SBIRT SBIRT IS CARRIED OUT AT: PRIMARY CARE CENTERS, HOSPITALS, AND OTHER COMMUNITY SETTINGS.

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2 WHO IS SAMHSA? THE SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION (SAMHSA) IS THE AGENCY WITHIN THE U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES THAT LEADS PUBLIC HEALTH EFFORTS TO ADVANCE THE BEHAVIORAL HEALTH OF THE NATION. SAMHSA'S MISSION IS TO REDUCE THE IMPACT OF SUBSTANCE ABUSE AND MENTAL ILLNESS ON AMERICA'S COMMUNITIES.

3 SBIRT SCREENING, BRIEF INTERVENTION, AND REFERRAL TO TREATMENT (SBIRT) IS A COMPREHENSIVE, INTEGRATED, PUBLIC HEALTH APPROACH TO THE DELIVERY OF EARLY INTERVENTION AND TREATMENT SERVICES. 1. PERSONS WITH SUBSTANCE USE DISORDERS 2. THOSE WHOSE USE ARE AT HIGHER LEVELS OF RISK SBIRT IS CARRIED OUT AT: PRIMARY CARE CENTERS, HOSPITALS, AND OTHER COMMUNITY SETTINGS.

4 WHAT IS SBIRT? AN INTERVENTION BASED ON MOTIVATIONAL INTERVIEWING STRATEGIES SCREENING: UNIVERSAL SCREENING FOR QUICKLY ASSESSING USE AND SEVERITY OF: ALCOHOL, ILLICIT DRUGS, AND PRESCRIPTION DRUG USE, MISUSE, AND ABUSE BRIEF INTERVENTION: BRIEF MOTIVATIONAL AND AWARENESS-RAISING INTERVENTION GIVEN TO RISKY OR PROBLEMATIC SUBSTANCE USERS REFERRAL TO TREATMENT: REFERRALS TO SPECIALTY CARE FOR PATIENTS WITH SUBSTANCE USE DISORDERS TREATMENT MAY CONSIST OF BRIEF TREATMENT OR SPECIALTY AOD (ALCOHOL AND OTHER DRUGS) TREATMENT.

5 GOAL OF SBIRT TO IDENTIFY AND EFFECTIVELY INTERVENE WITH THOSE WHO ARE AT MODERATE OR HIGH RISK FOR PSYCHOSOCIAL OR HEALTH CARE PROBLEMS RELATED TO THEIR SUBSTANCE USE.

6 WHY IS SBIRT IMPORTANT? UNHEALTHY AND UNSAFE ALCOHOL AND DRUG USE ARE MAJOR PREVENTABLE PUBLIC HEALTH PROBLEMS RESULTING IN MORE THAN 100,000 DEATHS EACH YEAR. THE COST TO SOCIETY IS MORE THAN $600 BILLION ANNUALLY. EFFECTS OF UNHEALTHY AND UNSAFE ALCOHOL AND DRUG USE HAVE FAR- REACHING IMPLICATIONS FOR THE INDIVIDUAL, FAMILY, WORKPLACE, COMMUNITY, AND THE HEALTH CARE SYSTEM.

7 RESULTS OF HAZARDOUS ALCOHOL AND SUBSTANCE ABUSE INJURY/TRAUMA CRIMINAL JUSTICE INVOLVEMENT SOCIAL PROBLEMS MENTAL HEALTH CONSEQUENCES (E.G. ANXIETY AND DEPRESSION) INCREASED ABSENTEEISM AND ACCIDENTS IN THE WORKPLACE

8 HISTORIC RESPONSE TO ALCOHOL AND OTHER SUBSTANCE USE PREVIOUSLY, SUBSTANCE USE INTERVENTION AND TREATMENT FOCUSED PRIMARILY ON SUBSTANCE ABUSE UNIVERSAL PREVENTION STRATEGIES AND ON SPECIALIZED TREATMENT SERVICES FOR THOSE WHO MET THE ABUSE AND DEPENDENCE CRITERIA. THERE WAS A SIGNIFICANT GAP IN SERVICE SYSTEMS FOR AT-RISK POPULATIONS.

9 SURVEY ON PATIENT ATTITUDES PATIENTS ARE OPEN TO DISCUSSING THEIR SUBSTANCE USE TO IMPROVE THEIR HEALTH

10 SUBSTANCE ABUSE: A PUBLIC HEALTH PERSPECTIVE

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12 RESEARCH DEMONSTRATES EFFECTIVENESS A GROWING BODY OF EVIDENCE ABOUT SBIRT S EFFECTIVENESS INCLUDING COST-EFFECTIVENESS HAS DEMONSTRATED ITS POSITIVE OUTCOMES. THE RESEARCH SHOWS THAT SBIRT IS AN EFFECTIVE WAY TO REDUCE DRINKING AND SUBSTANCE ABUSE PROBLEMS.

13 MAKING A MEASURABLE DIFFERENCE SINCE 2003, SAMHSA HAS SUPPORTED SBIRT PROGRAMS, WITH MORE THAN 1.5 MILLION PERSONS SCREENED. OUTCOME DATA CONFIRM A 40 PERCENT REDUCTION IN HARMFUL USE OF ALCOHOL BY THOSE DRINKING AT RISKY LEVELS AND A 55 PERCENT REDUCTION IN NEGATIVE SOCIAL CONSEQUENCES. OUTCOME DATA ALSO DEMONSTRATE POSITIVE BENEFITS FOR REDUCED ILLICIT SUBSTANCE USE. BASED ON REVIEW OF SBIRT GPRA DATA ( )

14 SBIRT IS A HIGHLY FLEXIBLE INTERVENTION

15 MEDICAL SPECIALTY AREAS

16 WHY IS IT IMPORTANT TO DO SBIRT IN PRIMARY CARE AND OTHER HEALTH CARE SETTINGS?

17 SBIRT DECREASES THE FREQUENCY AND SEVERITY OF ALCOHOL AND DRUG USE PRIMARY CARE IS ONE OF THE MOST CONVENIENT POINTS OF CONTACT FOR SUBSTANCE ISSUES. MANY PATIENTS ARE MORE LIKELY TO DISCUSS THIS SUBJECT WITH THEIR FAMILY PHYSICIAN THAN A RELATIVE, THERAPIST, OR REHAB SPECIALIST.

18 SBIRT REDUCES SHORT AND LONG TERM HEALTH CARE COSTS BY INTERVENING EARLY, SBIRT SAVES LIVES AND MONEY AND IS CONSISTENT WITH OVERALL SUPPORT FOR PATIENT WELLNESS LATE-STAGE INTERVENTION AND SUBSTANCE ABUSE TREATMENT IS EXPENSIVE, AND THE PATIENT HAS OFTEN DEVELOPED COMORBID HEALTH CONDITIONS

19 UNIVERSAL SCREENING DETECT CURRENT HEALTH PROBLEMS RELATED TO AT-RISK ALCOHOL AND SUBSTANCE USE AT AN EARLY STAGE BEFORE THEY RESULT IN MORE SERIOUS DISEASE OR OTHER HEALTH PROBLEMS DETECT ALCOHOL AND SUBSTANCE USE PATTERNS THAT CAN INCREASE FUTURE INJURY OR ILLNESS RISKS INTERVENE AND EDUCATE ABOUT AT-RISK ALCOHOL AND OTHER SUBSTANCE USE RESEARCH HAS SHOWN THAT APPROXIMATELY 90 PERCENT OF SUBSTANCE USE DISORDERS GO UNTREATED (NSDUH, 2007)

20 RATIONALE FOR UNIVERSAL SCREENING DRINKING AND DRUG USE ARE COMMON DRINKING AND DRUG USE CAN INCREASE THE RISK FOR HEALTH PROBLEMS, SAFETY RISKS, AND A HOST OF OTHER ISSUES DRINKING AND DRUG USE OFTEN GO UNDETECTED PEOPLE ARE MORE OPEN TO CHANGE THAN YOU MIGHT EXPECT

21 DETECTING RISK FACTORS EARLY SCREENING CAN BE A SIGNIFICANT STEP TOWARD EFFECTIVE INTERVENTION THE CLINICIAN IS OFTEN THE FIRST POINT OF CONTACT EARLY IDENTIFICATION AND INTERVENTION LEAD TO BETTER OUTCOMES PATIENTS ARE OFTEN SEEN BY A CLINICIAN BECAUSE OF A RELATED PHYSICAL PROBLEM Source: Treatnet. (2008). Screening, assessment and treatment planning. Retrieved from

22 KEY POINTS FOR SCREENING SCREEN EVERYONE USE VALIDATED TOOLS PRESCREENING IS USUALLY PART OF ANOTHER HEALTH AND WELLNESS SURVEY EXPLORE EACH SUBSTANCE; MANY PATIENTS USE MORE THAN ONE FOLLOW UP POSITIVES OR "RED FLAGS" BY ASSESSING DETAILS AND CONSEQUENCES OF USE USE MOTIVATIONAL INTERVIEWING SKILLS AND SHOW NONJUDGMENTAL, EMPATHIC VERBAL AND NONVERBAL BEHAVIORS DURING SCREENING

23 SCREENING FOR ALCOHOL USE WHEN SCREENING, IT S USEFUL TO CLARIFY WHAT ONE DRINK IS!

24 HOW MUCH IS ONE DRINK?

25 DRINKING LIMITS Healthy Men < 65 Healthy Women < 65 All > 65 4 drinks per day 3 drinks per day 3 drinks per day 14 drinks per week 7 drinks per week 7 drinks per week

26 EVIDENCE BEHIND THE NUMBERS STUDIES DEMONSTRATE THAT THE 5+/4+ LIMITS ACCURATELY REFLECT THE AMOUNT OF ALCOHOL CONSUMED AT WHICH PSYCHOMOTOR AND COGNITIVE IMPAIRMENT IS NOTABLY INCREASED IN BOTH MEN AND WOMEN. EPIDEMIOLOGIC RISK CURVE ANALYSES REVEAL SIGNIFICANT AND RAPID INCREASES IN THE RISKS OF UNINTENTIONAL INJURIES DEATHS RESULTING FROM EXTERNAL CAUSES BEING A TARGET OF AGGRESSION OR TAKING PART IN AN AGGRESSION-RELATED EVENT ALKOHOL USE DISORDERS UNFAVORABLE MEDICAL, WORK-RELATED, LEGAL, AND SOCIAL CONSEQUENCES RELATED TO DRINKING AS THE FREQUENCY OF EXCEEDING NIAAA S GUIDELINES INCREASES, THE LIKELIHOOD OF DEVELOPING THESE PROBLEMS INCREASES.

27 CATEGORIES OF DRINKING IV DEPENDENT: 5% III HARMFUL: 8% II RISKY: 9% I HEALTHY: 78%

28 SCREENING IN A PRACTICE SETTING

29 EVIDENCE BASED SCREENING TOOLS AUDIT-C: ALCOHOL USE DISORDERS IDENTIFICATION TEST SHORTENED AND MODIFIED AUDIT: ALCOHOL USE DISORDERS IDENTIFICATION TEST

30 AUDIT-C 3-ITEM ALCOHOL SCREEN CAN HELP IDENTIFY PERSONS WHO ARE HAZARDOUS DRINKERS OR HAVE ACTIVE ALCOHOL USE DISORDERS CAN BE USED AS A PRE-SCREEN

31 AUDIT-C 1. HOW OFTEN DO YOU HAVE A DRINK CONTAINING ALCOHOL? a. NEVER b. MONTHLY OR LESS c. 2-4 TIMES A MONTH d. 2-3 TIMES A WEEK e. 4 OR MORE TIMES A WEEK 2. HOW MANY STANDARD DRINKS CONTAINING ALCOHOL DO YOU HAVE IN A TYPICAL DAY? a. 1 OR 2 b. 3 OR 4 c. 5 OR 6 d. 7 TO 9 e. 10 OR MORE 3. HOW OFTEN DO YOU HAVE SIX OR MORE DRINKS ON ONE OCCASION? a. NEVER b. LESS THAN MONTHLY c. MONTHLY d. WEEKLY e. DAILY OR ALMOST DAILY

32 AUDIT ALCOHOL USE DISORDERS IDENTIFICATION TEST (AUDIT) 10-ITEM ALCOHOL SCREEN DEVELOPED BY WORLD HEALTH ORGANIZATION (WHO) CAN BE SELF-ADMINISTERED OR THROUGH AN INTERVIEW ADDRESSES RECENT ALCOHOL USE, ALCOHOL DEPENDENCE SYMPTOMS, AND ALCOHOL-RELATED PROBLEMS

33 AUDIT STRENGTHS: PUBLIC DOMAIN TEST AND MANUAL ARE FREE VALIDATED IN MULTIPLE SETTINGS, INCLUDING PRIMARY CARE BRIEF AND FLEXIBLE FOCUSES ON RECENT ALCOHOL USE CONSISTENT WITH ICD-10 AND DSM IV DEFINITIONS OF ALCOHOL DEPENDENCE, ABUSE, AND HARMFUL ALCOHOL USE LIMITATIONS: DOES NOT SCREEN FOR DRUG USE OR ABUSE, ONLY ALCOHOL

34 AUDIT QUESTIONNAIRE

35 AUDIT DOMAIN

36 SCORING THE AUDIT Score Zone Action 0-3: Women 0-4 Men 4-12: Women 5-14: Men 13-19: Women 15-19: Men 20+: Women 20+: Men I - Low Risk II - Risky III - Harmful IV - Severe Brief Education Brief Intervention Brief Intervention or Referral to Specialized Treatment Referral to Specialized Treatment

37 PRESCREENING & SCREENING FOR DRUGS

38 EVIDENCE BASED SCREENING TOOLS DAST (10) 10-ITEM BRIEF SCREENING TOOL CAN BE ADMINISTERED BY CLINICIAN OR SELF-ADMINISTERED YES OR NO RESPONSES CAN BE USED WITH ADULTS AND OLDER YOUTH

39 PRESCREENING

40 A POSITIVE DRUG SCREEN

41 DAST (10) WHAT IS IT? CONTAINS 10 ITEMS, COMPLETED AS SELF-REPORT OR VIA INTERVIEW. DAST(10) CONSISTS OF SCREENING QUESTIONS FOR AT-RISK DRUG USE. DEVELOPED BY ADDICTION RESEARCH FOUNDATION, NOW THE CENTER FOR ADDICTION AND MENTAL HEALTH YIELDS A QUANTITATIVE INDEX OF PROBLEMS RELATED TO DRUG MISUSE

42 DAST(10) QUESTIONNAIRE

43 DAST(10) INTERPRETATION

44 SCORING THE DAST(10) Score Zone of Use Action o 1 - Healthy None 1-2, plus No daily use of any substance No weekly use of opioids, cocaine, or methamphetamine No injection drug use in the past three months Not currently in drug abuse treatment II - Risky Offer advice on benefits and importance of remaining drug abstinent Monitor and reassess at next visit Consider providing educational materials 1-2 (without meeting the criteria above) II - Risky Brief Intervention 3-5 III - Harmful 6+ IV - Severs Brief Intervention or Referral to specialized treatment Referral to specialized treatment

45 SCREENING: SUMMARY SCREENING IS THE FIRST STEP OF THE SBIRT PROCESS AND DETERMINES THE SEVERITY AND RISK LEVEL OF THE PATIENT S SUBSTANCE USE. THE RESULT OF A SCREEN ALLOWS THE PROVIDER TO DETERMINE IF A BRIEF INTERVENTION OR REFERRAL TO TREATMENT IS A NECESSARY NEXT STEP FOR THE PATIENT.

46 BASED ON FINDINGS OF SCREENING THE CLINICIAN HAS VALID, PATIENT SELF-REPORTED INFORMATION THAT IS USED IN BRIEF INTERVENTION. OFTEN THE PROCESS OF SCREENING SETS IN MOTION PATIENT REFLECTION ON THEIR SUBSTANCE USE BEHAVIOR.

47 BRIEF INTERVENTION BRIEF INTERVENTIONS ARE EVIDENCE-BASED PRACTICES DESIGNED TO MOTIVATE INDIVIDUALS AT RISK OF SUBSTANCE ABUSE AND RELATED HEALTH PROBLEMS TO CHANGE THEIR BEHAVIOR BY HELPING THEM UNDERSTAND HOW THEIR SUBSTANCE USE PUTS THEM AT RISK AND TO REDUCE OR GIVE UP THEIR SUBSTANCE USE. HEALTHCARE PROVIDERS CAN ALSO USE BRIEF INTERVENTIONS TO ENCOURAGE THOSE WITH MORE SERIOUS DEPENDENCE TO ACCEPT MORE INTENSIVE TREATMENT WITHIN THE PRIMARY CARE SETTING OR A REFERRAL TO A SPECIALIZED ALCOHOL AND DRUG TREATMENT AGENCY.

48 RESEARCH INDICATES: BRIEF INTERVENTIONS ARE LOW COST AND EFFECTIVE FOR HARMFUL DRINKING. THERE IS A GROWING BODY OF LITERATURE SHOWING THE EFFECTIVENESS OF SBIRT FOR RISKY DRUG USE. BRIEF INTERVENTIONS ARE FEASIBLE AND HIGHLY EFFECTIVE COMPONENTS OF AN OVERALL PUBLIC HEALTH APPROACH TO REDUCING ALCOHOL MISUSE. (SAMHSA Whitepaper, 2011 ( (Whitlock et al., 2004, for U.S. Preventive Services Task Force)

49 BRIEF INTERVENTION IN PRIMARY CARE IN PRIMARY CARE SETTINGS, BRIEF INTERVENTIONS LAST FROM 5 MINUTES OF BRIEF ADVICE TO MINUTES OF BRIEF COUNSELING. BRIEF INTERVENTIONS ARE NOT INTENDED TO TREAT PEOPLE WITH SERIOUS SUBSTANCE DEPENDENCE, BUT RATHER TO TREAT PROBLEMATIC OR RISKY SUBSTANCE USE. SKILLFULLY CONDUCTED, BRIEF INTERVENTIONS ARE ESSENTIAL TO SUCCESSFUL SBIRT IMPLEMENTATION. THE TWO MOST COMMON BEHAVIORAL THERAPIES USED IN SBIRT PROGRAMS ARE BRIEF VERSIONS OF COGNITIVE BEHAVIORAL THERAPY AND MOTIVATIONAL INTERVIEWING, OR SOME COMBINATION OF THE TWO.

50 MOTIVATIONAL INTERVIEWING TECHNIQUES WITH SBIRT MODEL ADDRESSES WHERE THE PATIENT IS CURRENTLY IN THE CYCLE OF CHANGE ASSISTS PERSON TO MOVE THROUGH STAGES OF CHANGE TOWARD SUCCESSFUL SUSTAINED CHANGE

51 STAGES OF CHANGE PRE-CONTEMPLATION CONTEMPLATION PREPARATION ACTION MAINTENANCE RELAPSE

52 DEFINITION OF MOTIVATIONAL INTERVIEWING MOTIVATIONAL INTERVIEWING IS A CLIENT-CENTERED, DIRECTIVE METHOD FOR ENHANCING INTRINSIC MOTIVATION TO CHANGE BY EXPLORING AND RESOLVING AMBIVALENCE.

53 WHAT MI IS NOT A WAY OF TRICKING PEOPLE INTO DOING WHAT YOU WANT THEM TO DO A SPECIFIC TECHNIQUE PROBLEM SOLVING OR SKILL BUILDING PATIENT-CENTERED THERAPY EASY TO LEARN A PANACEA FOR EVERY CLINICAL CHALLENGE

54 PEOPLE ARE GENERALLY BETTER PERSUADED BY THE REASONS WHICH THEY HAVE THEMSELVES DISCOVERED THAN BY THOSE WHICH HAVE COME INTO THE MIND OF OTHERS. BLAISE PASCAL

55 THE SPIRIT OF MOTIVATIONAL INTERVIEWING COLLABORATIVE EVOCATIVE RESPECTFUL OF AUTONOMY COMPASSIONATE

56 TASKS OF MOTIVATIONAL INTERVIEWING ENGAGE THROUGH HAVING SENSITIVE CONVERSATIONS WITH PATIENTS FOCUS ON WHAT S IMPORTANT TO THE PATIENT REGARDING BEHAVIOR, HEALTH, AND WELFARE EVOKE THE PATIENT S PERSONAL MOTIVATION FOR CHANGE NEGOTIATE PLANS

57 FOUR BASIC SKILLS OF MI OPEN ENDED QUESTIONS AFFIRMATIONS REFLECTIVE LISTENING SUMMARY STATEMENTS

58 PRINCIPLES OF MOTIVATIONAL INTERVIEWING MI IS FOUNDED ON FIVE BASIC PRINCIPLES: EXPRESS EMPATHY DEVELOP DISCREPANCY AVOID ARGUMENTATION ROLL WITH RESISTANCE SUPPORT SELF-EFFICACY Reference: Miller, W. R., Zweben, A., DiClemente, C. C., & Rychtarik, R. G. (1992). Motivational enhancement therapy manual: A clinical research guide for therapists treating individuals with alcohol abuse and dependence. Rockville, MD: National Institute on Alcohol Abuse and Alcoholism

59 WHAT IS EMPATHY? REFLECTS AN ACCURATE UNDERSTANDING ASSUMES THE PERSON S PERSPECTIVES ARE UNDERSTANDABLE, COMPREHENSIBLE, AND VALID SEEKS TO UNDERSTAND THE PERSON S FEELINGS AND PERSPECTIVES WITHOUT JUDGING

60 THE IMPORTANCE OF EXPRESSING EMPATHY COMMUNICATES ACCEPTANCE, WHICH FACILITATES CHANGE ENCOURAGES A COLLABORATIVE ALLIANCE, WHICH PROMOTES CHANGE LEADS TO AN UNDERSTANDING OF EACH PERSON S UNIQUE PERSPECTIVE, FEELINGS, AND VALUES, WHICH MAKE UP THE MATERIAL WE NEED TO FACILITATE CHANGE

61 TIPS FOR EXPRESSING EMPATHY GOOD EYE CONTACT RESPONSIVE FACIAL EXPRESSION BODY ORIENTATION VERBAL AND NONVERBAL ENCOURAGERS REFLECTIVE LISTENING/ASKING CLARIFYING QUESTIONS AVOID EXPRESSING DOUBT/PASSING JUDGMENT

62 WHAT IS DEVELOPING DISCREPANCY? DISCREPANCY IS THE DISTANCE BETWEEN THE PATIENTS CURRENT BEHAVIOR AND ONE ORE MORE CHANGE GOALS OFTEN INVOLVES IDENTIFYING ONE S PERSONAL GOALS PROFESSIONALS CAN ASK PATIENT WHAT IS GOOD ABOUT BEHAVIOR AND WHAT IS NOT SO GOOD ABOUT SAME BEHAVIOR

63 DEVELOP DISCREPANCY: EXAMPLES EXAMPLE 1: HOW WILL THINGS E FOR YOU A YEAR FROM NOW IF YOU CONTINUE TO? EXAMPLE 2: HOW DO YOU THINK YOUR LIFE WOULD BE DIFFERENT IF YOU WERE NOT DRINKING?

64 AVOID ARGUMENTATION RESISTANCE TO CHANGE IS STRONGLY AFFECTED BY YOUR RESPONSE NORMALIZE TO PATIENT THAT HAVING DIFFICULTIES WHILE CHANGING IS NOT UNCOMMON

65 RESISTANCE RESISTANCE IS WHAT HAPPENS WHEN THE PROFESSIONAL PUSHES FOR A CHANGE WHEN PATIENT ISN T READY CLIENTS WHO EXHIBIT RESISTANCE ARE LESS LIKELY TO CHANGE RESISTANCE IS NORMAL

66 ROLLING WITH RESISTANCE WHAT DOESN T WORK PERSUASION RIGHTING REFLEX WHAT DOES WORK EXPRESSING EMPATHY DEVELOP DISCREPANCY SUPPORT SELF EFFICACY USE CHANGE TALK

67 ROLLING WITH RESISTANCE: EXAMPLES EXAMPLE 1 : PATIENT: I DON T PLAN TO QUIT DRINKING ANYTIME SOON CLINICIAN: YOU DON T THINK THAT ABSTINENCE WOULD WORK FOR YOU RIGHT NOW EXAMPLE 2: PATIENT: MY HUSBAND IS ALWAYS NAGGING ME ABOUT MY DRINKING ALWAYS CALLING ME AN ALCOHOLIC. IT REALLY BUGS ME CLINICIAN: IT SOUNDS LIKE HE REALLY CARES ABOUT YOU AND IS CONCERNED, ALTHOUGH HE EXPRESSES IT IN A WAY THAT MAKES YOU ANGRY

68 SUPPORT SELF-EFFICACY SELF EFFICACY IS DEFINED AS ONE S BELIEF IN ONE S ABILITY TO SUCCEED IN SPECIFIC SITUATIONS OR ACCOMPLISH A TASK PATIENTS ARE RESPONSIBLE FOR CHOOSING AND CARRYING OUT ACTIONS TO CHANGE

69 CHANGE, CONFIDENCE, & IMPORTANCE RULERS CHANGE RULER RATING SCALE (0-10) USED TO ASSESS A CLIENT S MOTIVATION FOR A PARTICULAR CHANGE CONFIDENCE RULER RATING SCALE (0-10), CLIENTS ARE ASKED TO RATE THEIR LEVEL OF CONFIDENCE IN THEIR ABILITY TO MAKE A PARTICULAR CHANGE IMPORTANCE RULER RATING SCALE (0-10), CLIENTS ARE ASKED TO RATE THE IMPORTANCE OF MAKING A PARTICULAR CHANGE

70 VIDEO DEMONSTRATION FOR MORE VIDEO DEMONSTRATIONS GO TO:

71 REFERRAL TO TREATMENT INPATIENT TREATMENT RESIDENTIAL PROGRAMS PARTIAL HOSPITALIZATION OR DAY TREATMENT OUTPATIENT AND INTENSIVE OUTPATIENT PROGRAMS METHADONE CLINICS

72 INPATIENT TREATMENT PROVIDED IN SPECIAL UNITS OF HOSPITALS OR MEDICAL CLINICS OFFERS BOTH DETOXIFICATION AND REHABILITATION NOT AS COMMON AS IT USED TO BE

73 RESIDENTIAL PROGRAMS THERAPEUTIC COMMUNITY HAVE PHASES OF TREATMENT WITH DIFFERENT EXPECTATIONS OFTEN OFFER GED PREP CLASSES, JOB-SEEKING SKILLS, AND CAREER TRAINING

74 PARTIAL HOSPITALIZATION MAY BE PROVIDED IN HOSPITALS OR FREE STANDING CLINICS ATTENDS TREATMENT BUT LIVES AT HOME USUALLY LAST AT LEAST 3 MONTHS

75 OUTPATIENT & INTENSIVE OUTPATIENT PROVIDE TREATMENT AT A PROGRAM SITE PERSON LIVES ELSEWHERE OFFERED AT A VARIETY OF PLACES HEALTH CLINICS, COMMUNITY MENTAL HEALTH CLINICS, COUNSELORS OFFICES

76 INTENSIVE OUTPATIENT TREATMENT REQUIRE A PERSON TO ATTEND 9-20 HOURS OF TREATMENT PER WEEK LAST FROM ABOUT 2 MONTHS TO 1 YEAR DO BEST IF WILLING TO ATTEND OUTPATIENT COUNSELING

77 OPIOID (METHADONE) TREATMENT CLINICS OFFER MEDICATION ASSISTED OUTPATIENT TREATMENT SERVE THOSE WHO ARE DEPENDED ON OPIOID DRUGS PROVIDE COUNSELING AND OTHER SERVICES

78 RESOURCES SAMHSA SBIRT: SAMHSA WEBSITE: BEHAVIORAL HEALTH TREATMENT LOCATOR: SUICIDE PREVENTION LIFELINE: NATIONAL HELPLINE: DISASTER DISTRESS HELPLINE: HELP/DISASTER-DISTRESS-HELPLINE

79 CONTACT INFORMATION TERRIE FRITZ PHONE: EXT PAGE MILLER PHONE EXT

80 QUESTIONS