SBIRT Screening Brief Intervention and Referral to Treatment
SBIRT Screening, Brief Intervention and Referral to Treatment SBIRT Works – Saving Lives, Money and Time with Screening, Brief Intervention and Referral to Treatment in the Emergency Department Presented by Research Into Action – A Knowledge Translation Initiative The University of Texas School of Public Health Institute for Health Policy
SBIRT Screening, Brief Intervention and Referral to Treatment Overview • What is SBIRT? • Why implement SBIRT? • Where do we go from here? • Resources
SBIRT Screening, Brief Intervention and Referral to Treatment What Is SBIRT? • SBIRT is the acronym for Screening, Brief Intervention and Referral to Treatment • SBIRT is designed to identify, intervene and treat people with substance abuse problems
SBIRT Screening, Brief Intervention and Referral to Treatment Why Implement SBIRT? • SBIRT works • SBIRT saves money
SBIRT Screening, Brief Intervention and Referral to Treatment SBIRT Works SBIRT reduces injuries and ED re-admissions SBIRT reduces substance misuse and abuse • Brief interventions as short as 30 minutes significantly reduced problem drinking. Also, a 47 percent reduction in injuries requiring ED or trauma center re-admission at three years. Gentilello, et al. , Alcohol Interventions in a Trauma Center as a Means of Reducing the Risk of Injury Recurrence, Annals of Surgery, 1999 • Collaborative study by NIAAA and SAMHSA indicated that speaking to ED patients about their alcohol consumption reduces hazardous drinking in those patients. Alcohol & Drug Abuse Weekly, January 2008
SBIRT Screening, Brief Intervention and Referral to Treatment SBIRT Works (continued) • Meta-analysis of 21 randomized trials in primary care found that SBIRT recipients reduced alcohol intake by three drinks per week. Results consistent across all trials. Kaner, et al. , Brief Intervention in Primary Care for Alcohol Misuse, International Journal of Epidemiology, 2007
SBIRT Screening, Brief Intervention and Referral to Treatment SBIRT Saves Money • Each $1 spent on screening and brief intervention saves almost $4 in other health care-related costs. Gentilello, et al. , Alcohol Interventions for Trauma Patients Treated in EDs and Hospitals: A Cost-Benefit Analysis, Annals of Surgery, 2005 • In January 2005, Alcohol & Drug Abuse Weekly estimated that emergency rooms and trauma centers could save up to $2 billion by offering brief substance abuse interventions to injured patients.
SBIRT Screening, Brief Intervention and Referral to Treatment Where Do We Go From Here? • Obtaining funding • Overcoming staff resistance • Effective SBIRT training • Navigating the insurance rapids • Picking the right assessment tool
SBIRT Screening, Brief Intervention and Referral to Treatment Obtaining Funding There a number of state and national programs offering funding for SBIRT studies: • Project In. Sight – Austin, Texas – www. insightforhealth. com • SAMHSA funding of SBIRT initiatives – http: //sbirt. samhsa. gov/csat_awards/funding_opps. htm • National Institute on Alcohol Abuse and Alcoholism – Funding Opportunities www. niaaa. nih. gov/researchinformation/extramuralresearch/#funding
SBIRT Screening, Brief Intervention and Referral to Treatment Overcoming Staff Resistance • SBI Toolkit for Healthcare – www. ensuringsolutions. org/resources_list. htm? cat_id=2005 • NIAAA Helping Patients Who Drink Too Much: A Clinician’s Guide – http: //pubs. niaaa. nih. gov/publications/Practitioner/Clinicians. Guide 20 05/clinicians_guide. htm • Emergency Nurses Association SBIRT Toolkit – http: //www. ena. org/ipinstitute/SBIRT/Tool. Kit/Pages/toolkit. aspx
SBIRT Screening, Brief Intervention and Referral to Treatment Effective SBIRT Training • SAMHSA – http: //sbirt. samhsa. gov/tools_resources/curriculum. htm • Boston University – http: //www. bu. edu/act/ • In. Sight Provider Training – http: //www. insightforhealth. com/provider. html
SBIRT Screening, Brief Intervention and Referral to Treatment Effective SBIRT Training (continued) • Experienced trainers in Texas – • Carrie L. Dodrill, Ph. D Veterans Affairs Medical Center Houston, TX Voice: 713 -791 -1414 x 6490 • Mary Marden Velasquez, Ph. D The University of Texas at Austin School of Social Work Austin, TX Phone: (512) 471 -7019 • Kirk von Sternberg, Ph. D The University of Texas at Austin School of Social Work Austin, TX (512) 232 -0633 12
SBIRT Screening, Brief Intervention and Referral to Treatment Navigating the Insurance Rapids • As of April 2004, 38 states (including Texas) still had Uniform Accident and Sickness Policy Provision (UPPL) laws. UPPL repeal successful in several states, American College of Surgeons Cross Country, 2007 • UPPL laws allow insurers to deny coverage when injury is alcohol- or drug-related. • Key informants for our study in Harris County did not cite UPPL as a barrier to treating patients found to be under the influence.
SBIRT Screening, Brief Intervention and Referral to Treatment Navigating the Insurance Rapids (continued) • A 2008 survey shows that 58 percent of U. S. health plans pay for screening and brief intervention, and that the federal government covers 5. 8 million of its workers. Feds cover screening, brief intervention, Nation’s Health, 2008 • With its efficacy proven, current procedural terminology (CPT) codes for SBIRT have been created: -CPT 99408 for 15 -30 minutes SBI -CPT 99409 for > 30 minutes SBI American Medical Association, CPT 2008, Professional Edition, 2008
SBIRT Screening, Brief Intervention and Referral to Treatment Navigating the Insurance Rapids (continued) • Centers for Medicare and Medicaid Services (CMS) also have codes: -Medicare G 0396 SBI >15 minutes G 0397 SBI > 30 minutes -Medicaid H 0049 Screening H 0050 Brief Intervention American Medical Association, HCPCS 2008: Medicare’s National Level II Codes, 2008
SBIRT Screening, Brief Intervention and Referral to Treatment Picking the Right Assessment Tool • A SAMHSA guide reviews five major screening tools: AUDIT, CAGE, CRAFFT, BAC, and the binge drinking question. Alcohol Screening and Brief Intervention for Trauma Patients: Committee on Trauma Quick Guide, Alcoholism & Drug Abuse Weekly, May 2007 • CAGE and AUDIT have emerged as most commonly used screening tools in emergency departments. Vaca & Winn, The Basics of Alcohol Screening, Brief Intervention and Referral to Treatment in the Emergency Department, Western Journal of Emergency Medicine, 2007
SBIRT Screening, Brief Intervention and Referral to Treatment More Resources • Funding: -National Institute on Drug Abuse www. nida. nih. gov/researchers. html -Texas Department of State Health Services http: //www. dshs. state. tx. us/fic/default. shtm -Project Mainstream www. projectmainstream. net/projectmainstream. asp? cid= 82
SBIRT Screening, Brief Intervention and Referral to Treatment More Resources (continued) • Training: -Community Health Association of Mountain and Plain States http: //www. champsonline. org/events/Distance_Libra ry. asp#Vol 15 -18 -Society for Academic Emergency Medicine http: //www. saem. org/saemdnn/Home/Communities/ Interest. Groups/Public. Health/tabid/136/Default. aspx
SBIRT Screening, Brief Intervention and Referral to Treatment You Can Start Your SBIRT Program Now! • Research Into Action has prepared an all-inclusive resource guide. • You can start setting up your SBIRT program TODAY. 19
SBIRT Screening, Brief Intervention and Referral to Treatment This program was produced and distributed by Research Into Action – A Knowledge Translation Initiative The University of Texas School of Public Health Institute for Health Policy For more information about Research Into Action and the subject of knowledge translation, visit our Web site, www. ktexchange. org, or contact us at Researchintoaction@uth. tmc. edu
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