chronic and acute diagnosis ¨ Behavioral Health Issues: depression,

trauma and anxiety

MAP CLINIC: CULTURAL DIVERSITY

Diverse Cultures

¨ Provided over 10,000 client encounters

(2015)

¨ Diverse diagnosis ¨ Countries of Origin ¤ Guatemala Venezuela ¤ Honduras Philippines' ¤ El Salvador Egypt ¤ Mexico China ¤ Peru ¤ Nigeria ¤ Ethiopia ¤ Columbia

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Developing a Vulnerability Profile

Engage in Data Mining to Target V Factors

Define Vulnerable Population

Develop Strategies for Adaptation

Identify Factors that Impact SBIRT

What do we know about Immigrants Refugees and Undocumented?

Immigrants Refugees Undocumented Racism and Discrimination Language Loss of social roles Depression Suicide Parent Child Family conflict Trauma Substance abuse Immigrant issues plus…. Persecution Hardship/Torture No medical care Societal rejection Online threat of deportation No legal protection Not qualified for government assistance Vulnerable to exploitation Unjust labor practices Housing and food instability

Data Mining Results

¨ Newcomers adopt the alcohol and substance use pattern of the

host country. Some maintain the pattern from home country.

¨ Different groups have different patterns. ¨ Central Americans drink less than Mexicans ¨ US born Mexican drink more than non US born Mexicans ¨ Immigrants from Central American and Mexican males drink

more than women

¨ Immigrant and US born males exhibit correlation between

depression and drinking level

¨

Guttman, M.C. (1999).Ethnicity, Alcohol and Acculturation. Social Science and Medicine.48:173-184.

Substance Use Disorder Excessive Use No Problem

Traditional Treatment

Abstinence

Brief Intervention Brief Treatment Promote Behavior Change Primary Prevention Screening & Feedback Drink Responsibly

SUBSTANCE USE RISK STRATIFICATION

MAP CLINIC VULNERABILITY PROFILE

¨ Status: Undocumented

Immigrant and Refugees

¨ Language ¨ Cultural Patterns ¨ Health Status ¨ Gender Roles ¨ Behavioral Health Issues

( trauma, anxiety and depression

Need a Shared Consensus on Target Vulnerable Populations

What poses the greatest threat to harm?

¨ Discussion may result in perceived

differences in vulnerable populations and the criteria for determining vulnerability in an interprofessional setting.

¨ Health Diagnosis ¨ PHQ9 ¨ Language ¨ Ethnicity ¨ Status

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Implementing SBIRT with Vulnerable Populations

Homelessness

¨ Approximately 18% of individuals are homeless in

the US (National Alliance to End Homelessness, 2016).

¨ SUD has been linked as a contributing factor to

homelessness (McQuistion et al., 2014).

¨ Estimates of SUD among individuals who are

homeless are between 30 and 77% depending on demographics (Lehman et al., 1993; Forney, et al 2007).

SBIRT in people who are Homeless

¨ UCLA QUIT screened

in 214 individuals who were homeless with to test SBI in a health clinic setting (Gelbert et al. 2012).

¨ Results for SBI: ¤ 11% Low/no risk ¤ 42% Moderate risk ¤ 47% Dependence

www.wikimedia

Example: Men’s Shelter

¨ 150 bed facility open 24 hrs/365 days a yr ¨ Serves 3 meals/day ¨ On site medical & dental clinic ¨ Case management services ¨ Drug and alcohol treatment services

Example: Women’s Shelter

¨ 60 beds open 24

hrs/365 days a year

¨ Serves 3 meals/day ¨ Case management ¨ Medical clinic

SBIRT within Homeless Shelters

¨ Staff trained in SBIRT ¨ Men’s Shelter received a

HRSA grant to implement SBIRT at intake

¨ Men’s Shelter has on site

D & A tx

¨ Medical services provided ¨ Office space provided ¨ Warm hand-off to case

management services for referral to treatment

¨ Men’s shelter physical

proximity to campus was far for students

¨ On fair weather days

clients often out of shelter

¨ Sometimes other

groups/activities conflicted with times students were present

Benefits Challenges

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Food Insecurity

¨ Estimated 12.7% of Americans are food insecure

sometime during 2015. (Hunger Alliance, 2016)

¨ Approximately 59% of food-insecure households

relied upon nutrition assistance programs (e.g. SNAP , WIC, School Lunch program) (Hunger Alliance, 2016).

¨ Recent study conducted by Pruitt et al. (2016) found

individuals who were food insecure more likely to smoke; no difference among those who don’t receive assistance in alcohol use.

Picture: www.wrightway.com

Example: Food bank

¨ Provides ~23 million meals a year ¨ Emergency clothing ¨ Housing/rent assistance ¨ Financial management (e.g. payee) ¨ Public benefits & healthcare enrollments ¨ Case management services ¨ Job training services

Picture: www.frenchdistrict.com

SBIRT within Food Bank

¨ Office space ¨ Administration invested

in program

¨ Warm hand-off to

case management services for referral to treatment services

¨ Only some staff trained in

SBIRT

¨ Screening only implemented

when students present

¨ Looking to implement it

program wide but many different entry ways into services

¨ Clients may not disclose due

to potential loss of services

Benefits Challenges

Federally Qualified Health Centers (FQHC) (Wright, 2013)

¨ Primary care clinics first established in 1965 during

“War on Poverty”

¨ Located in areas that are medically underserved ¤ High rates of uninsured individuals and Medicaid

beneficiaries

¨ Provides high quality, cost effective health care ¨ Requires 51% of governing board to consist of

consumers of center.

FQHC and SBIRT

¨ Madreas et al. (2009) examined SBIRT services

implemented in medical settings across 6 states and found upon 6 month follow up significant improvements from baseline for illicit drug use and heavy alcohol use.

¨ Kelly et al. (2016) recruited adolescent participants

(12-17) in Baltimore MD from June 2012 through 2013.

¤ 30% of adolescents reported using more than one

substance within the last year

¤ ~22% reported alcohol use ¤ 16% cannabis ¤ 10% tobacco ¤ 3% illicit drugs besides cannabis

Picture:www.qkrrudwls.tistory.com

Example: FQHC

¨ Follows the philosophy of Christ’s community

development (John Perkins, founder of Christian Community Health Fellowship) who espoused the three “R’s”: relocation, reconciliation and redistribution.

¨ More than 33,000 visits per year across 5 sites ¨ Includes pediatric clinic ¨ Agency also has two school-based health centers

4/5/17 9

FQHC

¨ Supportive of student

learning.

¨ SBIRT is in EMR. ¨ Have social worker and

counselor on staff for warm hand-off.

¨ Recent Ohio state grant

provides $ to FQHC for training allied health students in order to encourage these students to seek employment at FQHC at graduation.

¨ Medical assistants initially screen

patients with AUDIT-C.

¨ When patients aren’t feeling

well, don’t want to see students.

¨ Sometimes issues with space. ¨ Sometimes staff did not

remember students were to see patients.

¨ Students needed to be aware of

and be comfortable with a Christian faith based mission. Benefits Challenges

Steps to Consider for Implementing SBIRT with Vulnerable Populations

Identify Supporters

¨ Identify individuals who are

trained in SBIRT or who would like to be trained

¨ Get buy in from

administration, board of directors

¨ If possible, use

clients/consumers who are in support of services

Identify Process

¨ When will screening occur? ¨ How will it be explained to patient? ¨ Where will it occur (physical space)? ¨ Who will perform SBIRT? ¨ What measures will be used? ¨ What steps will be taken when a positive screening occurs? ¨ How will this impact the person who has a positive screen? ¨ Identify referrals to use in the community, if needed that are

appropriate to their circumstances, cultural beliefs, etc.

¨ How will billing occur?

MAP Clinic Patient/Client Profile

¨ Undocumented immigrant often recently arrived ¨ Survival mode ¨ Has experienced multiple trauma life events ¨ Food Insecurity ¨ Imminent Homelessness ¨ Insufficient funds to pay for meds ¨ Acute and Chronic health conditions ¨ Fearful and Anxious About Immigration Status

SBIRT in the MAP Clinic

¨ Faculty and student providers were trained in SBIRT ¨ Due to constant rotation of students, SBIRT training is

• ngoing

¨ SBIRT screening is a normal part of the intake

protocol.

¨ 80 Positive Screens ¨ Over 5800 referrals ¨ In varying states of acculturation

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SBIRT PATIENT PROFILE

Trauma Co-Morbidity Health Status Exacerbation of mental health Depression Anxiety

SBIRT

Domestic &

• ther violence

Language Blocked Access to Resources Cultural Traditions

Vulnerabilities that Impact SBIRT

¨ Ethnicity/Culture ¨ Age ¨ Gender ¨ Socioeconomic status ¨ Immigrant Status ¨ Education

Attainment/literacy

¨ Communication ¨ Access to Services ¨ Hispanics, Ethiopians, Arabs ¨ Children, Youth, Adults ¨ More Females ¨ Low Income Poverty ¨ Undocumented ¨ Low education

levels/literacy( low)

¨ Generally not eligible

Vulnerability Impacting SBIRT

Adapting SBIRT to Vulnerable Populations

¨ Race and Ethnicity/SBIRT (Manuel, Satre &Tsoh, 2015) ¤ Risky substance use varies by race/ethnicity n Patterns of alcohol and drug use n Consequences of alcohol and drug use- Hispanic men

greater alcohol related problems and death

n Hispanic women drink and take drugs less than males n Under-utilized treatment ¨ Screening instruments vary in work with ethic groups ¤ AUDIT most evaluated screen for multiple groups

Cultural Adaptation of SBIRT

¨ The systematic modification of an evidence based

treatment or intervention protocol to consider language, culture and context in such a way that it is compatible with the client’s cultural patterns, meanings and values. ( Bernal, Jimenez-Chavey, Domench Rodriguez, 2009)

¤ Mistrust of the health care system ¤ Lack of empathy/respect conveyed by provider re: health ¤ Felt information was being withheld ¤ Spanish language for recent immigrants

Acculturative Stress

¨ Experience of immigration is often stressful and

result in signs of psychological distress manifesting itself in excessive drinking and substance use.

¤ Grieving home cultures ¤ Trauma in passageway to new country ¤ Males often separated from family ¤ Discrimination and prejudice experience ¤ Loneliness and Isolation

Examples: Screening Issues

¨ Language

Many patients do not speak English

¤ SBIRT screening forms

need to be translated

¤ Consideration of

multiple languages

¤ Diversity of dialects ¤ Fidelity ¨ Culture/Gender

Many of the women have partners/spouses who use substances

¨ Need to empower

women

¨ Send educational

materials home

Vulnerability Impact on SBIRT

4/5/17 11 Vulnerabilities that Impact SBIRT: BNI

¨ Homelessness ¨ Health Risk ¨ Geographic Residence ¨ Language Proficiency ¨ Access to

Resources(uninsured)

¨ Trauma ¨ Co-Occurring Disorders ¨ Culture ¨ Survival Mode ¨ Co-Morbidity ¨ Access to Treatment ¨ Need translation ¨ Available resources ¨ May be related to

substance use

¨ Complexity ¨ Reflect acculturation issues

Vulnerability Impact on SBIRT

Brief Intervention with MI

¨ Brief intervention with MI had greater effect with

ethnic minority groups (Field & Caetano, 2012)

¨ BMI with MI reduced drinking risk in moderate users ¨ Hispanics had significant reduction in use of alcohol

use

¨ CAMI- Culturally Adapted MI had significant impact

• n reducing drinking (Lee, 2011). Adaptation:

¤ Provided child care, transportation, after hour appts,

focus on cultural values and factors related to status.

Examples: Referral to Treatment

¤ Referral options are

limited for this group

¤ Need to develop

informal resources

¤ Advocate for resource ¤ Advocate with

community groups for resources to meet need

¨ Pain ¨ Inability to access

medical care options

¨ Core Behavioral health

issues

¤ Trauma ¤ Depression ¤ Anxiety

Undocumented Status

Co-Morbidity/Co-Occurring

Referral to Treatment

¨ Hispanics more likely to access treatment speciality

services and referral from health care provider

¨ More likely to experience admission delays to

treatment

¤ Barrier to treatment entry. (Gryczynski, et al 2011)

Steps to Building a Vulnerability Profile

SBIRT Implementation Define Vulnerable Population s Research Risk For Substance Use (Data Mining) Pair SBIRT Risk Stratification With Data Develop a plan to adapt

Universal Screening

Negative No Risk Provide Positive Reinforcement Full Screening Tools AUDIT DAST Tobacco (FND) Positive Harmful or Problem Use/ Provide Referral to Treatment

Mild /Moderate Risk/ Brief Intervention

Low Risk Provide Positive Reinforcement SBIRT Outcomes

SBIRT PROCESS

Vulnerability Factors Impact

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Summary

¨

Interprofessional collaboration is particularly critical to clients who have multiple risk factors facing

• them. The complexity of need

requires a more holistic approach to impact positive outcomes.

¨

Vulnerable populations can reduce the risk to harm and promote a strengths based experience with providers when there is a shared understanding and targeting of vulnerable populations.

¨ Implementing SBIRT in an

interprofessional setting can be challenging but rewarding with better patient outcomes. Many students are being trained in a “silo” fashion which is not conducive to understanding the holistic needs of clients

¨ Serving vulnerable populations will

• ften require balancing adapting

to meet the cultural needs of the patient without compromising the fidelity of the evidence based practice. Conclusion Conclusion Support for the University of Cincinnati’s Interprofessional Screening, Brief Intervention, Referral to Treatment provided by SAMHSA (1H79TI025942) Support for George Mason University’s TeamsUp Screening, Brief Intervention, Referral to Treatment project provided by 1H79T1025983-01.

References

Coleman-Jensen,A., Rabbitt, M. P., Gregory, C. A.,& Anita Singh, A. Household Food Security in the United States in 2015, ERR-215, U.S. Department of Agriculture, Economic Research Service, September 2016. Forney, J. C., Lombardo, S., & Toro, P. A. (2007). Diagnostic and other correlates of HIV risk behaviors in a probability sample of homeless adults. Psychiatric Services, 58, 92–99. Gelberg, L., Andersen, R. M., Arangua, L., Vahidi, M., Johnson, B., Becerra, V., ... & Shoptaw, S. (2012). Screening, brief intervention, and referral to treatment among homeless and marginally housed primary-care patients in Skid Row. Addiction science & clinical practice, 7(1), A58. Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative. Kelly, S. M., Gryczynski, J., Mitchell, S. G., Kirk, A., O’Grady, K. E., & Schwartz, R. P. (2014). Validity of brief screening instrument for adolescent tobacco, alcohol, and drug

• use. Pediatrics, 133(5), 819-826.

Lehman, A. F., & Cordray, D. S. (1993). Prevalence of alcohol, drug and mental disorders among the homeless: One more time. Contemporary Drug Problems, 20, 355–383. Madras, B. K., Compton, W. S., Avula, D., Stegbauer, T., Stein, J. B., & Clark, H. W. (2009). Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites: Comparison at intake and 6 months later. Drug and Alcohol Dependence, 99, 280–295 McQuistion, H. L., Gorroochurn, P., Hsu, E., & Caton, C. L. (2014). Risk factors associated with recurrent homelessness after a first homeless episode. Community mental health journal, 50(5), 505-513. National Alliance to End Homelessness (2016, April 6). The State of Homelessness. Available at http://www.endhomelessness.org/library/entry/SOH2016 Pruitt, S. L., Leonard, T., Xuan, L., Amory, R., Higashi, R. T., Nguyen, O. K., ... & Swales, S. (2016). Peer Reviewed: Who Is Food Insecure? Implications for Targeted Recruitment and Outreach, National Health and Nutrition Examination Survey, 2005–2010. Preventing chronic disease, 13. Wright, B. (2013, February). Who governs Federally Qualified Health Centers? Journal of Health Politics, Policy and Law, 38, 27-55. doi 10.1215/03616878-1898

References

Abdulrahim S, El Shareef M, Alameddine M, Afifi RA, Hammad S. (2010) The Potentials and Challenges of an Academic-Community Partnership in a Low-trust Urban Context. Journal of Urban Health: Bulletin of the New York Academy of Medicine. ;87(6):1017–1020. [PMC free article] [PubMed] Babor, T.F. McRee, R.G. Kassenbaum, P.A. (2007). Screening, Brief Intervention and Referral to Treatment ( SBIRT): Toward a Public Health Approach to the Management of Substance abuse. Substance Abuse, 28, 7-30. Bendregal, L.E. Sobell, L.C. Sobell, M. B. (2006). Psychometrics of a Spanish Version of the DAST-10 and the

• RAGS. Addiction Behavior, 31(2). 309-319.

Bernal, G. Jimenez-Chafey, M. Domenech, R. (2009). Cultural adaptation of treatment: A resources for considering culture in Evidence Based Practice Professional Psychology: Research and Practice, 40(4), 361-368. Caetano, R. Acculturation, Drinking and Social Settings Among US Hispanics. (1987). 19(3): 215-26 PubMed. Center for Substance Abuse Treatment. Substance abuse Treatment: Addressing the Specific Needs of Women, Rockville ( MD);(2009) Treatment Improvement Protocol Series( Tip Series, No, 51. Chapter 6. Field, C.A. Caetano, R.(2012) Ethnic Differences in the Effect of Drug Use and Drug Dependence on Brief Motivational Interventions Targeting Alcohol Use. Drug Alcohol Dependence. 126 (1-2): 21-26. Field, C.A., Caetano, R. Harris, T.R. Ethnic Differences in Drinking Outcomes Following a Brief Alcohol Intervention in the Trauma Care Setting. ( 2010). Addiction. 105(1): 62-73, ( PubMed). Gryczynski,J. Schwartz, R.P.(201). Patterns in Admission Delays to Outpatient Methodone Treatment in the U.S. Journal of Substance Abuse treatment. 41(4).431-439.(PubMed) Guttman, M.C. (1999).Ethnicity, Alcohol and Acculturation. Social Science and Medicine.48:173-184.

References

Interprofessional Education Collaborative. (2016). Core competencies for interprofessional collaborative practice: 2016

• update. Washington, DC:Interprofessional Education Collaborative

Johnson, T.P. (2002) Migration and Substance Use Evidence from the U.S. National Health Interview Survey, Substance Use and Misuse, 37(8-10,941-72. Lee, C.S. Hernandez, C., Colby, S.M.(2011). A Cultural Adaptation of Motivational Interviewing for Latino Heavy Drinking Among Hispanics. Cultural Diversity Ethnic Minority Psychology. 17(3). 317-324. Manuel, J.K., Satre, D.D., Tsoh, J.(2015) Adapting Screening, Brief Intervention and Referral to Treatment ( SBIRT) for Alcohol and Drugs to Culturally Diverse Clinical Populations. Journal of Addiction Medicine, October, 9(5): 343-351.

• NIAAA. Immigrants, Refugees and Alcohol. Retrieved

March13,2017.http://pubs.niaaa.nih.gov/publications/Social/Module10Fimmigrant Rahm, A. K. Boggs, J. Martin, C. (2015). Facilitators and Barriers to Implementing Screening, Brief intervnetion and Referral to Treatment ( SBIRT) in Primary Care in Integrated Health Settings. Substance Abuse, 36:3, 281-288 Szaflarski, M. Cubbins, L. Ying, J. (2011). Epidemiology of Alcohol Abuse Among US Immigrant Populations. Journal of Immigrant Minority Health, August, 13 (4). 647-658.

• NIAAA. Immigrants, Refugees and Alcohol. Retrieved

March13,2017.http://pubs.niaaa.nih.gov/publications/Social/Module10Fimmigrant Vulnerable Population: Who Are They?. Retrieved March 13, 2017 from http://www.ajme.com/journals/supplement/2006/2006-11-vol12-n13suppl/nov06-2390ps348-s352.

Thank You!

Shauna P. Acquavita, PhD, MSW acquavsa@ucmail.uc.edu Molly Everett Davis, EdD, MSW mdavi7@gmu.edu

4/5/17 13

Ask Questions

Ask questions through the “Questions” Pane Will be answered live at the end

In Our Last Few Moments…

¨ PowerPoint Slides ¨ Certificate of

Completion

¨ On Demand

Recording

¨ Evaluation Survey ¨ Follow-up Email

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