Difference between revisions of "Expand SBIRT Program"

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<div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output"><div class="mw-parser-output">''Return to &nbsp;[[ZOOM_MAP_-_Increase_Early_Intervention_for_People_Misusing_Drugs|Zoom Map - Increase Early Intervention for People Misusing Drugs]]''
= Introductory Paragraph =
''Go to [[ZOOM_MAP_-_Expand_SBIRT_Program|Zoom Map - Expand SBIRT Program]]''


----
SBIRT is an abbreviation of Screening, Brief Intervention, and Referral to Treatment. It is a popular model for prevention and early intervention because all patients are screened regardless of an identified disorder. This allows healthcare professionals to reach a wider range of people - not just those who are seeking treatment for substance use disorder (SUD) or behavioral health. This is especially critical for those who may be at risk for substance use disorder but may not meet established criteria. Additionally, SBIRT screens for all types of substance use, not just dependencies.


Screening, Brief Intervention and Referral to Treatment (SBIRT) is used to provide care for substance users across the spectrum from early intervention to extensive specialized treatment. This represents a paradigm shift in substance-abuse treatment, which has historically focused on people that meet the criteria for substance abuse or dependence as defined by the ''Diagnostic and Statistical Manual of Mental Disorders,'' Fourth Edition.
This evidence-based, public health approach is a paradigm shift in substance-use treatment because SBIRT places risky substance use where it belongs—in the realm of healthcare. Routine screening helps identify and intervene with patients whose use puts them at risk for health issues. SBIRT focuses on identifying risky substance use to help prevent the onset of the more costly disease of addiction. Similar to preventive screenings for chronic diseases such as cancer, diabetes, and hypertension, SBIRT is an effective tool for identifying risk levels related to substance use and for providing the appropriate intervention. Expanding the use of SBIRT can provide critical pathways for people to access treatment earlier.


The SBIRT model screens all patients regardless of an identified disorder, allowing healthcare professionals in a variety of settings to address a patient's behavioral health even when that patient is not actively seeking treatment or care for their behavioral health problems. While SBIRT is well-established as an effective intervention for risky alcohol use researchers and clinicians are just beginning to explore it as an intervention for risky drug use.<sup class="reference"><ref>[1]Page Not Found </ref></sup>
= Key Information =


By expanding the use of SBIRT and improving SBIRT practices, communities should be able to reduce the number of people who develop a dependency on opioids or Opioid Use Disorder. It should provide pathways for people to get appropriate help sooner--which reduces the potential negative impact of using opioids. SBIRT can be done in many different settings, and there are a variety of ways to do each element of SBIRT. This creates many opportunities to expand and improve SBIRT practices. &nbsp;
Communities can expand the use of SBIRT tools by increasing public awareness of the SBIRT approach and the value of identifying people who are at high risk or might be using substances. SAMHSA supports a research-based comprehensive behavioral health SBIRT model which reflects the six following characteristics: <ref>https://www.samhsa.gov/sites/default/files/sbirtwhitepaper_0.pdf</ref>


__TOC__
* '''It is brief. '''The initial screening is accomplished quickly (about 5-10 minutes) and the intervention and treatment components indicated by the screening results are completed in significantly less time than traditional substance abuse specialty care.


= Research on the Effectiveness of SBIRT =
* '''Screening is universal.''' The patients, clients, students, or other target populations are all screened as part of the standard intake process.


While the strongest evidence for the effectiveness of SBIRT relates to using it to address alcohol misuse, there is growing evidence in its effectiveness in accelerating people getting help with misuse of opioids.<br/> &nbsp; This [https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.13675 2017 report summarizes five years of research on SBIRT]<br/> &nbsp; The research covered eleven multi-site programs in two cohorts of SAMHSA grant recipients were each funded for 5 years to promote the use and sustained implementation of SBIRT. They screened more than 1 million people. The programs used substance use specialists instead of medical generalists to deliver services.
* '''One or more specific behaviors are targeted.''' The screening tool addresses a specific behavioral characteristic deemed to be problematic, or pre-conditional to substance dependence or other diagnoses.


&nbsp;
* '''The services occur in a public health, or other non-substance use treatment setting'''.


*Greater intervention intensity was associated with larger decrease in substance use.  
* '''It is comprehensive.''' The program includes a seamless transition between brief universal screening, brief intervention and/or brief treatment, and referral to care.  
*Brief intervention and treatment had positive outcomes, brief intervention was more cost effective for most substances.  


<br/> Four factors influenced SBIRT sustainability:
* '''Strong research or substantial experiential evidence supports the model.''' At a minimum, programmatic outcomes demonstrate a successful approach.


*Presence of a program champion
According to SAMHSA, one of the benefits of the SBIRT approach is that it is easy to learn relative to other behavioral treatment techniques that may require lengthy specialized training. As such, it can be implemented by diverse health professionals who work in busy medical settings -- physicians, nurses, social workers, health educators, and paraprofessionals.
*Availability of funding
*Systematic change
*Effective management of SBIRT provider challenges


<br/> Key Findings:
== The SBIRT Process ==


*SBIRT was adapted successfully to the needs of early identification efforts for harmful use of alcohol and illicit drugs
'''Screening.''' The very first step of the SBIRT process is screening. Ideally, it is used universally -- whether at an annual physical exam or other regularly occurring appointments with a provider or healthcare specialist. It uses a quick and simple method of identifying patients who use alcohol or other substances at risky levels, identifies use or experimenting, can help identify individuals who use substances at risky levels, as well as those who are already experiencing substance use-related issues.
*SBIRT is an innovative way to integrate management of substance use disorders into primary care and general medicine
*SBIRT improved treatment system equity, efficiency, and economy


&nbsp;
'''Brief Intervention.''' After an initial screening, the individual may be referred for a brief intervention where a healthcare professional engages a patient in a short conversation, providing feedback and advice. According to SAMHSA, commonly used models for brief interventions treatment include:


= SBIRT Related Training =
*Cognitive-Behavioral Therapy (CBT)
*Motivational Enhancement Therapy
*Community Reinforcement Approach
*Solution-focused Therapy


== General Training ==
'''Referral to Treatment''' If the patient requires additional services, the healthcare professional may recommend a brief therapy or treatment. SAMHSA recommends that referral to treatment is a critical component of the SBIRT process for patients who screen showing that they need additional services. It involves establishing a clear method of follow-up with patients that have been identified as having a possible dependency on a substance or in need of specialized treatment. The referral to treatment process consists of assisting a patient with accessing specialized treatment, selecting treatment facilities, and helping navigate any barriers such as treatment cost or lack of transportation that could hinder treatment in a specialty setting.


One of the keys to expanding the use of Screening and SBIRT tools is to increase the general awareness of the SBIRT approach and the value of identifying people who are misusing substances (or at risk of misusing substances) as soon as possible.&nbsp;
Models for brief treatment recommended by SAMHSA include:


This set of Webinars provides valuable background and could be shared with many different community stakeholders:&nbsp;&nbsp;[https://sbirt.webs.com/webinars https://sbirt.webs.com/webinars]
*Brief Negotiated Interview
*Brief Counseling
*FRAMES (Feedback, Responsibility, Menu of options, Empathy, Self-efficacy)
*Motivational Interviewing (MI) techniques


More SBIRT Training Resources are available at&nbsp; [http://www.sbirteducation.com http://www.sbirteducation.com]&nbsp;
== Integration of SBIRT ==


== Screening and Intervention Training ==
Besides typical healthcare settings, there are many other places where professionals come into contact with people who may be at risk of substance use disorder.


Efforts to significantly expand SBIRT in a region will require significant training of a large number of people. One option to accomplish this is through the use of technology.
* '''Hospitals and Emergency Rooms.''' Individuals with SUD or just occasional use regularly access emergency care. Utilizing the SBIRT approach with individuals seeking care can be beneficial. A 2018 study examined an SBIRT program in Allegheny County, Pennsylvania emergency rooms and measured Medicaid claims data. It concluded that SBIRT had the potential to reduce healthcare costs and that SBIRT use in the emergency department can be readily incorporated into existing practice settings. <ref>https://warmhandoff.org/wp-content/uploads/2019/07/Safe-Landing-ED.pdf</ref>


'''Kognito''' offers and accredited [https://kognito.com/products/sbi-with-adolescents technology-based training on Screening and Brief Intervention] for youth that use innovative simulations to provide training and evaluate the skills of those taking the training.
* '''Dentists and Oral Surgeons''' can play an important role in SBIRT. A study in the Journal of the American Dental Association (JADA)  showed that in the late 90s, dentists were the top specialty providers of immediate-release opioids, accounting for 15.5% of those prescriptions. <ref>https://jada.ada.org/article/S0002-8177(18)30419-7/pdf</ref>The American Dental Association recommends dentists and oral surgeons incorporate NIDA's "Screening for Substance Use in the Dental Setting" to help dental professionals recognize the signs of risky substance use and addiction. <ref>https://www.drugabuse.gov/nidamed-medical-health-professionals/science-to-medicine/screening-substance-use/in-dental-setting</ref>


The program was developed in collaboration with NORC at the University of Chicago and adopted by more than 40 schools of health professions and state agencies. It helps improve patient-provider communication and supports the integration of substance use SBI in primary care settings. It is a cost-effective way to train large numbers of people.
* '''Community Health Centers and Clinics.''' Community health providers offer excellent opportunities for early intervention with at-risk substance users and intervention for persons with SUDs and mental health issues. The state of New Hampshire was an early adopter of SBIRT in a community setting. By incorporating SBIRT, New Hampshire found that universal screening lowers the barriers to early intervention and treatment, integrated care, and increased positive outcomes for patients. <ref>http://sbirtnh.org/wp-content/uploads/2016/05/The-Power-of-Best-Practices-Launching-SBIRT-in-a-Community-Health-Center.pdf</ref>


The [https://kognito.com/approach Kognito Conversation Platform] has an innovative behavior change model integrates several evidence-based models and techniques, game mechanics, and learning principles. In these simulations, users enter a virtual environment and engage in role-play conversations with emotionally-responsive virtual humans. Through practice and receiving personalized feedback, users learn and assess their competency to lead similar conversations in real life. Kognito is the only company with health simulations listed in the National Registry of Evidence-based Programs and Practices (NREPP).
* '''Schools.''' An estimated 310,000 adolescents (aged 12-17) misused prescription pain relievers for the first time in 2018 - that's 850 teens every day. <ref>https://www.samhsa.gov/data/report/2018-nsduh-annual-national-report</ref>Many states have moved forward to expand SBIRT in school settings. In fact, schools offer a prime opportunity to identify, support, and redirect students in middle school and high school. Massachusetts was one of the first states to require SBIRT in a school setting and is considered a model for school-based SBIRT <ref>https://www.communitycatalyst.org/resources/publications/document/Massachusetts-Provides-a-Model-for-Addressing-Students-Risky-Substance-Use-7_6_18.pdf</ref>. Other states now incorporating SBIRT in schools include New York, Pennsylvania, California, Florida, and Texas. A 2017 study  found that universal delivery of school-based SBIRT to all students -- not just substance-using students -- provides 2 types of prevention. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5753915/</ref>First, it can prevent the onset of substance use by motivating abstinent students to remain abstinent. Second, it can reduce substance use among users by providing education on the consequences of substance use and by brainstorming strategies to cut down or quit if the student wishes to do so. The School-Based Health Alliance is currently testing and refining the adaptation of school-based SBIRT into 17 health care settings in seven states.<ref>http://www.sbh4all.org/current_initiatives/sbirt-in-sbhcs/</ref>


= Screening&nbsp; =
= Relevant Research =


== Effective Screening Tools ==
A growing body of evidence demonstrates SBIRT’s effectiveness in creating positive outcomes for those with substance use disorder. A 2017 report "Screening, Brief Intervention and Referral to Treatment:implications of SAMHSA’s SBIRT initiative for substance abuse policy and practice" studied eleven multi-site programs of SAMHSA grant recipients each funded for 5 years to promote the use and implementation of SBIRT. <ref>https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.13675</ref>They screened more than 1 million people and reviewed five years of SBIRT research, concluding that its implementation was associated with improvements in treatment system equity, efficiency, and economy, including:


One of the most promising ways to enhance SBIRT is to use some of the new screening tools that are based on new science and that use new technology.&nbsp; The use of tools make it easier for screenings to be done, and the results of the screenings shoudl be more detailed and valuable.&nbsp; &nbsp;Also, in many cases, the screening is a billable event, and if it is done using technology, then it will minize the burden on the healthcare professionals.&nbsp;
* Greater intervention intensity was associated with larger decreases in substance use.
* Brief intervention and treatment had positive outcomes- brief intervention was more cost-effective for most substances.
* Adapts successfully to the needs of early identification efforts for harmful use of alcohol and illicit drugs.
* Integrates management of substance use disorders into primary care and general medicine.


'''[http://interasolutions.com OARS]'''<br/> '''Opioid Abuse Risk Screener (OARS)''' was developed as a comprehensive self-administered measure of potential risk that includes a wide range of critical elements noted in the literature to be relevant to opioid risk.<ref>Development and preliminary validation of the Opioid Abuse Risk Screener. (n.d.). Retrieved December 5, 2019, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5193264/
=Impactful Federal, State, and Local Policies=
</ref>&nbsp;This 43-question assessment is administered using an iPad (tablet) and takes about 10 - 12 minutes to complete. It is HIPAA compliant, EMR supported, and has high reliability, validity and preditablity scores. The assessment is instantly scored and a report is available to the prescribing physician that provides a summary opioid risk profile and a multidimensional assessment of risk factors. The OARS also provides depression and anxiety scores that can be used for SBIRT assessments and wellness visits, including scores for the PHQ-9 and the GAD-7. All information is provided in a compressive easy to read report which clearly identifies aberrant behavior and risk factors for followup by the provider with the patient during the visit.


The OARS is reimbursable with an average rate of $40/screening. Providers can get reimbursed in most cases with the CPT Code 96103 or the SBIRT codes while taking important steps to identify individuals that may be at risk for opioid misuse or abuse.
SAFE Solutions is an ever-growing platform. Currently limited information is readily available for this section. SAFE Project is dedicated to providing communities with the most relevant and innovative materials. We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration. Please check back soon.


InteraSolutions, the company that developed OARS, received a 2018 recipient of the State of Ohio's [https://www.usnews.com/news/best-states/ohio/articles/2018-09-12/ohio-set-to-award-latest-prizes-in-opioid-science-challenge Opioid Science Challenge] that seeks to identify and support scientific breakthroughs that help to address the opioid crisis. The OARS screening tool was recognized as one of those important breakthroughs.&nbsp;
= Available Tools and Resources =


[[More_information_on_the_Opioid_Abuse_Risk_Screener|More information on the Opioid Abuse Risk Screener]] (OARS)
*'''SAMHSA''' offers a wide list of general resources for SBIRT with links to technical assistance, online apps, and other research.<ref>https://www.samhsa.gov/sbirt</ref>


= Brief Intervention =
'''Electronic Health Records (EHR).'''
One way to enhance the impact of SBIRT is to integrate information from the process into the EHR. <ref>https://www.indianasbirt.org/ehr-modification</ref> An EHR Toolkit and links to recorded webinars are provided by the Institute for Research, Education and Training in Addictions (IRETA). <ref> https://ireta.org/resources/electronic-health-record-toolkit/</ref> This youtube resource <ref>https://www.youtube.com/watch?v=faO_bJdNyBQ</ref> is provided by IRETA and SAMHSA's Addiction Technology Transfer Center Network <ref>https://attcnetwork.org/</ref> and provides a good overview on implementing the integration of SBIRT data into EHRs.


Models for brief treatment recommended by SAMHSA<sup class="reference"><ref>[8]Page Not Found </ref></sup> include:
'''An SBIRT website at the University of Missouri-Kansas City''' provides links to all of the following resources for three different populations -  adolescents, older adults, and women: <ref>https://www.sbirt.care/resources.aspx</ref>


#[[Resources_on_Brief_Negotiated_Interview|Brief Negotiated Interview]]
''For Adolescents:''
#Brief counseling
#[[Additional_Info_on_FRAMES|Feedback, Responsibility, Menu of options, Empathy, Self-efficacy (FRAMES)]]
#[[Additional_Info_on_Motivational_Interviewing|Motivational Interviewing (MI) techniques]]


= Referral to Treatment =
* '''SBIRT for Adolescents''' - Sharon Levy, MD, MPH is a board-certified Developmental-Behavioral Pediatrician and has recorded a webinar with valuable information about screening and brief intervention to prevent or reduce substance use in youth.<ref>https://www.youtube.com/watch?v=JtCd4jATtFw</ref>.


According to SAMHSA<sup class="reference"><ref>[9]Page Not Found </ref></sup> , commonly used models for brief treatment include:
*'''SBIRT Oregon''' - workflow, screening forms, clinical tools, curriculum, and video demonstrations


#[[Resources_on_Cognitive_Behavioral_Therapy|Cognitive-Behavioral Therapy]] (CBT)
* '''SBIRT for Youth Learning Community''' - contains information about applying SBIRT in various settings with live and webinar information <ref>https://ireta.org/resources/sbirt-for-youth-learning-community-webinar-introduction-review-of-research/</ref>
#Motivational Enhancement Therapy
#Community Reinforcement Approach
#Solution-focused Therapy


= Promising Programs =
*'''Adolescent SBIRT Curriculum''' - skills based education on Adolescent SBIRT. Contains Instructor's Toolkit with a Learner's Guide to Adolescent SBIRT with supplemental resources, and web-based SBI with simulation program <ref>https://sbirt.webs.com/curriculum</ref>


There are many promising programs that seek to expand SBIRT into places where professionals come into contact with people who have started to misuse substances.&nbsp; Several programs have focused on populations that have co-occuring mental health issues, which often leads to self-medication and abuse.
*'''NIAAA Alcohol Screening And Brief Intervention For Youth: A Practitioner's Guide''' - information on screening and brief intervention for youth ages 9 to 18 years of age <ref>https://www.niaaa.nih.gov/alcohols-effects-health/professional-education-materials/alcohol-screening-and-brief-intervention-youth-practitioners-guide</ref>.


== Healthcare&nbsp;Settings ==
*'''NIDA Principles Of Adolescent Substance Use Disorder Treatment: A Research-Based Guide''' - contains a guide with 13 researched-based principles of adolescent substance use disorder treatment <ref>https://nida.nih.gov/sites/default/files/podata_1_17_14.pdf</ref>


Healthcare professinals often come into contact with patients who may have substance misuse issues.&nbsp;&nbsp;
''For Older Adults:''
 
*'''Prescription Drug Abuse: Older Adults''' - NIDA highlights issues surrounding prescription drug misuse among older adults <ref>https://nida.nih.gov/publications/research-reports/misuse-prescription-drugs/what-scope-prescription-drug-misuse</ref>


=== Hopsitals and Emergency Rooms ===
*'''SBIRT and Older Adults''' - this website contains webinars that address the use of SBRIT with older adults <ref>https://bigsbirteducation.webs.com/</ref>


[https://www.bu.edu/bniart/files/2011/02/SBIRT-emergency-care-setting.pdf https://www.bu.edu/bniart/files/2011/02/SBIRT-emergency-care-setting.pdf]
*'''Florida BRITE Project''' -  funded by SAMHSA, this SBIRT grant focuses on implementing SBIRT with older adults


=== Dentists and Oral Surgeons ===
*'''Older Americans Behavioral Health Issue Brief 3: Screening And Preventative Brief Interventions For Alcohol And Psychoactive Medication Misuse/Abuse''' - covers the basics of SBIRT published by SAMHSA and the Administration on Aging <ref>https://www.ncoa.org/wp-content/uploads/Issue-Brief-3-Screening-Brief-Intervention_508_Color.pdf</ref>


The Journal of the American Dental Association, Volume 142, Issue 7, July 2011, Pages 800-810&nbsp;&nbsp;[http://attcnetwork.org/userfiles/file/NFA-SBIRT/110727_The_Applicability_of_SBIRT_in_Dental_Settings_CABHP_Lit_Rev https://www.sciencedirect.com/science/article/pii/S0002817714622649]
''For Women:''


The Journal of the American Dental Association, Volume 144, Issue 6, June 2013, Pages 627-638&nbsp;[https://www.sciencedirect.com/science/article/pii/S0002817714607674 https://www.sciencedirect.com/science/article/pii/S0002817714607674]
* '''Substance Use and Women''' - covers substance use issues among women, including sex and gender differences in substance use, substance use while pregnant and breastfeeding, sex and gender differences in substance use disorder treatment, other sex and gender issues for women related to substance use from the NIDA. <ref>https://nida.nih.gov/publications/drugfacts/substance-use-in-women</ref>


== Community Health Centers and Clinics ==
*'''Special Considerations for Women''' - This article provides information on the role of SBIRT in averting fetal alcohol spectrum disorder (FASD) <ref>https://pubmed.ncbi.nlm.nih.gov/31334924/</ref>


&nbsp;
*'''ATTC Center of Excellence on Behavioral Health for Pregnant and Postpartum Women and Their Families''' - contains resources on a family-centered approach to behavioral health support for pregnant and postpartum women, including links to recent literature and government publications, online courses, and training. <ref>https://attcppwtools.org</ref>


== Agencies and Programs Addressing Mental Health ==
*'''SBIRT Oregon Pregnancy Clinical Tools''' -  "SBIRT Oregon offers a reference sheet, pocket card, and patient handout for providers to use with pregnant women who are using substances." <ref>https://www.sbirtoregon.org/clinic-tools/</ref>


Add information here<br/> [https://ireta.org/resources/what-is-sbirt-and-why-might-it-fit-well-in-mental-health-settings-the-research-is-just-beginning https://ireta.org/resources/what-i]<br/> [https://ireta.org/resources/what-is-sbirt-and-why-might-it-fit-well-in-mental-health-settings-the-research-is-just-beginning s-sbirt-and-why-might-it-fit-well-in-mental-health-settings-the-research-is-just-beginning/]
*'''Behavioral Health Risks Screening Tool For Pregnant Women''' - This tool used to screen pregnant women for substance use was developed by the Institute for Health and Recovery.<ref>https://d3vz56oilt3wha.cloudfront.net/resources/5p_forms/5Ps%20screening%20tool%20-%20English.pdf</ref>


== Schools ==
= Promising Practices =


Some states, like Massachusetts have been moving to significantly expand SBIRT in schools.<ref> [2]SBIRT in Schools | Massachusetts Screening, Brief Intervention and Referral to Treatment (MASBIRT). (n.d.). Retrieved December 5, 2019, from https://www.masbirt.org/schools
If a community wants to expand SBIRT, it may require training a large number of people. One cost-effective option to accomplish this is through the use of technology-supported trainings:
</ref><br/> A research report shared early findings:&nbsp;<sup><ref>[3]Brenda L, Curtis (2014). Translating SBIRT to public school settings: An initial test of feasibility, Journal of Substance Abuse Treatment, Retrieved from https://www.integration.samhsa.gov/Translating_SBIRT_Curtis_etal.pdf
</ref></sup><br/> Training on using SBIRT in schools to address alcohol use:&nbsp;<sup><ref>[4]School SBIRT: Identifying and Addressing Substance Use, (n.d), Retrieved from: https://neushi.org/student/programs/attachments/SBIRTHandouts.pdf.</ref></sup><br/> This article has encouraging updates and resources on using SBIRT in School-Based Health Clinics:<sup><ref>[5]Substance Use Prevention in SBHC | School-Based Health Alliance Substance Use Prevention in SBHC | Redefining Health for Kids and Teens. (n.d.). Retrieved December 5, 2019, from http://www.sbh4all.org/current_initiatives/sbirt-in-sbhcs/
</ref></sup><br/> &nbsp;


= Referral Pathways =
*'''IRETA '''(The Institute for Research, Education, and Training in Addiction) provides online training for both professionals and the public, as well as free webinars and on-site prescriber education<ref>https://ireta.org/training/overview/</ref>.
*'''NORC''' is a public policy and social research organization affiliated with the University of Chicago. They provide hosted Webinars on Screening, Brief Intervention, and Referral to Treatment (SBIRT) training includes resources for professionals, adolescent SBIRT, workplace/EAP, community stakeholders, and other addiction or behavioral professionals. NORC provides SBIRT education in both on-demand and live webinars. <ref>https://www.sbirteducation.com/</ref>
*'''Kognito''' offers accredited technology-based training on SBIRT for youth using innovative simulations to evaluate the skills of those taking the training. <ref>https://kognito.com/products/sbi-with-adolescents</ref> The program was developed in collaboration with NORC at the University of Chicago and has been adopted by more than 40 schools of health professions and state agencies. Additionally, the Kognito Conversation Platform<ref>https://kognito.com/approach</ref> has an innovative behavior change model that integrates several evidence-based models and techniques, game mechanics, and learning principles. Kognito is listed in the National Registry of Evidence-based Programs and Practices (NREPP). 


= Integration of SBIRT into Electronic Health Records =
Communities can also enhance SBIRT by incorporating technology through new screening tools. These tools make it easier for health professions to expand initial screenings while opening up a new avenue to engage patients and individuals. Screening tools may include phone apps, tablet-based screening, computer-administered screening, interactive voice response, web-based or even text-based.


One way to enhance the impact of SBIRT is to integrate information from the process into the Electronic Health Record (EHR).&nbsp; "Modifying your organization's electronic health record to support SBIRT can accelerate your patient flow, reduce the burden of data collection, and allow you to monitor and measure the success of your SBIRT implementation."<ref>https://www.indianasbirt.org/ehr-modification</ref>
*'''SBIRT Oregon App<ref>http://www.sbirtoregon.org/screening-app/</ref>:''' The Department of Family Medicine at Oregon Health and Science University designed online resources and an SBIRT app for primary care and emergency medicine settings in Oregon and the U.S. The patient uses a web-based screening app for tablet, phone, or desktop, which quickly screens and assesses them for substance use and depression, converts answers into chart-ready notes, reads questions out loud for patients with low literacy, and delivers screening tools in English or Spanish.  
*'''Screen for Opioid Abuse Risk (SOAR in Ohio, also known as OARS)<ref>https://intera.solutions/soar-ohio-screen-opioid-abuse-risk/</ref>''' was developed as a comprehensive self-administered measure of potential risk. It includes a wide range of critical elements noted in the literature to be relevant to opioid risk. This 43-question assessment is administered using a tablet and takes about 10 - 12 minutes to complete. The assessment is instantly scored and a report is available to the prescribing physician. The report provides a summary opioid risk profile and a multidimensional assessment of risk factors. SOAR also provides depression and anxiety scores that can be used for SBIRT assessments and wellness visits.


An overview on this topic, and links to recorded webinars can be found in the SBIRT and Electronic Health Records Toolkit:&nbsp;[https://ireta.org/resources/electronic-health-record-toolkit/ https://ireta.org/resources/electronic-health-record-toolkit/]
= Sources =


This [https://www.youtube.com/watch?v=faO_bJdNyBQ recorded webinar], provided by [https://ireta.org/ IRETA] and&nbsp;the [https://attcnetwork.org/ Addiction Technology Transfer Center Network], provides a good overview on implementing the integration of SBIRT data into EHRs.&nbsp;
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= Funding =
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The following organizations are currently funding research and initiatives to expand SBIRT:


#Conrad N. Hilton Foundation<sup class="reference"><ref>[6]Foundation 818.851.3700, C. N. H. (n.d.). Grants. Retrieved December 5, 2019, from Conrad N. Hilton Foundation website: https://www.hiltonfoundation.org/grants
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</ref></sup>  
#Substance Abuse and Mental Health Service Administration<sup class="reference"><ref>[7]michelle.harrington. (2014, April 3). SBIRT Grantees [Text]. Retrieved December 5, 2019, from https://www.samhsa.gov/sbirt/grantees
</ref></sup>  
#A report by Catalyst shares several innovative ways to fund SBIRT in schools&nbsp;&nbsp;<br/> [https://www.communitycatalyst.org/resources/publications/document/Funding-and-Sustaining-SBIRT-in-Schools-December-2015.pdf?1451325931 Funding Screening, Brief Intervention, and Referral to Treatment (SBIRT) in Public Schools]
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= Tools & Resources =


[[TR_-_Expand_SBIRT_Program|TR - Expand SBIRT Program]]
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[[Category:SAFE-Full Spectrum Prevention]]
[[Category:SAFE-Full Spectrum Prevention]]

Revision as of 10:39, 1 September 2023

Introductory Paragraph

SBIRT is an abbreviation of Screening, Brief Intervention, and Referral to Treatment. It is a popular model for prevention and early intervention because all patients are screened regardless of an identified disorder. This allows healthcare professionals to reach a wider range of people - not just those who are seeking treatment for substance use disorder (SUD) or behavioral health. This is especially critical for those who may be at risk for substance use disorder but may not meet established criteria. Additionally, SBIRT screens for all types of substance use, not just dependencies.

This evidence-based, public health approach is a paradigm shift in substance-use treatment because SBIRT places risky substance use where it belongs—in the realm of healthcare. Routine screening helps identify and intervene with patients whose use puts them at risk for health issues. SBIRT focuses on identifying risky substance use to help prevent the onset of the more costly disease of addiction. Similar to preventive screenings for chronic diseases such as cancer, diabetes, and hypertension, SBIRT is an effective tool for identifying risk levels related to substance use and for providing the appropriate intervention. Expanding the use of SBIRT can provide critical pathways for people to access treatment earlier.

Key Information

Communities can expand the use of SBIRT tools by increasing public awareness of the SBIRT approach and the value of identifying people who are at high risk or might be using substances. SAMHSA supports a research-based comprehensive behavioral health SBIRT model which reflects the six following characteristics: [1]

  • It is brief. The initial screening is accomplished quickly (about 5-10 minutes) and the intervention and treatment components indicated by the screening results are completed in significantly less time than traditional substance abuse specialty care.
  • Screening is universal. The patients, clients, students, or other target populations are all screened as part of the standard intake process.
  • One or more specific behaviors are targeted. The screening tool addresses a specific behavioral characteristic deemed to be problematic, or pre-conditional to substance dependence or other diagnoses.
  • The services occur in a public health, or other non-substance use treatment setting.
  • It is comprehensive. The program includes a seamless transition between brief universal screening, brief intervention and/or brief treatment, and referral to care.
  • Strong research or substantial experiential evidence supports the model. At a minimum, programmatic outcomes demonstrate a successful approach.

According to SAMHSA, one of the benefits of the SBIRT approach is that it is easy to learn relative to other behavioral treatment techniques that may require lengthy specialized training. As such, it can be implemented by diverse health professionals who work in busy medical settings -- physicians, nurses, social workers, health educators, and paraprofessionals.

The SBIRT Process

Screening. The very first step of the SBIRT process is screening. Ideally, it is used universally -- whether at an annual physical exam or other regularly occurring appointments with a provider or healthcare specialist. It uses a quick and simple method of identifying patients who use alcohol or other substances at risky levels, identifies use or experimenting, can help identify individuals who use substances at risky levels, as well as those who are already experiencing substance use-related issues.

Brief Intervention. After an initial screening, the individual may be referred for a brief intervention where a healthcare professional engages a patient in a short conversation, providing feedback and advice. According to SAMHSA, commonly used models for brief interventions treatment include:

  • Cognitive-Behavioral Therapy (CBT)
  • Motivational Enhancement Therapy
  • Community Reinforcement Approach
  • Solution-focused Therapy

Referral to Treatment If the patient requires additional services, the healthcare professional may recommend a brief therapy or treatment. SAMHSA recommends that referral to treatment is a critical component of the SBIRT process for patients who screen showing that they need additional services. It involves establishing a clear method of follow-up with patients that have been identified as having a possible dependency on a substance or in need of specialized treatment. The referral to treatment process consists of assisting a patient with accessing specialized treatment, selecting treatment facilities, and helping navigate any barriers such as treatment cost or lack of transportation that could hinder treatment in a specialty setting.

Models for brief treatment recommended by SAMHSA include:

  • Brief Negotiated Interview
  • Brief Counseling
  • FRAMES (Feedback, Responsibility, Menu of options, Empathy, Self-efficacy)
  • Motivational Interviewing (MI) techniques

Integration of SBIRT

Besides typical healthcare settings, there are many other places where professionals come into contact with people who may be at risk of substance use disorder.

  • Hospitals and Emergency Rooms. Individuals with SUD or just occasional use regularly access emergency care. Utilizing the SBIRT approach with individuals seeking care can be beneficial. A 2018 study examined an SBIRT program in Allegheny County, Pennsylvania emergency rooms and measured Medicaid claims data. It concluded that SBIRT had the potential to reduce healthcare costs and that SBIRT use in the emergency department can be readily incorporated into existing practice settings. [2]
  • Dentists and Oral Surgeons can play an important role in SBIRT. A study in the Journal of the American Dental Association (JADA) showed that in the late 90s, dentists were the top specialty providers of immediate-release opioids, accounting for 15.5% of those prescriptions. [3]The American Dental Association recommends dentists and oral surgeons incorporate NIDA's "Screening for Substance Use in the Dental Setting" to help dental professionals recognize the signs of risky substance use and addiction. [4]
  • Community Health Centers and Clinics. Community health providers offer excellent opportunities for early intervention with at-risk substance users and intervention for persons with SUDs and mental health issues. The state of New Hampshire was an early adopter of SBIRT in a community setting. By incorporating SBIRT, New Hampshire found that universal screening lowers the barriers to early intervention and treatment, integrated care, and increased positive outcomes for patients. [5]
  • Schools. An estimated 310,000 adolescents (aged 12-17) misused prescription pain relievers for the first time in 2018 - that's 850 teens every day. [6]Many states have moved forward to expand SBIRT in school settings. In fact, schools offer a prime opportunity to identify, support, and redirect students in middle school and high school. Massachusetts was one of the first states to require SBIRT in a school setting and is considered a model for school-based SBIRT [7]. Other states now incorporating SBIRT in schools include New York, Pennsylvania, California, Florida, and Texas. A 2017 study found that universal delivery of school-based SBIRT to all students -- not just substance-using students -- provides 2 types of prevention. [8]First, it can prevent the onset of substance use by motivating abstinent students to remain abstinent. Second, it can reduce substance use among users by providing education on the consequences of substance use and by brainstorming strategies to cut down or quit if the student wishes to do so. The School-Based Health Alliance is currently testing and refining the adaptation of school-based SBIRT into 17 health care settings in seven states.[9]

Relevant Research

A growing body of evidence demonstrates SBIRT’s effectiveness in creating positive outcomes for those with substance use disorder. A 2017 report "Screening, Brief Intervention and Referral to Treatment:implications of SAMHSA’s SBIRT initiative for substance abuse policy and practice" studied eleven multi-site programs of SAMHSA grant recipients each funded for 5 years to promote the use and implementation of SBIRT. [10]They screened more than 1 million people and reviewed five years of SBIRT research, concluding that its implementation was associated with improvements in treatment system equity, efficiency, and economy, including:

  • Greater intervention intensity was associated with larger decreases in substance use.
  • Brief intervention and treatment had positive outcomes- brief intervention was more cost-effective for most substances.
  • Adapts successfully to the needs of early identification efforts for harmful use of alcohol and illicit drugs.
  • Integrates management of substance use disorders into primary care and general medicine.

Impactful Federal, State, and Local Policies

SAFE Solutions is an ever-growing platform. Currently limited information is readily available for this section. SAFE Project is dedicated to providing communities with the most relevant and innovative materials. We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration. Please check back soon.

Available Tools and Resources

  • SAMHSA offers a wide list of general resources for SBIRT with links to technical assistance, online apps, and other research.[11]

Electronic Health Records (EHR). One way to enhance the impact of SBIRT is to integrate information from the process into the EHR. [12] An EHR Toolkit and links to recorded webinars are provided by the Institute for Research, Education and Training in Addictions (IRETA). [13] This youtube resource [14] is provided by IRETA and SAMHSA's Addiction Technology Transfer Center Network [15] and provides a good overview on implementing the integration of SBIRT data into EHRs.

An SBIRT website at the University of Missouri-Kansas City provides links to all of the following resources for three different populations - adolescents, older adults, and women: [16]

For Adolescents:

  • SBIRT for Adolescents - Sharon Levy, MD, MPH is a board-certified Developmental-Behavioral Pediatrician and has recorded a webinar with valuable information about screening and brief intervention to prevent or reduce substance use in youth.[17].
  • SBIRT Oregon - workflow, screening forms, clinical tools, curriculum, and video demonstrations
  • SBIRT for Youth Learning Community - contains information about applying SBIRT in various settings with live and webinar information [18]
  • Adolescent SBIRT Curriculum - skills based education on Adolescent SBIRT. Contains Instructor's Toolkit with a Learner's Guide to Adolescent SBIRT with supplemental resources, and web-based SBI with simulation program [19]
  • NIAAA Alcohol Screening And Brief Intervention For Youth: A Practitioner's Guide - information on screening and brief intervention for youth ages 9 to 18 years of age [20].
  • NIDA Principles Of Adolescent Substance Use Disorder Treatment: A Research-Based Guide - contains a guide with 13 researched-based principles of adolescent substance use disorder treatment [21]

For Older Adults:

  • Prescription Drug Abuse: Older Adults - NIDA highlights issues surrounding prescription drug misuse among older adults [22]
  • SBIRT and Older Adults - this website contains webinars that address the use of SBRIT with older adults [23]
  • Florida BRITE Project - funded by SAMHSA, this SBIRT grant focuses on implementing SBIRT with older adults
  • Older Americans Behavioral Health Issue Brief 3: Screening And Preventative Brief Interventions For Alcohol And Psychoactive Medication Misuse/Abuse - covers the basics of SBIRT published by SAMHSA and the Administration on Aging [24]

For Women:

  • Substance Use and Women - covers substance use issues among women, including sex and gender differences in substance use, substance use while pregnant and breastfeeding, sex and gender differences in substance use disorder treatment, other sex and gender issues for women related to substance use from the NIDA. [25]
  • Special Considerations for Women - This article provides information on the role of SBIRT in averting fetal alcohol spectrum disorder (FASD) [26]
  • ATTC Center of Excellence on Behavioral Health for Pregnant and Postpartum Women and Their Families - contains resources on a family-centered approach to behavioral health support for pregnant and postpartum women, including links to recent literature and government publications, online courses, and training. [27]
  • SBIRT Oregon Pregnancy Clinical Tools - "SBIRT Oregon offers a reference sheet, pocket card, and patient handout for providers to use with pregnant women who are using substances." [28]
  • Behavioral Health Risks Screening Tool For Pregnant Women - This tool used to screen pregnant women for substance use was developed by the Institute for Health and Recovery.[29]

Promising Practices

If a community wants to expand SBIRT, it may require training a large number of people. One cost-effective option to accomplish this is through the use of technology-supported trainings:

  • IRETA (The Institute for Research, Education, and Training in Addiction) provides online training for both professionals and the public, as well as free webinars and on-site prescriber education[30].
  • NORC is a public policy and social research organization affiliated with the University of Chicago. They provide hosted Webinars on Screening, Brief Intervention, and Referral to Treatment (SBIRT) training includes resources for professionals, adolescent SBIRT, workplace/EAP, community stakeholders, and other addiction or behavioral professionals. NORC provides SBIRT education in both on-demand and live webinars. [31]
  • Kognito offers accredited technology-based training on SBIRT for youth using innovative simulations to evaluate the skills of those taking the training. [32] The program was developed in collaboration with NORC at the University of Chicago and has been adopted by more than 40 schools of health professions and state agencies. Additionally, the Kognito Conversation Platform[33] has an innovative behavior change model that integrates several evidence-based models and techniques, game mechanics, and learning principles. Kognito is listed in the National Registry of Evidence-based Programs and Practices (NREPP).

Communities can also enhance SBIRT by incorporating technology through new screening tools. These tools make it easier for health professions to expand initial screenings while opening up a new avenue to engage patients and individuals. Screening tools may include phone apps, tablet-based screening, computer-administered screening, interactive voice response, web-based or even text-based.

  • SBIRT Oregon App[34]: The Department of Family Medicine at Oregon Health and Science University designed online resources and an SBIRT app for primary care and emergency medicine settings in Oregon and the U.S. The patient uses a web-based screening app for tablet, phone, or desktop, which quickly screens and assesses them for substance use and depression, converts answers into chart-ready notes, reads questions out loud for patients with low literacy, and delivers screening tools in English or Spanish.
  • Screen for Opioid Abuse Risk (SOAR in Ohio, also known as OARS)[35] was developed as a comprehensive self-administered measure of potential risk. It includes a wide range of critical elements noted in the literature to be relevant to opioid risk. This 43-question assessment is administered using a tablet and takes about 10 - 12 minutes to complete. The assessment is instantly scored and a report is available to the prescribing physician. The report provides a summary opioid risk profile and a multidimensional assessment of risk factors. SOAR also provides depression and anxiety scores that can be used for SBIRT assessments and wellness visits.

Sources

  1. ↑ https://www.samhsa.gov/sites/default/files/sbirtwhitepaper_0.pdf
  2. ↑ https://warmhandoff.org/wp-content/uploads/2019/07/Safe-Landing-ED.pdf
  3. ↑ https://jada.ada.org/article/S0002-8177(18)30419-7/pdf
  4. ↑ https://www.drugabuse.gov/nidamed-medical-health-professionals/science-to-medicine/screening-substance-use/in-dental-setting
  5. ↑ http://sbirtnh.org/wp-content/uploads/2016/05/The-Power-of-Best-Practices-Launching-SBIRT-in-a-Community-Health-Center.pdf
  6. ↑ https://www.samhsa.gov/data/report/2018-nsduh-annual-national-report
  7. ↑ https://www.communitycatalyst.org/resources/publications/document/Massachusetts-Provides-a-Model-for-Addressing-Students-Risky-Substance-Use-7_6_18.pdf
  8. ↑ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5753915/
  9. ↑ http://www.sbh4all.org/current_initiatives/sbirt-in-sbhcs/
  10. ↑ https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.13675
  11. ↑ https://www.samhsa.gov/sbirt
  12. ↑ https://www.indianasbirt.org/ehr-modification
  13. ↑ https://ireta.org/resources/electronic-health-record-toolkit/
  14. ↑ https://www.youtube.com/watch?v=faO_bJdNyBQ
  15. ↑ https://attcnetwork.org/
  16. ↑ https://www.sbirt.care/resources.aspx
  17. ↑ https://www.youtube.com/watch?v=JtCd4jATtFw
  18. ↑ https://ireta.org/resources/sbirt-for-youth-learning-community-webinar-introduction-review-of-research/
  19. ↑ https://sbirt.webs.com/curriculum
  20. ↑ https://www.niaaa.nih.gov/alcohols-effects-health/professional-education-materials/alcohol-screening-and-brief-intervention-youth-practitioners-guide
  21. ↑ https://nida.nih.gov/sites/default/files/podata_1_17_14.pdf
  22. ↑ https://nida.nih.gov/publications/research-reports/misuse-prescription-drugs/what-scope-prescription-drug-misuse
  23. ↑ https://bigsbirteducation.webs.com/
  24. ↑ https://www.ncoa.org/wp-content/uploads/Issue-Brief-3-Screening-Brief-Intervention_508_Color.pdf
  25. ↑ https://nida.nih.gov/publications/drugfacts/substance-use-in-women
  26. ↑ https://pubmed.ncbi.nlm.nih.gov/31334924/
  27. ↑ https://attcppwtools.org
  28. ↑ https://www.sbirtoregon.org/clinic-tools/
  29. ↑ https://d3vz56oilt3wha.cloudfront.net/resources/5p_forms/5Ps%20screening%20tool%20-%20English.pdf
  30. ↑ https://ireta.org/training/overview/
  31. ↑ https://www.sbirteducation.com/
  32. ↑ https://kognito.com/products/sbi-with-adolescents
  33. ↑ https://kognito.com/approach
  34. ↑ http://www.sbirtoregon.org/screening-app/
  35. ↑ https://intera.solutions/soar-ohio-screen-opioid-abuse-risk/
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