How Might SBIRT Impact Adolescent Treatment? Shelly Dutch, CSAC, ICS

Barriers in the Treatment System Few teens with AODA are identified Those who are identified rarely receive services Stigma associated with AODA Health insurance reimbursement Historically, AODA treatment has been separate from primary care

Characteristics of teens presenting for AODA treatment: AOD involvement can range from mild substance abuse to physical dependence Alcohol and marijuana are most prevalent Multiple co-occurring problems is the norm Multiple systems are often involved (e.g., mental health, juvenile justice)

Connections Counseling An AODA and MH certified outpatient clinic in Madison, WI Multi-disciplinary and passionate staff Services developed with teenagers in mind (not step-down adult model) Family (parental) involvement is key for the best outcomes Peer mentors integrated into treatment services

What adolescent treatment providers can learn from the SBIRT model: Five lessons 1)Long-term relationships matter 2)Brief Intervention can be effective 3)Harm reduction is a valid approach 4)Non-specialists can be effective 5)Implementing evidence-based treatments is an important goal to strive towards

1. Long-term relationships matter Pediatrician-young person relationship can last over a period of years Adolescents are highly relational Paradigm shift in treatment: acute care versus recovery management

2. Brief Intervention with teens BI is well established with adults and shows promise with adolescents BI is developmentally relevant for adolescents BI expands service options (e.g., stand alone intervention, treatment readiness)

3. Harm reduction is a valid approach Abstinence is the long-term goal…AND… Harm reduction can get the change process started Various options:  Reduce AOD quantity, or frequency, or route of administration  Change of risky settings, times or activities

4. Non-specialists can be effective Studies show that AODA counselors without a recovery history are just as effective as those in recovery Counselor empathy is a key predictor of outcome Blurring of boundaries between specialist treatment and addressing AODA in other settings

5. Movement toward implementing evidence-based treatments (EBTs) Historically, AODA treatment providers have used methods discredited by research Although there is currently a “renaissance” in adolescent treatment research, a large research-practice gap remains In medicine there is a high standard of care based on research evidence

5. Implementing EBTs (cont.) Treatment administrators increasingly recognize the need for direct observation and feedback of practice to promote delivery of EBTs SBIRT inspires attention to implementing EBTs and to developing better evaluations to measure our programs’ outcomes

Summary The SBIRT model reflects several national trends which can greatly inform improvements in the AODA treatment system With greater linkages to primary care comes increased accountability for what AODA treatment providers do

Questions and Discussion