Expand SBIRT Program - Revision history

G.Lehrman at 14:18, 24 October 2021

2021-10-24T14:18:11Z

G.Lehrman at 14:17, 24 October 2021

2021-10-24T14:17:13Z

G.Lehrman at 05:26, 24 October 2021

2021-10-24T05:26:51Z

G.Lehrman at 05:24, 24 October 2021

2021-10-24T05:24:28Z

G.Lehrman at 05:24, 24 October 2021

2021-10-24T05:24:06Z

G.Lehrman at 05:22, 24 October 2021

2021-10-24T05:22:49Z

G.Lehrman at 05:22, 24 October 2021

2021-10-24T05:22:29Z

G.Lehrman at 05:20, 24 October 2021

2021-10-24T05:20:29Z

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G.Lehrman at 05:18, 24 October 2021

2021-10-24T05:18:19Z

G.Lehrman at 05:17, 24 October 2021

2021-10-24T05:17:37Z

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 = Key Information =
 == The 6 Characteristics of a Behavioral Health SBIRT Model ==
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 <span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">4. '''The services occur in a public health, or other non-substance use treatment setting'''.&nbsp;&nbsp;</span>
-<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">5. '''It is comprehensive.''' The program includes a seamless transition between brief universal screening, brief intervention and/or brief treatment, and referral to care.&nbsp;</span> <span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">6. '''Strong research or substantial experiential evidence supports the model.''' At a minimum, programmatic outcomes demonstrate a successful approach.</span> &nbsp; &nbsp;
+<span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">5. '''It is comprehensive.''' The program includes a seamless transition between brief universal screening, brief intervention and/or brief treatment, and referral to care.&nbsp;</span>
 == SBIRT Related Training ==

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 *Motivational Interviewing (MI) techniques
-If the patient requires additional services, the healthcare professional may recommend a '''Referral to Treatment (RT''')<ref>https://www.integration.samhsa.gov/clinical-practice/sbirt/referral-to-treatment</ref> — brief therapy or treatment to patients who screen showing they need additional services. SAMHSA recommends that referral to treatment is a critical component of the SBIRT process. It involves establishing a clear method of follow-up with patients that have been identified as having a possible dependency on a substance or in need of specialized treatment. The referral to treatment process consists of assisting a patient with accessing specialized treatment, selecting treatment facilities, and helping navigate any barriers such as treatment cost or lack of transportation that could hinder treatment in a specialty setting.&nbsp; &nbsp; &nbsp;
+If the patient requires additional services, the healthcare professional may recommend a '''Referral to Treatment (RT''')<ref>https://www.integration.samhsa.gov/clinical-practice/sbirt/referral-to-treatment</ref> — brief therapy or treatment to patients who screen showing they need additional services. SAMHSA recommends that referral to treatment is a critical component of the SBIRT process. It involves establishing a clear method of follow-up with patients that have been identified as having a possible dependency on a substance or in need of specialized treatment. The referral to treatment process consists of assisting a patient with accessing specialized treatment, selecting treatment facilities, and helping navigate any barriers such as treatment cost or lack of transportation that could hinder treatment in a specialty setting.&nbsp; &nbsp;
-= Relevant Research =
+== Integrate SBIRT into Other Settings &nbsp; ==
 Besides typical healthcare settings, there are many other places where professionals come into contact with people who may be at risk of substance use disorder.&nbsp; &nbsp;
-== Hospitals and Emergency Rooms ==
+=== Hospitals and Emergency Rooms ===
 Individuals with SUDs or just occasional use regularly access emergency care.&nbsp; Utilizing the SBIRT approach with individuals seeking care can be beneficial. A 2018 study <ref>https://warmhandoff.org/wp-content/uploads/2019/07/Safe-Landing-ED.pdf</ref> examined an SBIRT program in Allegheny County, Pennsylvania emergency rooms. It&nbsp;concluding that SBIRT had the potential to reduce healthcare costs and utilization, as measured by Medicaid claims data&nbsp;and that SBIRT use in the emergency department&nbsp;can be readily incorporated into existing practice settings.
-== Dentists and Oral Surgeons ==
+=== Dentists and Oral Surgeons ===
 Dentists and oral surgeons can play an important role in SBIRT. In fact, a study in the Journal of the American Dental Association (JADA) <ref>https://jada.ada.org/article/S0002-8177(18)30419-7/pdf</ref> showed that in the late 90s, dentists were the top specialty providers of immediate-release opioids, accounting for 15.5% of those prescriptions. The American Dental Association recommends dentists and oral surgeons incorporate NIDA's "Screening for Substance Use in the Dental Setting"<ref>https://www.drugabuse.gov/nidamed-medical-health-professionals/science-to-medicine/screening-substance-use/in-dental-setting</ref>&nbsp; to help dental professionals recognize the signs of risky substance use and addiction.
-== Community Health Centers and Clinics ==
+=== Community Health Centers and Clinics ===
 Community health providers offer excellent opportunities for early intervention with at-risk substance users and intervention for persons with SUDs and mental health issues. The state of New Hampshire<ref>http://sbirtnh.org/wp-content/uploads/2016/05/The-Power-of-Best-Practices-Launching-SBIRT-in-a-Community-Health-Center.pdf</ref> was an early adopter of SBIRT in a community setting. By incorporating SBIRT, New Hampshire found that universal screening lowers the barriers to early intervention and treatment, integrated care, and increased positive outcomes for patients.
-== Schools ==
+=== Schools ===
 An estimated 310,000 adolescents (aged 12-17)<ref>https://www.samhsa.gov/data/report/2018-nsduh-annual-national-report</ref> misused prescription pain relievers for the first time in 2018 - that's 850 teens every day.&nbsp; Many states have moved forward to expand SBIRT in school settings. In fact, schools offer a prime opportunity to identify, support, and redirect students in middle school and high school. Massachusetts was one of the first states to require SBIRT in a school setting and is considered a model for school-based SBIRT <ref>https://www.communitycatalyst.org/resources/publications/document/Massachusetts-Provides-a-Model-for-Addressing-Students-Risky-Substance-Use-7_6_18.pdf</ref>. Other states now incorporating SBIRT in schools include New York, Pennsylvania, California, Florida, and Texas.
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 The School-Based Health is currently testing and refining the adaptation of&nbsp; school-based SBIRT into 17 health care settings in seven states.<ref>http://www.sbh4all.org/current_initiatives/sbirt-in-sbhcs/</ref>
-&nbsp; &nbsp; &nbsp; &nbsp;
+&nbsp;
-= Integrate SBIRT into Electronic Health Records =
+== Integrate 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)<ref>https://www.indianasbirt.org/ehr-modification</ref>.&nbsp;
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 *An overview of&nbsp;this topic&nbsp;and links to recorded webinars can be found in IRETA's SBIRT and Electronic Health Records Toolkit . <ref> https://ireta.org/resources/electronic-health-record-toolkit/</ref>
 *This [https://www.youtube.com/watch?v=faO_bJdNyBQ recorded webinar], provided by [https://ireta.org/ IRETA] and&nbsp;the [https://attcnetwork.org/ Addiction Technology Transfer Center Network], provides a good overview on implementing the integration of SBIRT data into EHRs.&nbsp;
 &nbsp; &nbsp;

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 <span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">SBIRT places risky substance use where it belongs—in the realm of healthcare. It focuses on identifying risky substance use to help prevent the onset of the more costly disease of addiction. Similar to preventive screenings for chronic diseases such as cancer, diabetes, and hypertension, SBIRT is an effective tool for identifying risk levels related to substance use and for providing the appropriate intervention<ref name="Why SBIRT? SBIRT Colorado"> https://www.integration.samhsa.gov/clinical-practice/sbirt/SBIRT_Colorado_WhySBIRT.pdf</ref>.</span> <span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">By expanding the use of SBIRT and improving SBIRT practices, it can provide critical pathways for people to access treatment earlier.</span> &nbsp; &nbsp;
 == The 6 Characteristics of a Behavioral Health SBIRT Model ==
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 <span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">5. '''It is comprehensive.''' The program includes a seamless transition between brief universal screening, brief intervention and/or brief treatment, and referral to care.&nbsp;</span> <span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">6. '''Strong research or substantial experiential evidence supports the model.''' At a minimum, programmatic outcomes demonstrate a successful approach.</span> &nbsp; &nbsp;
-= SBIRT Related Training =
+== SBIRT Related Training ==
-== General Training ==
+=== General Training ===
 How can communities expand Screening and SBIRT tools? One way is to increase public awareness of the SBIRT approach and the value of identifying people who are at high risk or might&nbsp;be using substances.&nbsp;
@@ Line 40: / Line 42: @@
 The NORC&nbsp;is a public policy and social research organization affiliated with the University of Chicago.&nbsp; They provide hosted Webinars on Screening, Brief Intervention, and Referral to Treatment (SBIRT) training includes resources for professionals, adolescent SBIRT, workplace/EAP, community stakeholders, and other addiction or behavioral professionals. <ref>https://www.sbirteducation.com/</ref>&nbsp; NORC provides SBIRT education both in on-demand and live webinars.
-&nbsp;
+== The SBIRT Process ==
-= The SBIRT Process =
+=== Screening ===
 The very first step of the SBIRT process is screening. Ideally, it is used universally -- whether at an annual physical or other regularly occurring appointments with a provider or healthcare specialist. It uses a quick and simple method of identifying patients who use alcohol or other substances at at-risk levels, identifies use or experimenting, can help identify individuals who use substances at at-risk levels, as well as those who are already experiencing substance use-related issues.
 == Brief Intervention and Referral to Treatment ==
@@ Line 83: / Line 67: @@
 If the patient requires additional services, the healthcare professional may recommend a '''Referral to Treatment (RT''')<ref>https://www.integration.samhsa.gov/clinical-practice/sbirt/referral-to-treatment</ref> — brief therapy or treatment to patients who screen showing they need additional services. SAMHSA recommends that referral to treatment is a critical component of the SBIRT process. It involves establishing a clear method of follow-up with patients that have been identified as having a possible dependency on a substance or in need of specialized treatment. The referral to treatment process consists of assisting a patient with accessing specialized treatment, selecting treatment facilities, and helping navigate any barriers such as treatment cost or lack of transportation that could hinder treatment in a specialty setting.&nbsp; &nbsp; &nbsp;
 = Integrate SBIRT into Other Settings &nbsp; =
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 &nbsp;
 = Promising Practices =

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 &nbsp;
 = Promising Practices =
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 *'''SAMHSA''' offers a wide list of general resources for SBIRT with links to technical assistance, online apps, and other research.<ref>https://www.integration.samhsa.gov/clinical-practice/sbirt</ref>
-=== Communities can also enhance SBIRT by incorporating technology through new screening tools. These tools make it easier for health professions to expand initial screenings while opening up a new avenue to engage patients and individuals. Screening tools may include phone apps, tablet-based screening, computer-administered screening (available in Spanish), interactive voice response, web-based or even text-based. ===
+Communities can also enhance SBIRT by incorporating technology through new screening tools. These tools make it easier for health professions to expand initial screenings while opening up a new avenue to engage patients and individuals. Screening tools may include phone apps, tablet-based screening, computer-administered screening (available in Spanish), interactive voice response, web-based or even text-based.
 *'''SBIRT Oregon App<ref>http://www.sbirtoregon.org/screening-app/</ref>:'''&nbsp; The Department of Family Medicine at Oregon Health and Science University designed online resources and an SBIRT app for primary care and emergency medicine settings in Oregon and the U.S.&nbsp;The patient uses a web-based screening app for tablet, phone, or desktop, which quickly screens and assesses patients for substance use and depression, converts answers into chart-ready notes, reads questions out loud for patients with low literacy, and delivers screening tools in English or Spanish.

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 <li><span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">Improves treatment system equity, efficiency, and economy</span></li>
 </ul>
 &nbsp; &nbsp;
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 &nbsp;
 = Promising Practices =
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 *'''IRETA '''(The Institute for Research, Education, and Training in Addiction) provides online training for both professionals and the public, as well as free webinars and on-site prescriber education<ref>https://ireta.org/training/overview/</ref>.
 *'''SAMHSA''' offers a wide list of general resources for SBIRT with links to technical assistance, online apps, and other research.<ref>https://www.integration.samhsa.gov/clinical-practice/sbirt</ref>
 &nbsp;

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 &nbsp;
 = Promising Practices =
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 *'''IRETA '''(The Institute for Research, Education, and Training in Addiction) provides online training for both professionals and the public, as well as free webinars and on-site prescriber education<ref>https://ireta.org/training/overview/</ref>.
 *'''SAMHSA''' offers a wide list of general resources for SBIRT with links to technical assistance, online apps, and other research.<ref>https://www.integration.samhsa.gov/clinical-practice/sbirt</ref>
 <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">Gena Fitzgerald</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span>
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   &nbsp;
 = Sources =

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 &nbsp;   </div> &nbsp; </div></div>
 = Tools & Resources =
 [[TR_-_Expand_SBIRT_Program|TR - Expand SBIRT Program]]
-<div class="mw-parser-output">
-<span style="background-color: #ffffff;  color: #222222;  font-family: arial,sans-serif;  font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff;  color: #ff0000;  font-family: arial,sans-serif;  font-size: 12.8px">Gena Fitzgerald</span><br/> <span style="background-color: #ffffff;  color: #222222;  font-family: arial,sans-serif;  font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff;  color: #ff0000;  font-family: arial,sans-serif;  font-size: 12.8px">[fill out table below]</span>
+<span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">PAGE MANAGER</span>:''' </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">Gena Fitzgerald</span><br/> <span style="background-color: #ffffff; color: #222222; font-family: arial,sans-serif; font-size: 12.8px">'''<span style="color: #4d4d4d">SUBJECT MATTER EXPERT</span>''': </span><span style="background-color: #ffffff; color: #ff0000; font-family: arial,sans-serif; font-size: 12.8px">[fill out table below]</span>
 {| class="wiki_table"
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 &nbsp;
-</div> </div>
+ </div> &nbsp;
-<div class="mw-parser-output">
 = Sources =

@@ Line 23: / Line 23: @@
 <span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">By expanding the use of SBIRT and improving SBIRT practices, it can provide critical pathways for people to access treatment earlier.</span> &nbsp; </div></div></div></div>
-= Research on the Effectiveness of SBIRT =
 <span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">A growing body of evidence demonstrates SBIRT’s effectiveness in creating positive outcomes for those with substance use disorder. </span><span style="font-size:11pt; font-family:Arial; color:#000000; background-color:transparent; font-weight:400; font-style:normal; font-variant:normal; text-decoration:none; vertical-align:baseline; white-space:pre; white-space:pre-wrap">A&nbsp; 2017 report<ref name="Screening, Brief Intervention and Referral to Treatment:implications of SAMHSA’s SBIRT initiative for substanceabuse policy and practice">https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.13675</ref> studied eleven multi-site programs of SAMHSA grant recipients each funded for 5 years to promote the use and&nbsp; implementation of SBIRT. They screened more than 1 million people and reviewed five years of SBIRT research, concluding that its&nbsp;implementation was associated with improvements in treatment system equity, efficiency, and economy, including:</span>
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 </ul>
 == The 6 Characteristics of a Behavioral Health SBIRT Model ==