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
HHS HRSA SAMHSA State Health Department Division of Behavioral Health SBIRT Colorado Clinical and Case Management Settings
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
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
Target Population SBIRT is designed to target people with nondependent use and to provide effective strategies for early intervention.
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%
Days Used at 6 Month Follow up 12 10 8 6 4 2 Alcohol Marijuana Illicit drugs 0 Intake 6 mth followup
Implementation Steps
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
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
Brief Intervention Brief conversation focused on behavior change Educate about risk Goal setting is key component
How have you tried to encourage behavior change?
Helpful Responses Questionnaire
Brief Intervention Step 1: Raise the Subject Step 2: Provide Feedback Step 3: Enhance Motivation Step 4: Negotiate and Advise
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?
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
Step 3: Enhance Motivation Pre-Contemplation Contemplation Maintenance Action Preparation
Motivational Interviewing Identify and encourage behavior change Increase awareness Explore and resolve ambivalence
Examples of MI Strategies Open ended questions Affirmation Reflective listening Summarizing Goal is to elicit Change Talk!!!
Elicit and Reflect Change Talk Ask direct, open ended questions Weigh pros and cons with decisional balance Use the importance and confidence rulers
Decisional Balance What are some of the good things about your use? What are some of the less good things about your use?
Step 4: Negotiate and Advise Elicit response Negotiate a goal Assist in developing a plan Summarize
Closing the Intervention Show appreciation Affirm positive behaviors Respect decisions Offer information Arrange for follow up
Payer Code Description Fee Commercial CPT 99408 CPT 99409 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
Role Play!
improvinghealthcolorado.org
.THANK YOU. Leigh Fischer, MPH Program Manager, SBIRT Colorado Peer Assistance Services, Inc. 2170 S. Parker Rd., #229 Denver, CO 80231 Phone: (303) 369 0039 x237 Email: LFischer@peerassist.org