Transcript Project S-START Overview - Family & Community Medicine

University of Texas Health Science Center
at San Antonio
®
Project S-START
Project Aim:
To improve knowledge, attitudes and SBIRT
practices of South Texas resident physicians in six
medical specialties, with sustained curricular use
and clinical practices
Project S-START
• Key Personnel:
Project Director:
Project Co-Director:
Project Coordinator:
Director of Evaluation:
Janet F. Williams, M.D. – Dept Pediatrics
Sandra Burge, Ph.D. – Dept Family Medicine
Suyen Schneegans, M.A. - Dept Pediatrics
Nancy Amodei, Ph.D. – Dept Pediatrics
• Key Policy Organizations:
Medical School Dean & Former Dean/Current UTHSCSA President
Graduate Medical Education Deans
Council of Residency SBIRT Trainers (CRST):
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Pediatrics (UTHSC; BAMC military)
OB-Gyn
Family Medicine (UTHSC; South TX, Fort Hood, Santa Rosa)
Psychiatry (Adult & Child)
Internal Medicine (UTHSC; South TX)
Surgery
Program Structure & Start-up
Resources for all Departments
Thea Lyssy, Website & Curriculum Developer
Pediatrics
YR
01
YR
02
Internal
Medicine
OB-GYN
• Patricia Wathen
• Erin Nelson
• George Crawford
• Michelle Conde
• Sean Garcia
• Elly Xenakis
YR
03
FCM - UT
• Janet F. Williams
• Noemi Adame
• Lizette Gomez
• Sylvia Leal-Castenon
• Juan Parra
• Gabriel
Medrano
Internal Medicine
(S. TX)
• Gary Souffrant
• James Hanley
• Rosita Frazier
• Sandra Burge
• Nida Emko
• Alexandra Loffredo
• Manuel Oscos-Sanchez
Psychiatry
• Michael Dawes
• Brenda Talley
• Vivek Singh
• Jason
Schillerstrom
Surgery
• Daniel Dent
• Ronald Stewart
• Ross Willis
• Shannon Lopez
• Rochelle Cortes
FM – Fort Hood
• Doug Maurer
• Drew Baird
• Dena George
• Zaal Paymaster
FM-McAllen
• James
Tysinger
• Sunand
Kallumadanda
Adolescent
Medicine (BAMC)
• Elisabeth Stafford
• Dale Ahrendt
• Jesse Barondeau
FM –
Santa Rosa
• Tamara
Armstrong
Site Locations
 Family Medicine – Fort Hood
 UTHSC- SA
 Brooke Army Medical Center
(BAMC)
 CHRISTUS Santa Rosa
 Family Medicine – McAllen
 Internal Medicine – (RAHC)
Regional Academic Health
Center
Program Model
1) Ask pre-screening questions
If “negative”
No further questions
Praise
If “positive”
Begin Screening
Low to
Moderate Risk
Moderate to
High Risk
Brief
Intervention
Brief Intervention &
Referral to Treatment
High to Very
High Risk
Referral to
Treatment
• Evidence-based algorithm is tailored to each department
• Goal: sustainability & to find ways to reinforce it in the program and the resident’s practice
Faculty Training
 Used the Train the Trainer model to train SBIRT faculty in:
 Pediatrics
 Family & Community Medicine - UTHSCSA
 Family Medicine – Fort Hood
 Family Medicine – CHRISTUS Santa Rosa
 Other Methods:
 Personal consultation
 CRIT (IM Chief Resident Immersion Training in SBIRT)
 Sharing resources via project website
 Council of Residency SBIRT Trainers (CRST) Newsletter
 Email correspondence
Curriculum Description – page 1
 Length of the training program:
 Training is longitudinal, infused through the length of each training
program - 3 to 5 years
 8 proposed training modules:
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Cultural Competency approaches to SBIRT services
Medical Conditions linked to Substance Abuse
Use of Pre-Assessment & Screening Tools
Brief Interventions & Referrals to Treatment procedures
Pharmacotherapy for relapse prevention, maintenance, & other
prescribing drugs
Outpatient Medical Management & Integrated Provider System
Electronic Medical Health Records
Administrative Issues
Curriculum Description – page 2
 Screening tools used in the curriculum:
 CRAFFT, CAGE, CAGE-AID, TACE, ASSIST, BNI-ART
 Brief Intervention (BI) procedures:
 BI spectrum of skills: positive feedback, build strengths, dispel myths, brief
directed advice, range of intervention strategies from brief to multisession
discussions.
 Motivational interviewing/ Motivational enhancement techniques
 Referral to Treatment (RT) Support
 Online Bexar County Substance Abuse Resources Directory
 SAMHSA Treatment Locator Resources
 Mid-Coast Family Services (regional referral service)
Methods of Curriculum Delivery
 Training workshops
 Lecture/discussion
 Objective-driven learning
modules/discussion
 Grand Rounds
 Video library
 Project S-START Website
• Revised Medical Record
templates
• Pocket Card Assignments
• Pocket Card Reminders
• Self-directed/monitored online
learning (Blackboard modules)
• OSCE (Observed Standardized
Clinical Exams)
SBIRT Curricular Strategies by Specialty
Pediatrics
Large Group
Didactic Lecture
Small Group
Discussion
Skill-Building
Workshops
Reading
Assignments
Screening
Questions In
Medical Records
Reminder
Pocket Cards
Screening
Assignments*
Inpatient Clinical
Supervision
Outpatient
Clinical
Supervision
Independent
Study
Module
(Blackboard)
OSCE (Observed
Standardized
Clinical Exams)
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OBGYN
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Psychiatry
Internal
Medicine
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IM ERAHC
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psych only)
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FM –
McAllen
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FM -Fort FM -Santa Surgery
Hood
Rosa
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but not in
place yet)
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FCM
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Dissemination Model – page 1
 Posters
 AMERSA, 2009
 Society for Adolescent Medicine, 2010
 6th Annual Innovations in Health Science Education, 2010
 Annual Research Day at Fort Hood, 2010
 Pediatrics Research Day, 2010
 American Academy of Family Physicians, 2010
 Texas Academy of Family Physicians, 2010
 AAMC/ CDC Public Health in Medical Education Conference, 2010
 AMERSA, 2010 (2)
 North American Primary Care Research Group, 2010
 Society for Adolescent Health and Medicine, 2011
 Innovations in Health Science Education, 2011 (2)
 AMERSA, 2011 (2)
Dissemination Model – page 2
 Oral Presentations
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AMERSA, 2009 (2)
Society of Teachers of Family Medicine (45 min x 2), 2010
World Organization of Family Doctors, 2010
American Academy of Addiction Psychiatry, 2010
Southern Society of Pediatric Research, 2011
Society of Teachers of Family Medicine, 2011
Society for Adolescent Health & Medicine (workshop), 2011
Pediatric Academic Societies (workshop), 2011
INebria conference, (workshop), 2011
AMERSA (workshop), 2011
Dissemination Model – page 3
 Invited Presentations
 Texas Medical Association, 2009 (3)
 Texas Pediatric Society, 2009
 ONDCP US-Mexico Binational Drug Demand
Reduction Policy Meeting , 2010
 Society for Pediatric Anesthesiology (keynote), 2010
 Pediatrics for the Practitioner, 2010
 Northside Independent School District, 2010
 Editorial
 Journal of Adolescent Health, March 2011 issue
 Social Media
 Blog on ONDCP website, 2010
Dissemination: CRST Meetings
Council of Residency SBIRT Trainers (CRST) Meetings
Date
Pediatrics
BAMC
FCM
Internal
Medicine
Psychiatry
OB-Gyn
FM –
Fort
Hood
FM –
Santa
Rosa
Trauma
Nursing
1.29.09
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1.30.09
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9.29.09
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12.08.09
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3.09.10
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8.17.10
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2.15.11
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6.28.11
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7.19.11
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Dissemination: Newsletters
 CRSTy Times Newsletter
 6 Editions
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July 2009
September 2009
January 2010
July 2010
December 2010
July 2011
 Resident Newsletter
 Will be sent out quarterly
 Will serve as a reinforcement for SBIRT and evaluation reminder
Dissemination: Project Website
 Project S-START website
 http://familymed.uthscsa.edu/sstart/
 Total number of hits & views
 Timeframe: 1.06.09 to 7.31.11
 Total # of hits = 28,510
 Avg. hits per day = 30
 Total page views = 10,089
 Avg. page view per day = 10
Dissemination: Substance Abuse Resource Directory
 Bexar County Substance
Abuse Resource Directory
 http://bexarlist.com
Dissemination: Publication Committee
 Writing Group Meetings – work on SBIRT publications
 Have had 3 meetings
 Submissions to the Substance Abuse journal
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Lessons from the field: Challenges in implementing crossdisciplinary SBIRT residency training curricula
Opportunities and challenges: Implementing a brief
assessment and a brief intervention in substance abuse
consults in the South Texas veteran’s health care system
Implementing adolescent SBIRT education in pediatric
residency curricula
Sustainability Model: Electronic Health Record
 Example of EHR
changes – UTHSC FCM
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Alcohol
Other drugs
Tobacco
* Screenshot from Sunrise
Sustainability Model: Medical Health Records
Acute Care Encounter
 Example of Paper HR
change – Pediatrics
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Alcohol
Other drugs
Tobacco
 New Pediatric iPad Project:
 All residents
 SBIRT Algorithm &
Pocket Cards
Sustainability Model: MHR in Pediatrics
Child Health Record (11-20 years-old)
Sustainability Model: State SBIRT Project
 Proposed 5 year SAMHSA-CSAT grant: Texas SBIRT Project
 Collaborated with the Texas Department of State Health
Services (DSHS)
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DSHS will develop an integrated model of care to provide SBIRT
within primary care settings
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UTHSCSA will serve as a centralized web-based clearinghouse to:
 disseminate SBIRT related information
 link people with SBIRT tools and resources
 pair new providers with an experienced mentor
 develop an SBIRT mobile application
 find speakers to promote SBIRT
 provide training at professional conferences and meetings