Delivering Screening, Brief Intervention, and Referral to Treatment to Mitigate High-Risk - PowerPoint Presentation

1. Delivering Screening, Brief Intervention, and Referral to Treatment to Mitigate High-Risk Substance Use in STI Clinical Settings

2. Presenter Introduction (Note: Slide serves as a placeholder for presenter(s) who wish to include their picture and any introductory information.)  First Name and Last NameLorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat.

3. SBIRT Training Overview This training provides an overview of the Screening, Brief Intervention, and Referral to Treatment (SBIRT) intervention, which motivates clients seeking STI services who are engaged in high-risk substance use (HRSU) to pursue HRSU treatment and care services.  The following presentation addresses: What is HRSU?What is SBIRT?Evidence Supporting Use of SBIRT to Address HRSU in STI ClinicsHRSU and STIs: A SyndemicSBIRT Logistics SBIRT for HRSU: Client Populations and Enrollment CriteriaScreeningsPromoting the InterventionEducational Materials for ClientsStaffing Electronic Health Record (EHR) SystemSBIRT for HRSU: Intervention Steps Questions and Answers

4. What is HRSU? High-risk substance use (HRSU) refers to: Use of illicit drugs Non-medical use of prescription drugsNote: focus is on substances that pose a high-risk for negative health outcomes (see below). Does not include the use of alcohol or marijuana.Possible impacts of HRSU: Drug dependence, substance use disorders, and non-fatal and fatal overdoses HIV, viral hepatitis, and other infections or wounds, primarily associated with injection drug use Disinhibition encouraging unprotected sex and needle-sharing, which can drive the spread of STIs and other diseases, including HIV and viral hepatitis.1,2 Substance use disorder and HRSU rates are often higher among STI clinic clients than the general population.

5. What is SBIRT? SBIRT for HRSU is a brief behavioral intervention that identifies clients engaged in HRSU through evidence-based screening; offers motivational interviewing to help clients set goals to engage in specific health services; and provides encouragement, referral, and a warm handoff to treatment and care.SBIRT steps include the following: ScreeningIdentifying/assessing the degree of substance use and identifying the appropriate level of treatment among clients; Brief InterventionIncreasing awareness of substance use among clients, motivating behavior change; and Referral to Treatment Connecting clients requiring additional services to care.

6. Evidence Supporting Use of SBIRT to Address HRSU in STI Clinics SBIRT was initially developed to help connect people engaged in alcohol use to treatment.  SBIRT has been applied in other clinical settings, including the early identification and intervention for those engaged in substance use who seek services in STI clinics. One 2007 study with New York City STI clinics found that the SBIRT model successfully connected patients with substance use treatment, resulting in improvements in their substance use disorder and mental health, and reduced their condomless sexual contact.4The Addressing High-Risk Substance Use through STI Clinics: Strengthening Connections to Treatment and Behavioral Health Services project demonstrated the use of the SBIRT intervention to motivate and connect people seeking STI services who are engaged in HRSU with HRSU treatment and care services.5

7. Evidence Supporting Use of SBIRT to Address HRSU in STI Clinics Persons engaged in HRSU at STI clinics report higher rates of: Condomless sexMultiple partnersSTI diagnoses6 Specific population factors to consider: While men who have sex with men (MSM) have a higher burden of STIs and HRSU than the general population,7,8,9 increases in STIs and HRSU have been reported among heterosexuals and women as well.10,11,12

8. Evidence Supporting Use of SBIRT to Address HRSU in STI Clinics Social Determinants of HRSU include:PovertyHomelessnessHousing instability Lack of adequate insurance coverage and health careLimited educational attainment13,14,15,16 These determinants also drive additional risk factors for HRSU and STIs:Engagement with the legal system Anonymous sexSex in exchange for resources, including drugs and money17,18,19

9. HRSU and STIs: A Syndemic HRSU and STIs represent a syndemic, defined as follows:1. Two (or more) diseases or health conditions cluster within a specific population;202. Contextual and social factors create the conditions in which two (or more) diseases or health conditions cluster; and 3. The clustering of diseases results in adverse disease interactions—biological, social, or behavioral—increasing the health burden of affected populations. SYNDEMIC MODELS 21,22

10. HRSU and STIs: A SyndemicPopulations inequitably impacted by STIs and HRSU: Black, Indigenous, and other people of color (BIPOC)LGBTQIA+ peopleJustice-involved populationsPeople who use drugsPeople experiencing homelessness and unstable housingYoung peoplePregnant people 13,14,15,16These diseases and conditions cluster due to the intersection of individual and interpersonal factors, barriers to health services, and social determinants of health.23,24,25,26  

11. SBIRT LogisticsSTI clinics present a unique opportunity to reach people engaged in HRSU and connect them with potentially life-saving treatment and care. Components integral to implementing SBIRT for HRSU in STI clinical settings include:Client Populations and Enrollment CriteriaIntervention Promotion Educational Materials for ClientsStaffing Electronic Health Record (EHR) System

12. SBIRT Logistics: Client Populations and Enrollment Criteria (Note: Clinics will need to enter details about their clinic’s population(s) of focus.)SBIRT for HRSU Client PopulationName of Population ScreeningSTIHRSUNumber of Cases / Rate of STIs for the focus population(s) in the catchment areaNumber of Cases / Rate of HRSU for the focus population(s) in the catchment area Number of Cases / Rate of STIs in the client population in your clinic Number of Cases / Rate of HRSU in the client population in your clinic

13. SBIRT Logistics: Client Populations and Enrollment Criteria Cont.(Note: Detail the SBIRT enrollment requirements at your clinic. Suggested factors are listed below.)Enrollment CriteriaScreeningAge Location of ResidenceSTI Status HRSU Engagement Example: Ages 18 and older (example) Number of Cases / Rate of HRSU for the focus population(s) in the catchment area Example: Symptoms of STIs in the previous 12 monthsTreated presumptively for an STI in the last 12 months Sought care at STI clinics for routine testingEngagement in high-risk sexual behaviors in the previous 12 monthsEngagement in HRSU within a certain time period HRSU Screening Score(s)

14. SBIRT Logistics: Screenings Deciding who among our potential participants will receive our SBIRT for HRSU intervention depends upon their screening scores.27,28  We use two screenings: HRSU Intervention ScreeningsScreeningPurpose of ScreeningMode of DeliveryScoreScreening 1National Institutes of Drug Abuse (NIDA) Quick Screen Determines if participants have used drugs, other substances in past 12 months and how often.First SurveySelf-ReportYes or NoScreening 2Drug Abuse Screening Test (DAST-10)Serves as primary HRSU screener.Second survey administered if Screening 1 = yesSelf-ReportScore range: 1-10 pointsLow HRSU/Low-Risk= 1-2 pointsHarmful/Mid-Risk = 3-5 pointsSevere/High-Risk = 6+ pointsClients who score a 6 or higher are referred to the SBIRT for HRSU intervention.

15. SBIRT Logistics: Promoting the Intervention (Below are proposed details about your clinic’s plans to promote the intervention to clients, as appropriate. This can be updated per each clinic’s needs.)Promoting the InterventionThe intervention is promoted through the following modalities (in English and other languages, as noted).PromotionsEngagementLanguages DocumentPrinted posters and flyers posted within the clinic and in partner spaces. Downloadable versions can be shared as well.English, Spanish, Other PostElectronic posts on clinic and partner websites, social media, and/or newsletters. English, Spanish, Other AdvertisementAdvertisements and promotions disseminated on websites (banner ads) and through Google ads, dating apps, and other third-party platforms.English, Spanish, Other Electronic Health RecordClinical health record review to find clients with a history of HRSU who meet enrollment guidelines.English, Spanish, Other In Person VisitMost clients may learn about and be enrolled when they come in to seek services. English, Spanish, Other

16. (Below are proposed details about the educational information you will provide clients about HRSU, SBIRT, and HRSU and STI services.)Educational materials offer opportunities for clinicians to provide clients with information about HRSU treatment and care options during STI services, fostering program buy-in and fidelity. Media Type of PublicationLanguages DocumentPrinted and electronic brochures, flyers, and postcards English, Spanish, Other VideoAn educational video English, Spanish, OtherSBIRT Logistics: Educational Materials for Clients

17. SBIRT Logistics: StaffingThe success of SBIRT for HRSU in STI clinical settings depends on staff like you. Clients often worry about their health and other factors exacerbating their HRSU.  Our team ensures clients feel supported throughout the HRSU screening process and, if warranted, a subsequent warm handoff to HRSU treatment. Our team includes: Administrative StaffClinical Staff Peer Navigator Data Management/Evaluation IT Provider/Web Developer Behavioral Health Staff or Partner Staff Roles [Administrative Staff Roles at Your Clinic][Clinical Staff Roles at Your Clinic][Peer Navigators, if applicable][Data Management / Evaluation Staff Roles at Your Clinic][IT Provider/Web Developer Roles at Your Clinic][Behavioral Health Staff Roles at Your Clinic or Partner Roles]Staff Intervention Duties Client ManagementClient Screening, Tracking, and Warm Handoff  Client EducationClient Data Tracking and Intervention EvaluationCreation, integration, and maintenance of SBIRT for HRSU forms, alerts in Electronic Health Record SystemProvides behavioral health services / Accepts referrals from STI clinic for HRSU treatment and care provision and coordination

18. SBIRT Logistics: Electronic Health Record System Our electronic health record system serves as the cornerstone of the SBIRT for HRSU intervention: Smart tags/phrases and pop-ups that serve as reminders about SBIRT and/or clients who may qualify for it.Integrated electronic forms that facilitate and record results of the SBIRT for HRSU screening process, including screening and SBIRT for HRSU results. Information about the results and other resources that clients may access through their customer medical record portal.

19. SBIRT for HRSU: Intervention StepsThe following provides an overview of facilitating SBIRT for HRSU at the clinic. Invite clients who satisfy enrollment requirements to participate in HRSU for SBIRT intervention, noting benefits of addressing HRSU during STI services. Step 1: EngageIf clients say no, provide clients community resources and information about HRSU treatment via the customer medical record portal. In-person clients may receive additional printed materials. If clients say yes, the intervention consent process is conducted. In person, this is done via tablet, and for telemedicine, through an online survey. Step 2: ConsentStep 3: ScreenFacilitate NIDA Quick Screen and (based on score) DAST-10 via tablet (in person) or online electronic survey (telemedicine). Step 4: Review If (-) for HRSU, review maintenance of healthy behaviors.If (+) for HRSU, initiate SBIRT for HRSU process.Discuss with clients their HRSU and options for treatment.Step 5: Discuss Overcome client reticence by asking if HRSU fits with their values, eliciting change talk about HRSU and sexual risk behaviors, motivating change, and making a plan for changes to happen. Step 6: Motivate Step 7: Connect Provide clients who decline HRSU treatment a list of community resources and information about HRSU treatment. Encourage clients to discuss HRSU treatment at a future clinic visit. For clients prepared for HRSU treatment, facilitate a warm handoff to a behavioral therapist. (If an immediate handoff is not possible or this is a telemedicine appointment, facilitate a referral.) Step 8: Evaluate All clients invited to participate are asked to complete an evaluation, which is maintained in their electronic client record. Clinical staff periodically complete intervention evaluations. Results are used to update the process as needed.

20. Q&A Session

21. Follow Up and Contact Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod.Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod.Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod.

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