THE SBIRT MODEL JARED FERGUSON MSW LCSW Clinical
THE SBIRT MODEL JARED FERGUSON, MSW, LCSW Clinical Director, First Step House Utah State Designated Examiner General Helping Professional
WHAT IS SBIRT • “SBIRT is a comprehensive, integrated, public health approach to the delivery of early intervention and treatment services for persons with substance use disorders, as well as those who are at risk of developing these disorders. ” –SAMHSA, 2016
THE PURPOSE OF SBIRT • SBIRT Provides “primary care centers, hospital emergency rooms, trauma centers, and other community settings provide opportunities for early intervention with at-risk substance users before more severe consequences occur. ” –SAMHSA, 2016
WHY DO SBIRT? • It works! • SBIRT has screened 1. 5 million people since 2003 • Addressing screening results head-on has resulted in: • 40% reduction in drinking by drinkers at high-risk levels • 55% reduction in negative social consequences -2003 -2011 GPRA Data
WHO IS AT RISK FOR SUBSTANCE USE PROBLEMS? Under the right circumstances, Everyone is at risk
GRADES OF SUBSTANCE USE PROBLEMS Use Abuse Dependence
BUT WE DON’T HAVE THESE PROBLEMS IN UTAH! Au Contraire! • From 2011 to 2015, Utah ranked 4 th in the US for drug poisoning deaths 1 • Utah is ranked 8 th in the nation in overdose fatalities (16. 9 per 100, 000)2 • 1 in 20 (87, 184)people in Utah are in need of substance use treatment 3
SBIRT COMPONENTS
SBIRT IS 3 PARTS • Screening • Brief Intervention • Referral to Treatment
SCREENING
SCREENING DEFINED • “A quick and simple method of identifying patients who use substances at at-risk levels, as well as those who are already experiencing substance use-related issues. ” –SAMHSA, 2016
WHY SCREEN? • Finding conditions or diseases before they become problematic • Post-screening treatment is often less invasive and less expensive • Screens may provide an opportunity to educate patients and their families
THE IMPORTANCE OF SCREENING • We can only fix the problems we know exist, but if it’s not broke, don’t fix it • Allows for targeted interventions • More accurate application of treatment • Determining risk of patient to themselves and others • Helps providers know how to converse with a patient
BARRIERS TO SCREENING • Increased intake time • Being unsure of what to do if one learns a patient has a substance use disorder • Patient or staff resistance • Historical inaccuracy and impaired recall of patient • Reluctance to self-report, knowing that information could be shared with treatment • Sharing personal information in a less-private setting
YOUR EXPERIENCE WITH SCREENS • Have any of you worked in a setting where you used a validated tool? If so, please share.
VALIDATED SCREENING TOOLS • ASSIST/NIDA-Modified ASSIST: Alcohol, Smoking, and Substance Abuse Involvement Screening Test (interview, 8 questions, rating scales) • AUDIT: Alcohol Use Disorder Identification Test (self-administered, 10 Questions) • DAST: Drug Abuse Screening Test (self-administered, 10 Questions) • TCU-DS: Texas Christian University Drug Screen (self-administerd, 17 Questions)
AUDIT
SO, YOU HAVE A POSITIVE SCREEN • 25% of all screens will be positive Positive Screen Low/Mod Risk: Brief Intervention Mod/High Risk: Referral to Treatment
JUST A LITTLE PUSH • You are a trusted professional and CAN make a difference • 40% of smokers are considering quitting • 20% of smokers are planning to quit • Patients are often aware of their problems
ROLE PLAY
REFERRALS TO TREATMENT
REFERRAL RESOURCES • Nation-wide • https: //findtreatment. samhsa. gov/ • State-wide • http: //dsamh. utah. gov/substance-use-disorders/ • County-wide • http: //slco. org/behavioral-health/community/treatment-services/
THE 5 A’S • ASK every patient whether she/he uses tobacco, alcohol, or drugs • ADVISE users about the risk of substance use and benefits of a tobacco-free lifestyle • ASSESS willingness to make a quit attempt • ASSIST them in quitting • ARRANGE for follow-up
SBIRT IMPLEMENTATION RESOURCES • http: //www. integration. samhsa. gov/clinical-practice/sbirt • “Challenges and Opportunities for Integrating Preventive Substance-Use-Care Services in Primary Care through the Affordable Care Act” (Available on Psyc. INFO and Pub. Med. gov)
THANK YOU! Jared Ferguson, MSW, LCSW jaredf@gmail. com 801˖ 232˖ 3499
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