Angela McClellan, OCPS I
Director
Coalition for a Drug-Free Mahoning County
September 5, 2013

http://pointsadhsblog.wordpress.com/2013/05/20/9832/

 Source: http://www.jmir.org/2010/5/e60/ , http://captus.samhsa.gov/prevention-practice/prevention-and-behavioral-health/behavioralhealth-lens-prevention/3

 Problem Identification and Referral is an AOD prevention strategy that refers to intervention oriented prevention services that primarily targets indicated populations to address the earliest indications of an AOD problem. Services by this strategy focus on preventing the progression of the problem.
 This strategy does not include clinical assessment and/or treatment for substance abuse and dependence.
Source: Ohio Department of Mental Health and Addiction Services Prevention Continuum of Care Taxonomy

 Interventions that directly serve the customer and allow for two-way interaction at that instance.







Intervention, Brief Screening and Referral Services
Drug-Free Workplace Programs/EAP
Programs
Student Assistance Program Services
Support Groups
Consumer Advocacy and Linkage
Risk Reduction Activities
Source: Ohio Department of Mental Health and Addiction Services Prevention Continuum of Care Taxonomy

Abstinence Responsible Use
Dependence
Source: Jim Aiello, MA, Med, Institute for Research, Education and Training in Addictions (IRETA), (www.ireta.org)
6

Source: Jim Aiello, MA, Med, Institute for Research, Education and Training in Addictions (IRETA), (www.ireta.org)
7

Source: Jim Aiello, MA, Med, Institute for Research, Education and Training in Addictions (IRETA), (www.ireta.org)
8

Abstinence
Experimental
Use
Social
Use
Binge
Use
Abuse
Dependence
Source: Jim Aiello, MA, Med, Institute for Research, Education and Training in Addictions (IRETA), (www.ireta.org) 9

Dependent
4 %
Brief Intervention and Referral for additional
Services
25%
Low Risk or
Abstinence
No Intervention; screening and feedback only 71%
Drinking Behavior Intervention Need
Source: Jim Aiello, MA, Med, Institute for Research, Education and Training in Addictions (IRETA), (www.ireta.org)
10

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.
Source: http://www.samhsa.gov/prevention/sbirt/

 SBIRT is a tool to detect risky or hazardous substance use before the onset of abuse or dependence, early intervention, and treatment for people who have problematic or hazardous
[alcohol] problems .
http://www.samhsa.gov/prevention/sbirt/SBIRTwhitepaper.pdf

 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
.
Source: http://www.samhsa.gov/prevention/sbirt/

2.
3.
4.
1.
5.
6.
It is brief (e.g., typically about 5-10 minutes for brief interventions; about 5 to 12 sessions for brief treatments).
The screening is universal.
One or more specific behaviors are targeted.
The services occur in a public health or other non-substance abuse treatment setting.
It is comprehensive (comprised of screening, brief intervention/treatment, and referral to treatment).
Strong research or experiential evidence supports the model’s effectiveness.
http://www.samhsa.gov/prevention/sbirt/SBIRTwhitepaper.pdf

EFFECTIVENESS OF SBIRT AND ITS COMPONENTS FOR BEHAVIORAL HEALTH CONDITIONS
Alcohol Misuse/Abuse
Illicit Drug
Misuse/Abuse
Tobacco Use
Screening
√
√
√
Brief
Intervention ¹
√
*
√
Brief
Treatment ²
√
*
√
Referral to
Treatment
√
√
√
Evidence for
Effectiveness of
SBIRT
Comprehensive
SBIRT effective
(Category B classification,
USPSTF)
Growing but inconsistent evidence
Effective brief approach consistent with SBIRT (USPSTF;
2008 U.S. Public
Health Service (PHS)
Clinical Practice
Guideline
No evidence to date for depression Depression
√ - √
Trauma/Anxiety
Key:
Disorders
√ * -
√
Evidence for effectiveness/utility of component
* Component Demonstrative to show Promising Results
Not Demonstrated and/or Not Utilized
√
√
No evidence to date for trauma/anxiety disorders
¹Brief intervention as defined by the SAMHSA SBIRT program involved 1-5 sessions lasting 5 minutes to an hour.
Among SBIRT grantees funded by SAMHSA, about 15% of patients receive scores that indicate a brief intervention.
²Brief treatment as part of SBIRT involves 5-12 sessions, lasting up to an hour. Amount State SBIRT grantees funded by SAMHSA, about 3% of patients receive a score that dictates a brief treatment.

AUDIT
AUDIT-C
DAST
ASSIST
Alcohol Use Disorders identification Test
Alcohol Use Disorders Identification Test - Consumption
Drug Abuse Screening Test
Alcohol, Smoking, Substance, Involvement, Screening Test
CAGE Cut Down, Annoyed, Guilty, Eye Opener
* Also Single Question Method has been found to be effective.

 The SBIRT approach is easy to learn relative to other behavioral treatment techniques
 It can be implemented by diverse health professionals, e.g.
Physicians, Nurses, Social Workers, Health Educators,
Prevention Specialists, Paraprofessionals, etc.

 The goal is to provide a quick hand off to specialty treatment if the
Primary Care site cannot provide more intensive service.
 Close tracking to confirm patient compliance with treatment is critical to good health care provision.

Screening
Low Risk
Moderate
Risk
No Further
Intervention
Brief
Intervention
Moderate to
High Risk
Severe Risk to
Dependency
Brief
Intervention
Referral to
Specialty
Treatment

Doug Wentz, M.A., O.C.P.S. II
Community Services Director

 Federally Qualified Healthcare Center
 Began SBIRT with patients at one site in Youngstown, OH. (Five other sites in region serve as control group).
 Social Worker/Prevention Specialist (former CDCA) to screen
 Preliminary results:
 99% of clients voluntarily participate in the screening
 70% of 1-Question screens are positive for AOD or depression
 Diagnostic rates more than doubled (vs. increase of 1.6% at control location)

Law Enforcement
Senior Citizens
Families
Service Organizations
 We have the Know How!
 Coalitions have connections in all twelve sectors
 “New” definition of problem has been our definition all along
Medical Services
Government
Social Services
Youth
Faith Community
Media
Education Businesses

 Information Dissemination
 Training
 Networking
 Bringing new faces to the table
 Grants and other Funding
 Training Revenue

 How do we pay for this?
 No, seriously, how do we pay for this?
 So what, this isn’t our target substance?
 Have you ever tried to get doctors to attend anything?
<<sarcasm font>>
 How can we/our collaborative partners get paid for this?
 How do we get trained to be trainers?
 Where can I find resources?

 www.ireta.org
 www.attcnetwork.org/sbirt
 www.sbirtonline.org
 www.niaa.nih.gov
 www.HealthTeamWorks.org
 www.drugabuse.gov
 www.samhsa.gov/prevention/sb irt
 Angela McClellan, OCPS I
Director
Coalition for a Drug-Free Mahoning County
Angela@DrugFreeMahoningCounty.org
(ofc) 330.953.3212
(cell) 330.771.7732
 Doug Wentz, MA, OCPS II
Community Services Director
Neil Kennedy Recovery Clinic
Douglas.Wentz@GatewayRehab.org
(ofc) 330.792.4724 x 7128
(cell) 330.509.3650