prepared forMichigan Primary Care Association
Peer Assistance Services, Inc.Dedicated to quality, accessible prevention andintervention services in workplaces andcommun...
Programs• Peer Health Assistance Programs (Dental, Pharmacy, Nursing,  and other professions)• Colorado TASC (Treatment Ac...
Acknowledgements
Objectives•   Discuss evidence that supports SBIRT•   Identify core components of SBIRT•   Describe lessons learned from S...
Why SBIRT?
“The administration will continue to promote the integration of SBIRT in to mainstream health care, disseminate informatio...
Support for SBIRT•   The Joint Commission•   The American College of Surgeons Committee on Trauma•   The U.S. Preventive S...
Prevention Priorities
Billing CodesPayer        Code        Description                                        FeeCommercial   CPT 99408   Alcoh...
SBIRT Colorado
History of SBIRT in Colorado
County Population Density 2000
Brief                 Intervention                    35%Screening only     60%                                  Brief The...
161412108                             Alcohol6                             Marijuana4                             Illicit ...
Screening, Brief Intervention and Referral to Treatment
The SBIRT Process•   Introducing SBIRT•   Brief Screen•   Screening•   Brief Intervention•   Referral to Treatment and Fol...
Introduction and Consent
Purpose of Screening
Brief Screen1.   How many drinks do you have per week?2.   When was the last time you had 4/5 or more drinks in     one da...
Moderate Drinking Guidelines
What is a standard drink?
Screening InstrumentsUse for follow-up in those who test positive on the brief screen:• ASSIST: Alcohol, Smoking, and Subs...
Brief Intervention
What is Brief Intervention?• A brief motivational conversation• Single 3-5 minute to multiple 15-30 minute sessions  have ...
Motivational InterviewingWilliam Miller and Steven RollnickAmbivalence as central constructPersuasion elicits resistanceAl...
Examples of MI StrategiesOpen-ended questionsAffirmationReflective listeningSummarizing      Goal is to elicit change talk...
Don’t Assume•   Patient ought to change•   Patient wants to change•   Patient’s health motivates him/her•   Now is the rig...
Brief InterventionStep 1: Raise the SubjectStep 2: Provide FeedbackStep 3: Enhance MotivationStep 4: Negotiate and Advise
Step 1: Raise the SubjectRaise the subject of substance use  “Would you mind taking a few minutes to   talk with me about ...
Step 2: Provide FeedbackDiscuss health risks of alcohol and other  substances   “At this level of consumption, you are at ...
Step 3: Enhance MotivationPre-Contemplation                               Contemplation Maintenance                       ...
Step 4: Negotiate and AdviseElicit response: “What are some of your thoughts regarding   our discussion?Negotiate a goal: ...
Closing the InterventionShow appreciation to your clientAffirm positive behaviorsRespect client’s decisionsOffer informati...
Referral to Brief Therapy and                Treatment• If patient scores high on assessment• What is brief therapy?• Know...
Sustainability• Identify an internal champion• Flexibility in how SBI can be implemented• Best to combine with other healt...
References•   The National Center on Addiction and Substance Abuse at Columbia University. The Cost of Substance Abuse to ...
www.improvinghealthcolorado.org  www.healthteamworks.org
SBIRT Practical Prevention Tool
SBIRT Practical Prevention Tool
SBIRT Practical Prevention Tool
SBIRT Practical Prevention Tool
SBIRT Practical Prevention Tool
SBIRT Practical Prevention Tool
SBIRT Practical Prevention Tool
SBIRT Practical Prevention Tool
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SBIRT Practical Prevention Tool

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SBIRT Practical Prevention Tool

  1. 1. prepared forMichigan Primary Care Association
  2. 2. Peer Assistance Services, Inc.Dedicated to quality, accessible prevention andintervention services in workplaces andcommunities, focusing on substance abuse andrelated issues. Incorporated in 1984
  3. 3. Programs• Peer Health Assistance Programs (Dental, Pharmacy, Nursing, and other professions)• Colorado TASC (Treatment Accountability for Safer Communities)• Workplace Prevention Services (WPS)• Prescription Drug Abuse Prevention Program• SBIRT (Screening, Brief Intervention, and Referral to Treatment)
  4. 4. Acknowledgements
  5. 5. Objectives• Discuss evidence that supports SBIRT• Identify core components of SBIRT• Describe lessons learned from SBIRT Colorado• Review solutions to commonly perceived barriers
  6. 6. Why SBIRT?
  7. 7. “The administration will continue to promote the integration of SBIRT in to mainstream health care, disseminate informationabout SBIRT to a wide variety of health care settings, highlightmodel programs that are using SBIRT, and encourage training opportunities for the allied health professions.” -2012 National Drug Control Strategy
  8. 8. Support for SBIRT• The Joint Commission• The American College of Surgeons Committee on Trauma• The U.S. Preventive Services Task Force• The American Congress of Obstetricians and Gynecology• The Emergency Nurses Association• The Office of National Drug Control Policy• The Centers for Medicare and Medicaid Services• The Center for Substance Abuse Treatment• Health Resources and Services Administration• National Institute on Alcohol Abuse and Alcoholism• National Institute on Drug Abuse
  9. 9. Prevention Priorities
  10. 10. Billing CodesPayer Code Description FeeCommercial CPT 99408 Alcohol and/or substance abuse structured $33.41 screening and brief intervention services; 15 to 30 minutes CPT 99409 Alcohol and/or substance abuse structured screening and brief intervention services; $65.51 greater than 30 minutesMedicare G0396 Alcohol and/or substance abuse structured $29.42 screening and brief intervention services; 15 to 30 minutes G0397 Alcohol and/or substance abuse structured screening and brief intervention services; $57.69 greater than 30 minutesMedicaid H0049 Alcohol and/or drug screening $24.00 H0050 Alcohol and/or drug service, brief intervention, $48.00 per 15 minutes
  11. 11. SBIRT Colorado
  12. 12. History of SBIRT in Colorado
  13. 13. County Population Density 2000
  14. 14. Brief Intervention 35%Screening only 60% Brief Therapy 2% Referral to Treatment 3%
  15. 15. 161412108 Alcohol6 Marijuana4 Illicit drugs20 Intake 6 mth follow- up
  16. 16. Screening, Brief Intervention and Referral to Treatment
  17. 17. The SBIRT Process• Introducing SBIRT• Brief Screen• Screening• Brief Intervention• Referral to Treatment and Follow-Up
  18. 18. Introduction and Consent
  19. 19. Purpose of Screening
  20. 20. Brief Screen1. How many drinks do you have per week?2. When was the last time you had 4/5 or more drinks in one day?3. In the past year, have you used or experimented with an illegal drug or prescription drug for nonmedical reasons?4. Do you currently smoke or use any form of tobacco products?
  21. 21. Moderate Drinking Guidelines
  22. 22. What is a standard drink?
  23. 23. Screening InstrumentsUse for follow-up in those who test positive on the brief screen:• ASSIST: Alcohol, Smoking, and Substance Involvement Screening Test• AUDIT: Alcohol Use Disorders Identification Test• DAST-10: Drug Screening Test (not including alcohol)• CRAFFT: Adolescent drug and alcohol screening
  24. 24. Brief Intervention
  25. 25. What is Brief Intervention?• A brief motivational conversation• Single 3-5 minute to multiple 15-30 minute sessions have led to decreased use• Most effective with at-risk clients who are not addicted• Educating clients about the health risks of their substance use has led to behavior change• BIs are low cost, quick, client friendly, easy to do
  26. 26. Motivational InterviewingWilliam Miller and Steven RollnickAmbivalence as central constructPersuasion elicits resistanceAlternative to direct persuasion and it works! Source: William Miller (2002)
  27. 27. Examples of MI StrategiesOpen-ended questionsAffirmationReflective listeningSummarizing Goal is to elicit change talk!!!
  28. 28. Don’t Assume• Patient ought to change• Patient wants to change• Patient’s health motivates him/her• Now is the right time for patient to change• Tough approach is best
  29. 29. Brief InterventionStep 1: Raise the SubjectStep 2: Provide FeedbackStep 3: Enhance MotivationStep 4: Negotiate and Advise
  30. 30. Step 1: Raise the SubjectRaise the subject of substance use “Would you mind taking a few minutes to talk with me about your substance use?”
  31. 31. Step 2: Provide FeedbackDiscuss health risks of alcohol and other substances “At this level of consumption, you are at increased risk for health and other consequences such as…”Review drinking guidelines “The recommended guidelines for healthy women/men are…
  32. 32. Step 3: Enhance MotivationPre-Contemplation Contemplation Maintenance Preparation Action
  33. 33. Step 4: Negotiate and AdviseElicit response: “What are some of your thoughts regarding our discussion?Negotiate a goal: “Why are you a 5 and not a 7?” and “What are some steps you could take?”Assist in developing a plan: “What will be challenging for you to meet this goal? What is your plan for overcoming these challenges?”Summarize: “What I heard you say is…”
  34. 34. Closing the InterventionShow appreciation to your clientAffirm positive behaviorsRespect client’s decisionsOffer informationArrange for follow up
  35. 35. Referral to Brief Therapy and Treatment• If patient scores high on assessment• What is brief therapy?• Know your resources!
  36. 36. Sustainability• Identify an internal champion• Flexibility in how SBI can be implemented• Best to combine with other health screening and education to enhance integrated care• Involve the entire team• Train nursing students and residents to establish SBI as a routine practice
  37. 37. References• The National Center on Addiction and Substance Abuse at Columbia University. The Cost of Substance Abuse to America’s Health Care System. Report 2: Medicare Hospital Costs. May 1994. Available at http://www.casacolumbia.org/articlefiles/379- Cost%20of%20Substance%20Abuse%20Report%202.pdf.• Mokdad A, Marks J, Stroup D, Gerberding J. Actual causes of death in the United States, 2000. JAMA 2004;291:1238--45.• Substance Abuse and Mental Health Services Administration. (2006) Results from the 2005 National Survey on Drug Use and Health: National findings Rockville (MD): Office of Applied Studies.• Maciosek, MV, Coffield, AB, Edwards, MS, et al. Priorities Among Effective Clinical Preventive Services. Results of a Systematic Review and Analysis. Am J Prev Med 2006; 31 (1) 52-61. Available at http://www.prevent.org/data/files/initiatives/prioritiesamongeffectiveclinicalpreventivesvcsresultsofreviewandanalysis.pdf.• D’Onofrio G, Pantalon MV, Degutis LC, et al. The Yale Brief Negotiated Interview Manual. Yale University School of Medicine. 2005. Available at http://www.ihs.gov/nonmedicalprograms/nc4/documents/appendix_a_yale_bni_manual.pdf.• William Miller, Rollnick Steven. Motivational Interviewing, Second Edition: Preparing People for Change. 2002.
  38. 38. www.improvinghealthcolorado.org www.healthteamworks.org

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