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Week #2 sbirt attc webinar series th
- 2. SBIRT Referral to Treatment, Warm Hand Off
- 3. Agenda • Welcome • Agenda • Review Homework Assignment-Discuss Videos and Proficiency Checklist • Presentation • Referrals to Treatment using Brief Intervention Skills • Making Effective Referrals • Warm Handoffs or “Slightly Warm Handoffs” • Utilizing Technology in SBIRT implementation • Summary • Preview of next week • Assign Homework-Group Activity on Referral options • Questions
- 4. Why are we looking at all of this??
- 5. “But perhaps we should also spend some time this month asking some tough questions. While we trust in our prevention and treatment strategies, could they be more robust? 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.”- Linda Rosenberg, President and CEO, National Council for Behavioral Health Recovery Month: A Time For Some Tough Questions September 19, 2014
- 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. Of those patients screened in primary care . . . • Approximately 5% will require a referral to specialty treatment. SAMHSA, 2013
- 9. A Strong Referral to an Appropriate Treatment Provider Is Key When Referring to Treatment … So, what strategies can you use to make a strong referral?
- 10. Three Key Strategies to Make a Strong Referral 1. Use the brief intervention to build the patient’s confidence and willingness to go to a specialty provider before making the referral 2. Be prepared to make referrals – know the specialty treatment providers in your area 3. Conduct a “warm handoff” when possible
- 11. 1. Use a brief intervention to prepare the patient for specialty care • Use motivational techniques to build the patient’s confidence and willingness to go to a specialty provider before making the referral.
- 12. Brief Intervention – See the Forrest, Not Just the Trees Forrest = • Spirit of Motivational Interviewing • Motivate the patient to consider changing behavior Trees = • Brief Intervention Steps
- 13. GuidingDirecting Following Rollnick, Miller, Butler, 2008 Which Communication Styles Do You Use with Patients, and When?
- 14. What Makes Brief Intervention Different? Oregon SBIRT Primary Care – Curriculum Module II Directive Communication Guiding Communication • Explain why • Respect for autonomy, goals, values • Tell how • Readiness to change • Emphasize importance • Ambivalence • Persuading • Empathy, non-judgment, respect • Clinician is the expert • Patient is the expert Communication Styles
- 15. MI Spirit = Essential for effective BI Partnership Evocation Compassion Acceptance
- 18. Sailing through Sustain Talk: Pause and Reflect • “I just have a couple of drinks to help me relax.” • “I’m not paying you to talk to me about drinking! Geez, I’m just here for a cold.” • “Everyone smokes a little weed.” • “Sure once in a while I drink more than I should, but it doesn’t cause any major problems in my life.” • “My dad was an alcoholic. I don’t drink like him.”
- 19. Sailing through Sustain Talk: Support Patient Choice “You are the only one who can decide what the best thing for you is relative to your use of alcohol.” “I’m not here to tell you what to do. I’m just interested in finding out what some of your thoughts are and sharing some information with you.” “It’s totally up to you whether you make a change.” “You may, or may not, decide to make a change based on our conversation today.”
- 20. Prepare the Patient for Specialty Care • Ask the patient to share his/her worries or what they imagine treatment will be like • Provide correct information
- 21. Prepare the Patient for Specialty Care • Ask the patient to “look ahead” and identify any potential obstacles or roadblocks • Discuss ways to address these issues
- 22. • 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
- 23. Referral to Treatment: What you can say during the BNI • 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?”
- 24. 2. Be prepared to make referrals • 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. SAMHSA, 2013
- 25. • SAMHSA’s National Treatment Facility Locator http://findtreatment.samhsa.gov Know your referral resources SAMHSA, 2013
- 26. Warm Hand Off
- 27. 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, 2013
- 28. When conducting a warm handoff . . . 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 Indiana University “Understanding SBIRT” curriculum, 2013
- 29. What if the person does not want a referral? • Plan a specific follow-up visit • At follow-up visit: • Inquire about use • Review goals and progress • Reinforce and motivate • Review tips for progress
- 30. Using Technology in the Delivery of SBIRT
- 31. Meeting People Where they are at Digital Natives Digital Immigrants Zur and Zur 2016 Meeting People Where They ARE…
- 32. •741741741741
- 33. THE CASSAVE APPTHE CASSAVE APP
- 35. Sneak Peek at next week …. Tips on Implementation of SBIRT and Workflow
- 36. Let’s Make Strong Referrals! Week #2- 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.
Editor's Notes
- Start Session with slide in presentation mode as everyone joins in the zoom meeting. Move on to the next slide in slide show mode.
- We are going to talk in more detail about each of the aspects of SBIRT.
- If your screening and intervention with the patient indicates a need for specialty care, your role in referring the patient to the appropriate treatment provider is critical.
- From: Making Successful Referrals for Substance Use Disorders UCSF SoM Collaborative Education Project Elinore McCance-Katz, MD, PhD http://dgim.ucsf.edu/SBIRT/
- When we discuss the brief intervention, we will learn motivational techniques you can use to prepare the patient for specialty care. The idea with the graphic is that with any behavior change, people feel both ways about it. We call this ambivalence. Part of them wants to change and part of them doesn’t. From: Making Successful Referrals for Substance Use Disorders UCSF SoM Collaborative Education Project Elinore McCance-Katz, MD, PhD http://dgim.ucsf.edu/SBIRT/
- Different communication styles are used for different purposes. No value judgment about the worthiness of each of these approaches, only the issue of incongruence between style and task. Ask students: “when do you use each of these communication styles with patients?” and solicit a few responses. Directing – Telling a patient what procedures they’re going to undergo; telling a patient how to use a medication Following – Having a patient tell you about their health problem Guiding – Discussing possible treatment options; discussing behavior change. Discuss that the communication style behind the brief intervention is key – should be guiding “How you talk to people about change will influence their receptivity to consider making changes.” Motivational Interviewing in Health Care: Helping Patients Change Behavior , Stephen Rollnick, William Miller, Christopher Butler
- Key Points Characteristics of the Directive Communication style doesn’t tap into the patient’s own motivation In this style, the clinician is the expert. Explains why the patient should make a behavior change, tells them how to do it, and emphasizes how important it is to change. Meets client’s resistance by using persuasion Patient doesn’t have an opportunity to explore their own motivation. Characteristics of the Guiding Communication style the roles are reversed –your patient is the expert because it’s really their behavior that you’re discussing Patients come in with a lot of ambivalence – they rarely have concrete ideas on want to change they want to make It’s important to while you provide information, you want to be empathetic and non-judgmental Important to assess how ready the patient is to change and what that change might look like
- Partnership – collaboration & power sharing Evocation – eliciting & drawing out Compassion - Acceptance
- I am going to share with you a couple of MI skills to use if they patient doesn’t seem very open to having the conversation. We now use the phrase “sailing through sustain talk” instead of “rolling with resistance.” The phrase “rolling resistance” implie a judgmental attitude about the client’s preferences, values and/or attitude.
- Explain and then take examples from the audience Key Points MI Assumptions Motivation is a state of readiness to change and it fluctuates Motivation for change does not reside solely within the client Change talk and sustain talk can be influenced by communication style Ambivalence is normal Most change is self-directed and accomplished with natural resources
- --The key to reflective listening is to get curious and really try to understand how the patient sees things and what they are experiencing. --Reflective Listening is a way to demonstrate empathy and to build rapport. When people feel heard and understood they are much less likely to become defensive and they are usually willing to talk about their substance use. --Provide a reflection and pause. --Possible exercise divide into several groups and have each group come up with a couple of reflective responses to respond to the client statement on this slide. --Could write these on a handout with space for participants to write a reflection
- From: Making Successful Referrals for Substance Use Disorders UCSF SoM Collaborative Education Project Elinore McCance-Katz, MD, PhD http://dgim.ucsf.edu/SBIRT/
- From: Making Successful Referrals for Substance Use Disorders UCSF SoM Collaborative Education Project Elinore McCance-Katz, MD, PhD http://dgim.ucsf.edu/SBIRT/
- From: Making Successful Referrals for Substance Use Disorders UCSF SoM Collaborative Education Project Elinore McCance-Katz, MD, PhD http://dgim.ucsf.edu/SBIRT/
- Statements adapted from CalMHSA Website’s Warm Handoff Scripts: http://ibhp.org/index.php?section=pages&cid=123
- A time-intensive process for busy clinics – needs more than a list of treatment agencies or a phone number. Time consuming case management effort. Have them talk in small groups and identify ways they might link to their local community clinics and primary care clinics.
- Encourage a follow-up visit with the patient. This way you can monitor their substance use, review progress toward any goals the patient may have agreed upon during your initial brief intervention session, reinforce their movement toward change, and provide tips for making additional changes.