Back To Basics: The 3 Fundamentals That Everyone Always Forgets About SBIRT

What Is SBIRT?

The Substance Abuse and Mental Health Services Administration (SAMHSA) definition of Screening, Brief Intervention, and Referral to Treatment (SBIRT) states that:

“…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. 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.”

Three fundamentals to remember about SBIRT are:

• “Screening quickly assesses the severity of substance use and identifies the appropriate level of treatment.
• Brief intervention focuses on increasing insight and awareness regarding substance use and motivation toward behavioral change.
• Referral to treatment provides those identified as needing more extensive treatment with access to specialty care” (SAMHSA, 2021).

SBIRT is an extremely useful tool for healthcare and behavioral health providers for a variety of populations, such as college and university students, adolescents, employees in employee assistance programs, people in mental health disorder treatment programs, Hispanic/Latino populations, active military and veterans, and women during pregnancy. The usefulness of SBIRT is partly due to the fact that it exists as a “pivot point” between “treatment” and “prevention”,” dividing awareness and prevention activities from treatment, recovery, and maintenance activities on the Institute of Medicine (IOM) Continuum of Care, as shown below. As such, it helps in the decision-making process to help determine the appropriateness of either ongoing prevention services or entering into treatment services.

How Does SBIRT Work?

The process for implementing SBIRT is stated in the full name of the intervention: Screening, Brief Intervention, and Referral to Treatment. The screening part of the process uses brief, validated, and universal prescreening/screening tools. Patients are identified as being in one of four categories: No or Low Risk, Moderate Risk, Moderate to High Risk, or Severe Risk, Dependence. Those identified as having No or Low Risk receive no further intervention. Those identified as having Moderate Risk receive a brief intervention. Those identified as having Moderate to High Risk receive a brief treatment either onsite or through referral. Those identified as being at Severe Risk to Dependence are referred to specialty treatment.

Previous treatment modalities have focused on people diagnosed with a SUD as outlined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). SBIRT is a modality that provides services at all points of the IOM Continuum of Care, meeting the needs of those not yet diagnosed or who do not yet meet the full criteria for a SUD. Interventions can be applied at earlier-and less severe- levels of severity. One of the strengths of SBIRT is that it can also be used to intervene and prevent further development of a SUD (SAMHSA, 2013). The method screens all patients and allows healthcare professional to offer services even without an identified disorder and even when a patient is not seeking treatment. The six characteristics identified by SAMHSA include:

1. It is brief – initial screening takes about 5-10 minutes.
2. The screening is universal – as part of the intake process, all members of the target population are screened.
3. Specific behaviors are addressed – the focus is on problem behaviors that are preconditional to substance use or dependence.
4. Services are provided in public health, medical, or other settings outside of treatment settings – these may include the emergency room, office of a primary care physician, or school setting.
5. The process is comprehensive – The transition from the brief screening to brief intervention and referral to specialized SUD treatment is part of a continuous process.
6. The model is strongly supported by research – program outcomes are successful according to the evidence base.

Although initially successful for Alcohol Use Disorder (AUD) the research base of applications to the treatment of other drugs continues to grow (SAMHSA, 2013). SBIRT screens many more people than previous modalities, and the cost is lower for both the patient and society. This allows more people to be treated at the level needed to reduce some of the many costly medical conditions that are associated with people with SUDs, reducing the suffering and societal cost (SAMHSA, 2013).

Enhance Your SBIRT Skills During Your Lunch Break!

An important – and free – training is being offered by the National Frontier and Rural Telehealth Education Center NFAR tec starting on June 22, 2021 @ 12:00 pm – 1:30 pm. This virtual event is actually a series of 6 real time educational sessions that will be held every Tuesday from May 25 – July 6, 2021, from 12:00 p.m. -1:30 p.m. (PT). The training details are as follows:

CASAT Adopt SBIRT Project | Workwise

866-617-2816 (toll-free)

Preparing Your Health Center For SBIRT Implementation (SBIRT-IP)

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is designed to provide universal screening, prevention, and early intervention and treatment within health care settings for people who have risky or hazardous alcohol and/or drug use. This extended online learning series will provide 16 hours of instruction for healthcare providers establishing or currently implementing SBIRT in their agency. Through virtual, interactive learning, participants will receive real-time performance feedback related to their current use and implementation strategies of SBIRT with an emphasis on integrating brief interventions into current services and workflow.  This is not a webinar series and active participation to gain/improve skills are required.

Objectives:

• Learn foundational knowledge on core aspects essential to SBIRT
• Identify drug and alcohol screening tools for use in general, pregnant, or adolescent populations in a health care setting.
• Demonstrate a brief intervention utilizing the FLO algorithm.
• Understand and utilize a warm handoff to facilitate referral for high risk substance use behavior.
• Identify at least two implementation strategies towards integration that could be used in a health care setting.
• Discuss sustainability of SBIRT in a Health Care setting.
• Identify the signs of compassion fatigue in the workplace.

This Training is Intended for the Following Audience:

Community Health Workers, Medical Assistants, Nurses and Behavioral Health Providers located in Nevada. Currently using SBIRT or in the process of implementing SBIRT in a healthcare setting.

Participant Commitment & Expectations:

• Access to appropriate technology to utilize Zoom videoconferencing platform (internet connection, webcam, laptop/tablet, speakers and microphone)
• Attend a one-hour online Orientation on May 25, 2021 at 12:00 pm
• Commit to 6-weeks of online training for 1.5 hours weekly from June 1 – July 6, 2021
• Complete weekly self-study learning activities

Trainer/Facilitator:

Christina Boyd, LSCSW, LCAC

There is No Cost to Participate:

The first 35 registrants will receive a waiver that covers the entire $350 cost of participation. Due to limited enrollment, if you cannot commit to the full participant requirements, please defer this registration opportunity to others.

Please Note:

Registrants enrolled in this series are expected to attend all sessions. In addition, it is expected that participants will have access to the appropriate technology by April 7th in order to fully participate and be on camera at least 90% of the time. This is not a webinar series and active participation to gain/improve skills are required.

Continuing Education:

This series has been approved for a total of 16 contact hours (includes 9 hours of instruction, 6 hours of assignments, and 1 hour for the Orientation Session) through the following professional associations: NEVADA – Nevada Board of Examiners for Alcohol, Drug & Gambling Counselors; Nevada State Board of Nursing; Board of Examiners for Marriage and Family Therapists and Clinical Professional Counselors; State of Nevada Board of Examiners for Social Workers. NATIONAL – National Association for Addiction Professionals (NAADAC), International Certification & Reciprocity Consortium (IC&RC), and the National Board for Certified Counselors (NBCC) ACEP No. 6492. No credit will be awarded for non-attendance or partial attendance. The knowledge and skills learned should be applied within the framework of any applicable Operating and/or Credentialing regulations in your State of practice.

Questions:

Please contact the Workwise Staff at workwise@casat.org or by phone at 775-784-6265 or 866-617-2816 (toll-free), or Click to Register ( Email;  Event website ).

Resources from SAMHSA:

• Alcohol Misuse: Screening and Behavioral Counseling Interventions in Primary Care from the U.S. Preventive Services Task Force – 2013 recommends “screening and behavioral counseling interventions in primary care to reduce alcohol misuse.”
• Alcohol Screening and Brief Intervention for Youth – A Practitioner’s Guide from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) is designed to help health care professionals quickly identify youth at risk for alcohol-related problems.
• Clinicians Guide to Online Training from the National Institute on Alcohol Abuse and Alcoholism is an online interactive, 10-minute video course.
• Preventative Health Services for Adults within the Affordable Care Act includes Alcohol Misuse Screening and Counseling for Adults.
• TAP 33: Systems-Level Implementation of Screening, Brief Intervention, and Referral to Treatment (SBIRT) – 2013 describes core elements of SBIRT programs for people with or at risk for substance use disorders.
• The Clinician’s Screening Tool for Drug Use in General Medical Settings from the National Institute for Drug Abuse (NIDA) guides clinicians through a series of questions to identify risky substance use in their adult patients.
• Vital Signs: Communication Between Health Professionals and Their Patients About Alcohol Use — 44 States and the District of Columbia, 2011 from the Centers for Disease Control and Prevention reports on the number of patients discussing alcohol consumption with a health professional.
• White Paper on Screening, Brief Intervention and Referral to Treatment (SBIRT) in Behavioral Healthcare – 2011 (PDF | 204 KB) report discusses the evidence supporting the effectiveness of SBIRT.

Additional resource materials can be found in the CASAT OnDemand Resources & Downloads page.

References

About Screening, Brief Intervention, and Referral to Treatment (SBIRT). SAMHSA. (n.d.). https://www.samhsa.gov/sbirt/about.

Substance Abuse and Mental Health Services Administration. Systems-Level Implementation of Screening, Brief Intervention, and Referral to Treatment. Technical Assistance Publication (TAP) Series 33. HHS Publication No. (SMA) 13-4741. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013.

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