1. 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

2. 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.

3. 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

4. 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

5. *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

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

7. 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) 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%)

8. 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 (

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

10. 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)

11. 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

12. Who?
What?
Where?
When?
Why?

13. 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

14. 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

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

16. 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)

17. Substance Use Continuum

18. Rethinking Substance Use Problems From a Public Health Perspective

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

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

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

22. 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…

23. Questions?
THANK YOU!
For more information