This document provides information about making referrals to treatment for substance use disorders as part of implementing SBIRT (Screening, Brief Intervention, and Referral to Treatment). It discusses three key strategies for making strong referrals: 1) Using a brief intervention to prepare the patient, 2) Being prepared with referral resources, and 3) Conducting a "warm handoff" by directly introducing the patient to a treatment provider. The learning activity asks providers to identify local treatment options and resources to facilitate referrals.

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

2. Referral to Treatment
and
Warm Handoffs
Week #3

3. Agenda
• Check in
• Review Learning Activity-Referral ResourcesWelcome
• Brief Review of a Brief Intervention
• Making a good Referral
• Warm Handoff
Presentation
• Preview of next week
• Review Next Week’s Learning Activity-Review and Reflect on
your own workflow
• Questions
Summary

4. Let’s Talk about your Learning Activity!
Videos and Checklist

6. https://www.youtube.com/wat
ch?v=b-ilxvHZJDc&t=30s
A Brief Negotiated Interview-
Breakdown of Steps
SBIRT Oregon

7. creening
• Pre-screen/
Annual Screen -
universal
• Full Screen -
targeted
eferral to
reatment
• Help patients
showing signs
of a substance
use disorder to
access specialty
care.
SBIRT

8. Approximately
5% will require
a referral to
specialty
treatment.
Of those patients screened
in primary care . . .

9. So, what strategies can you use to make
a strong referral?
A Strong Referral to an
Appropriate Treatment
Provider Is Key
When Referring to Treatment …

10. Making Successful Referrals for Substance Use Disorders UCSF SoM Collaborative Education
Project Elinore McCance-Katz, MD, PhD http://dgim.ucsf.edu/SBIRT/
Use the brief
intervention to build the
patient’s confidence and
willingness to go to a
specialty provider before
making the referral
1
Be prepared to make
referrals – know the
specialty treatment
providers in your area
2
Conduct a “warm
handoff” when possible
3
Three Key Strategies to Make a Strong Referral

11. Making Successful Referrals for Substance
Use Disorders UCSF SoM Collaborative
Education Project Elinore McCance-Katz,
MD, PhD http://dgim.ucsf.edu/SBIRT/
•Ask the patient
to share
his/her worries
or what they
imagine
treatment will
be like
•Provide correct
information
Prepare the Patient for
Specialty Care

12. Making Successful Referrals for Substance Use
Disorders UCSF SoM Collaborative Education
Project Elinore McCance-Katz, MD, PhD
http://dgim.ucsf.edu/SBIRT/
• Use motivational
techniques to build
the patient’s
confidence and
willingness to go to a
specialty provider
before making the
referral.
1. Use a brief intervention to prepare
the patient for specialty care

13. Making Successful Referrals for Substance Use Disorders UCSF
SoM Collaborative Education Project Elinore McCance-Katz,
MD, PhD http://dgim.ucsf.edu/SBIRT/
• Ask the patient to “look
ahead” and identify any
potential obstacles or
roadblocks
• Discuss ways to address
these issues
1. Prepare the Patient
for Specialty Care

14. Making Successful Referrals for Substance Use Disorders UCSF
SoM Collaborative Education Project Elinore McCance-Katz,
MD, PhD http://dgim.ucsf.edu/SBIRT/
• Remind the patient that he/she has choice. If
one program doesn’t fit, try another.
• There are many options just as there are many
paths to recovery.
• If appropriate, and with releases
in place, enlist the support of
family members or friends the
patient identifies as important in
his/her life.
Prepare the Patient for Specialty Care

15. Statements adapted from CalMHSA Website’s Warm Handoff
Scripts: http://ibhp.org/index.php?section=pages&cid=123
• Have you ever tried to quit before?
• What worked for you in the past when you tried to quit or
cut down?
• Based on your scores, I’m concerned about your level of
substance use, and would recommend that we find a
specialist to help you.
• Based on your scores, I’m concerned about your level of
substance use. I work with someone who specializes in
helping with these issues. I would like you to speak with
them today to better help me help you. Is it alright with
you if I introduce you to her/him?
• I have a member of our team who helps me assess these
types of problems so that I can provide you with the best
care. Together we can develop a plan to deal with this.
May I introduce you?”
Referral to Treatment:
What you can say during the BNI

16. • Who do you call (#’s and names?)
• What form do you fill out?
• Who on your team can help you set up an
appointment?
• Maintain an up-to-date roster of public and
private treatment and peer support resources in
your community.
2. Be prepared to make
referrals

17. • SAMHSA’s National Treatment Facility Locator
http://findtreatment.samhsa.gov
Know your referral resources

18. Warm Hand Off

19. 3. Conduct a
“warm
handoff”
Clinician directly introduces the patient
to the SUD treatment provider at the
time of the patient’s visit.
Establish an initial direct contact between
the patient and the treatment provider
Convey your trust and rapport with
treatment provider.
Evidence strongly indicates that warm handoffs are dramatically more
successful than passive referrals.
(SAMHSA SBIRT, 2013)

20. Indiana University “Understanding SBIRT” curriculum, 2013
Remove referral barriers
• Discuss a range of treatment options
• Identify programs and providers by name and have contact info available
• Assist the patient in making the first appointment; help them make the
call
• Call or help the patient call the insurance company or local authority who
oversees access
When conducting a warm handoff . .

21. •Plan a specific follow-up visit
•At follow-up visit:
•Inquire about use
•Review goals and progress
•Reinforce and motivate
•Review tips for progress
What if the person does not
want a referral?

22. You never know when you
might plant a seed

23. Using
Technology in
the Delivery
of SBIRT

24. Digital Natives
VS.
Digital
Immigrants
(Zur and Zur 2016)

25. 741741

26. THE CASSAVE APP

28. Implementation
of SBIRT
into Workflow
Sneak Peek at next
week ….

29. Let’s Make Strong Referrals!
Week #3- Learning Activity
Start to look for Substance Use Disorder or Behavioral Health treatment options in your
community, region, or on-line. Answer the following questions.
1. Do you know what the treatment options are for different levels of substance use disorder treatment are in your state,
region, or community? Who can you ask? Where can you find them? What does someone have to do to be assessed
for a level of treatment needed?
2. Is there a good list or treatment finder in your area?
3. If you have a list, does someone keep the list up to date for easy use by your providers?
4. Do you have easy to read instructions for those receiving the referrals on how to contact community resources
(phone numbers, names, address, intake process)
5. If these lists or resources are not available, what would be the steps to create them? Who would need to lead this or
be involved?
6. If these lists or handouts are not available, start to develop them in a way that would be helpful to your providers.

30. What is One thing that you did this week
to improve or develop SBIRT in your
medical setting?

31. QUESTIONS?