Transcript SAMHSA Powerpoint Template

Screening, Brief
Intervention, and Referral to
Treatment (SBIRT)
Erich Kleinschmidt
May 19, 2014
CDC report – Jan. 2012
• One in six Americans binge drinks four times
per month
• Average number of drinks during binge is 8
• 40,000 deaths per year (binge-specific)
• 2006 - $167.7 billion alcohol-related costs
• Age group that binge drinks most often – 65+
• Income group with most binge drinkers - $75K+
CDC Morbidity & Morality Weekly Report, Jan. 10, 2012 Vol. 61
CDC Report continued – binge drinking
responsible for:
• Risk factor for motor vehicle accidents,
violence, suicide, hypertension, heart attack,
STDs, unintended pregnancy, FAS, SIDS
• 85% of all alcohol-impaired driving episodes
involved binge drinking (2010)
• Accounted for 50% of all alcohol consumed by
adults; 90% of youth
• Most binge drinkers are not dependent
CDC Morbidity & Morality Weekly Report, Jan. 10, 2012 Vol. 61
Focus of SBIRT
Dependent
Use
4%
Harmful or
Risky Use
Low Risk Use
or Abstention
25%
71%
Brief Intervention and
Referral to Treatment
Brief Intervention
No
Intervention
What exactly is SBIRT?
• SBIRT—Screening, Brief Intervention, and
Referral to Treatment
• Universal screening of pts within medical
settings
• If screened positive – brief intervention (guided
discussion) with medical provider occurs
• If screening reveals dependence – referral to
specialty substance abuse treatment provider
SBIRT & Medical Connection
 Takes advantage of the “teachable moment”
 Patients aren’t seeking treatment but
screening opens door for awareness &
education
 Increases access to clinically appropriate care
for nondependent as well as dependent
persons in a non-drug treatment setting
Ranked in top ten of prevention services
1. Discuss daily use of aspirin
2. Childhood immunization Series
3. Tobacco use screening and brief intervention
4. Colorectal cancer screening
5. Hypertension screening
6. Influenza immunization
7. Pneumococcal immunization
8. Problem drinking screening & brief intervention
9. Vision screening – adults
10.Cervical cancer screening
(Partnership for Prevention – Priorities for America’s Health:
Capitalizing on Life-Saving, Cost Effective Prev Services, 2006)
SBIRT “Patient Flow”
Brief Treatment
Cognitive behavioral
treatment with
multiple sessions
available
Screen
Identification of
substance related
problems
Brief Intervention
Raises awareness of
risks and motivates
client toward
concrete
goals/actions
Referral to Tx
Referral of those
with more serious
abuse/dependency
Universal Prescreen
• (-) Negative
Provide positive reinforcement
(+) Positive
Low risk: Provide
positive reinforcement
Further screening with
• ASSIST
• AUDIT
• CRAFFT
• DAST
Moderate risk: Provide
Brief Intervention
Moderate high-risk: Provide
Brief Therapy
High risk:
Refer to treatment
Screening Tools
• Four commonly used screening instruments:
- Alcohol Use Disorders Identification Test
(AUDIT or AUDIT – C)
- Alcohol, Smoking, and Substance
Involvement Screening Test (ASSIST)
- Drug Abuse Screening Test (DAST)
- CRAFFT (for adolescents)
- All can be found online and downloadable
Effective Screening Program Typically
Yields…
• Approximately 25% of all
patients will screen positive
for some level of substance
misuse or abuse
• Of those, the approximately
70% will be “at-risk” drinkers
• Most will be open to
addressing their substance
abuse problems (if discussed
in a non-judgmental manner)
Identify Referral Resources
Short-term and long-term residential treatment centers
Community agencies for referrals
Hospital inpatient and outpatient centers
State treatment centers
Has been implemented in many settings
• Thus far, SAMHSA has funded 26 states, 2 tribal
organizations, and 12 colleges since 2003 (five yr
grants to states; 3 yr to colleges)
• States currently includes: IN, TN, SC, NC, VT, NY,
WA, IL, CO, Am Samoa, AZ, IA, NJ, NM, OH
• Clinical sites include: trauma centers, EDs, inpatient
units, community health centers, FQHCs, tribal health
centers, elder services agencies, adolescent care
clinics, college health centers, VA clinics, urban STD
clinics, National Guard installations, others…
SBIRT Training Programs
• SBIRT training of resident physicians (19
grantees) since Sept ’08 (five yr grants)
• New SBIRT Training for Medical Professionals
(residents, social wk, nursing, counseling,
others) started in Sept. 2013 (14 grantees
including U.Miami – Coral Gables) for 3 years
Additional Initiatives
• Youth Build USA – recent funding from Hilton
Foundation – at risk program for older
adolescents & young adults construction skills
• New York – School-based health centers (high
schools)
• National Guard units – IA, KY, TN, CT, LA, IN
Payer
Reimbursement for SBIRT
Services
Commercial
Insurance
Medicare
Medicaid
Code
Description
Fee Schedule
CPT
99408
Alcohol and/or substance abuse
structured screening and brief
intervention services; 15 to 30 minutes
$33.41
CPT
99409
Alcohol and/or substance abuse
structured screening and brief
intervention services; greater than 30
minutes
$65.51
G0396
Alcohol and/or substance abuse
structured screening and brief
intervention services; 15 to 30 minutes
$29.42
G0397
Alcohol and/or substance abuse
structured screening and brief
intervention services; greater than 30
minutes
$57.69
H0049
Alcohol and/or drug screening
$24.00
H0050
Alcohol and/or drug service, brief
intervention, per 15 minutes
$48.00
SBIRT reimbursement is available
but…
• Need to set up system for submitting claims
(typically complex for start up)
• Can be restrictions as to type of health
professional that can bill (licensed vs
unlicensed, etc…)
• May get resistance from medical providers to
add SBIRT to already heavy workload
Key Considerations for Starting
SBI Program
 Develop a Screening protocol
 Develop a Brief Intervention protocol
 Monitor and evaluate program (strong QI mgt essential)
 Identify community referral resources, protocols, & tracking
 Reimbursement strategy & considerations (work with billing dept
to establish reimbursement lines)
 Staff training needs and supervision
 Program “champions” and buy-in from CEO/Admin staff
Additional Considerations
Who Will Do the Screening and Brief
Intervention?
•
•
•
•
•
•
•
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“SBIRT” counselors/health educator model
Social Workers
Registered Nurses
Psychologists
Physicians
Dedicated contracted personnel
Medical Assistants
Para-professionals
Challenges & Lessons Learned
• Buy-in issues from existing medical staff
(time/work load, don’t want to deal with “addicts”, now that
we’ve identified them, now what?, etc..)
• Funding for additional staffing (or train existing staff)
• Need for management to be supportive and influence
implementation (important to have “champions”)
• Consistent training available for new staff
• “Drift” from universal screening to “case finding” approach
SBIRT Websites/Resources
http://beta.samhsa.gov/sbirt
http://www.attcnetwork.org/regcenters/index_
nfa_sbirt.asp
Questions/Discussion
For further information, etc…contact:
[email protected]