Expand SBIRT Program

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Screening, Brief Intervention and Referral to Treatment (SBIRT) is used to provide care for substance users across the spectrum from early intervention to extensive specialized treatment. This represents a paradigm shift in substance-abuse treatment, which has historically focused on people that meet the criteria for substance abuse or dependence as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.

The SBIRT model screens all patients regardless of an identified disorder, allowing healthcare professionals in a variety of settings to address a patient's behavioral health even when that patient is not actively seeking treatment or care for their behavioral health problems. While SBIRT is well-established as an effective intervention for risky alcohol use researchers and clinicians are just beginning to explore it as an intervention for risky drug use.

By expanding the use of SBIRT and improving SBIRT practices, communities should be able to reduce the number of people who develop a dependency on opioids or Opioid Use Disorder. It should provide pathways for people to get appropriate help sooner--which reduces the potential negative impact of using opioids. SBIRT can be done in many different settings, and there are a variety of ways to do each element of SBIRT. This creates many opportunities to expand and improve SBIRT practices.  

Research on the Effectiveness of SBIRT

While the strongest evidence for the effectiveness of SBIRT relates to using it to address alcohol misuse, there is growing evidence in its effectiveness in accelerating people getting help with misuse of opioids.
  This 2017 report summarizes five years of research on SBIRT
  The research covered eleven multi-site programs in two cohorts of SAMHSA grant recipients were each funded for 5 years to promote the use and sustained implementation of SBIRT. They screened more than 1 million people. The programs used substance use specialists instead of medical generalists to deliver services.

 

• Greater intervention intensity was associated with larger decrease in substance use.
• Brief intervention and treatment had positive outcomes, brief intervention was more cost effective for most substances.

Four factors influenced SBIRT sustainability:

• Presence of a program champion
• Availability of funding
• Systematic change
• Effective management of SBIRT provider challenges

Key Findings:

• SBIRT was adapted successfully to the needs of early identification efforts for harmful use of alcohol and illicit drugs
• SBIRT is an innovative way to integrate management of substance use disorders into primary care and general medicine
• SBIRT improved treatment system equity, efficiency, and economy

 

SBIRT Related Training

General Training

One of the keys to expanding the use of Screening and SBIRT tools is to increase the general awareness of the SBIRT approach and the value of identifying people who are misusing substances (or at risk of misusing substances) as soon as possible. 

This set of Webinars provides valuable background and could be shared with many different community stakeholders:  https://sbirt.webs.com/webinars

More SBIRT Training Resources are available at  http://www.sbirteducation.com 

Screening and Intervention Training

Efforts to significantly expand SBIRT in a region will require significant training of a large number of people. One option to accomplish this is through the use of technology.

Kognito offers and accredited technology-based training on Screening and Brief Intervention for youth that use innovative simulations to provide training and evaluate the skills of those taking the training.

The program was developed in collaboration with NORC at the University of Chicago and adopted by more than 40 schools of health professions and state agencies. It helps improve patient-provider communication and supports the integration of substance use SBI in primary care settings. It is a cost-effective way to train large numbers of people.

The Kognito Conversation Platform has an innovative behavior change model integrates several evidence-based models and techniques, game mechanics, and learning principles. In these simulations, users enter a virtual environment and engage in role-play conversations with emotionally-responsive virtual humans. Through practice and receiving personalized feedback, users learn and assess their competency to lead similar conversations in real life. Kognito is the only company with health simulations listed in the National Registry of Evidence-based Programs and Practices (NREPP).

Screening 

Effective Screening Tools

One of the most promising ways to enhance SBIRT is to use some of the new screening tools that are based on new science and that use new technology.  The use of tools make it easier for screenings to be done, and the results of the screenings shoudl be more detailed and valuable.   Also, in many cases, the screening is a billable event, and if it is done using technology, then it will minize the burden on the healthcare professionals. 

OARS
Opioid Abuse Risk Screener (OARS) was developed as a comprehensive self-administered measure of potential risk that includes a wide range of critical elements noted in the literature to be relevant to opioid risk. This 43-question assessment is administered using an iPad (tablet) and takes about 10 - 12 minutes to complete. It is HIPAA compliant, EMR supported, and has high reliability, validity and preditablity scores. The assessment is instantly scored and a report is available to the prescribing physician that provides a summary opioid risk profile and a multidimensional assessment of risk factors. The OARS also provides depression and anxiety scores that can be used for SBIRT assessments and wellness visits, including scores for the PHQ-9 and the GAD-7. All information is provided in a compressive easy to read report which clearly identifies aberrant behavior and risk factors for followup by the provider with the patient during the visit.

The OARS is reimbursable with an average rate of $40/screening. Providers can get reimbursed in most cases with the CPT Code 96103 or the SBIRT codes while taking important steps to identify individuals that may be at risk for opioid misuse or abuse.

InteraSolutions, the company that developed OARS, received a 2018 recipient of the State of Ohio's Opioid Science Challenge that seeks to identify and support scientific breakthroughs that help to address the opioid crisis. The OARS screening tool was recognized as one of those important breakthroughs. 

More information on the Opioid Abuse Risk Screener (OARS)

Brief Intervention

Models for brief treatment recommended by SAMHSA include:

1. Brief Negotiated Interview
2. Brief counseling
3. Feedback, Responsibility, Menu of options, Empathy, Self-efficacy (FRAMES)
4. Motivational Interviewing (MI) techniques

Referral to Treatment

According to SAMHSA , commonly used models for brief treatment include:

1. Cognitive-Behavioral Therapy (CBT)
2. Motivational Enhancement Therapy
3. Community Reinforcement Approach
4. Solution-focused Therapy

Promising Programs

There are many promising programs that seek to expand SBIRT into places where professionals come into contact with people who have started to misuse substances.  Several programs have focused on populations that have co-occuring mental health issues, which often leads to self-medication and abuse.

Healthcare Settings

Healthcare professinals often come into contact with patients who may have substance misuse issues.  

Hopsitals and Emergency Rooms

https://www.bu.edu/bniart/files/2011/02/SBIRT-emergency-care-setting.pdf

Dentists and Oral Surgeons

The Journal of the American Dental Association, Volume 142, Issue 7, July 2011, Pages 800-810  https://www.sciencedirect.com/science/article/pii/S0002817714622649

The Journal of the American Dental Association, Volume 144, Issue 6, June 2013, Pages 627-638 https://www.sciencedirect.com/science/article/pii/S0002817714607674

 

Agencies and Programs Addressing Mental Health

Add information here
https://ireta.org/resources/what-i
s-sbirt-and-why-might-it-fit-well-in-mental-health-settings-the-research-is-just-beginning/

Schools

Some states, like Massachusetts have been moving to significantly expand SBIRT in schools.
A research report shared early findings: 
Training on using SBIRT in schools to address alcohol use: 
This article has encouraging updates and resources on using SBIRT in School-Based Health Clinics:
 

Integration of SBIRT into Electronic Health Records

One way to enhance the impact of SBIRT is to integrate information from the process into the Electronic Health Record (EHR).  "Modifying your organization's electronic health record to support SBIRT can accelerate your patient flow, reduce the burden of data collection, and allow you to monitor and measure the success of your SBIRT implementation."

An overview on this topic, and links to recorded webinars can be found in the SBIRT and Electronic Health Records Toolkit: https://ireta.org/resources/electronic-health-record-toolkit/

This recorded webinar, provided by IRETA and the Addiction Technology Transfer Center Network, provides a good overview on implementing the integration of SBIRT data into EHRs. 

Funding

The following organizations are currently funding research and initiatives to expand SBIRT:

1. Conrad N. Hilton Foundation
2. Substance Abuse and Mental Health Service Administration
3. A report by Catalyst shares several innovative ways to fund SBIRT in schools  
   Funding Screening, Brief Intervention, and Referral to Treatment (SBIRT) in Public Schools

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