Equipping Residents to Address Alcohol and Drug Abuse: The National SBIRT Residency Training Project Journal of Graduate Medical Education, Vol. 4 No. 1 (March 2012), pp Janice Pringle, PhD Alicia Kowalchuk, DO Jessica Adams Meyers, MSEd J. Paul Seale, MD

Background Rates of alcohol and substance use in medical patients are significant Healthcare costs of SUDs are substantial SBIRT is a cost effective preventive service Low rates of SBIRT implementation in practice Low rates correlate with lack of training and low clinician self-efficacy

SAMHSA SBIRT Residency Training Programs $19 million over 5 years to 17 programs Develop and implement SBIRT training programs within residencies, integrating into core curricula for post grant sustainability Generate toolkit of common training tools and implementation strategies Educate large cohort of residents who will continue SBIRT in post residency practice

SAMHSA SBIRT Medical Residency Programs Access Community Health Network Albany Medical Center Baylor College of Medicine InSight SBIRT Residency Training Program Boston University Combined Residency Program in Pediatrics Howard University SBIRT Medical Residency Program Indiana University Kettering Medical Center Mercer University School of Medicine Oregon Health and Science University Family Medicine Residency Natividad Medical Center University of California, San Francisco – San Francisco General Hospital University of California, San Francisco – Department of General and Internal Medicine University of Maryland University of Missouri Health Care University of Pittsburgh SMaRT Program University of Texas Health Science Center at San Antonio-Pediatric Residency Yale University Emergency Medicine

Geographical Distribution of Residency SBIRT Grantees

Survey Purpose and Design Collaboration of 4 programs to describe the breadth of programs near their mid points Survey of all 17 program directors Descriptive stats, frequencies and comments collected ( ) and analyzed using Qualtrics Number of participating residents obtained from SAMHSA summary of grantees’ biannual report data through June 2011

Participating Residencies or Fellowships by Specialty 15 Family Medicine 14 Internal Medicine 12 Pediatrics 10 Obstetrics and Gynecology 10 Psychiatry – Adult and Child 7 Emergency Medicine 4 Surgery – including Oral Maxillofacial, Trauma 2 Preventive Medicine 1 Anesthesiology 1 Infectious Disease 1 Podiatry

Major Curricula Features Attention deficit hyperactivity disorder (ADHD) and addiction Curricular adjustments for different specialties Definitions of substance abuse and dependence Brief intervention approaches Addiction as a chronic disease Clinical skills evaluation Community focus Confidence ruler Cultural awareness Drinker’s pyramid Impaired physicians/residents Motivation for change/motivational enhancement skills/motivational interviewing Neurobiology of addiction Overview of the public health issues associated with hazardous alcohol and drug use Pain management Pharmacological treatment of addictive disorders Precepting SBIRT (for faculty/resident champion training) Prescription drug abuse Referral to treatment approaches SBIRT implementation approaches Screening

Distribution of Curricula Delivery Methods

Screening Instruments Taught ASSIT AUDIT and AUDIT-C CAGE CRAFFT DAST DSM IV criteria SQS-Drug (NIDA) SQS-Alcohol (NIAAA) TACE T-ASI TWEAK

Useful Training Resources Validated screening tools Standardized patient encounters NIAAA Clinician’s Guide Georgia-Texas Improving Brief Intervention Project modules Billing and coding information

Residents Trained 2867 residents trained as of June % of residents report using SBIRT – Monthly surveys (self report) – Chart reviews – Procedural logs – Tracking forms 16 grantees training PGY 2 and 3 residents 15 grantees training PGY 1 residents

Other Training Provided Chaplains Clinical pharmacists Counselors Faculty Front desk staff Health care educators Medical assistants Medical students Nurses Nurse practitioners Nurse midwives Physical therapists Physician assistants Physician assistant students Psychologists

Most Cited Challenges Finding time in residents’ schedules to deliver both face-to-face and online SBIRT training Dearth of SBIRT trained faculty role models Lack of reliable assessment methods to document SBIRT competence Focusing SBIRT on at-risk users Disseminating SBIRT beyond the 17 programs Sustaining SBIRT curricula post grant

Questions and Answers