Overview of Colorado SBIRT

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1 Integrating Mental Health and Substance Use Services with HIV/AIDS Prevention Overview of Colorado SBIRT U.S. Conference on AIDS Orlando, Florida September 13, 2010 Presenter: Leigh Fischer, Program Manager SBIRT Colorado

2 HHS HRSA SAMHSA State Health Department Division of Behavioral Health SBIRT Colorado Clinical and Case Management Settings

3 SAMHSA Grantees 2003 California Cook Inlet Tribal Council Illinois New Mexico Pennsylvania Texas Washington 2006 Colorado Florida Massachusetts Wisconsin 2008 Georgia Missouri Tanana Chiefs Alaska West Virginia

4 What is SBIRT? Screening: To identify people at risk for a condition that wouldn t otherwise be detected Brief Intervention: short motivational conversation for those who screen positive Referral to Treatment: For those who have more serious problems

5 Target Population SBIRT is designed to target people with nondependent use and to provide effective strategies for early intervention.

6

7 Data Collected SAMHSA data collection sites ~ 90,000 patients Screening only = 58% Brief Intervention = 11% Brief Therapy or Treatment Referral = 5% Tobacco only BI = 26% Ryan White funded data collection sites ~ 2,500 Screening only = 46% Brief Intervention = 17% Brief Therapy or Treatment referral = 14% Tobacco only BI = 23%

8 Days Used at 6 Month Follow up Alcohol Marijuana Illicit drugs 0 Intake 6 mth followup

9 Implementation Steps

10 Universal Prescreen Negative Positive Provide positive reinforcement Further assessment: ASSIST/AUDIT/DAST/CRAFFT Low risk: Provide Positive Reinforcement Moderate risk: Provide Brief Intervention Moderate-High risk: Recommend Brief Therapy High risk: Refer to Treatment

11

12

13 Validated Screening Tools ASSIST: Alcohol, Smoking, and Substance Involvement Screening Test AUDIT: Alcohol Use Disorders Identification Test DAST-10: Drug Screening Test CRAFFT: Adolescent drug and alcohol screening

14 Brief Intervention Brief conversation focused on behavior change Educate about risk Goal setting is key component

15 How have you tried to encourage behavior change?

16

17 Helpful Responses Questionnaire

18 Brief Intervention Step 1: Raise the Subject Step 2: Provide Feedback Step 3: Enhance Motivation Step 4: Negotiate and Advise

19 Step 1: Raise the Subject Raise the subject of substance use Would you mind taking a few minutes to talk with me about your substance use?

20 Step 2: Provide Feedback Discuss health risks of alcohol and other substances At this level of consumption, you are at increased risk for health and other consequences such as Review drinking guidelines The recommended guidelines for healthy women/men are

21 Step 3: Enhance Motivation Pre-Contemplation Contemplation Maintenance Action Preparation

22 Motivational Interviewing Identify and encourage behavior change Increase awareness Explore and resolve ambivalence

23 Examples of MI Strategies Open ended questions Affirmation Reflective listening Summarizing Goal is to elicit Change Talk!!!

24 Elicit and Reflect Change Talk Ask direct, open ended questions Weigh pros and cons with decisional balance Use the importance and confidence rulers

25 Decisional Balance What are some of the good things about your use? What are some of the less good things about your use?

26 Step 4: Negotiate and Advise Elicit response Negotiate a goal Assist in developing a plan Summarize

27 Closing the Intervention Show appreciation Affirm positive behaviors Respect decisions Offer information Arrange for follow up

28 Payer Code Description Fee Commercial CPT CPT Alcohol and/or substance abuse structured screening and brief intervention services; 15 to 30 minutes Alcohol and/or substance abuse structured screening and brief intervention services; greater than 30 minutes $33.41 $65.51 Medicare G0396 Alcohol and/or substance abuse structured screening and brief intervention services; 15 to 30 minutes $29.42 G0397 Alcohol and/or substance abuse structured screening and brief intervention services; greater than 30 minutes $57.69 Medicaid H0049 Alcohol and/or drug screening $24.00 H0050 Alcohol and/or drug service, brief intervention, per 15 minutes $48.00

29 Role Play!

30 improvinghealthcolorado.org

31 .THANK YOU. Leigh Fischer, MPH Program Manager, SBIRT Colorado Peer Assistance Services, Inc S. Parker Rd., #229 Denver, CO Phone: (303) x237

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