Roger Zoorob, MD, FAAFP Sandra J. Gonzalez, MSSW, LCSW Logistics of Effective Implementation Roger Zoorob, MD, FAAFP Sandra J. Gonzalez, MSSW, LCSW

Learning Objectives Understand the role of a clinical champion in the process of implementing alcohol SBI and FASD screening into their practice Utilize the Interprofessional Practice Manual to integrate members of their practice into the screening and brief intervention process using an interprofessional model

Preparing for implementation What is your current practice when it comes to screening for risky alcohol use? What is your comfort level when discussing this matter with patients? Are there identifiable barriers and facilitators (e.g., workflow, EHR, staff support – MAs)? Do you have a process in place for referral? In-house, external?

Types of Champions Leadership Champions Practice-Based Champions Content Experts Champions Leadership Champions hold senior positions within a healthcare organization, and range from the chief executive officer to a medical director of a clinic. Practice Based Champions are the front line doctors, nurses, behaviorists, and medical assistants that deal directly with patients. These champions are essential to establishing and maintaining the use of FASD prevention techniques within the clinical setting. Content Champions are the content experts, typically from academia, who influence the next generation of healthcare practitioners through direct teaching at the university level, lecturing and promoting FASD prevention techniques at national conferences, and authoring scholarly articles.

Leadership Champions Are in a position to influence policy on a large scale Understand the value of FASD screening/prevention given the minimal additional resources necessary to implement Willing to invest time towards refining institutional policy and working with managers to make it happen Willing to utilize network of contacts to identify additional opportunities for implementation Establish institutional policy, guidance, and processes Consult with Clinical Champions to ensure implementation is effective and sustainable (practice change) Identify other potential healthcare systems and/or executive champions.

Practice Based Champions Are passionate about FASD screening/prevention Are enthusiastic about implementation Are able to work with various personalities to achieve goals Are knowledgeable about clinical processes Promote the benefits of FASD screening/prevention amongst clinical staff Monitor who troubleshoots implementation Set a good example by consistently screening for FASD/prevention and entering information into the electronic health record.

Content Expert Champions Typically have prior experience/interest in FASD prevention Actively publish and/or attend conferences to reach a larger network Identify candidate healthcare systems/champions for implementation Present at national/regional conferences, etc., on the merits of FASD screening/prevention and of this project in particular.

How can YOU be a champion for success?

Tools for Implementation

The process of implementation Laying the ground work Need? Organizational commitment? Adapting Alcohol SBI to Your Practice Screening plan Brief Intervention plan Referral plan Implementing Alcohol SBI in Your Practice Orientation and training Pilot Test Launching the program Refining and Promoting Monitoring Share successes Adapted from CDC: Planning and Implementing Screening and Brief Intervention for Risky Alcohol Use

Tools for Implementation: Electronic Health Record

Tools for Implementation: Patient

Health and Wellness Form IV. AUDIT (US)/AUDIT 1-3 (US) I. Assess Physical Activity II. Depression screen (PHQ-2) III. Intimate Partner Violence Screen Section IV is the 10 item AUDIT – Alcohol Use Disorders Identification Test V. Assess Nutrition

BFM Health and Wellness Form

Roles of the Clinical Team Patient Services Representative/Front Desk Medical Assistant/Nurse Resident/Physician Behavioral Health Provider

Primary Care Provider/other Clinic flow PSR MA/Nurse Primary Care Provider/other

Patient Services Representative

Medical Assistant/Nurse

Resident/Physician/Other Provider

Summary Points for Implementation Roll with resistance. Alcohol screening and brief intervention is about culture change, not just training. Brief intervention techniques are useful. Be willing to adapt. May need to shorten training to align with the needs of the primary care practice. Utilize an easy form to evaluate proficiency and competency. Ensure buy-in. Training and implementation should have continuity. For example, if you train residents and their attending does not do it, it is a problem. Give staff a voice on how things are implemented. Buy-in from everyone involved (including front desk) is essential. Consider substance use disorders the same way you do other chronic diseases. SBI/RT and MI are tools. Be efficient. The brief intervention can be accomplished in 4 minutes.