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SBIRT: Screening, Brief Intervention, Referral to Treatment

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Presentation on theme: "SBIRT: Screening, Brief Intervention, Referral to Treatment"— 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


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

4 SBIRT Core Components

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

6 SBIRT Process Universal Prescreening
Symptoms Identification Difficult Minimal Self-Referral Full Assessment for Positive Prescreen 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 Interview Style Screen Administered for Positive Prescreen
Alcohol, Smoking, Substance Involvement Screening Test (ASSIST) World Health Organization (WHO) Interview Style Screen Administered for Positive Prescreen 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: 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 Therapeutic Alliance
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” Avoiding Labeling & Confrontation Roll with Resistance Enhance Self-Efficacy 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
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” 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 Hospital Units
Primary Care Practices Urgent Care Federally Qualified Health Center Health & Behavioral Health Clinic Addiction Facilities Educational Institutions 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 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: 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

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

16 SBIRT Coding
Payer Code Description Fee Schedule Commercial Insurance CPT 99408 Alcohol and/or substance abuse structured screening and brief intervention services; 15 to 30 minutes $33.41 CPT 99409 Alcohol and/or substance abuse structured screening and brief intervention services; greater than 30 minutes $65.51 Medicare G0396 $29.42 G0397 $57.69 Medicaid H0049 Alcohol and/or drug screening $24.00 H0050 Alcohol and/or drug service, brief intervention, per 15 minutes $48.00

17 Common Behavioral Health Codes
CPT Code Description 90801 Diagnostic interview 90804 Individual psychotherapy, 20‒30 minutes 90806 Individual psychotherapy, 45‒50 minutes



20 A 16-session curriculum manual for conducting brief treatment
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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