SBIRT: Screening, Brief Intervention, Referral to Treatment Stephen Ferrante, M.S.W. Group Victory Managing Partner Barry University School of Social Work Professor sferrante@groupvictory.net 954-249-2323 September 27, 2013

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

SBIRT Core Components

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

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

Prescreen: Part I

Prescreen: Part II

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

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

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

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; 30:181-189. 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; 1999 48(5): 378-84

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

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 http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/SBIRT_Factsheet_ICN904084.pdf

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

SBIRT Coding http://sbirt.samhsa.gov/coding.htm 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

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

http://sbirt.samhsa.gov/about.htm

A 16-session curriculum manual for conducting brief treatment The Result: A 16-session curriculum manual for conducting brief treatment (Dupree & Schonfeld, CSAT, 2005) http://kap.samhsa.gov/products/manuals/pdfs/substanceabuserelapse.pdf

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