SBIRT and Women’s Health LYNN CAMPANARIO NOVEMBER, 2014

AFFORDABLE CARE ACT MENTAL HEALTH PARITY ADDICTION EQUITY ACT Setting the stage for opportunity… & 2

The lay of the land in Sonoma County Federally Qualified Health Centers (11) Tribal Health Clinic (1) Pending FQHC (1) Specialty satellite clinics (4) 3

What is SBIRT? S creening B rief I ntervention R eferral to T reatment 4

5% 20% 35% 40% } Low Risk Use or Abstain from use Risky Use Probable Addiction 5

Best Practice Evaluated with positive outcomes Universal screening Reduce and prevent high risk substance use or abuse Prevent disease, accidents and injuries resulting in better patient outcomes Reduce costly healthcare utilization Good Business SBIRT is reimbursable (for positive alcohol screen) Many payers reimburse for SBIRT services New opportunities to engage with patient Establishes collaborative partnerships 6

Access Points Medical  MediCal primary care providers  Other community health providers  ERs/Trauma Centers  Dental Offices Non-Medical  Schools  Criminal justice  Homeless shelters  County social service providers  Employee Assistance Programs (EAPs) 7

Training Plan  State requirements  Diverse participation  Pre-survey re: past/current experiences  Face-to-Face training  Comprehensive  Learning Collaborative  Site-specific Technical Assistance  Develop local capacity  Train-the-Trainer  Countywide trainers circle  On-line resources  Evaluation Plan 8

SBIRT “map” Behavior Change Motivate Increase Awareness Pre- Screen Screen Brief Intervention Reduce or Stop use Treatment Referral to Trmt 9

Pre-Screen Screen Brief Intervention Referral to Treatment 10

Pre-Screen Screen Brief Intervention Referral to Treatment 11

Pre-Screen Screen Brief Intervention Referral to Treatment Pre-Scren (SHA) Administer AUDIT- C/AUDIT, DAST or ASSIST Healthy Use Give positive reinforcement of healthy use Risky/Hazardous Use Assess Readiness to Change If not ready... Offer information and support; follow-up If ready... Provide Brief Intervention (BI) Possible Abuse Assess Readiness to Change If not ready... Do not refer. Provide BI; follow-up If ready... Assess readiness to accept referral for treatment If not ready... Do not refer. Provide BI; follow-up If ready... Link to treatment services Screen + on Alcohol and/or Drugs Universally Screen (min. annually) 12

Pre-Screen Screen Brief Intervention Referral to Treatment Comprehensive SUDS Treatment DetoxResidential Intensive Outpatient Outpatient Medication Assisted Therapy Aftercare Self-help support 13

So what happened? Standards of Implementation Mechanisms of data collection, analysis and reporting Process Patients screened Patients with score >? Patients receiving BI Patients referred Follow-up results Process improvement Outcomes State-mandated Local/regional AOD use Health improvements Identification of new issues 14

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 Variation in patient approach  Patient’s Stage of Change  Patient’s plan on how to address the issue  Release of information  Linkages to SUDs Treatment Providers  Patient’s support system 16

Lynn Campanario AOD Prevention Coordinator Sonoma County Department of Health Services ? 17