Screening, Brief Intervention, Referral, and Treatment (SBIRT) Juli Harkins June 26, 2005 Division of Services Improvement Organization and Financing Branch

3 Consider these facts…  20 million Americans (8%) of the population aged 12 or older were current users of illicit drugs.  3 million 1 st time marijuana users (each day an average of 7K, mostly <age 18)  2 million current cocaine users  1 million current hallucinogen users  119,000 current heroin users  6 million current users of psychotherapeutic drugs taken non-medically Source: 2003 NSDUH

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5 FemaleMale Felt No Need for TX Felt Need for TX Received TX 2002 NSDUH Most People Who Needed Treatment for an Illicit Drug Problem Did Not Feel a Need for Treatment

6 Felt No Need for TX Felt Need for TX Received TX Most People Who Needed Treatment for Alcohol Problems Did Not Feel a Need for Treatment 2002 NSDUH FemaleMale

7 Why SBIRT? The research suggests…  Substance use and abuse have significant medical, social, and financial consequence to our society.  Effective treatments exist but fewer than half of those who need treatment for substance use disorders receive the appropriate treatment.  Early and brief intervention is more effective clinically and much more cost efficient than the traditional more intensive treatment necessary if the use progresses to addiction.  Excessive drinking and illicit drug use are often undiagnosed by medical professionals and go untreated, leading to a more chronic, severe condition.

8 SBIRT Encourages Moving from Research to Practice and from Science to Service in Medical Care Settings.  Emergency services, chest pain, urgent care  Trauma inpatient  Primary care  Dental services, pre-natal, breast exam clinics, adolescent clinics

Brief Intervention and Boosters Assessment, Treatment, Support Education, Information (Brief Advice) and Boosters Prevention Treatment Intervention Linkages by uniform decision rules; permeable boundaries Generalist System Specialist System Integrated Spectrum of Users and Services Non-Users and Low Risk UsersAt-RiskUsers AbuseDisorder DependenceDisorder

10 SBIRT Goals as a Conceptual Model and Planning Tool  Increase access to clinically appropriate care for nondependent as well as dependent persons  Link generalist and specialist treatment systems  Combine prevention, intervention, and treatment toward a consistent continuum of care.  Diminish barriers to access to care  Increase the numbers of screenings and BI’s.  Reduce Prevalence of Alcohol, Drug, and Medications Related Disorders  Building coalition between health care services and alcohol and drug treatment services

11 SBIRT: Core Clinical Components  Screening: Very brief screening provides identification of substance related problems.  Brief Intervention: Raises awareness of risks and motivation of client toward acknowledgement.  Brief Treatment: Cognitive behavioral work with clients who acknowledge risks and are seeking help.  Referral: Referral of those with more serious addictions.

12 California $3.485m Cook Inlet Tribal Council$1.672m Illinois$3.500m New Mexico$3.500m Pennsylvania$2.970m Texas$3.500m Washington$2.970m Awards are renewable for up to five years, depending on performance and availability of funding. FFY 2003 Cooperative Agreement Awards made to 6 States and 1 Tribal Organization

Recommended S-BIRT Awards FY 2003 WA AK AI/AN CA NM TX IL PA

14 SBIRT GPRA Summary (6/22/05)

15 SBIRT Grants:  Expanding the State’s continuum of care to include screening,brief intervention, brief treatment, and referral services in medical and other community settings;  Supporting clinically appropriate treatment services for nondependent substance users;  Developing collaborative linkages between providers of SBIRT services and the more traditional substance abuse treatment providers to build resilience and facilitate recovery; and  Identifying opportunities for system and policy change to improve access to care and ensure a life in the community for everyone.

16 SBIRT Evaluation:  CSAT has funded Cross-site evaluation team: contractors Johnson, Bassin & Shaw (JBS), RTI International, and the University of Connecticut Health Center (UCHC)  Purpose: to understand how SBIRT will work best in various settings and under different approaches and examine which SBIRT models offer the greatest potential to improve the U.S. healthcare system  Evaluation Plan is under development

17 SBIRT ACTIVITIES Around the Corner: College University Grants New Fall Grants Worldwide Collaboration Current Involvement: Uniform Accident and Sickness Policy and Provision Law Studies CMS Coding National Highway Transportation and Safety Administration Office of National Drug Control Policy American Society of Addiction Medicine