April Velasco PhD Deputy Regional Health Administrator US Dept of Health and Human Services Region II NY NJ PR USVI Recent CDC report Jan 2012 One in six Americans binge drinks four times per month ID: 718941
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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)Slide2
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. 61Slide3
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. 61Slide4
Focus of SBIRT
Dependent
Use
Brief Intervention
Brief Intervention and
Referral to Treatment
No
Intervention
Harmful or
Risky Use
Low Risk Use
or AbstentionSlide5
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 Slide6
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 occursSlide7
SBIRT Ranked in top ten of prevention services
Discuss daily use of aspirin
Childhood immunization Series
Tobacco use screening and brief intervention
Colorectal cancer screening
Hypertension screening
Influenza immunization
Pneumococcal immunization
Problem drinking screening & brief intervention
Vision screening – adults
Cervical cancer screening(Partnership for Prevention – Priorities for America’s Health: Capitalizing on Life-Saving, Cost Effective Prev Services, 2006)Slide8
SBIRT and ACA
Taking a closer look at the potential newly insured population post-ACA marketplace enrollment
Prevalence estimates and dataSlide9
PREVALENCE OF
ANY MENTAL ILLNESS
BY POPULATION
CI = Confidence Interval
Sources: 2008 –
2011
National Survey of Drug Use and
Health, 2011
American Community SurveySlide10
PREVALENCE OF
SUBSTANCE USE DISORDER
BY POPULATION
CI = Confidence Interval
Sources: 2008 –
2011
National Survey of Drug Use and
Health, 2011
American Community SurveySlide11
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 SurveySlide12
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 SurveySlide13
SBIRT Implementation
Implementation strategies
ConsiderationsSlide14
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 TherapyHigh risk: Refer to treatment
(-) NegativeSlide15
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)Slide16
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 conditionsPlan to talk about it more than once (at future doctor visits) Small, obtainable goals (let patient tell you want he/she can handle)Slide17
Identify Referral Resources
Community agencies for referrals
Short-term and long-term residential treatment centers
Hospital inpatient and outpatient centers
State treatment centersSlide18
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 staffSlide19
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 Slide20
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 staffSlide21
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…Slide22
Questions/Discussion
For additional information and resources.
Contact:
April Velasco
212-264-2560
april.velasco@hhs.gov