Georgia: National Leader in Training an SBIRT Workforce J. Paul Seale, MD Family Physician Professor & Director of Research Dept. of Family Medicine Navicent Health/Mercer University Macon, GA, USA

Healthy Habits Project  Macon Family Medicine clinic  Clinicians trained: 25 residents, 8 faculty and 2 physician assistants (now 108 residents after 13 years)  Screened 3,041 patients, 241 (8%) positive screens, 115 (3.8%) received BIs  Demonstrated SBIRT’s feasibility Seale, Shellenberger et al, Substance Abuse 2005; Seale, Shellenberger et al, BMC Family Practice 2005

Project 2: GA-TX “Improving Brief Intervention” Project  Timeline:  Aim: Replicate results of Healthy Habits Project in 8 residency programs (4 in GA, 4 in TX)  Engaged “early adopter” faculty to serve as site coordinators: Rome (Floyd Medical Center), Atlanta (Morehouse Family Medicine), Albany (Phoebe Putney Family Medicine), Savannah (Memorial Family Medicine)

Dissemination Results  189 residents & 6 faculty trained  Broad geographic distribution across Georgia Shellenberger, Seale et al, Academic Medicine 2009; Seale, Velasquez et al, Substance Abuse 2012

Project 3: Georgia BASICS State SBIRT Initiative  Aim: Implement alcohol/drug SBIRT in 2 largest hospital systems in GA  Partnered with state health dept, Grady Health Systems, Emory & GA State U.  Focused on SBIRT in emergency departments  New: “specialist model” of SBI delivery  $15 million over 5 years Johnson et al. Use of AUDIT-based measures, ACER 2013; Johnson et al. Integration of screening question… Annals of Emerg Med 2013

SBIRT Grants by State, 2008 Missouri W. Virginia Georgia Medical School Residency Grants

Project 4: Southeastern Consortium for Substance Abuse Training  Rationale: limited SBI/substance abuse initiatives in the southeastern US  Aim: Implement alcohol/drug SBIRT in primary care residencies GA/NC/SC  Recruited 4 Family Medicine, 3 Internal Medicine residencies & PA program

Dissemination Results  9 new clinics in 8 training programs, 434 residents & 200+ faculty trained in 3 states  Added SBI training in new discipline: Physician Assistant training program  Training, systems intervention & strong QI component led to increased SBI rates in clinics  Pioneering work on coding & billing Seale, Johnson et al, Academic Medicine 2015; Le, Johnson et al, JGIM 2015

Project 5: SECSAT for Advanced Practice Registered Nurses  Rationale: as primary care delivery changes to serve more patients, nurse practitioners are in ideal role to do SBI and bill for services provided  Engaged 6 GA advanced practice nursing programs (Mercer, Emory, UNG, Armstrong Atlantic, GCSU, South U.)  Recruited 2 other “top ten” nursing programs—Johns Hopkins, UAB

Dissemination Outcomes  Training in 8 new nursing programs, 587 students, 74 faculty and preceptors trained in initial 2 years (goal: 900)  Creation of online training materials for distance learners  Very high level of interest, engagement and ownership of this important preventive practice  Major efforts toward establishing national SBIRT training standards

Newest Wave of SBIRT Trainees (63 new US grants)  Augusta University  Medical students, nurse practitioners, residents in Family Medicine and psychiatry, & psychology students  Morehouse School of Medicine  Training students in medicine, nursing and social work

GA Workforce—Poised for SBIRT Dissemination  13 years of training projects  >2,600 students/residents & 118 faculty in medicine, nursing and PA programs across Georgia & nearby states  Follow-up interviews indicate these trainees use SBI after graduation  Opportunities to accelerate use of this important preventive service by “turning on” and funding SBIRT codes

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