North Shore-Long Island Jewish Health System SBIRT at NSLIJ New York Screening, Brief Intervention, and Referral to Treatment (NYSBIRT-II) North Shore-Long Island Jewish Health System Department of Emergency Medicine Division of General Internal Medicine Department of Psychiatry & Behavioral Health Sandeep Kapoor, MD Director, SBIRT Assistant Professor of Medicine Hofstra North Shore-LIJ School of Medicine

National Council for Behavioral Health Sponsored by the NYS Council for Community Behavioral Healthcare and the National Council for Behavioral Health Dr. Kapoor have no conflicts of interest to report.

NYSBIRT-II SAMHSA OASAS CASAColumbia and NSLIJ Collaborative Team (Substance Abuse and Mental Health Services Administration) Service Grant Sponsor OASAS (NYS Office of Alcoholism and Substance Abuse Services) Service Grant Administrator CASAColumbia and NSLIJ Service Grant Partners Training, Technical Assistance, Grant Evaluators - CASA Operations and Clinical Services - NSLIJ Collaborative Team Department of Emergency Medicine Division of General Internal Medicine Department of Psychiatry & Behavioral Health Emergency Medicine Southside ED SIUH - South ED SIUH - North ED Lenox Health Greenwich Village SBIRT: To identify and effectively intervene with those who are at moderate or high risk for psychosocial or health care problems related to their substance use. ** Rethinking Substance Use Problems From a Public Health Perspective Internal Medicine 865 Northern Blvd LIJ – ACU 2001 Marcus Ave Staten Island North - MAP

Leadership NSLIJ SBIRT NSLIJ Department of Medicine Sandeep Kapoor, MD Director, NSLIJ SBIRT Nancy Kwon, MD, MPA Principal Investigator – Emergency Medicine Joseph Conigliaro, MD, MPH Principal Investigator – Internal Medicine Jon Morgenstern, PhD Principal Investigator – Psychiatry NSLIJ Department of Medicine Thomas McGinn, MD, MPH Chairman, Medicine Jeanne Morley, MD SBIRT MD Champion – Internal Medicine Lauren McCullagh, MPH Administrative Director - Research NSLIJ Department of Emergency Medicine John D’Angelo, MD Chairman, Emergency Medicine Mark Auerbach, MD, MBA SBIRT MD Champion Mae Ward, RN Administrative Director – Research Karen Kline Senior Administrative Director II NSLIJ Department of Psychiatry John Kane, MD Chairman, Psychiatry Bruce Goldman, LCSW The Zucker Hillside Hospital Daniel Coletti, PhD New York State Office of Alcoholism and Substance Abuse Services (OASAS) Connie Burke NYSBIRT Project Director Peggy Bonneau Director of Health Initiatives The National Center for Addiction and Substance Abuse at Columbia University (CASAColumbia) Charlie Neighbors, PhD Director Megan O’Grady, PhD Associate Director

*During SBIRT Health Coach Hours* Services Delivered *During SBIRT Health Coach Hours*  Dec2013-July2015   Completed PreScreens PreScreen Positive Brief Interventions Referrals to Treatment Southside ED (20 months) 23,490 14% 1143 295 SIUH South ED (15 months) 8,850 10% 417 68 SIUH North ED (15 months) 18,650 9% 573 87 Lenox Health GV (12 months) 5,264 24% 512 166 Primary Care + Emergency Medicine (20 months) 104,357 11% 3708 729

Understanding the Importance Who? What? Where? When? Why?

How many people are at risk? More than 1/2 of Americans age 12+ years are current drinkers An estimated 58.6 million people (23.1% of general population) recently engaged in a heavy drinking episode 16.9 million reported a heavy drinking episodes on ≥ 5 days in the past month An estimated 18.7 million Americans drink alcohol in ways that are potentially unhealthy 20.5 Million people need, but do not receive treatment for illicit drug or alcohol use Major source of referrals to treatment are NOT healthcare providers (only 6.6%), though most people see a doctor at least one time per year Reference: SAMHSA (2011). 2010 National Survey on Drug Use and Health RESTRUCTURE? Unhealthy heavy drinking episode: is defined as having five or more drinks on the same occasion on at least 1 day in the 30 days prior to the survey Heavy drinking is defined as binge drinking on at least 5 days in the past 30 days. Most people referred via criminal justice/DUI (38%) or self (33%)

Patients Are Open To Discussing Their Substance Use Survey on Patient Attitudes Agree/Strongly Agree “If my doctor asked me how much I drink, I would give an honest answer.” 92% “If my drinking is affecting my health, my doctor should advise me to cut down on alcohol.” 96% “As part of my medical care, my doctor should feel free to ask me how much alcohol I drink.” 93% Disagree/Strongly Disagree “I would be annoyed if my doctor asked me how much alcohol I drink.” 86% “I would be embarrassed if my doctor asked me how much alcohol I drink.” 78% Source: Miller, P. M., et al. (2006). Alcohol & Alcoholism. Adapted from The Oregon SBIRT Primary Care Residency Initiative training curriculum (www.sbirtoregon.org)

Understanding the Importance Who? What? Where? When? Why?

Referral to Specialty Treatment The SBIRT Process SBIRT Components Pre-Screening Brief strategy to identify at-risk population using a valid, brief standardized questionnaire at the initial point of service < 1 minute Full Screening Valid extended standardized questionnaire administered with patient if they qualify based on the prescreen scores < 3 minutes Brief Intervention One or more discussions with health care professional focused on reducing or stopping unhealthy substance use: Assessment & feedback on substance use Simple advice, goal setting, agree on plan 10-20 minutes Referral to Specialty Treatment Based on extent of substance use/abuse, patients may require more than a brief intervention Every effort is made, in real-time, to provide a ‘warm handoff’ to community treatment providers and those within the NSLIJ Health System. Evidence Based protocol that provides us with an avenue to MAKE the CONNECTION (substance use and health, social, etc… issues)

Pre-Screening Questions: Alcohol, Drugs, Tobacco 1. How often do you have a drink containing alcohol? Never Monthly or less 2-4 times a month 2-3 times a week 4 or more times a week 2. How many standard drinks containing alcohol do you have on a typical (drinking) day? 1 or 2 3 or 4 5 or 6 7 to 9 10 or more 3. How often do you have 6 or more drinks on one occasion? Never Less than monthly Monthly Weekly Daily or almost daily 4. In the past 12 months have you used drugs other than those required for medical reasons? Yes No 5. In the past year, how often have you used tobacco products? Never Once or twice Monthly Weekly Daily or almost daily

Who? What? Where? When? Why?

Internal Medicine Clinic NSLIJ Sites for SBIRT Services By January 2015, eight sites (in Long Island, Staten Island, and Manhattan) will provide SBIRT services. As there are 18 Hospitals and nearly 400 points of entry within NSLIJHS, SBIRT service implementation system wide will speak volumes. Emergency Department Internal Medicine Clinic

ED SBIRT Workflow Patient enters the Emergency Room Patient is pre-screened by RNs after vital signs Responses from pre-screen are documented into EMR *Positive screen will elicit an ICON to the Health Coach. Health Coach will perform full screen and provide brief intervention for positive full screens Health Coach will discuss case with treating Physician/Nurse Health coach will work with clinical team members and PATIENT to secure a referral to treatment if needed

Understanding the Importance Who? What? Where? When? Why?

Making the Connection SBIRT allows us to NORMALIZE the discussion and treat substance use as the healthcare issue it is Risky use Heart Disease Hypertension Gastritis Sleep Depression Cancers STDs Fetal alcohol spectrum disorders Evidence Based tool that provides us with an avenue to MAKE the CONNECTION Similar to preventative screenings for chronic diseases (ie. diabetes and hypertension)

Substance Use Continuum

Rethinking Substance Use Problems From a Public Health Perspective

“The road to success is Programmatic Service Delivery paved by challenges” Programmatic Service Delivery Referral To Treatment

Allow their passion to motivate sustainability… Let your passion motivate others… Allow their passion to motivate sustainability…

What’s Next? Training Implementation Service Delivery Year One Completed What’s Next?

What’s Next? Engage… Engage… ENGAGE Refresh/Revisit all Training Elicit Feedback on Implementation Examine Fidelity of Service Delivery Engage… Engage… ENGAGE Allow their passion to motivate sustainability…

Questions? THANK YOU! For more information SBIRTinfo@nshs.edu