1. Screening, Brief Intervention & Referral (SBIR)
4/29/2018
CSAM-SCAM Fundamentals
Screening, Brief Intervention & Referral (SBIR)
Dr. David Luckow, CFPC, DABAM, MRO
Adapted from presentation by Peter R. Butt, MD CCFP (EM), FCFP

2. Disclosures
No financial or pharma conflict of interest.

3. 30-second summary S – Screening BI – Brief Intervention R - Referral

4. Objectives WWW.SBIR-DIBA.CA
Review the origin of Canada’s SBIR initiative.
Explore the process of SBIR for various risk categories.
Explore the CFPC website:

5. Development and Background
Alcohol SBIR
CCSA and CFPC
Development and Background

6. Canada’s National Alcohol Strategy
Led by the Canadian Centre on Substance Abuse.
Developed a comprehensive, collaborative, stakeholder endorsed set of 41 recommendations:
Reducing Alcohol Related Harm in Canada: Toward a Culture of Moderation (CCSA 2007)

7. Alcohol SBIR: NAS Recommendations
#7 Develop integrated, culturally sensitive screening, brief intervention and referral (SBIR) tools and strategies
#9 Improve access to addiction services in isolated, rural and remote regions of Canada, and for vulnerable populations.

8. Development and Implementation
Online prototype was developed and tested by the CFPC
CFPC now maintains the site, with open access

9. Challenges to Primary Care SBIR Uptake
Need for national Low Risk Drinking Guidelines
Credible information and endorsement
Time: seamless inclusion in busy practices

10. Challenges to Primary Care SBIR Uptake
Comfort with the process and inclusion of Motivational Interviewing
Ability to address alcohol use disorder
Appropriate technology and resources for both the practice and patient.

11. The Site
The Site
College of Family Physicians of Canada, open source

12. low-risk drinking guidelines
Alcohol SBIR
The site,
low-risk drinking guidelines
and
Standard Drinks

16. Alcohol SBIR
Menu Orientation

17. Break to web browser

19. Screening and Assessment
Alcohol SBIR
Screening and Assessment

20. Screening Alternatives
Evidence based LRDG’s
Waiting room screening alternatives:
1) Primary level AUDIT-C, CRAFFT, or PHQ 4
2) Secondary level GAINS-SS
Potential for App and EMR migration of broader lifestyle and mental health screening, with focused intervention.

22. Brief Intervention and Referral
Alcohol SBIR
Brief Intervention
and Referral

23. Stages of Change Relapse Pre-contemplation Success Maintenance
Planning
Action
Maintenance
Relapse
Success
(Prochaska & Di Clemente, Transtheoretical Model of Change)

24. A Motivational Approach
Start wherever the person is at: acknowledge their reality
Roll with resistance
Avoid arguments or a power struggle
Be persuasive, not confrontational or abusive

26. Brief Intervention, Follow up and Support for Elevated Risk
Alcohol SBIR
Brief Intervention,
Follow up and Support
for Elevated Risk

29. Brief Intervention, Follow up and Support for Alcohol Abuse
Alcohol SBIR
Brief Intervention,
Follow up and Support
for Alcohol Abuse

32. Alcohol SBIR
Brief Intervention, Referral, Follow up and Support for Alcohol Dependency

35. Objectives Accomplished
Review the origin of Canada’s SBIR initiative
Explore the content and format
Explore the CFPC website:

36. References & Recommended Reading
American Society of Addiction Medicine,
Canadian Society of Addiction Medicine,
Canadian Centre on Substance Abuse,
National Institute of Drug Abuse,
National Native Addiction Partnership Foundation,
Wellbriety Movement,
Mate, Gabor. In The Realm of Hungry Ghosts. A.A.Knopf Canada. 2008