1. week-1 powerpoint-sbirt_feb-2019

1. Christina Boyd, LSCSW, LCAC
Preparing your Health Center for
SBIRT Implementation

2. Overview of SBIRT
Week #1

3. • Overview of Workwise Series
• Introductions
Welcome
• Need for these Services
• Overview of SBIRT
• Screening Tools (S of SBIRT)
Presentation
• Preview of next week
• Assign Learning Activity
• Questions
Summary
Agenda

4. Workwise is an online learning series that provides
interactive training and consultation to professionals
delivering behavioral health services on topics essential to
increasing knowledge, building skills, and changing practice
through the adoption of evidence-based and promising
practices.
Workwise uses:
➢Virtual interactive training through real-time skill-based
learning and practice
➢Group and self- study activities
➢Reading assignments
➢Discussions
Workwise

5. Week Agenda/Topic Assignment DATE
Orientation to Technology Session Feb 21
One Welcome/Overview of SBIRT and Intro to Screening Tools
Audit C, CRAFFT 2.0, DAST
View Video and Score an AUDIT and a
DAST Screen
Feb 28
Two Closer Look at Brief Interventions
The steps to a Brief Intervention and the spirit of MI
View Videos with Proficiency Checklist March 7
Three Referral to Treatment/Warm Handoff: Making effective referrals,
Resources in your community, utilizing technology
Group activity on referral options March 14
Four Implementation of SBIRT into Workflow:
Tips, Hurdles, Strategies on BH Integration
View Video, Diagram workflow in your
agency
March 21
Five Integration of BH
Strategies in your agency, region, and state
Real-time observation with checklist March 28
Six Cultural Considerations/Co-Occurring Disorders
Additional screening options for co-occurring disorders, prevalence
of other disorders such as depression and anxiety, cultural
sensitivity in the implementation process
April 4
SBIRT IP Series

6. Introductions!

7. How will these
services benefit the
patients that I am
here to help?
Something to
Ponder…

8. • Standardized tools to quickly assess risk level
• Pre-screen - universal
• Full Screen - targeted
Screening
• Help patients understand their substance use
and health impact; motivate behavior
change.
Brief
Intervention
• Help patients showing signs of a substance
use disorder to access specialty care.
Referral to
Treatment
SBIRT

9. What are we
really talking
about?

10. Why are we
looking at all
of this??

11. “… The reality is that most people — less than 11 percent — who need
treatment for an illicit drug or alcohol problem receive it.
Not only are more than 23 million Americans addicted to alcohol and drugs, but
because so many of these people go undiagnosed and untreated, the estimated annual
combined health care cost and lost productivity is some $365 billion.”
Addendum:
Blog: September 1, 2015
“According to the National Institute on Drug Abuse, the disease costs $700 billion
annually in treatment costs, crime and lost productivity.”
- Linda Rosenberg, President and CEO, National Council for Behavioral
Health
Recovery Month: A Time For Some Tough
Questions-September 19, 2014

12. • It is no longer a question
of “IF” we go to more
outcome based payment
systems, but “WHEN”
IS THIS AN IF WE GO TO
THE ER SITUATION…OR A
WHEN?

13. CDC. Wide-ranging online data for
epidemiologic research (WONDER). Atlanta,
GA: CDC, National Center for Health Statistics;
2016. Available at http://wonder.cdc.gov.
“78 Americans
die every day
from an opioid
overdose.”

14. FASD Facts

15. Meyer-Leu et al., 2011; WHO, 2014; SAMHSA, NSDUH, 2013
World Health
Organization
Recommendations:
#1: Ask all pregnant
women about substance
use at every visit
#2: Offer brief intervention
to pregnant women using
alcohol or drugs
• 18% of US women report alcohol use during 1st trimester;
4% during 2nd and 3rd trimesters
• Drug use among pregnant women:
• 1st trimester: 9.0%
• 2nd trimester: 4.8%
• 3rd trimester: 2.4%

16. Physically it affects us…

17. Alcohol

18. • Marijuana use also causes
reproductive health issues. There is a
lot of misinformation about marijuana
use during pregnancy and
breastfeeding.
Marijuana

19. OPIOIDS

20. Human
Toll

21. What is ONE
drink?

22. http://rethinkingdrinking.niaaa.nih.gov/
• A drink is:
• One 12-ounce can/bottle of beer
• One 5-ounce glass of wine
• One shot of hard liquor (1 ½ oz)
What is ONE drink?

23. http://rethinkingdrinking.niaaa.nih.gov/
*Women who
are pregnant or
may become
pregnant should
not drink
alcohol.
Low-Risk Drinking Guidelines
National Institutes of Health

24. • Any use of a recreational drug
Recreational drugs include
methamphetamines (speed, crystal),
cannabis (marijuana, pot), inhalants (paint
thinner, aerosol, glue), tranquilizers (Valium),
barbiturates, cocaine, ecstasy, hallucinogens
(LSD, mushrooms), or narcotics (heroin)
• Using a prescription medication
for nonmedical reasons
Risky Drug Use

25. • Standardized tools to quickly assess risk level
• Pre-screen - universal
• Full Screen - targeted
Screening
• Help patients understand their substance use
and health impact; motivate behavior change.
Brief
Intervention
• Help patients showing signs of a substance
use disorder to access specialty care.
Referral to
Treatment
SBIRT:
Screening

26. National Institute on Alcohol Abuse and Alcoholism
National Institute on Drug Use
Drugs - NIDA
Alcohol - NIAAA
Pre-Screening:
Universal/Everyone gets screened

27. AUDIT-C

28. AUDIT: Alcohol Use Disorder Identification Test
DAST: Drug Abuse Screening Test
ASSIST: Alcohol, Smoking, and Substance Abuse
Involvement Screening Test
GAIN or GAIN-SS: Global Appraisal of Individual
Needs
5Ps Plus: For pregnant and post-partum women
CRAFFT: Car, Relax, Alone, Forget, Family or Friends,
Trouble (adolescents)
Full Screening
Tools-
Targeted for
those
positive on
Brief Screen

29. AUDIT:
Alcohol

31. NWATTC SBIRT Slides, 2014
Low Risk or Abstain
I
RiskyII
HarmfulIII
Severe
IV
Risk Levels
Score Risk Level
14+
Zone 4: Severe Use,
Probable Substance
Use Disorder
10-13 Zone 3: Harmful Use
4-9 Zone 2: Risky Use
0-3 Zone 1: Low Risk Use
What do the AUDIT Scores Mean?

32. NWATTC SBIRT Slides, 2014
Low Risk or Abstain
I
RiskyII
HarmfulIII
Severe
IV
Risk Levels
• Positive health message –
describe low-risk levels
• Low risk is not necessarily
NO risk
Recommended Intervention
• Patient NOT at risk for health or
social complications based on
alcohol use
Zone 1 defined: 0-3
What do the AUDIT Zones Mean?

33. NWATTC SBIRT Slides, 2014
Severe
Harmful
Risky
IV
III
II
I
Low Risk or Abstain
Risk Levels
• Brief Intervention (BI) with goal
of reducing alcohol use
Recommended Intervention
• Alcohol use likely leads to new
health problems or makes existing
ones worse
• An individual can fall into this zone
based on amount of alcohol use
alone (no negative consequences)
Zone 2 defined: 4-9
What do the AUDIT Zones Mean?

34. NWATTC SBIRT Slides, 2014
Severe
Harmful
Risky
IV
III
II
I
Low Risk or Abstain
Risk Levels
• Brief Intervention to reduce or
abstain (Brief Treatment if
available) and specific follow-up
appointment
Recommended Intervention
• Patient has experienced repeated
negative consequences
• Patient continues to use despite
persistent problems
Zone 3 defined: 10-13
What do the AUDIT Zones Mean?

35. NWATTC SBIRT Slides, 2014
Severe
Harmful
Risky
IV
III
II
I
Low Risk or Abstain
Risk Levels
• Brief Intervention to accept
referral to specialist treatment
for diagnostic evaluation
Recommended Intervention
• Multiple signs of substance use
disorder, such as:
– Negative consequences; tolerance;
withdrawal; uncontrolled use
• Is not a diagnosis in and of itself
Zone 4 defined: 14+
What do the AUDIT Zones Mean?

36. DAST: Drugs

37. Score Degree of Problems r/t Drug
Abuse
Suggested Action
0 No Problem Reported None at this time
1-2 Low Level Monitor, Reassess at a Later Date
3-5 Moderate Level Further Investigation
6-8 Substantial Level Intensive Assessment
DAST-10 Scoring

38. CRAFFT:
Adolescents
12-18

39. 5 P’s Plus

40. Parents Did any of your parents have a problem with alcohol or other drug use? YES NO
Peers Do any of your friends have a problem with alcohol or other drug use? YES NO
Partner Does your partner have a problem with alcohol or other drug use? YES NO
Are you feeling at all unsafe in any way in your relationship with your current partner? YES NO
Emotional Health -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? YES NO
Past- In the past, have you had difficulties in your life due to alcohol or other drugs, including prescription
medications? YES NO
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 drinkd per day in the last month?
Smoking- Have you smoked any cigarettes in the past three months? YES NO
Questions on
the 5 P’s

41. A Closer Look at
Motivating People
to CHANGE
And
Brief Interventions
Sneak Peek at
next week ….

42. Watch Video and Consider
Questions
-
Score an AUDIT and a DAST Screen
Learning Activity-Week #1