SBIRT in Primary Care Settings. José Esquibel SBIRT Project Director

Transcription

1 SBIRT in Primary Care Settings José Esquibel SBIRT Project Director

2 SBIRT Screening Brief Intervention and Referral to Treatment (SBIRT) is a public health approach to preventing risky substance use behavior. Patients are assessed for levels of substance use risk behaviors using standardized screening tools in primary healthcare settings. Patients showing risky substance use behaviors are provided a brief intervention, a short conversation incorporating feedback and advice, by a health professional. Patients who screen in need of additional services are also provided a referral to brief therapy or additional treatment.

3 SBIRT Colorado Strives to make SBIRT a standard of care across the state. Provide training to clinical support staff on brief screening and intervention techniques. Assists healthcare professionals in integrating alcohol, tobacco, and other substance use screening and interventions as part of overall primary care services.

4 SBIRT Colorado Grant Funded Sites 22 Sites 7 Rural Clinics (3 Federally Qualified Health Center) 1 Rural Hospital 7 Urban Clinics 6 Urban Hospitals 1 Dental Clinic

5 Non Grant Funded SBIRT Sites HIV Care Settings Federally Qualified Health Centers Level I and II Trauma Centers Colorado State Employees Assistance Program Multiple Primary Care Physicians utilizing the Colorado SBIRT Clinical Guidelines

6 Integration Models SBIRT Colorado Models vary from site to site: Health educator model Co location of behavioral health and primary care Integrated services (mainly FQHCs and larger hospitals in Colorado) HIV Sites Medical case management

7 Levels of Patient Risk: SBIRT Colorado Over 95,000 screens Low / No (SF) 61% Tobacco only (SF) 23% High (RT) 3% High Moderate (BT) 2% Moderate (BI) 11%

8 Brief Intervention (Moderate Risk) Motivational Interviewing techniques focused on raising a person s awareness and insight about their substance use and consequences Conducted by a health professional or behavioral health professional

9 Brief Therapy (Moderate to High Risk) Involves Motivational Interviewing approach with an assessment, education, problem solving, coping mechanisms and building a supportive social environment, centered on patient/client goals Trained healthcare professional, medical social worker, substance abuse treatment professional, behavioral health professional

10 Recommendations for Implementing SBIRT Identify and work with champions in primary care, behavioral health/ substance abuse treatment and prevention Promote SBIRT as a standard of care in partnership with champions Activate State Medicaid Codes to reimburse SBIRT services

11 Recommendations for Integration Improve communication and understanding between the primary care staff and substance abuse treatment Have an openness to new modalities, such as brief intervention and brief therapy Expand scope of focus to include high risk users of alcohol and other drugs and not only dependence

12 Recommendations for Integration Strive to meet or exceed National Committee for Quality Assurance (NCQA) standards for patient centered medical home Establish interdisciplinary teams Improve information exchange between primary care and substance abuse treatment/behavioral health providers

13 Recommendations About Financing Address barriers to payment in an integrated care setting Involve employers and insurers in state finance reform efforts Demonstrate value of services for substance use conditions in health care settings to payers: Return on investment and decrease in medical utilization (Insurers) Reducing days of work missed (employers)

14 José Esquibel