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SBIRT Practical Prevention Tool
This document discusses screening, brief intervention, and referral to treatment (SBIRT) programs. It provides an overview of SBIRT, including core components like screening instruments, brief interventions using motivational interviewing techniques, and referral to treatment for those who need higher levels of care. The document also discusses evidence and organizations that support SBIRT, lessons learned from SBIRT programs in Colorado, and solutions to common barriers in implementing SBIRT services.
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SBIRT Practical Prevention Tool
- 2. prepared for Michigan PrimaryCare Association
- 3. Peer Assistance Services,Inc. Dedicated to quality, accessible prevention and intervention services in workplaces and communities, focusing on substance abuse and related issues. Incorporated in 1984
- 4. Programs • Peer HealthAssistance Programs (Dental, Pharmacy, Nursing, and other professions) • Colorado TASC (Treatment Accountability for Safer Communities) • Workplace Prevention Services (WPS) • Prescription Drug Abuse Prevention Program • SBIRT (Screening, Brief Intervention, and Referral to Treatment)
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- 6. Objectives • Discuss evidence that supports SBIRT • Identify core components of SBIRT • Describe lessons learned from SBIRT Colorado • Review solutions to commonly perceived barriers
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- 11. “The administration willcontinue to promote the integration of SBIRT in to mainstream health care, disseminate information about SBIRT to a wide variety of health care settings, highlight model programs that are using SBIRT, and encourage training opportunities for the allied health professions.” -2012 National Drug Control Strategy
- 12. Support for SBIRT • The Joint Commission • The American College of Surgeons Committee on Trauma • The U.S. Preventive Services Task Force • The American Congress of Obstetricians and Gynecology • The Emergency Nurses Association • The Office of National Drug Control Policy • The Centers for Medicare and Medicaid Services • The Center for Substance Abuse Treatment • Health Resources and Services Administration • National Institute on Alcohol Abuse and Alcoholism • National Institute on Drug Abuse
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- 14. Billing Codes Payer Code Description Fee Commercial CPT 99408 Alcohol and/or substance abuse structured $33.41 screening and brief intervention services; 15 to 30 minutes CPT 99409 Alcohol and/or substance abuse structured screening and brief intervention services; $65.51 greater than 30 minutes Medicare G0396 Alcohol and/or substance abuse structured $29.42 screening and brief intervention services; 15 to 30 minutes G0397 Alcohol and/or substance abuse structured screening and brief intervention services; $57.69 greater than 30 minutes Medicaid H0049 Alcohol and/or drug screening $24.00 H0050 Alcohol and/or drug service, brief intervention, $48.00 per 15 minutes
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- 16. History of SBIRTin Colorado
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- 18. Brief Intervention 35% Screening only 60% Brief Therapy 2% Referral to Treatment 3%
- 19. 16 14 12 10 8 Alcohol 6 Marijuana 4 Illicit drugs 2 0 Intake 6 mth follow- up
- 20. Screening, Brief Intervention and Referral to Treatment
- 23. The SBIRT Process • Introducing SBIRT • Brief Screen • Screening • Brief Intervention • Referral to Treatment and Follow-Up
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- 27. Brief Screen 1. How many drinks do you have per week? 2. When was the last time you had 4/5 or more drinks in one day? 3. In the past year, have you used or experimented with an illegal drug or prescription drug for nonmedical reasons? 4. Do you currently smoke or use any form of tobacco products?
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- 29. What is astandard drink?
- 30. Screening Instruments Use forfollow-up in those who test positive on the brief screen: • ASSIST: Alcohol, Smoking, and Substance Involvement Screening Test • AUDIT: Alcohol Use Disorders Identification Test • DAST-10: Drug Screening Test (not including alcohol) • CRAFFT: Adolescent drug and alcohol screening
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- 32. What is BriefIntervention? • A brief motivational conversation • Single 3-5 minute to multiple 15-30 minute sessions have led to decreased use • Most effective with at-risk clients who are not addicted • Educating clients about the health risks of their substance use has led to behavior change • BIs are low cost, quick, client friendly, easy to do
- 33. Motivational Interviewing William Millerand Steven Rollnick Ambivalence as central construct Persuasion elicits resistance Alternative to direct persuasion and it works! Source: William Miller (2002)
- 34. Examples of MIStrategies Open-ended questions Affirmation Reflective listening Summarizing Goal is to elicit change talk!!!
- 35. Don’t Assume • Patient ought to change • Patient wants to change • Patient’s health motivates him/her • Now is the right time for patient to change • Tough approach is best
- 36. Brief Intervention Step 1:Raise the Subject Step 2: Provide Feedback Step 3: Enhance Motivation Step 4: Negotiate and Advise
- 37. Step 1: Raisethe Subject Raise the subject of substance use “Would you mind taking a few minutes to talk with me about your substance use?”
- 38. Step 2: ProvideFeedback Discuss health risks of alcohol and other substances “At this level of consumption, you are at increased risk for health and other consequences such as…” Review drinking guidelines “The recommended guidelines for healthy women/men are…
- 39. Step 3: EnhanceMotivation Pre-Contemplation Contemplation Maintenance Preparation Action
- 40. Step 4: Negotiateand Advise Elicit response: “What are some of your thoughts regarding our discussion? Negotiate a goal: “Why are you a 5 and not a 7?” and “What are some steps you could take?” Assist in developing a plan: “What will be challenging for you to meet this goal? What is your plan for overcoming these challenges?” Summarize: “What I heard you say is…”
- 41. Closing the Intervention Showappreciation to your client Affirm positive behaviors Respect client’s decisions Offer information Arrange for follow up
- 42. Referral to BriefTherapy and Treatment • If patient scores high on assessment • What is brief therapy? • Know your resources!
- 43. Sustainability • Identify aninternal champion • Flexibility in how SBI can be implemented • Best to combine with other health screening and education to enhance integrated care • Involve the entire team • Train nursing students and residents to establish SBI as a routine practice
- 44. References • The National Center on Addiction and Substance Abuse at Columbia University. The Cost of Substance Abuse to America’s Health Care System. Report 2: Medicare Hospital Costs. May 1994. Available at http://www.casacolumbia.org/articlefiles/379- Cost%20of%20Substance%20Abuse%20Report%202.pdf. • Mokdad A, Marks J, Stroup D, Gerberding J. Actual causes of death in the United States, 2000. JAMA 2004;291:1238--45. • Substance Abuse and Mental Health Services Administration. (2006) Results from the 2005 National Survey on Drug Use and Health: National findings Rockville (MD): Office of Applied Studies. • Maciosek, MV, Coffield, AB, Edwards, MS, et al. Priorities Among Effective Clinical Preventive Services. Results of a Systematic Review and Analysis. Am J Prev Med 2006; 31 (1) 52-61. Available at http://www.prevent.org/data/files/initiatives/prioritiesamongeffectiveclinicalpreventivesvcsresultsofreviewandanalysis.pdf. • D’Onofrio G, Pantalon MV, Degutis LC, et al. The Yale Brief Negotiated Interview Manual. Yale University School of Medicine. 2005. Available at http://www.ihs.gov/nonmedicalprograms/nc4/documents/appendix_a_yale_bni_manual.pdf. • William Miller, Rollnick Steven. Motivational Interviewing, Second Edition: Preparing People for Change. 2002.
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