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SBIRT: Screening, Brief Intervention, Referral to Treatment Stephen Ferrante, M.S.W. Group Victory Managing Partner Barry University School of Social Work.

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Presentation on theme: "SBIRT: Screening, Brief Intervention, Referral to Treatment Stephen Ferrante, M.S.W. Group Victory Managing Partner Barry University School of Social Work."— Presentation transcript:

1 SBIRT: Screening, Brief Intervention, Referral to Treatment Stephen Ferrante, M.S.W. Group Victory Managing Partner Barry University School of Social Work Professor September 27, 2013

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3 Specialized Treatment Primary Prevention Brief Intervention None Mild Moderate Severe Substance Abuse Severity and Level of Care Adapted from the SAMHSA TIP #34 (1999) and Institute of Medicine (1990) Substance Abuse Severity

4 SBIRT Core Components

5 SBIRT Approach National Evidence-based Initiative for Screening, Brief Intervention, and Referral to Treatment SBIRT Approach National Evidence-based Initiative for Screening, Brief Intervention, and Referral to Treatment Engagement Engagement Pre-Screening: Risk Identification Pre-Screening: Risk Identification Screening & Assessment: Risk Intensity Screening & Assessment: Risk Intensity Appropriate Intervention: Brief Intervention / Brief Treatment / Outpatient Treatment / Inpatient Care / Referral Ancillary Services Appropriate Intervention: Brief Intervention / Brief Treatment / Outpatient Treatment / Inpatient Care / Referral Ancillary Services Discharge with Outcome Screening Discharge with Outcome Screening Follow-up Screens Follow-up Screens

6 SBIRT Process Universal Prescreening Universal Prescreening – Symptoms Identification Difficult – Minimal Self-Referral Full Assessment for Positive Prescreen Full Assessment for Positive Prescreen Level of Risk dictates Service Type: Level of Risk dictates Service Type: – Screening & Feedback (SF) for negative screens – Brief Intervention (BI) for moderate risk – Brief Treatment (BT) for moderate to high risk – Referral to Treatment (RT) - high risk/problem use

7 Prescreen: Part I

8 Prescreen: Part II

9 Alcohol, Smoking, Substance Involvement Screening Test (ASSIST) World Health Organization (WHO) Interview Style Screen Administered for Positive Prescreen Interview Style Screen Administered for Positive Prescreen ASSIST developed to help healthcare professionals detect and manage substance use ASSIST developed to help healthcare professionals detect and manage substance use Scores provide a “level of risk” for substance misuse and type of service that follows: Scores provide a “level of risk” for substance misuse and type of service that follows: – Low risk = Screening & Feedback about results – Moderate risk = indicates the need for Brief Intervention – Moderate to High Risk = Brief Treatment – High Risk = Referral to Treatment

10 Motivational Interviewing Motivational Interviewing Therapeutic Alliance People who “Screen Positive” for Substance Misuse People who “Screen Positive” for Substance Misuse – May be reluctant to seek help – May be ambivalent about decision to change behavior Confrontation & Labeling may Produce “Resistance” and/or “in Denial” Confrontation & Labeling may Produce “Resistance” and/or “in Denial” Avoiding Labeling & Confrontation Avoiding Labeling & Confrontation Roll with Resistance Roll with Resistance Enhance Self-Efficacy Enhance Self-Efficacy Build Confidence in One’s Coping Strategies Build Confidence in One’s Coping Strategies

11 Motivational Interviewing Acknowledging Motivation, Readiness & Ability for Change Meeting Individuals Where They are Respectful Listening Accepting Individual’s Perspective Identifying Consequences of Problem Facilitating Perception Shift on Impact of Problem Empowering Individual to Generate Insights & Solutions Expressing Belief in Person’s Capacity to Change Offsetting Denial, Resentment & Shame

12 Early SBIRT Examples Emergency Departments Emergency Departments – Bernstein E, Bernstein J, Levenson S: Project ASSERT: An ED-based intervention to increase access to primary care, preventive services, and the substance abuse treatment system. Ann Emerg Med, 1997; 30: Primary Care Practices as “Brief Physician Advice” Primary Care Practices as “Brief Physician Advice” – Fleming, MF., Manwell, LB, Barry, KL, Adams, W, & Stauffacher, EA Brief physician advice for alcohol problems in older adults: A randomized community-based trial. J Fam Pract; (5):

13 SBIRT Today Emergency Departments Emergency Departments Hospital Units Hospital Units Primary Care Practices Primary Care Practices Urgent Care Urgent Care Federally Qualified Health Center Federally Qualified Health Center Health & Behavioral Health Clinic Health & Behavioral Health Clinic Addiction Facilities Addiction Facilities Educational Institutions Educational Institutions Community Service Settings Community Service Settings

14 Health Care Providers can Provide SBIRT Services under Medicare Medicare pays for medically reasonable & necessary SBIRT services in physicians’ offices & outpatient hospitals Medicare pays for medically reasonable & necessary SBIRT services in physicians’ offices & outpatient hospitals Physicians, Physician Assistants, Nurse Practitioners, Clinical Nurse Specialists, Clinical Psychologists, or Clinical Social Workers can bill for SBIRT Physicians, Physician Assistants, Nurse Practitioners, Clinical Nurse Specialists, Clinical Psychologists, or Clinical Social Workers can bill for SBIRT To bill Medicare, providers of MH services must be: To bill Medicare, providers of MH services must be: – Licensed or certified to perform mental health services by the state in which they perform the services; – Qualified to perform the specific mental health services rendered; and – Working within their State Scope of Practice Act MLN/MLNProducts/Downloads/SBIRT_Factsheet_ICN pdf

15 SBIRT Billing & Reimbursement Affordable Care Act Recommended Service Affordable Care Act Recommended Service Screening & Brief Intervention Reimbursement Screening & Brief Intervention Reimbursement – Commercial insurance CPT codes – Medicare G codes – Medicaid HCPCS codes Florida has not approved Medicaid Billing Codes Florida has not approved Medicaid Billing Codes SAMHSA Block & SBIRT Grants SAMHSA Block & SBIRT Grants

16 PayerCodeDescription Fee Schedule Commercial Insurance CPT Alcohol and/or substance abuse structured screening and brief intervention services; 15 to 30 minutes $33.41 CPT Alcohol and/or substance abuse structured screening and brief intervention services; greater than 30 minutes $65.51 Medicare G0396 Alcohol and/or substance abuse structured screening and brief intervention services; 15 to 30 minutes $29.42 G0397 Alcohol and/or substance abuse structured screening and brief intervention services; greater than 30 minutes $57.69 Medicaid H0049Alcohol and/or drug screening$24.00 H0050 Alcohol and/or drug service, brief intervention, per 15 minutes $48.00 SBIRT Coding

17 CPT CodeDescription 90801Diagnostic interview Individual psychotherapy, 20 ‒ 30 minutes Individual psychotherapy, 45 ‒ 50 minutes Common Behavioral Health Codes

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20 The Result: A 16-session curriculum manual for conducting brief treatment (Dupree & Schonfeld, CSAT, 2005)

21 Questions Answers Comments Thank You!


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