Culturally Competent SBIRT:
An Evidence-Informed
Clinical Case Study
Khanh Ly, BS
Derek Satre, PhD
Jennifer Manuel, PhD
Sandra Larios, PhD
Scott Steiger, MD
*Jason Satterfield, PhD
University of California
San Francisco
Roadmap
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SBIRT overview: Summary of
recommendations
Literature review: Cultural Competence
Notions of “competence”
Clinical case presentation
u Illustrations of adaptations
Funding: SAMHSA/CSAT grant #1U79TI025404-01
awarded to Dr. Satterfield
No Conflicts of Interest to Report
Learning Objectives
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To understand how cultural
considerations can impact SBIRT
delivery in primary care.
To illustrate specific SBIRT adaptations
to better serve diverse patients.
To explore cultural factors such as
family and community values that may
influence motivation to reduce
substance use.
SBIRT Recommendations
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USPSTF recommends annual, universal
screening for alcohol in adult primary
care (Whitlock et al., 2004)
Positive screen followed by more in
depth assessment for severity and
possible diagnosis
Brief intervention and/or referral to
treatment with scheduled F/U
SBIRT and Diverse
Patients?
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Screening: n=13 studies
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Language, literacy
Stigma, privacy, power
AUDIT has broad support, available in the
most languages
F Sensitivity remains high but specificity is
lowered especially some Chinese
translations
ASSIST – internationally developed (WHO)
SBIRT and Diverse
Patients?
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BI: n=8 studies (usually 1-2 brief discussions)
u Motiv Interviewing (or MI “spirit”) most
commonly used.
F Meta-analysis: Hettema et al., 2005
u BNI – ED settings (e.g. Bernstein;
D’Onofrio)
F + results for cocaine, opioids, alcohol
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+/- for PC illicit drugs (Saitz, Roy-Bryne,
Gelberg)
Culture, Social and
Structural Contexts
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Culture Characteristics
u Language, beliefs, customs, food, music,
communication style, health practices
Education
u Literacy, health literacy
Geography, neighborhoods
Resources, “structures” that influence the
experience of health, illness, and health
interventions
Notions of “Competence”
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Early approaches to cultural
competence
u The checklist approach
Middle approaches
u General skills
Current approaches
u Structural competence (Hansen)
u Critical consciousness (Lypson)
Clinical Case: Ronaldo
(Satre et al., 2015)
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47yo married man seeing PCP
HPI: Back pain after alcohol-related fall
Soc Hx: Born in Honduras, bilingual, HS
education + trade school, 2 adult daughters,
social pressure to drink
Screening and Assessment
u AUDIT = 17 (at risk/hazardous)
u Motiv Interviewing, DSM Dx = SUD, mild?
SUD and Tx Epidemiology
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Some studies suggest substance use
disorders are over-represented in Latino
men (SAMHSA, 2013)
SUD treatment is underutilized(by
everyone) but especially by racial and
ethnic minorities (Cook & Alegria, 2011)
Hispanic men have more problems
related to alcohol compared to whites
(Caetano, 2003)
Notions to keep in mind
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First – language and literacy
Second – power, trust, respect
Third – culturally tied considerations
u familismo
u espiritismo
u machismo
u respeto
Clinical Case Conclusion
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What did Ronaldo’s PCP do?
She assessed acculturation and patient
preferences re interview language and
style.
She used familismo, respeto, and
machismo to facilitate discussion of
material and build motivation
Negotiated a reduction in drinking and
approach to managing pain
Culturally “Competent”
SBIRT?
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Cultural and structural sensitivity seem
achievable for screening and BI
There are few studies on exactly how to
adapt/improve interventions
Better attention to cultural and structural
factors may be a missing “active
ingredient” for BI’s
Thank You
Jason.Satterfield@ucsf.edu
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UCSF Collaborative
Education Project
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Kathy Julian
Sandra Larios
Khanh Ly
Jennifer Manuel
Ellie McCance-Katz
Gina Moreno-John
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Pat O’Sullivan
Derek Satre
Scott Steiger
Janice Tsoh
Maria Wamsley
Patrick Yuan