1. SBIRT: Screening, Brief Intervention, and Referral to Treatment Shelley Scheffler, PhD, LCSW Sr Staff /Trainer / NeC ATTC Diana Padilla Cultural Proficiency Program Manager / NeC ATTC

2. PresentersShelley Scheffler, PhD, LCSW SR Staff, Behavioral Health Care ConsutantDiana Padilla Cultural Proficiency Program Manager2 3. Webinar Goals Goal: Provide healthcare professionals with an overview of SBIRT (screening, brief intervention, referral and treatment) and its benefits for healthcare settings. Define alcohol and substance use through a public health lens State how SBIRT can quickly assess alcohol and substance use. State that applying SBIRT can disrupt the progression to substance and alcohol abuse. 3 4. Historically Substance Abuse Services have focused on two areas: 1. Prevention Preventing or delaying the onset of substance use.2. Treatment Providing time, cost, and labor intensive services to patients who are acutely or chronically ill.4 5. Poll #1 What is moderate drinking for men and women? Men: 6 drinks per day, Women 5 per day Men: 5 drinks per day, Women 5 per day Men: 4 drinks per day, Women 3 per day Depends on persons BMI 5 6. NIAAA Moderate Limits Healthy Men < 65 4 drinks per day 14 drinks per week AND Healthy Women & Men 65 3 drinks per day 7 drinks per weekEXCEEDING THESE LIMITS IS A RED FLAG INDICATING THE NEED FOR A FULL SCREEN 6 7. 7 Types of Drinkers 4%Dependent25%Dependence Symptoms Harmful Hazardous71%Low Risk Current abstinence Lifetime abstinence 7 8. Research Risky drinking causes more total accidental harm than the heavy drinking of alcoholics (HigginsBiddle et al., Reducing Risky Drinking: Alcohol Research Center, Univ. of Conn. Health Center, 1996)If we could provide a 100% cure to every substance dependent person in the United States, we would not be close to curing most of the substance related problems in our country 8 9. Poll #2 Risky substance use behavior is a concern for which: Behavioral health care Addiction counselors Primary care providers All the above 9 10. Substance Use isA Public Health Problem 10 11. A New Initiative: SBIRT Systems change initiative requiring us to1. Re-conceptualize how we understand substance use problems 2. Re-define how we identify substance use problems and 3. Re-design how we treat substance use problems. 11 12. SBIRT Saves Money Researchers found that every dollar invested in SBIRT saved $4.30 in future health care costs. These reduced costs are associated with changes in: Alcohol use ED visits Hospital days Legal events Motor vehicle crashes Texas report revealed SBIRT saved more than: $4 million in the year after the patients received services. Emergency room usage dropped. Shift from inpatient to outpatient treatment 12 13. Risk Reduction SBIRT is a universal, selective, and indicated prevention and treatment strategy designed to intervene based on patient need and prevent/treat substance use problems at various levels13 14. SBIRT Provides Identification of substance use problems using a public health approach and universal screening Progressive levels of clinical interventions based on level of need and motivation for change14 15. Primary Goal of SBIRT To identify those who are at moderate or high risk for psycho-social or health care problems related to their substance use choices Not to identify those who are dependent and need higher levels of care 15 16. Goals of SBIRT? Improve identification of substance misuse decrease alcohol and drug use Decrease health care cost related to substance abuse problems Enhance treatment access within the recommended levels of care 16 17. Poll #3 Who do most individuals listen to? Doctors Nurses Social workers Substance use counselors17 18. Learning from Health Care The Health Care System:Routinely screens for potential medical problems (hypertension, cancer, diabetes) Provides preventive services prior to the onset of acute symptoms Delays or precludes the development of chronic conditions 18 19. SBIRT Characteristics Its brief Universal screening One or more behaviors are targeted Non-substance use treatment settings Comprehensive Evidence-based practice (SAMHSA) 19 20. 3 Components of SBIRT Screening Brief intervention Referral to treatment20 21. Screening & Brief Intervention Screening21 22. Screening The purpose of screening is to: Identify patients who are most likely to benefit from brief intervention and assess level of risk Not to diagnose alcohol dependence or identify patients requiring long term treatment 22 23. Evidence-based Screening Tools AUDIT Alcohol Use Disorder Identification Test DAST Drug Abuse Screening Test POSIT Problem Oriented Screening Instrument for Teenagers CRAFFT Adolescent Screen (Car, Relax, Alone, Forget, Family or Friends, Trouble) ASSIST Alcohol, Smoking, and Substance Abuse Involvement Screening Test GAIN or GAIN-SS (Short Screener) * Or other Screening Tools approved by OASAS 23 24. Screening & Brief Intervention Brief Intervention24 25. 5 Steps of Brief Intervention Raise the subjectExplore options for change Provide feedback & informationElicit responseNegotiate plan25 26. Screening & Brief InterventionReferral to Treatment26 27. Question Where does referral and treatment fit in the SBIRT model? 27 28. Referral To Treatment When brief interventions have failed to reduce or eliminate risky substance use it is time to discuss a different intense intervention28 29. Discussion Points Substance use in excess of safe limits Score on the screening instrument Problems related to substance use, e.g. days absent at work29 30. Free NeC ATTC Trainings Face to face: 4 hour training 12 hour (2 day) trainingEmail northeastcaribbean@attcnetwork.org or call 212-845-446330 31. Thank You!31