1. SCREENING BRIEF INTERVENTION AND REFERRAL TO TREATMENT (SBIRT) 1

2. WHAT IS SBIRT? Screening, Brief Intervention, and Referral to Treatment An evidenced based, integrated and comprehensive approach to the Identification Intervention and Treatment of Substance (Drug and Alcohol) Usage Service Code 99408 SBIRT 2

3. SBIRT has been defined by SAMHSA as a comprehensive, integrated, public health approach to the delivery of early intervention for individuals with risky alcohol and drug use, and the timely referral to more intensive substance abuse treatment for those who have substance abuse disorders. http://www.samhsa.gov/prevention/SBIRT/SBIRTwhitepaper.pdf 3

4. WHY IS SBIRT IMPORTANT? SBIRT has been shown to be effective in: Promoting progression to independence Improving medical conditions Preventing medical conditions related to substance use, abuse and dependence Decreasing trauma related mortality: –Alcohol alone is a factor in: Up to 70% of homicides 40-50% of fatal motor vehicle accidents 60% of fatal burns 40% of fatal falls 4

5. Who is eligible to deliver SBIRT services? This service is rendered by a member of the provider’s staff who is performing this service as a regular duty within the scope of that staff member’s knowledge, experience, and education. 5

6. SBIRT is unique in its universal screening of all patients regardless of an identified disorder, allowing health care professionals to address the spectrum of such behavioral health problems even when the patient is not actively seeking an intervention or treatment for his or her problems. http://www.samhsa.gov/prevention/SBIRT/SBIRTwhitepaper.pdf 6

7. Integrated Screening Tool is BRIEF Questions require Yes/No answers Questions address: – Parents – Peers – Partner – Emotional Health – Past/Present 7

8. SBIRT Screening – A brief process of identifying substance use & behavioral health issues Brief Intervention –A 5-10 minute session to raise awareness of risks and increase motivation to engage support in choices that promote health –Substance use related risky behavior has been identified and brief treatment is needed – Cognitive behavioral work for the patient to acknowledge risks and change behavior (5 to 12 sessions) Referral for – A substance abuse disorder or mental health disorder is Treatment suspected and client is referred for assessment and possibly more intense treatment 8

9. SCREENING OVERVIEW Utilize the Institute for Health and Recovery (IHR) Integrated Screening Tool for initial screening: – Incorporates behavioral health and substance use Approach is simple, concise, and systematic Identifies the appropriate level of intervention Maintained as part of the medical record ‘Brief Intervention’ performed following screening if needed Referral made for additional screening and more intensive treatment if determined necessary 9

10. WHAT IS A BRIEF INTERVENTION? Short dialogue between provider and patient that provides: – Feedback –Education –Guidance Successful at encouraging and motivating a change in behavior: – Greatest success is achieved using Motivational Interviewing techniques Meant to be 5 – 10 minutes Easy to conduct in any clinical setting 10

11. BRIEF INTERVENTION ESSENTIALS Providing Feedback: – Compare and discuss patient specific data gathered during the screening – Opportunity to educate the patient and establish a link to current medical problems and risk level/substance abuse Engage Patient Through Feedback: – Examples: “I see you do not use any substances/alcohol. Those are good health choices for you.” OR “Can we review the screening tool you completed? You checked ‘yes’ for your significant other using drugs and alcohol. Can we discuss that further?” Discuss ongoing treatment: – Patient and screener discuss client’s need for ongoing treatment AND – Client completes Alaska Screening Tool and if results indicate – Client is referred for an Integrated Assessment and development of a formal treatment plan 11

12. BRIEF INTERVENTION PROCESS Designed for use by providers who may or may not specialize in addiction treatment and depression Uses motivational approaches based on how ready the person is to change their behavior Gives feedback and suggestions respectfully, without judgment or accusations Providing feedback is effective in motivating a change in behavior A majority of screens require no intervention as they are negative 12

13. REFERRAL TO TREATMENT PROCESS “Positive” Response To Emotional Health Questions And/or To Substance Abuse Issues Referral to Treatment – if the screening reveals that the recipient meets any of the circumstances identified below, the community behavioral health services provider will refer the recipient to a behavioral health treatment program that will meet their needs - is at severe risk of substance use problems - is already substance dependent - has already received brief intervention or treatment for --substance abuse and was non-responsive - has an emotional disorder that meets criteria for DSM diagnosis Client is advised that full assessment is required before formal treatment can begin for substance abuse issues and/ or emotional issues 13

14. During the screening process be sure to address the following: 1.Advise your client of the medical concerns for their health. 2.Advise client to abstain or reduce use. 3.Observe patient's reaction to questions. 4.If indicated refer for further assessment. 14

15. SBIRT Screening Brief Intervention and Referral for Treatment Tool Provider Name: ______________________________________________________ Recipient: ___________________________________________________________ Date Screened:_______________________________________________________ Name of Staff performing screening: _____________________________________ Referred to: _____________________ Patient Refused Referral Referral Not Warranted (A response of No indicates that the screening results are negative.) Parents (If response is yes, review risk with client.) Did any of your parents have a problem with alcohol or other drug use? Peers (If response is yes, review risk with client.) Do any of your friends have a problem with alcohol or other drug use? Partner (If response is yes, review risk with client.) Does your partner have a problem with alcohol or other drug use? Emotional Health (If response is yes, refer for mental health evaluation.) Over the last few weeks, has worry, anxiety, depression, or sadness made it difficult for you to do your work, get along with people, or take care of things at home? Past In the past, have you had difficulties in your life due to alcohol or other drugs, including prescription medications? Present In the past month, have you drunk any alcohol or used other drugs? 1. How many days per month do you drink? 2. How many drinks on any given day? 3. How often did you have 4 or more drinks per day in the last month? Screener Checklist Did you advise your client of the medical concerns for their health? Did you advise client to abstain or reduce use? Did you observe patient's reaction to questions? Did you refer for further assessment? 15