SUMMARY REPORT
MEETING 36
Date:
Time:
Location:
Hosts:
Wednesday, July 23, 2014
11:00AM – 12:00PM
Conference Call
UCLA Integrated Substance Abuse Programs (ISAP) & the
California Department of Health Care Services (DHCS)
Topic:
Presenter:
Brief Treatment Toolkit for Primary Care
Adam Brooks, PhD
Research Scientist
Treatment Research Institute
Logistics
 Summary and materials discussed from the previous ILC meetings are
available at http://www.uclaisap.org/integration/html/learningcollaborative/index.html. Subsequent meeting materials will continue to be
posted on this site.
 The next ILC meeting will be held on August 27, 2014 from 11:00 AM to
12:00 PM. All further meetings are scheduled to be held at 11:00 AM (PT)
on the 4th Wednesday of every month, unless otherwise noted.
ILC Meeting 36 Topic:
Brief Treatment Toolkit for Primary Care
Topic Introduction – Brandy Oeser, MPH UCLA ISAP
 Today’s learning collaborative focuses on a brief treatment toolkit
developed by the Treatment Research Institute (TRI) for addressing
substance use disorders in primary care. Our presenter Adam Brooks,
PhD is a Research Scientist at TRI. His research interests include
computer-assisted treatment and training interventions, use of phone
technology in treatment and recovery monitoring, and workforce
development in the use of evidence-based practices.
Dr. Brooks will discuss development and testing of the toolkit, and will
share information on a patient health education support tool that can also
be provided in primary care. He will furthermore discuss initial
implementation results and engagement rates from a study using the brief
treatment toolkit.
Adam Brooks, PhD
Treatment Research Institute
Summary

Acknowledgements and Disclosure
o This project has been a collaboration of TRI, a nonprofit organization for
addiction research and dissemination, and partners at FQHCs and
universities. Project funding was provided by the Pennsylvania
Department of Health.
o Two products from TRI are discussed in today’s presentation: the SBIRT
Toolkit and the Keep it Moving™ Graphic Novel. Proceeds from the
dissemination of TRI’s products help to support future research projects.

Introduction
o Study Rationale
 Screening, brief intervention, and referral to treatment (SBIRT) is a
method of screening patients for risky or harmful substance use in
primary care, in order to help address the many health problems that
can be associated with substance use
 SBIRT has demonstrated efficacy when delivered to individuals with
alcohol use disorders and patients in primary care, but the evidence for
other substances is more mixed. The literature suggests that these
individuals may require more intensive interventions to benefit from
SBIRT
 The purpose of this study was to test the use of SBIRT for drug use
problems, comparing “classic” single-session SBIRT with a more
intensive on-site treatment approach. The intensive on-site treatment
approach had to be flexible to suit the needs of the setting, providers
and patients; and needed to be user-friendly for clinicians and patients
 To facilitate implementation, researchers developed a toolkit to assist
in patient communication, and guided clinicians to deliver the
intervention with fidelity
o What is SBIRT+?
 SBIRT+ (“SBIRT plus”) is a more intensive SBIRT intervention,
consisting of 2-6 sessions, with the number of sessions varying based
on a client’s specific needs
 SBIRT+ is based on motivational enhancement therapy (MET)
techniques, with the addition of other evidence-based strategies as
needed, including relapse prevention/cognitive behavioral therapy and
12-step facilitation
 The goal is to help patients reduce their substance use and provide
referrals for patients with more severe needs to access specialty care
treatment
 Ongoing follow-up to patients is provided by telephone
o Research Questions
 Is one brief-intervention session enough?
 Will drug-users return for additional sessions?
 Is expanded brief intervention (SBIRT+) more cost-effective than
traditional SBIRT?
o Study Design
 The plan was to screen 5,000 patients at 3 Philadelphia FQHC clinics
for AOD use, identifying at least 1,000 harmful users. From this group,
about 600 would be approached, consent to participate in the study,
and be randomized to the two study groups: SBIRT and SBIRT+.
 All participants are assessed at 3, 6, 9, and 12 months for follow-up
o Intervention Content
 Motivational Enhancement Therapy (MAT) consists of 2 40-minute
sessions to negotiate and develop a realistic change plan with the
patient, and further follow-up sessions to examine progress, renew
motivation, and redo commitment
 For primary care, the intervention was adjusted to 30 minutes for at
least the first two sessions
 Clinicians can also use CBT techniques such as functional
analysis, helping patients to manage feelings and stress, and
coping with withdrawal; 12-step facilitation techniques; and referral
to further treatment if needed
 Clinicians check in on a monthly basis with SBIRT+ patients in person
or by phone and use a 10-item questionnaire to evaluate progress

Tools for Brief Intervention and Patient Education
o Why a toolkit?
 Improved fidelity and retention when counselors are trained and
equipped with a Toolkit
 Provides a cost-effective dissemination approach
 Improved counselor and patient satisfaction
 Tailor interventions to primary care
 Broaden use of interventions beyond substances (health habit
change)
 Multimedia materials provide a chance to influence what patients
receive beyond the scope of this study
 Make lasting impact in equipping behavioral health clinicians to
integrate brief treatment in primary care
o The SBIRT+ Toolkit
 Consists of 35 brief tools in the form of client take-away cards and
Quick Guides to help clinicians understand how to use each of the
cards (refer to the PPT listed in Appendix 2 for samples of the tools)
 Options are provided for 15-minute interventions and 5-minute
interventions, depending on the amount of time available to clinicians

Activities are printed on the cards allowing patients to interact with the
information
o Graphic Novel/Activity Book: Keep it Moving™: A Guide to Breaking Habits
 A useful health education tool to provide to patients who may not come
back for additional sessions or who are already motivated to change
and need information for how to do so
 Book is guided by theory: exercises are integrated into the storyline,
serves as a workbook, and is engaging and culturally sensitive
 Format is low-cost, revisable, scalable, and available in text or digital

Preliminary Results
o Screening and Enrollment Rates
 Across sites, 10,456 patients received the initial screener, 3,237 were
flagged for drug/alcohol use, and 563 were ultimately enrolled in the
study and randomized into an intervention group
o Participant Characteristics
 The average age of participants was about 40 years; 45% were
female; 81% were Black, 7% White, 12% Other, and 8% Hispanic
 Majority of participants were not employed (70%); 14% were homeless
 About 1/3 of participants in either condition reported alcohol as their
primary substance; 1/3 reported marijuana, and 1/3 reported other illicit
substances
 Among participants reporting other substances as their primary
substance, cocaine was most frequently reported
o Participant Engagement with Intervention
 Overall, participants were satisfied with the intervention. They felt it
was helpful to be asked about AOD at the health center and reported
being comfortable discussing their AOD use
 The intervention had high engagement, with majority of participants
attending at least the first three brief treatment sessions
 Referrals were more challenging:
 About 60% of participants reported receiving a referral for specialty
services, but of those, 60% reported that they did not receive any
services
 About 20% of participants reported entering treatment

Conclusion
o Summary and Future Plans
 FQHC patients with substance use disorders will return for brief
treatment visits focused on harm reduction / abstinence
 Patients reported significant comfort and acceptability of screening and
brief treatment in primary care
 Despite efforts to increase specialty care treatment entry, actual
engagement rates remained low


Future reporting will analyze differences in outcomes between SBIRT /
SBIRT+ patients on substance use and medical health variables
Discussion: Q&A
o What was the licensure of behavioral health clinicians in the study?
 The clinics in this study already had 1 licensed clinical social worker
(LCSW) on staff at each site, and the research grant provided funding
to support an additional licensed behavioral health clinician at each
clinic (2 LCSWs and 1 licensed psychologist).
o Did clinicians conduct their own telephone follow-up calls?
 Clinicians conducted their own follow-up calls, both for administering
the RecoveryTrack™ questionnaire and reminding participants to
come back for additional sessions.
o What indicators did you use to identify patients with more severe
problems in need of specialized treatment?
 Participants with severe use scores according to the DAST and AUDIT
guidelines were considered to need specialty treatment. Those with
moderate scores were given brief treatment first and then referred to
specialty treatment if they needed further care.
o What ideas do you have for the future of ways to increase patients’
receptivity to treatment?
 Being a research study, the protocol was somewhat standardized. The
treatment period was set at 3 months and no more SBIRT+ sessions
were allowed after that time. However, tailoring it more to patients’
individual needs may have helped with engagement. An example
would be to allow patients to return if they want to continue treatment
outside the 3-month period, e.g., if they leave treatment and then
change their minds and want to come back. Other options might
include MAT and providing more on-site support through a substance
use counselor.
 For greater success referring patients outside to other outpatient
settings or to specialty care, it requires the clinics to negotiate and
build relationships with treatment programs so that they can check up
on referrals and make sure they’re completed. One of the clinics in the
study actively worked with the specialty treatment centers and was
able to increase the success of its outside referrals.
o Are there plans for future studies using certified substance use staff
to conduct SBIRT+ in primary care?
 For this study, we used licensed staff for billing purposes, but including
SU counselors and peer specialists would be a good idea for the
future. A team approach using SU counselors and peer specialists
could especially help in providing social support to patients and
modeling behavioral strategies and techniques.
o Do you think an integrated approach, with both counselors and
individuals licensed to use MAT, would help to support patients with
both their psychosocial issues as well as their medical conditions?
 Yes – the more options for treatment that are available to patients in
primary care, the better it is for patients. Many of them are dealing with
a variety of life issues that make them difficult to go other places for
specialty care. Patients will return for treatment if it is provided in
primary care, and they appreciate having options such as being able to
see their counselor or receive SUD medications in primary care.
o Is the toolkit currently available anywhere?
 TRI is currently developing the toolkit as a marketable package. It will
be made available for purchase in the near future.
o Did you collect any data on co-occurring mental health disorders
with SUD? If so, were these patients provided tailored treatment?
 Yes – one of the measures included in the study was the Addiction
Severity Index (ASI), which includes some items addressing mental
health. The clinicians seeing each patient were also providing case
management and therefore would be trying to address the patients’
MH needs or providing referrals for community MH treatment, because
that will help with the goal of reducing the patients’ substance use.
o When will further results be ready?
 We have a mailing list to keep people updated on the results from the
study and further development of the toolkit. If you are interested, send
me your e-mail address and I can add you to the list.
APPENDIX 1 – ATTENDEES
COUNTY PARTICIPANTS




Los Angeles (Donna Lee-Liu, Wayne Sugita)
San Bernardino (Dianne Sceranka)
Tuolumne (David LaMirada)
Plumas (Liz)
PROVIDERS & OTHER PARTICIPANTS







Adam Brooks – Presenter, Treatment Research Institute
Dr. Debra – The Center for Adolescent Addiction Recovery
Andrea Cook – UCSF/San Francisco General Hospital
David DeMille – New Directions
Norma Mtume
Simone
Jason R.
DHCS Participants
 Craig Chaffee
UCLA Participants




Valerie Pearce Antonini
Brandy Oeser
Elise Tran
Beth Rutkowski
*Please note that this list may be incomplete and is for reference purposes only.
APPENDIX 2 – Agenda and Relevant Materials



Introductions
 Adam Brooks, PhD (Treatment Research Institute)
Topic Discussion – Brief Treatment Toolkit for Primary Care
Question and Answer
MATERIALS FOR THIS MEETING

PPT Presentation – Brief Treatment Toolkit for Primary Care
RELEVANT LINKS


Treatment Research Institute Website
http://www.tresearch.org/
Other Brief Intervention Resources – SAMHSA-HRSA Center
for Integrated Health Solutions
http://www.integration.samhsa.gov/clinical-practice/sbirt/briefinterventions
Copies of materials can be found at UCLA ISAP’s Integration Website:
http://www.uclaisap.org/integration/html/learning-collaborative/index.html.