1. Screening, Brief Intervention, and Referral to Treatment April Velasco, PhD Deputy Regional Health Administrator US Dept of Health and Human Services, Region II (NY, NJ, PR, USVI)

2. Recent CDC report – Jan. 2012 One in six Americans binge drinks four times per month Average number of drinks during binge is 8 40,000 deaths per year (binge-specific) 2006 - $167.7 billion alcohol-related costs Age group that binge drinks most often – 65+ Income group with most binge drinkers - $75K+ CDC Morbidity & Morality Weekly Report, Jan. 10, 2012 Vol. 61

3. CDC Report continued – binge drinking responsible for: Risk factor for motor vehicle accidents, violence, suicide, hypertension, heart attack, STDs, unintended pregnancy, FAS, SIDS 85% of all alcohol-impaired driving episodes involved binge drinking (2010) Accounted for 50% of all alcohol consumed by adults; 90% of youth Most binge drinkers are not dependent CDC Morbidity & Morality Weekly Report, Jan. 10, 2012 Vol. 61

4. Focus of SBIRT Dependent Use 4% 25% 71% Brief Intervention Brief Intervention and Referral to Treatment No Intervention Harmful or Risky Use Low Risk Use or Abstention

5. What exactly is SBIRT? SBIRT—Screening, Brief Intervention, and Referral to Treatment Universal screening of patients within medical settings with use of validated screening tools If screened positive – brief intervention (guided discussion) with medical provider occurs If screening reveals dependence – referral to specialty substance abuse treatment provider

6. SBIRT: Primary Care Context Takes advantage of the “teachable moment” Patients aren’t seeking treatment but screening opens door for awareness & education Focus on addressing low/moderate risk usage as a preventative approach before addiction occurs

7. SBIRT Ranked in top ten of prevention services 1.Discuss daily use of aspirin 2.Childhood immunization Series 3.Tobacco use screening and brief intervention 4.Colorectal cancer screening 5.Hypertension screening 6.Influenza immunization 7.Pneumococcal immunization 8.Problem drinking screening & brief intervention 9.Vision screening – adults 10.Cervical cancer screening (Partnership for Prevention – Priorities for America’s Health: Capitalizing on Life-Saving, Cost Effective Prev Services, 2006)

8. SBIRT and ACA Taking a closer look at the potential newly insured population post-ACA marketplace enrollment Prevalence estimates and data

9. PREVALENCE OF ANY MENTAL ILLNESS BY POPULATION CI = Confidence Interval Sources: 2008 – 2011 National Survey of Drug Use and Health, 2011 American Community Survey

10. PREVALENCE OF SUBSTANCE USE DISORDER BY POPULATION CI = Confidence Interval Sources: 2008 – 2011 National Survey of Drug Use and Health, 2011 American Community Survey

11. PREVALENCE OF ANY MENTAL ILLNESS OR SUBSTANCE USE DISORDER BY POPULATION CI = Confidence Interval Sources: 2008 – 2011 National Survey of Drug Use and Health, 2011 American Community Survey

12. PREVALENCE OF ANY MENTAL ILLNESS AND SUBSTANCE USE DISORDER BY POPULATION CI = Confidence Interval Sources: 2008 – 2011 National Survey of Drug Use and Health, 2011 American Community Survey

13. SBIRT Implementation Implementation strategies Considerations

14. Universal Prescreen Provide positive reinforcement (+) Positive Further screening with ASSIST AUDIT CRAFFT DAST Low risk: Provide positive reinforcement Moderate risk: Provide Brief Intervention Moderate high-risk: Provide Brief Therapy High risk: Refer to treatment (-) Negative

15. Effective Screening Program Typically Yields… Approximately 25% of all patients will screen positive for some level of substance misuse or abuse Of those, the approximately 70% will be “at-risk” drinkers Most will be open to addressing their substance abuse problems (if discussed in a non- judgmental manner)

16. Brief Intervention Approach Uses “Motivational Interviewing” techniques Discuss healthy drinking levels for male/females (NIAAA standards) Weigh pros/cons of cutting down or quitting Use “scaling” to assess for readiness (i.e – on a 1 to 10 scale….) Effects on quality of life and/or existing medical conditions Plan to talk about it more than once (at future doctor visits) Small, obtainable goals (let patient tell you want he/she can handle)

17. Identify Referral Resources Community agencies for referrals Short-term and long-term residential treatment centers Hospital inpatient and outpatient centers State treatment centers

18. Key Considerations for Starting SBI Program Identify target population and location(s) Develop a Screening protocol Develop a Brief Intervention protocol Identify staff to monitor and evaluate program (strong QI mgt essential) Reimbursement strategy & considerations Staff training needs and supervision Program “champions” and buy-in from CEO/Admin staff

19. Additional Considerations Who Will Do the Screening and Brief Intervention? “SBIRT” counselors/health educator model Social Workers Registered Nurses Psychologists Physicians Dedicated contracted personnel Medical Assistants Para-professionals

20. Challenges & Lessons Learned Buy-in issues from existing medical staff Funding for additional staffing (or train existing staff) Need for management to be supportive and influence implementation Consistent training available for new staff

21. Useful Resources Numerous SBIRT grantee websites with training videos, screening protocols, insurance/billing information, toolkits, etc… Addiction Technology Transfer Centers (ATTC) – SAMHSA funded trainings in SBIRT, MI, etc… Other non-fed funded organizations offering training, resources, etc…

22. Questions/Discussion For additional information and resources. Contact: April Velasco 212-264-2560 april.velasco@hhs.gov