Transcript SBIRT Mahoning Count..

Angela McClellan, OCPS I
Director
Coalition for a Drug-Free Mahoning County
September 5, 2013
http://pointsadhsblog.wordpress.com/2013/05/20/9832/
 Source: http://www.jmir.org/2010/5/e60/, http://captus.samhsa.gov/prevention-practice/prevention-and-behavioral-health/behavioral-
health-lens-prevention/3
 Problem Identification and Referral is an AOD prevention strategy
that refers to intervention oriented prevention services that
primarily targets indicated populations to address the earliest
indications of an AOD problem. Services by this strategy focus on
preventing the progression of the problem.
 This strategy does not include clinical assessment and/or treatment
for substance abuse and dependence.
Source: Ohio Department of Mental Health and Addiction Services Prevention Continuum of Care Taxonomy
 Interventions that directly serve the customer and allow for two-way
interaction at that instance.
 Intervention, Brief Screening and Referral Services
 Drug-Free Workplace Programs/EAP
 Programs
 Student Assistance Program Services
 Support Groups
 Consumer Advocacy and Linkage
 Risk Reduction Activities
Source: Ohio Department of Mental Health and Addiction Services Prevention Continuum of Care Taxonomy
The Current Model:
A Continuum of Substance Use
Abstinence
Responsible Use
Dependence
Source: Jim Aiello, MA, Med, Institute for Research, Education and Training in Addictions (IRETA), (www.ireta.org) 6
The outdated model defines a
substance use problem as…
Dependence
Source: Jim Aiello, MA, Med, Institute for Research, Education and Training in Addictions (IRETA), (www.ireta.org)
7
The SBIRT model defines a
substance use problem as…
Excessive
Use
Source: Jim Aiello, MA, Med, Institute for Research, Education and Training in Addictions (IRETA), (www.ireta.org)
8
The SBIRT Model
A Continuum of Substance Use
Social
Use
Abstinence
Experimental
Use
Abuse
Binge
Use
Dependence
Source: Jim Aiello, MA, Med, Institute for Research, Education and Training in Addictions (IRETA), (www.ireta.org) 9
Dependent
4%
Brief Intervention
and Referral for
additional
Services
25%
Low Risk or
Abstinence
Drinking Behavior
71%
No Intervention;
screening and
feedback only
Intervention Need
Source: Jim Aiello, MA, Med, Institute for Research, Education and Training in Addictions (IRETA), (www.ireta.org)
10
SBIRT is a comprehensive, integrated, public health approach to the
delivery of early intervention and treatment services for persons with
substance use disorders, as well as those who are at risk of developing
these disorders.
Primary care centers, hospital emergency rooms, trauma centers, and
other community settings provide opportunities for early intervention
with at-risk substance users before more severe consequences occur.
Source: http://www.samhsa.gov/prevention/sbirt/
 SBIRT is a tool to detect risky or
hazardous substance use before the
onset of abuse or dependence, early
intervention, and treatment for people
who have problematic or hazardous
[alcohol] problems.
http://www.samhsa.gov/prevention/sbirt/SBIRTwhitepaper.pdf
 Screening quickly assesses the severity of substance use and identifies
the appropriate level of treatment.
 Brief intervention focuses on increasing insight and awareness
regarding substance use and motivation toward behavioral change.
 Referral to treatment provides those identified as needing more
extensive treatment with access to specialty care.
Source: http://www.samhsa.gov/prevention/sbirt/
1.
2.
3.
4.
5.
6.
It is brief (e.g., typically about 5-10 minutes for brief
interventions; about 5 to 12 sessions for brief treatments).
The screening is universal.
One or more specific behaviors are targeted.
The services occur in a public health or other non-substance abuse
treatment setting.
It is comprehensive (comprised of screening, brief
intervention/treatment, and referral to treatment).
Strong research or experiential evidence supports the model’s
effectiveness.
http://www.samhsa.gov/prevention/sbirt/SBIRTwhitepaper.pdf
EFFECTIVENESS OF SBIRT AND ITS COMPONENTS FOR BEHAVIORAL HEALTH CONDITIONS
Screening
Brief
Intervention ¹
Brief
Treatment ²
Referral to
Treatment
Evidence for
Effectiveness of
SBIRT
Alcohol Misuse/Abuse
√
√
√
√
Illicit Drug
Misuse/Abuse
√
*
*
√
√
√
√
√
√
-
√
√
Comprehensive
SBIRT effective
(Category B
classification,
USPSTF)
Growing but
inconsistent
evidence
Effective brief
approach consistent
with SBIRT (USPSTF;
2008 U.S. Public
Health Service (PHS)
Clinical Practice
Guideline
No evidence to date
for depression
√
No evidence to date
for trauma/anxiety
disorders
Tobacco Use
Depression
Trauma/Anxiety
Disorders
Key:
√
*
-
√
*
-
Evidence for effectiveness/utility of component
Component Demonstrative to show Promising Results
Not Demonstrated and/or Not Utilized
¹Brief intervention as defined by the SAMHSA SBIRT program involved 1-5 sessions lasting 5 minutes to an hour.
Among SBIRT grantees funded by SAMHSA, about 15% of patients receive scores that indicate a brief intervention.
²Brief treatment as part of SBIRT involves 5-12 sessions, lasting up to an hour. Amount State SBIRT grantees
funded by SAMHSA, about 3% of patients receive a score that dictates a brief treatment.
AUDIT
Alcohol Use Disorders identification Test
AUDIT-C
Alcohol Use Disorders Identification Test - Consumption
DAST
Drug Abuse Screening Test
ASSIST
Alcohol, Smoking, Substance, Involvement, Screening Test
CAGE
Cut Down, Annoyed, Guilty, Eye Opener
* Also Single Question Method has been found to be effective.
 The SBIRT approach is easy to learn relative to other
behavioral treatment techniques
 It can be implemented by diverse health professionals, e.g.
Physicians, Nurses, Social Workers, Health Educators,
Prevention Specialists, Paraprofessionals, etc.
 The goal is to provide a quick hand off to specialty treatment if the
Primary Care site cannot provide more intensive service.
 Close tracking to confirm patient compliance with treatment is
critical to good health care provision.
Screening
Low Risk
Moderate
Risk
Moderate to
High Risk
Severe Risk
to
Dependency
No Further
Intervention
Brief
Intervention
Brief
Intervention
Referral to
Specialty
Treatment
Doug Wentz, M.A., O.C.P.S. II
Community Services Director
 Federally Qualified Healthcare Center
 Began SBIRT with patients at one site in Youngstown, OH. (Five
other sites in region serve as control group).
 Social Worker/Prevention Specialist (former CDCA) to screen
 Preliminary results:
 99% of clients voluntarily participate in the screening
 70% of 1-Question screens are positive for AOD or depression
 Diagnostic rates more than doubled (vs. increase of 1.6% at
control location)
Families
Senior Citizens
Law Enforcement
 We have the Know How!
 Coalitions have connections in
all twelve sectors
 “New” definition of problem
Service Organizations
Medical Services
Social Services
Government
Youth
has been our definition all along
Faith Community
Media
Education
Businesses
 Information Dissemination
 Training
 Networking
 Bringing new faces to the table
 Grants and other Funding
 Training Revenue
 How do we pay for this?
 No, seriously, how do we pay for this?
 So what, this isn’t our target substance?
 Have you ever tried to get doctors to attend anything?
<<sarcasm font>>
 How can we/our collaborative partners get paid for
this?
 How do we get trained to be trainers?
 Where can I find resources?
 www.ireta.org
 www.attcnetwork.org/sbirt
 www.sbirtonline.org
 www.niaa.nih.gov
 www.HealthTeamWorks.org
 www.drugabuse.gov
 www.samhsa.gov/prevention/sb
irt
 Angela McClellan, OCPS I
Director
Coalition for a Drug-Free Mahoning County
[email protected]
(ofc) 330.953.3212
(cell) 330.771.7732
 Doug Wentz, MA, OCPS II
Community Services Director
Neil Kennedy Recovery Clinic
[email protected]
(ofc) 330.792.4724 x 7128
(cell) 330.509.3650