1. SBIRT Screening, Brief Intervention and Referral to Treatment

2. SBIRT Screening, Brief Intervention and Referral to Treatment What is SBIRT? Why implement SBIRT? Where do we go from here? Resources

3. SBIRT Screening, Brief Intervention and Referral to Treatment SBIRT is the acronym for Screening, Brief Intervention and Referral to Treatment SBIRT is designed to identify, intervene and treat people with substance abuse problems

4. SBIRT Screening, Brief Intervention and Referral to Treatment SBIRT works SBIRT saves money

5. SBIRT Screening, Brief Intervention and Referral to Treatment SBIRT reduces injuries and ED re-admissions SBIRT reduces substance misuse and abuse Brief interventions as short as 30 minutes significantly reduced problem drinking. Also, a 47 percent reduction in injuries requiring ED or trauma center re-admission at three years. Gentilello, et al., Alcohol Interventions in a Trauma Center as a Means of Reducing the Risk of Injury Recurrence, Annals of Surgery, 1999 Collaborative study by NIAAA and SAMHSA indicated that speaking to ED patients about their alcohol consumption reduces hazardous drinking in those patients. Alcohol & Drug Abuse Weekly, January 2008

6. SBIRT Screening, Brief Intervention and Referral to Treatment Meta-analysis of 21 randomized trials in primary care found that SBIRT recipients reduced alcohol intake by three drinks per week. Results consistent across all trials. Kaner, et al., Brief Intervention in Primary Care for Alcohol Misuse, International Journal of Epidemiology, 2007

7. SBIRT Screening, Brief Intervention and Referral to Treatment Each $1 spent on screening and brief intervention saves almost $4 in other health care-related costs. Gentilello, et al., Alcohol Interventions for Trauma Patients Treated in EDs and Hospitals: A Cost-Benefit Analysis, Annals of Surgery, 2005 In January 2005, Alcohol & Drug Abuse Weekly estimated that emergency rooms and trauma centers could save up to $2 billion by offering brief substance abuse interventions to injured patients.

8. SBIRT Screening, Brief Intervention and Referral to Treatment Obtaining funding Overcoming staff resistance Effective SBIRT training Navigating the insurance rapids Picking the right assessment tool

9. SBIRT Screening, Brief Intervention and Referral to Treatment There are a number of state and national programs offering funding for SBIRT studies: Project InSight – Austin, Texas – www.insightforhealth.com SAMHSA funding of SBIRT initiatives – http://sbirt.samhsa.gov/csat_awards/funding_opps.htm National Institute on Alcohol Abuse and Alcoholism – Funding Opportunities www.niaaa.nih.gov/researchinformation/extramuralresearch/#funding

10. SBIRT Screening, Brief Intervention and Referral to Treatment SBI Toolkit for Healthcare – www.ensuringsolutions.org/resources/resources_list.htm?cat_id=2005 NIAAA Helping Patients Who Drink Too Much: A Clinician’s Guide – http://pubs.niaaa.nih.gov/publications/Practitioner/CliniciansGuide20 05/clinicians_guide.htm Emergency Nurses Association SBIRT Toolkit – http://www.ena.org/ipinstitute/SBIRT/ToolKit/Pages/toolkit.aspx

11. SBIRT Screening, Brief Intervention and Referral to Treatment SAMHSA – http://sbirt.samhsa.gov/tools_resources/curriculum.htm Boston University – http://www.bu.edu/act/ InSight Provider Training – http://www.insightforhealth.com/provider.html

12. 12 SBIRT Screening, Brief Intervention and Referral to Treatment Experienced trainers in Texas – Carrie L. Dodrill, Ph.D Veterans Affairs Medical Center Houston, TX Voice: 713-791-1414 x 6490 Mary Marden Velasquez, Ph.D The University of Texas at Austin School of Social Work Austin, TX Phone: (512) 471-7019 Kirk von Sternberg, Ph.D The University of Texas at Austin School of Social Work Austin, TX (512) 232-0633

13. SBIRT Screening, Brief Intervention and Referral to Treatment As of April 2004, 38 states (including Texas) still had Uniform Accident and Sickness Policy Provision (UPPL) laws. UPPL repeal successful in several states, American College of Surgeons Cross Country, 2007 UPPL laws allow insurers to deny coverage when injury is alcohol- or drug-related. Key informants for our study in Harris County did not cite UPPL as a barrier to treating patients found to be under the influence.

14. SBIRT Screening, Brief Intervention and Referral to Treatment A 2008 survey shows that 58 percent of U.S. health plans pay for screening and brief intervention, and that the federal government covers 5.8 million of its workers. Feds cover screening, brief intervention, Nation’s Health, 2008 With its efficacy proven, current procedural terminology (CPT) codes for SBIRT have been created: -CPT 99408 for 15-30 minutes SBI -CPT 99409 for > 30 minutes SBI American Medical Association, CPT 2008, Professional Edition, 2008

15. SBIRT Screening, Brief Intervention and Referral to Treatment Centers for Medicare and Medicaid Services (CMS) also have codes: -Medicare G0396 SBI >15 minutes G0397 SBI > 30 minutes -Medicaid H0049 Screening H0050 Brief Intervention American Medical Association, HCPCS 2008: Medicare’s National Level II Codes, 2008

16. SBIRT Screening, Brief Intervention and Referral to Treatment A SAMHSA guide reviews five major screening tools: AUDIT, CAGE, CRAFFT, BAC, and the binge drinking question. Alcohol Screening and Brief Intervention for Trauma Patients: Committee on Trauma Quick Guide, Alcoholism & Drug Abuse Weekly, May 2007 CAGE and AUDIT have emerged as most commonly used screening tools in emergency departments. Vaca & Winn, The Basics of Alcohol Screening, Brief Intervention and Referral to Treatment in the Emergency Department, Western Journal of Emergency Medicine, 2007

17. SBIRT Screening, Brief Intervention and Referral to Treatment Funding: -National Institute on Drug Abuse www.nida.nih.gov/researchers.html -Texas Department of State Health Services http://www.dshs.state.tx.us/fic/default.shtm -Project Mainstream www.projectmainstream.net/projectmainstream.asp?cid= 82

18. SBIRT Screening, Brief Intervention and Referral to Treatment Training: -Community Health Association of Mountain and Plain States http://www.champsonline.org/events/Distance_Libra ry.asp#Vol15-18 -Society for Academic Emergency Medicine http://www.saem.org/saemdnn/Home/Communities/ InterestGroups/PublicHealth/tabid/136/Default.aspx

19. 19 SBIRT Screening, Brief Intervention and Referral to Treatment Research Into Action has prepared an all-inclusive resource guide. You can start setting up your SBIRT program TODAY.

20. SBIRT Screening, Brief Intervention and Referral to Treatment This program was produced and distributed by Research Into Action – A Knowledge Translation Initiative The University of Texas School of Public Health Institute for Health Policy For more information about Research Into Action and the subject of knowledge translation, visit our Web site, www.ktexchange.org, or contact us at Researchintoaction@uth.tmc.eduwww.ktexchange.org