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

2. 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

3. 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?

4. 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.

5. 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.

6. 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.

7. 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.

8. How can YOU be a champion for success?

9. Tools for Implementation

10. 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

11. Tools for Implementation: Electronic Health Record

12. Tools for Implementation: Patient

13. 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

14. BFM Health and Wellness Form

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

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

17. Patient Services Representative

18. Medical Assistant/Nurse

19. Resident/Physician/Other Provider

20. 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.