integrating care through the use of screening and brief intervention in hiv settings
DESCRIPTION
Integrating Care through the Use of Screening and Brief Intervention in HIV Settings. TRAINER’S NAME TRAINING DATE TRAINING LOCATION. Training Collaborators. Pacific AIDS Education and Training Center Charles R. Drew University of Medicine and Science University of California, Los Angeles - PowerPoint PPT PresentationTRANSCRIPT
Integrating Care through the Use of Screening and Brief
Intervention in HIV Settings
TRAINERrsquoS NAMETRAINING DATE
TRAINING LOCATION
Training Collaborators
bull Pacific AIDS Education and Training Center Charles R Drew University of Medicine and
Science University of California Los Angeles
bull Pacific Southwest Addiction Technology Transfer Center
bull UCLA Integrated Substance Abuse Programs
Test Your Knowledge
3
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Introductions
Briefly tell usWhat is your nameWhere do you work and what you do thereWho is your favorite musician or performerWhat is one reason you decided to attend this training session
Training OverviewOur goal for this training is to instruct HIV providers in specific SBIRT procedures and to developrsquo skills to deliver SBIRT in their daily clinical practice
Resources
bull Participantsbull Educational
materials from ATTCs and other centers
bull Trainers
Activities
bull Didactic learningbull Role playsbull Group discussionsbull Brief assessmentbull Links to additional
training
Outcomes
bull Develop skills to deliver SBIRT
bull Discuss implementation challenges and possible solutions
bull Integrate SBIRT in practice (long-term outcome)
This brief training course will teach you how to
bull Administer substance use screening
bull Deliver a brief intervention
bull Employ a motivational approach
bull Make referrals to specialized treatment if needed
What Will You Learn
Activity Reflection
Take some time to think about the most difficult change that you had to make in your life
How much time did it take you to move from considering that change to actually taking action
SBIRT Review of Key TermsScreening Very brief set of questions that identifies risk of
substance use related problems
Brief Intervention Brief counseling that raises awareness of risks and motivates client toward acknowledgement of problem
Brief Treatment Cognitive behavioral work with clients who acknowledge risks and are seeking help
Referral Procedures to help patients access specialized care
Benefits of SBIRTSubstance abuse
SBI may reduce alcohol and drug use significantly
Morbidity and mortality SBI reduces accidents injuries trauma emergency department visits depression drug-related infections and infectious diseases
Health care costsStudies have indicated that SBI for alcohol saves $2 - $4 for each $100 expended
Other outcomes SBI may reduce work-impairment reduce DUIs and improve neonatal outcomes
Benefits of SBIRT for Practice
bull Increases cliniciansrsquo awareness of substance use issues
bull Offers clinicians more systematic approach to addressing substance use (less of a ldquojudgment callrdquo)
The Key to Successful Interventions
Brief interventions are successful when clinicians relate patientsrsquo risky substance use to improvement in patientsrsquo overall health and wellbeing
Candidates for Routine Screening
bull College students bull Primary care patientsbull Mental health patientsbull Patients in infectious disease clinicsbull People with alcohol- or drug-related
legal offenses (eg DUI)
Rationale for Conducting SBIRT in an HIV Care Setting
HIV in 2013bull HIV is now considered a manageable chronic
illnessbull HIV patients are living longer and facing
multiple health issues in addition to their HIV diseasebull Homelessness bull Disease progressionbull Mental illnessbull Substance abuse
bull Engagement retention and adherence among HIV patients continues to present challenges to HIV care providers
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
Risks of Untreated Mental Health and Substance Use Problems
bull Poorer adherence to treatment and medication regimens
bull Higher hospitalization rates for medical complications
bull Greater likelihood of treatment drop-out or being lost to follow-up
bull Greater risk for opportunistic (re-) infectionbull Greater risk of psychosocial problemsbull Greater risk of suicide or accidental death
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
SBIRT in HIV Settingsbull SBIRT in primary care settings is effective in
changing behavior and preventing adverse outcomes attributable to alcohol and other drugs
bull People living with HIV are more likely than the general population to experience substance abuse problems
bull SBI protocols have not been readily implemented in HIV care settings
SOURCE Fischer L (2012) Addiction Science amp Clinical Practice 7(Suppl 1) A73
SBIRT in HIV Settings
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
Impact of a Computer-Assisted SBIRT Program in and HIV Setting
bull Implemented in San Francisco General Hospitalrsquos Positive Health Program (PHP) in 2010-11bull Most common substances reported were tobacco
(80) alcohol (54) cocaine (54) amphetamines (47) nonmedical sedative use (34) and nonmedical opioid use (27)
bull SBI for unhealthy substance use is acceptable to patients in HIV primary care settings
bull Significant decreases observed with amphetamines and sedatives significant increase in number of patients with HIV viral suppression
SOURCE Dawson Rose et al (2012) IAC Poster
Colorados Ryan White Collaborative SBIRT Project
bull Of 2500 patients screenedbull 31 (n=775) received a BI for risky alcohol tobacco
or drug usebull 23 (n=575) were referred for therapy or specialized
treatment
bull Recommendations for standardizing SBIRT in HIV settings include
bull Apply a systematic screening approachbull Train providers to conduct BIbull Establish a referral networkbull Integrate SBIRT with adherence and retention efforts
SOURCE Fischer L (2012) Addiction Science amp Clinical Practice 7(Suppl 1) A73
Activity Adoption of SBIRT Can SBIRT work in your setting
3 minutes
End
Training Collaborators
bull Pacific AIDS Education and Training Center Charles R Drew University of Medicine and
Science University of California Los Angeles
bull Pacific Southwest Addiction Technology Transfer Center
bull UCLA Integrated Substance Abuse Programs
Test Your Knowledge
3
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Introductions
Briefly tell usWhat is your nameWhere do you work and what you do thereWho is your favorite musician or performerWhat is one reason you decided to attend this training session
Training OverviewOur goal for this training is to instruct HIV providers in specific SBIRT procedures and to developrsquo skills to deliver SBIRT in their daily clinical practice
Resources
bull Participantsbull Educational
materials from ATTCs and other centers
bull Trainers
Activities
bull Didactic learningbull Role playsbull Group discussionsbull Brief assessmentbull Links to additional
training
Outcomes
bull Develop skills to deliver SBIRT
bull Discuss implementation challenges and possible solutions
bull Integrate SBIRT in practice (long-term outcome)
This brief training course will teach you how to
bull Administer substance use screening
bull Deliver a brief intervention
bull Employ a motivational approach
bull Make referrals to specialized treatment if needed
What Will You Learn
Activity Reflection
Take some time to think about the most difficult change that you had to make in your life
How much time did it take you to move from considering that change to actually taking action
SBIRT Review of Key TermsScreening Very brief set of questions that identifies risk of
substance use related problems
Brief Intervention Brief counseling that raises awareness of risks and motivates client toward acknowledgement of problem
Brief Treatment Cognitive behavioral work with clients who acknowledge risks and are seeking help
Referral Procedures to help patients access specialized care
Benefits of SBIRTSubstance abuse
SBI may reduce alcohol and drug use significantly
Morbidity and mortality SBI reduces accidents injuries trauma emergency department visits depression drug-related infections and infectious diseases
Health care costsStudies have indicated that SBI for alcohol saves $2 - $4 for each $100 expended
Other outcomes SBI may reduce work-impairment reduce DUIs and improve neonatal outcomes
Benefits of SBIRT for Practice
bull Increases cliniciansrsquo awareness of substance use issues
bull Offers clinicians more systematic approach to addressing substance use (less of a ldquojudgment callrdquo)
The Key to Successful Interventions
Brief interventions are successful when clinicians relate patientsrsquo risky substance use to improvement in patientsrsquo overall health and wellbeing
Candidates for Routine Screening
bull College students bull Primary care patientsbull Mental health patientsbull Patients in infectious disease clinicsbull People with alcohol- or drug-related
legal offenses (eg DUI)
Rationale for Conducting SBIRT in an HIV Care Setting
HIV in 2013bull HIV is now considered a manageable chronic
illnessbull HIV patients are living longer and facing
multiple health issues in addition to their HIV diseasebull Homelessness bull Disease progressionbull Mental illnessbull Substance abuse
bull Engagement retention and adherence among HIV patients continues to present challenges to HIV care providers
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
Risks of Untreated Mental Health and Substance Use Problems
bull Poorer adherence to treatment and medication regimens
bull Higher hospitalization rates for medical complications
bull Greater likelihood of treatment drop-out or being lost to follow-up
bull Greater risk for opportunistic (re-) infectionbull Greater risk of psychosocial problemsbull Greater risk of suicide or accidental death
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
SBIRT in HIV Settingsbull SBIRT in primary care settings is effective in
changing behavior and preventing adverse outcomes attributable to alcohol and other drugs
bull People living with HIV are more likely than the general population to experience substance abuse problems
bull SBI protocols have not been readily implemented in HIV care settings
SOURCE Fischer L (2012) Addiction Science amp Clinical Practice 7(Suppl 1) A73
SBIRT in HIV Settings
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
Impact of a Computer-Assisted SBIRT Program in and HIV Setting
bull Implemented in San Francisco General Hospitalrsquos Positive Health Program (PHP) in 2010-11bull Most common substances reported were tobacco
(80) alcohol (54) cocaine (54) amphetamines (47) nonmedical sedative use (34) and nonmedical opioid use (27)
bull SBI for unhealthy substance use is acceptable to patients in HIV primary care settings
bull Significant decreases observed with amphetamines and sedatives significant increase in number of patients with HIV viral suppression
SOURCE Dawson Rose et al (2012) IAC Poster
Colorados Ryan White Collaborative SBIRT Project
bull Of 2500 patients screenedbull 31 (n=775) received a BI for risky alcohol tobacco
or drug usebull 23 (n=575) were referred for therapy or specialized
treatment
bull Recommendations for standardizing SBIRT in HIV settings include
bull Apply a systematic screening approachbull Train providers to conduct BIbull Establish a referral networkbull Integrate SBIRT with adherence and retention efforts
SOURCE Fischer L (2012) Addiction Science amp Clinical Practice 7(Suppl 1) A73
Activity Adoption of SBIRT Can SBIRT work in your setting
3 minutes
End
Test Your Knowledge
3
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Introductions
Briefly tell usWhat is your nameWhere do you work and what you do thereWho is your favorite musician or performerWhat is one reason you decided to attend this training session
Training OverviewOur goal for this training is to instruct HIV providers in specific SBIRT procedures and to developrsquo skills to deliver SBIRT in their daily clinical practice
Resources
bull Participantsbull Educational
materials from ATTCs and other centers
bull Trainers
Activities
bull Didactic learningbull Role playsbull Group discussionsbull Brief assessmentbull Links to additional
training
Outcomes
bull Develop skills to deliver SBIRT
bull Discuss implementation challenges and possible solutions
bull Integrate SBIRT in practice (long-term outcome)
This brief training course will teach you how to
bull Administer substance use screening
bull Deliver a brief intervention
bull Employ a motivational approach
bull Make referrals to specialized treatment if needed
What Will You Learn
Activity Reflection
Take some time to think about the most difficult change that you had to make in your life
How much time did it take you to move from considering that change to actually taking action
SBIRT Review of Key TermsScreening Very brief set of questions that identifies risk of
substance use related problems
Brief Intervention Brief counseling that raises awareness of risks and motivates client toward acknowledgement of problem
Brief Treatment Cognitive behavioral work with clients who acknowledge risks and are seeking help
Referral Procedures to help patients access specialized care
Benefits of SBIRTSubstance abuse
SBI may reduce alcohol and drug use significantly
Morbidity and mortality SBI reduces accidents injuries trauma emergency department visits depression drug-related infections and infectious diseases
Health care costsStudies have indicated that SBI for alcohol saves $2 - $4 for each $100 expended
Other outcomes SBI may reduce work-impairment reduce DUIs and improve neonatal outcomes
Benefits of SBIRT for Practice
bull Increases cliniciansrsquo awareness of substance use issues
bull Offers clinicians more systematic approach to addressing substance use (less of a ldquojudgment callrdquo)
The Key to Successful Interventions
Brief interventions are successful when clinicians relate patientsrsquo risky substance use to improvement in patientsrsquo overall health and wellbeing
Candidates for Routine Screening
bull College students bull Primary care patientsbull Mental health patientsbull Patients in infectious disease clinicsbull People with alcohol- or drug-related
legal offenses (eg DUI)
Rationale for Conducting SBIRT in an HIV Care Setting
HIV in 2013bull HIV is now considered a manageable chronic
illnessbull HIV patients are living longer and facing
multiple health issues in addition to their HIV diseasebull Homelessness bull Disease progressionbull Mental illnessbull Substance abuse
bull Engagement retention and adherence among HIV patients continues to present challenges to HIV care providers
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
Risks of Untreated Mental Health and Substance Use Problems
bull Poorer adherence to treatment and medication regimens
bull Higher hospitalization rates for medical complications
bull Greater likelihood of treatment drop-out or being lost to follow-up
bull Greater risk for opportunistic (re-) infectionbull Greater risk of psychosocial problemsbull Greater risk of suicide or accidental death
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
SBIRT in HIV Settingsbull SBIRT in primary care settings is effective in
changing behavior and preventing adverse outcomes attributable to alcohol and other drugs
bull People living with HIV are more likely than the general population to experience substance abuse problems
bull SBI protocols have not been readily implemented in HIV care settings
SOURCE Fischer L (2012) Addiction Science amp Clinical Practice 7(Suppl 1) A73
SBIRT in HIV Settings
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
Impact of a Computer-Assisted SBIRT Program in and HIV Setting
bull Implemented in San Francisco General Hospitalrsquos Positive Health Program (PHP) in 2010-11bull Most common substances reported were tobacco
(80) alcohol (54) cocaine (54) amphetamines (47) nonmedical sedative use (34) and nonmedical opioid use (27)
bull SBI for unhealthy substance use is acceptable to patients in HIV primary care settings
bull Significant decreases observed with amphetamines and sedatives significant increase in number of patients with HIV viral suppression
SOURCE Dawson Rose et al (2012) IAC Poster
Colorados Ryan White Collaborative SBIRT Project
bull Of 2500 patients screenedbull 31 (n=775) received a BI for risky alcohol tobacco
or drug usebull 23 (n=575) were referred for therapy or specialized
treatment
bull Recommendations for standardizing SBIRT in HIV settings include
bull Apply a systematic screening approachbull Train providers to conduct BIbull Establish a referral networkbull Integrate SBIRT with adherence and retention efforts
SOURCE Fischer L (2012) Addiction Science amp Clinical Practice 7(Suppl 1) A73
Activity Adoption of SBIRT Can SBIRT work in your setting
3 minutes
End
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Introductions
Briefly tell usWhat is your nameWhere do you work and what you do thereWho is your favorite musician or performerWhat is one reason you decided to attend this training session
Training OverviewOur goal for this training is to instruct HIV providers in specific SBIRT procedures and to developrsquo skills to deliver SBIRT in their daily clinical practice
Resources
bull Participantsbull Educational
materials from ATTCs and other centers
bull Trainers
Activities
bull Didactic learningbull Role playsbull Group discussionsbull Brief assessmentbull Links to additional
training
Outcomes
bull Develop skills to deliver SBIRT
bull Discuss implementation challenges and possible solutions
bull Integrate SBIRT in practice (long-term outcome)
This brief training course will teach you how to
bull Administer substance use screening
bull Deliver a brief intervention
bull Employ a motivational approach
bull Make referrals to specialized treatment if needed
What Will You Learn
Activity Reflection
Take some time to think about the most difficult change that you had to make in your life
How much time did it take you to move from considering that change to actually taking action
SBIRT Review of Key TermsScreening Very brief set of questions that identifies risk of
substance use related problems
Brief Intervention Brief counseling that raises awareness of risks and motivates client toward acknowledgement of problem
Brief Treatment Cognitive behavioral work with clients who acknowledge risks and are seeking help
Referral Procedures to help patients access specialized care
Benefits of SBIRTSubstance abuse
SBI may reduce alcohol and drug use significantly
Morbidity and mortality SBI reduces accidents injuries trauma emergency department visits depression drug-related infections and infectious diseases
Health care costsStudies have indicated that SBI for alcohol saves $2 - $4 for each $100 expended
Other outcomes SBI may reduce work-impairment reduce DUIs and improve neonatal outcomes
Benefits of SBIRT for Practice
bull Increases cliniciansrsquo awareness of substance use issues
bull Offers clinicians more systematic approach to addressing substance use (less of a ldquojudgment callrdquo)
The Key to Successful Interventions
Brief interventions are successful when clinicians relate patientsrsquo risky substance use to improvement in patientsrsquo overall health and wellbeing
Candidates for Routine Screening
bull College students bull Primary care patientsbull Mental health patientsbull Patients in infectious disease clinicsbull People with alcohol- or drug-related
legal offenses (eg DUI)
Rationale for Conducting SBIRT in an HIV Care Setting
HIV in 2013bull HIV is now considered a manageable chronic
illnessbull HIV patients are living longer and facing
multiple health issues in addition to their HIV diseasebull Homelessness bull Disease progressionbull Mental illnessbull Substance abuse
bull Engagement retention and adherence among HIV patients continues to present challenges to HIV care providers
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
Risks of Untreated Mental Health and Substance Use Problems
bull Poorer adherence to treatment and medication regimens
bull Higher hospitalization rates for medical complications
bull Greater likelihood of treatment drop-out or being lost to follow-up
bull Greater risk for opportunistic (re-) infectionbull Greater risk of psychosocial problemsbull Greater risk of suicide or accidental death
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
SBIRT in HIV Settingsbull SBIRT in primary care settings is effective in
changing behavior and preventing adverse outcomes attributable to alcohol and other drugs
bull People living with HIV are more likely than the general population to experience substance abuse problems
bull SBI protocols have not been readily implemented in HIV care settings
SOURCE Fischer L (2012) Addiction Science amp Clinical Practice 7(Suppl 1) A73
SBIRT in HIV Settings
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
Impact of a Computer-Assisted SBIRT Program in and HIV Setting
bull Implemented in San Francisco General Hospitalrsquos Positive Health Program (PHP) in 2010-11bull Most common substances reported were tobacco
(80) alcohol (54) cocaine (54) amphetamines (47) nonmedical sedative use (34) and nonmedical opioid use (27)
bull SBI for unhealthy substance use is acceptable to patients in HIV primary care settings
bull Significant decreases observed with amphetamines and sedatives significant increase in number of patients with HIV viral suppression
SOURCE Dawson Rose et al (2012) IAC Poster
Colorados Ryan White Collaborative SBIRT Project
bull Of 2500 patients screenedbull 31 (n=775) received a BI for risky alcohol tobacco
or drug usebull 23 (n=575) were referred for therapy or specialized
treatment
bull Recommendations for standardizing SBIRT in HIV settings include
bull Apply a systematic screening approachbull Train providers to conduct BIbull Establish a referral networkbull Integrate SBIRT with adherence and retention efforts
SOURCE Fischer L (2012) Addiction Science amp Clinical Practice 7(Suppl 1) A73
Activity Adoption of SBIRT Can SBIRT work in your setting
3 minutes
End
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Introductions
Briefly tell usWhat is your nameWhere do you work and what you do thereWho is your favorite musician or performerWhat is one reason you decided to attend this training session
Training OverviewOur goal for this training is to instruct HIV providers in specific SBIRT procedures and to developrsquo skills to deliver SBIRT in their daily clinical practice
Resources
bull Participantsbull Educational
materials from ATTCs and other centers
bull Trainers
Activities
bull Didactic learningbull Role playsbull Group discussionsbull Brief assessmentbull Links to additional
training
Outcomes
bull Develop skills to deliver SBIRT
bull Discuss implementation challenges and possible solutions
bull Integrate SBIRT in practice (long-term outcome)
This brief training course will teach you how to
bull Administer substance use screening
bull Deliver a brief intervention
bull Employ a motivational approach
bull Make referrals to specialized treatment if needed
What Will You Learn
Activity Reflection
Take some time to think about the most difficult change that you had to make in your life
How much time did it take you to move from considering that change to actually taking action
SBIRT Review of Key TermsScreening Very brief set of questions that identifies risk of
substance use related problems
Brief Intervention Brief counseling that raises awareness of risks and motivates client toward acknowledgement of problem
Brief Treatment Cognitive behavioral work with clients who acknowledge risks and are seeking help
Referral Procedures to help patients access specialized care
Benefits of SBIRTSubstance abuse
SBI may reduce alcohol and drug use significantly
Morbidity and mortality SBI reduces accidents injuries trauma emergency department visits depression drug-related infections and infectious diseases
Health care costsStudies have indicated that SBI for alcohol saves $2 - $4 for each $100 expended
Other outcomes SBI may reduce work-impairment reduce DUIs and improve neonatal outcomes
Benefits of SBIRT for Practice
bull Increases cliniciansrsquo awareness of substance use issues
bull Offers clinicians more systematic approach to addressing substance use (less of a ldquojudgment callrdquo)
The Key to Successful Interventions
Brief interventions are successful when clinicians relate patientsrsquo risky substance use to improvement in patientsrsquo overall health and wellbeing
Candidates for Routine Screening
bull College students bull Primary care patientsbull Mental health patientsbull Patients in infectious disease clinicsbull People with alcohol- or drug-related
legal offenses (eg DUI)
Rationale for Conducting SBIRT in an HIV Care Setting
HIV in 2013bull HIV is now considered a manageable chronic
illnessbull HIV patients are living longer and facing
multiple health issues in addition to their HIV diseasebull Homelessness bull Disease progressionbull Mental illnessbull Substance abuse
bull Engagement retention and adherence among HIV patients continues to present challenges to HIV care providers
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
Risks of Untreated Mental Health and Substance Use Problems
bull Poorer adherence to treatment and medication regimens
bull Higher hospitalization rates for medical complications
bull Greater likelihood of treatment drop-out or being lost to follow-up
bull Greater risk for opportunistic (re-) infectionbull Greater risk of psychosocial problemsbull Greater risk of suicide or accidental death
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
SBIRT in HIV Settingsbull SBIRT in primary care settings is effective in
changing behavior and preventing adverse outcomes attributable to alcohol and other drugs
bull People living with HIV are more likely than the general population to experience substance abuse problems
bull SBI protocols have not been readily implemented in HIV care settings
SOURCE Fischer L (2012) Addiction Science amp Clinical Practice 7(Suppl 1) A73
SBIRT in HIV Settings
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
Impact of a Computer-Assisted SBIRT Program in and HIV Setting
bull Implemented in San Francisco General Hospitalrsquos Positive Health Program (PHP) in 2010-11bull Most common substances reported were tobacco
(80) alcohol (54) cocaine (54) amphetamines (47) nonmedical sedative use (34) and nonmedical opioid use (27)
bull SBI for unhealthy substance use is acceptable to patients in HIV primary care settings
bull Significant decreases observed with amphetamines and sedatives significant increase in number of patients with HIV viral suppression
SOURCE Dawson Rose et al (2012) IAC Poster
Colorados Ryan White Collaborative SBIRT Project
bull Of 2500 patients screenedbull 31 (n=775) received a BI for risky alcohol tobacco
or drug usebull 23 (n=575) were referred for therapy or specialized
treatment
bull Recommendations for standardizing SBIRT in HIV settings include
bull Apply a systematic screening approachbull Train providers to conduct BIbull Establish a referral networkbull Integrate SBIRT with adherence and retention efforts
SOURCE Fischer L (2012) Addiction Science amp Clinical Practice 7(Suppl 1) A73
Activity Adoption of SBIRT Can SBIRT work in your setting
3 minutes
End
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Introductions
Briefly tell usWhat is your nameWhere do you work and what you do thereWho is your favorite musician or performerWhat is one reason you decided to attend this training session
Training OverviewOur goal for this training is to instruct HIV providers in specific SBIRT procedures and to developrsquo skills to deliver SBIRT in their daily clinical practice
Resources
bull Participantsbull Educational
materials from ATTCs and other centers
bull Trainers
Activities
bull Didactic learningbull Role playsbull Group discussionsbull Brief assessmentbull Links to additional
training
Outcomes
bull Develop skills to deliver SBIRT
bull Discuss implementation challenges and possible solutions
bull Integrate SBIRT in practice (long-term outcome)
This brief training course will teach you how to
bull Administer substance use screening
bull Deliver a brief intervention
bull Employ a motivational approach
bull Make referrals to specialized treatment if needed
What Will You Learn
Activity Reflection
Take some time to think about the most difficult change that you had to make in your life
How much time did it take you to move from considering that change to actually taking action
SBIRT Review of Key TermsScreening Very brief set of questions that identifies risk of
substance use related problems
Brief Intervention Brief counseling that raises awareness of risks and motivates client toward acknowledgement of problem
Brief Treatment Cognitive behavioral work with clients who acknowledge risks and are seeking help
Referral Procedures to help patients access specialized care
Benefits of SBIRTSubstance abuse
SBI may reduce alcohol and drug use significantly
Morbidity and mortality SBI reduces accidents injuries trauma emergency department visits depression drug-related infections and infectious diseases
Health care costsStudies have indicated that SBI for alcohol saves $2 - $4 for each $100 expended
Other outcomes SBI may reduce work-impairment reduce DUIs and improve neonatal outcomes
Benefits of SBIRT for Practice
bull Increases cliniciansrsquo awareness of substance use issues
bull Offers clinicians more systematic approach to addressing substance use (less of a ldquojudgment callrdquo)
The Key to Successful Interventions
Brief interventions are successful when clinicians relate patientsrsquo risky substance use to improvement in patientsrsquo overall health and wellbeing
Candidates for Routine Screening
bull College students bull Primary care patientsbull Mental health patientsbull Patients in infectious disease clinicsbull People with alcohol- or drug-related
legal offenses (eg DUI)
Rationale for Conducting SBIRT in an HIV Care Setting
HIV in 2013bull HIV is now considered a manageable chronic
illnessbull HIV patients are living longer and facing
multiple health issues in addition to their HIV diseasebull Homelessness bull Disease progressionbull Mental illnessbull Substance abuse
bull Engagement retention and adherence among HIV patients continues to present challenges to HIV care providers
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
Risks of Untreated Mental Health and Substance Use Problems
bull Poorer adherence to treatment and medication regimens
bull Higher hospitalization rates for medical complications
bull Greater likelihood of treatment drop-out or being lost to follow-up
bull Greater risk for opportunistic (re-) infectionbull Greater risk of psychosocial problemsbull Greater risk of suicide or accidental death
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
SBIRT in HIV Settingsbull SBIRT in primary care settings is effective in
changing behavior and preventing adverse outcomes attributable to alcohol and other drugs
bull People living with HIV are more likely than the general population to experience substance abuse problems
bull SBI protocols have not been readily implemented in HIV care settings
SOURCE Fischer L (2012) Addiction Science amp Clinical Practice 7(Suppl 1) A73
SBIRT in HIV Settings
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
Impact of a Computer-Assisted SBIRT Program in and HIV Setting
bull Implemented in San Francisco General Hospitalrsquos Positive Health Program (PHP) in 2010-11bull Most common substances reported were tobacco
(80) alcohol (54) cocaine (54) amphetamines (47) nonmedical sedative use (34) and nonmedical opioid use (27)
bull SBI for unhealthy substance use is acceptable to patients in HIV primary care settings
bull Significant decreases observed with amphetamines and sedatives significant increase in number of patients with HIV viral suppression
SOURCE Dawson Rose et al (2012) IAC Poster
Colorados Ryan White Collaborative SBIRT Project
bull Of 2500 patients screenedbull 31 (n=775) received a BI for risky alcohol tobacco
or drug usebull 23 (n=575) were referred for therapy or specialized
treatment
bull Recommendations for standardizing SBIRT in HIV settings include
bull Apply a systematic screening approachbull Train providers to conduct BIbull Establish a referral networkbull Integrate SBIRT with adherence and retention efforts
SOURCE Fischer L (2012) Addiction Science amp Clinical Practice 7(Suppl 1) A73
Activity Adoption of SBIRT Can SBIRT work in your setting
3 minutes
End
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Introductions
Briefly tell usWhat is your nameWhere do you work and what you do thereWho is your favorite musician or performerWhat is one reason you decided to attend this training session
Training OverviewOur goal for this training is to instruct HIV providers in specific SBIRT procedures and to developrsquo skills to deliver SBIRT in their daily clinical practice
Resources
bull Participantsbull Educational
materials from ATTCs and other centers
bull Trainers
Activities
bull Didactic learningbull Role playsbull Group discussionsbull Brief assessmentbull Links to additional
training
Outcomes
bull Develop skills to deliver SBIRT
bull Discuss implementation challenges and possible solutions
bull Integrate SBIRT in practice (long-term outcome)
This brief training course will teach you how to
bull Administer substance use screening
bull Deliver a brief intervention
bull Employ a motivational approach
bull Make referrals to specialized treatment if needed
What Will You Learn
Activity Reflection
Take some time to think about the most difficult change that you had to make in your life
How much time did it take you to move from considering that change to actually taking action
SBIRT Review of Key TermsScreening Very brief set of questions that identifies risk of
substance use related problems
Brief Intervention Brief counseling that raises awareness of risks and motivates client toward acknowledgement of problem
Brief Treatment Cognitive behavioral work with clients who acknowledge risks and are seeking help
Referral Procedures to help patients access specialized care
Benefits of SBIRTSubstance abuse
SBI may reduce alcohol and drug use significantly
Morbidity and mortality SBI reduces accidents injuries trauma emergency department visits depression drug-related infections and infectious diseases
Health care costsStudies have indicated that SBI for alcohol saves $2 - $4 for each $100 expended
Other outcomes SBI may reduce work-impairment reduce DUIs and improve neonatal outcomes
Benefits of SBIRT for Practice
bull Increases cliniciansrsquo awareness of substance use issues
bull Offers clinicians more systematic approach to addressing substance use (less of a ldquojudgment callrdquo)
The Key to Successful Interventions
Brief interventions are successful when clinicians relate patientsrsquo risky substance use to improvement in patientsrsquo overall health and wellbeing
Candidates for Routine Screening
bull College students bull Primary care patientsbull Mental health patientsbull Patients in infectious disease clinicsbull People with alcohol- or drug-related
legal offenses (eg DUI)
Rationale for Conducting SBIRT in an HIV Care Setting
HIV in 2013bull HIV is now considered a manageable chronic
illnessbull HIV patients are living longer and facing
multiple health issues in addition to their HIV diseasebull Homelessness bull Disease progressionbull Mental illnessbull Substance abuse
bull Engagement retention and adherence among HIV patients continues to present challenges to HIV care providers
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
Risks of Untreated Mental Health and Substance Use Problems
bull Poorer adherence to treatment and medication regimens
bull Higher hospitalization rates for medical complications
bull Greater likelihood of treatment drop-out or being lost to follow-up
bull Greater risk for opportunistic (re-) infectionbull Greater risk of psychosocial problemsbull Greater risk of suicide or accidental death
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
SBIRT in HIV Settingsbull SBIRT in primary care settings is effective in
changing behavior and preventing adverse outcomes attributable to alcohol and other drugs
bull People living with HIV are more likely than the general population to experience substance abuse problems
bull SBI protocols have not been readily implemented in HIV care settings
SOURCE Fischer L (2012) Addiction Science amp Clinical Practice 7(Suppl 1) A73
SBIRT in HIV Settings
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
Impact of a Computer-Assisted SBIRT Program in and HIV Setting
bull Implemented in San Francisco General Hospitalrsquos Positive Health Program (PHP) in 2010-11bull Most common substances reported were tobacco
(80) alcohol (54) cocaine (54) amphetamines (47) nonmedical sedative use (34) and nonmedical opioid use (27)
bull SBI for unhealthy substance use is acceptable to patients in HIV primary care settings
bull Significant decreases observed with amphetamines and sedatives significant increase in number of patients with HIV viral suppression
SOURCE Dawson Rose et al (2012) IAC Poster
Colorados Ryan White Collaborative SBIRT Project
bull Of 2500 patients screenedbull 31 (n=775) received a BI for risky alcohol tobacco
or drug usebull 23 (n=575) were referred for therapy or specialized
treatment
bull Recommendations for standardizing SBIRT in HIV settings include
bull Apply a systematic screening approachbull Train providers to conduct BIbull Establish a referral networkbull Integrate SBIRT with adherence and retention efforts
SOURCE Fischer L (2012) Addiction Science amp Clinical Practice 7(Suppl 1) A73
Activity Adoption of SBIRT Can SBIRT work in your setting
3 minutes
End
Introductions
Briefly tell usWhat is your nameWhere do you work and what you do thereWho is your favorite musician or performerWhat is one reason you decided to attend this training session
Training OverviewOur goal for this training is to instruct HIV providers in specific SBIRT procedures and to developrsquo skills to deliver SBIRT in their daily clinical practice
Resources
bull Participantsbull Educational
materials from ATTCs and other centers
bull Trainers
Activities
bull Didactic learningbull Role playsbull Group discussionsbull Brief assessmentbull Links to additional
training
Outcomes
bull Develop skills to deliver SBIRT
bull Discuss implementation challenges and possible solutions
bull Integrate SBIRT in practice (long-term outcome)
This brief training course will teach you how to
bull Administer substance use screening
bull Deliver a brief intervention
bull Employ a motivational approach
bull Make referrals to specialized treatment if needed
What Will You Learn
Activity Reflection
Take some time to think about the most difficult change that you had to make in your life
How much time did it take you to move from considering that change to actually taking action
SBIRT Review of Key TermsScreening Very brief set of questions that identifies risk of
substance use related problems
Brief Intervention Brief counseling that raises awareness of risks and motivates client toward acknowledgement of problem
Brief Treatment Cognitive behavioral work with clients who acknowledge risks and are seeking help
Referral Procedures to help patients access specialized care
Benefits of SBIRTSubstance abuse
SBI may reduce alcohol and drug use significantly
Morbidity and mortality SBI reduces accidents injuries trauma emergency department visits depression drug-related infections and infectious diseases
Health care costsStudies have indicated that SBI for alcohol saves $2 - $4 for each $100 expended
Other outcomes SBI may reduce work-impairment reduce DUIs and improve neonatal outcomes
Benefits of SBIRT for Practice
bull Increases cliniciansrsquo awareness of substance use issues
bull Offers clinicians more systematic approach to addressing substance use (less of a ldquojudgment callrdquo)
The Key to Successful Interventions
Brief interventions are successful when clinicians relate patientsrsquo risky substance use to improvement in patientsrsquo overall health and wellbeing
Candidates for Routine Screening
bull College students bull Primary care patientsbull Mental health patientsbull Patients in infectious disease clinicsbull People with alcohol- or drug-related
legal offenses (eg DUI)
Rationale for Conducting SBIRT in an HIV Care Setting
HIV in 2013bull HIV is now considered a manageable chronic
illnessbull HIV patients are living longer and facing
multiple health issues in addition to their HIV diseasebull Homelessness bull Disease progressionbull Mental illnessbull Substance abuse
bull Engagement retention and adherence among HIV patients continues to present challenges to HIV care providers
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
Risks of Untreated Mental Health and Substance Use Problems
bull Poorer adherence to treatment and medication regimens
bull Higher hospitalization rates for medical complications
bull Greater likelihood of treatment drop-out or being lost to follow-up
bull Greater risk for opportunistic (re-) infectionbull Greater risk of psychosocial problemsbull Greater risk of suicide or accidental death
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
SBIRT in HIV Settingsbull SBIRT in primary care settings is effective in
changing behavior and preventing adverse outcomes attributable to alcohol and other drugs
bull People living with HIV are more likely than the general population to experience substance abuse problems
bull SBI protocols have not been readily implemented in HIV care settings
SOURCE Fischer L (2012) Addiction Science amp Clinical Practice 7(Suppl 1) A73
SBIRT in HIV Settings
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
Impact of a Computer-Assisted SBIRT Program in and HIV Setting
bull Implemented in San Francisco General Hospitalrsquos Positive Health Program (PHP) in 2010-11bull Most common substances reported were tobacco
(80) alcohol (54) cocaine (54) amphetamines (47) nonmedical sedative use (34) and nonmedical opioid use (27)
bull SBI for unhealthy substance use is acceptable to patients in HIV primary care settings
bull Significant decreases observed with amphetamines and sedatives significant increase in number of patients with HIV viral suppression
SOURCE Dawson Rose et al (2012) IAC Poster
Colorados Ryan White Collaborative SBIRT Project
bull Of 2500 patients screenedbull 31 (n=775) received a BI for risky alcohol tobacco
or drug usebull 23 (n=575) were referred for therapy or specialized
treatment
bull Recommendations for standardizing SBIRT in HIV settings include
bull Apply a systematic screening approachbull Train providers to conduct BIbull Establish a referral networkbull Integrate SBIRT with adherence and retention efforts
SOURCE Fischer L (2012) Addiction Science amp Clinical Practice 7(Suppl 1) A73
Activity Adoption of SBIRT Can SBIRT work in your setting
3 minutes
End
Training OverviewOur goal for this training is to instruct HIV providers in specific SBIRT procedures and to developrsquo skills to deliver SBIRT in their daily clinical practice
Resources
bull Participantsbull Educational
materials from ATTCs and other centers
bull Trainers
Activities
bull Didactic learningbull Role playsbull Group discussionsbull Brief assessmentbull Links to additional
training
Outcomes
bull Develop skills to deliver SBIRT
bull Discuss implementation challenges and possible solutions
bull Integrate SBIRT in practice (long-term outcome)
This brief training course will teach you how to
bull Administer substance use screening
bull Deliver a brief intervention
bull Employ a motivational approach
bull Make referrals to specialized treatment if needed
What Will You Learn
Activity Reflection
Take some time to think about the most difficult change that you had to make in your life
How much time did it take you to move from considering that change to actually taking action
SBIRT Review of Key TermsScreening Very brief set of questions that identifies risk of
substance use related problems
Brief Intervention Brief counseling that raises awareness of risks and motivates client toward acknowledgement of problem
Brief Treatment Cognitive behavioral work with clients who acknowledge risks and are seeking help
Referral Procedures to help patients access specialized care
Benefits of SBIRTSubstance abuse
SBI may reduce alcohol and drug use significantly
Morbidity and mortality SBI reduces accidents injuries trauma emergency department visits depression drug-related infections and infectious diseases
Health care costsStudies have indicated that SBI for alcohol saves $2 - $4 for each $100 expended
Other outcomes SBI may reduce work-impairment reduce DUIs and improve neonatal outcomes
Benefits of SBIRT for Practice
bull Increases cliniciansrsquo awareness of substance use issues
bull Offers clinicians more systematic approach to addressing substance use (less of a ldquojudgment callrdquo)
The Key to Successful Interventions
Brief interventions are successful when clinicians relate patientsrsquo risky substance use to improvement in patientsrsquo overall health and wellbeing
Candidates for Routine Screening
bull College students bull Primary care patientsbull Mental health patientsbull Patients in infectious disease clinicsbull People with alcohol- or drug-related
legal offenses (eg DUI)
Rationale for Conducting SBIRT in an HIV Care Setting
HIV in 2013bull HIV is now considered a manageable chronic
illnessbull HIV patients are living longer and facing
multiple health issues in addition to their HIV diseasebull Homelessness bull Disease progressionbull Mental illnessbull Substance abuse
bull Engagement retention and adherence among HIV patients continues to present challenges to HIV care providers
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
Risks of Untreated Mental Health and Substance Use Problems
bull Poorer adherence to treatment and medication regimens
bull Higher hospitalization rates for medical complications
bull Greater likelihood of treatment drop-out or being lost to follow-up
bull Greater risk for opportunistic (re-) infectionbull Greater risk of psychosocial problemsbull Greater risk of suicide or accidental death
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
SBIRT in HIV Settingsbull SBIRT in primary care settings is effective in
changing behavior and preventing adverse outcomes attributable to alcohol and other drugs
bull People living with HIV are more likely than the general population to experience substance abuse problems
bull SBI protocols have not been readily implemented in HIV care settings
SOURCE Fischer L (2012) Addiction Science amp Clinical Practice 7(Suppl 1) A73
SBIRT in HIV Settings
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
Impact of a Computer-Assisted SBIRT Program in and HIV Setting
bull Implemented in San Francisco General Hospitalrsquos Positive Health Program (PHP) in 2010-11bull Most common substances reported were tobacco
(80) alcohol (54) cocaine (54) amphetamines (47) nonmedical sedative use (34) and nonmedical opioid use (27)
bull SBI for unhealthy substance use is acceptable to patients in HIV primary care settings
bull Significant decreases observed with amphetamines and sedatives significant increase in number of patients with HIV viral suppression
SOURCE Dawson Rose et al (2012) IAC Poster
Colorados Ryan White Collaborative SBIRT Project
bull Of 2500 patients screenedbull 31 (n=775) received a BI for risky alcohol tobacco
or drug usebull 23 (n=575) were referred for therapy or specialized
treatment
bull Recommendations for standardizing SBIRT in HIV settings include
bull Apply a systematic screening approachbull Train providers to conduct BIbull Establish a referral networkbull Integrate SBIRT with adherence and retention efforts
SOURCE Fischer L (2012) Addiction Science amp Clinical Practice 7(Suppl 1) A73
Activity Adoption of SBIRT Can SBIRT work in your setting
3 minutes
End
This brief training course will teach you how to
bull Administer substance use screening
bull Deliver a brief intervention
bull Employ a motivational approach
bull Make referrals to specialized treatment if needed
What Will You Learn
Activity Reflection
Take some time to think about the most difficult change that you had to make in your life
How much time did it take you to move from considering that change to actually taking action
SBIRT Review of Key TermsScreening Very brief set of questions that identifies risk of
substance use related problems
Brief Intervention Brief counseling that raises awareness of risks and motivates client toward acknowledgement of problem
Brief Treatment Cognitive behavioral work with clients who acknowledge risks and are seeking help
Referral Procedures to help patients access specialized care
Benefits of SBIRTSubstance abuse
SBI may reduce alcohol and drug use significantly
Morbidity and mortality SBI reduces accidents injuries trauma emergency department visits depression drug-related infections and infectious diseases
Health care costsStudies have indicated that SBI for alcohol saves $2 - $4 for each $100 expended
Other outcomes SBI may reduce work-impairment reduce DUIs and improve neonatal outcomes
Benefits of SBIRT for Practice
bull Increases cliniciansrsquo awareness of substance use issues
bull Offers clinicians more systematic approach to addressing substance use (less of a ldquojudgment callrdquo)
The Key to Successful Interventions
Brief interventions are successful when clinicians relate patientsrsquo risky substance use to improvement in patientsrsquo overall health and wellbeing
Candidates for Routine Screening
bull College students bull Primary care patientsbull Mental health patientsbull Patients in infectious disease clinicsbull People with alcohol- or drug-related
legal offenses (eg DUI)
Rationale for Conducting SBIRT in an HIV Care Setting
HIV in 2013bull HIV is now considered a manageable chronic
illnessbull HIV patients are living longer and facing
multiple health issues in addition to their HIV diseasebull Homelessness bull Disease progressionbull Mental illnessbull Substance abuse
bull Engagement retention and adherence among HIV patients continues to present challenges to HIV care providers
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
Risks of Untreated Mental Health and Substance Use Problems
bull Poorer adherence to treatment and medication regimens
bull Higher hospitalization rates for medical complications
bull Greater likelihood of treatment drop-out or being lost to follow-up
bull Greater risk for opportunistic (re-) infectionbull Greater risk of psychosocial problemsbull Greater risk of suicide or accidental death
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
SBIRT in HIV Settingsbull SBIRT in primary care settings is effective in
changing behavior and preventing adverse outcomes attributable to alcohol and other drugs
bull People living with HIV are more likely than the general population to experience substance abuse problems
bull SBI protocols have not been readily implemented in HIV care settings
SOURCE Fischer L (2012) Addiction Science amp Clinical Practice 7(Suppl 1) A73
SBIRT in HIV Settings
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
Impact of a Computer-Assisted SBIRT Program in and HIV Setting
bull Implemented in San Francisco General Hospitalrsquos Positive Health Program (PHP) in 2010-11bull Most common substances reported were tobacco
(80) alcohol (54) cocaine (54) amphetamines (47) nonmedical sedative use (34) and nonmedical opioid use (27)
bull SBI for unhealthy substance use is acceptable to patients in HIV primary care settings
bull Significant decreases observed with amphetamines and sedatives significant increase in number of patients with HIV viral suppression
SOURCE Dawson Rose et al (2012) IAC Poster
Colorados Ryan White Collaborative SBIRT Project
bull Of 2500 patients screenedbull 31 (n=775) received a BI for risky alcohol tobacco
or drug usebull 23 (n=575) were referred for therapy or specialized
treatment
bull Recommendations for standardizing SBIRT in HIV settings include
bull Apply a systematic screening approachbull Train providers to conduct BIbull Establish a referral networkbull Integrate SBIRT with adherence and retention efforts
SOURCE Fischer L (2012) Addiction Science amp Clinical Practice 7(Suppl 1) A73
Activity Adoption of SBIRT Can SBIRT work in your setting
3 minutes
End
Activity Reflection
Take some time to think about the most difficult change that you had to make in your life
How much time did it take you to move from considering that change to actually taking action
SBIRT Review of Key TermsScreening Very brief set of questions that identifies risk of
substance use related problems
Brief Intervention Brief counseling that raises awareness of risks and motivates client toward acknowledgement of problem
Brief Treatment Cognitive behavioral work with clients who acknowledge risks and are seeking help
Referral Procedures to help patients access specialized care
Benefits of SBIRTSubstance abuse
SBI may reduce alcohol and drug use significantly
Morbidity and mortality SBI reduces accidents injuries trauma emergency department visits depression drug-related infections and infectious diseases
Health care costsStudies have indicated that SBI for alcohol saves $2 - $4 for each $100 expended
Other outcomes SBI may reduce work-impairment reduce DUIs and improve neonatal outcomes
Benefits of SBIRT for Practice
bull Increases cliniciansrsquo awareness of substance use issues
bull Offers clinicians more systematic approach to addressing substance use (less of a ldquojudgment callrdquo)
The Key to Successful Interventions
Brief interventions are successful when clinicians relate patientsrsquo risky substance use to improvement in patientsrsquo overall health and wellbeing
Candidates for Routine Screening
bull College students bull Primary care patientsbull Mental health patientsbull Patients in infectious disease clinicsbull People with alcohol- or drug-related
legal offenses (eg DUI)
Rationale for Conducting SBIRT in an HIV Care Setting
HIV in 2013bull HIV is now considered a manageable chronic
illnessbull HIV patients are living longer and facing
multiple health issues in addition to their HIV diseasebull Homelessness bull Disease progressionbull Mental illnessbull Substance abuse
bull Engagement retention and adherence among HIV patients continues to present challenges to HIV care providers
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
Risks of Untreated Mental Health and Substance Use Problems
bull Poorer adherence to treatment and medication regimens
bull Higher hospitalization rates for medical complications
bull Greater likelihood of treatment drop-out or being lost to follow-up
bull Greater risk for opportunistic (re-) infectionbull Greater risk of psychosocial problemsbull Greater risk of suicide or accidental death
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
SBIRT in HIV Settingsbull SBIRT in primary care settings is effective in
changing behavior and preventing adverse outcomes attributable to alcohol and other drugs
bull People living with HIV are more likely than the general population to experience substance abuse problems
bull SBI protocols have not been readily implemented in HIV care settings
SOURCE Fischer L (2012) Addiction Science amp Clinical Practice 7(Suppl 1) A73
SBIRT in HIV Settings
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
Impact of a Computer-Assisted SBIRT Program in and HIV Setting
bull Implemented in San Francisco General Hospitalrsquos Positive Health Program (PHP) in 2010-11bull Most common substances reported were tobacco
(80) alcohol (54) cocaine (54) amphetamines (47) nonmedical sedative use (34) and nonmedical opioid use (27)
bull SBI for unhealthy substance use is acceptable to patients in HIV primary care settings
bull Significant decreases observed with amphetamines and sedatives significant increase in number of patients with HIV viral suppression
SOURCE Dawson Rose et al (2012) IAC Poster
Colorados Ryan White Collaborative SBIRT Project
bull Of 2500 patients screenedbull 31 (n=775) received a BI for risky alcohol tobacco
or drug usebull 23 (n=575) were referred for therapy or specialized
treatment
bull Recommendations for standardizing SBIRT in HIV settings include
bull Apply a systematic screening approachbull Train providers to conduct BIbull Establish a referral networkbull Integrate SBIRT with adherence and retention efforts
SOURCE Fischer L (2012) Addiction Science amp Clinical Practice 7(Suppl 1) A73
Activity Adoption of SBIRT Can SBIRT work in your setting
3 minutes
End
SBIRT Review of Key TermsScreening Very brief set of questions that identifies risk of
substance use related problems
Brief Intervention Brief counseling that raises awareness of risks and motivates client toward acknowledgement of problem
Brief Treatment Cognitive behavioral work with clients who acknowledge risks and are seeking help
Referral Procedures to help patients access specialized care
Benefits of SBIRTSubstance abuse
SBI may reduce alcohol and drug use significantly
Morbidity and mortality SBI reduces accidents injuries trauma emergency department visits depression drug-related infections and infectious diseases
Health care costsStudies have indicated that SBI for alcohol saves $2 - $4 for each $100 expended
Other outcomes SBI may reduce work-impairment reduce DUIs and improve neonatal outcomes
Benefits of SBIRT for Practice
bull Increases cliniciansrsquo awareness of substance use issues
bull Offers clinicians more systematic approach to addressing substance use (less of a ldquojudgment callrdquo)
The Key to Successful Interventions
Brief interventions are successful when clinicians relate patientsrsquo risky substance use to improvement in patientsrsquo overall health and wellbeing
Candidates for Routine Screening
bull College students bull Primary care patientsbull Mental health patientsbull Patients in infectious disease clinicsbull People with alcohol- or drug-related
legal offenses (eg DUI)
Rationale for Conducting SBIRT in an HIV Care Setting
HIV in 2013bull HIV is now considered a manageable chronic
illnessbull HIV patients are living longer and facing
multiple health issues in addition to their HIV diseasebull Homelessness bull Disease progressionbull Mental illnessbull Substance abuse
bull Engagement retention and adherence among HIV patients continues to present challenges to HIV care providers
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
Risks of Untreated Mental Health and Substance Use Problems
bull Poorer adherence to treatment and medication regimens
bull Higher hospitalization rates for medical complications
bull Greater likelihood of treatment drop-out or being lost to follow-up
bull Greater risk for opportunistic (re-) infectionbull Greater risk of psychosocial problemsbull Greater risk of suicide or accidental death
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
SBIRT in HIV Settingsbull SBIRT in primary care settings is effective in
changing behavior and preventing adverse outcomes attributable to alcohol and other drugs
bull People living with HIV are more likely than the general population to experience substance abuse problems
bull SBI protocols have not been readily implemented in HIV care settings
SOURCE Fischer L (2012) Addiction Science amp Clinical Practice 7(Suppl 1) A73
SBIRT in HIV Settings
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
Impact of a Computer-Assisted SBIRT Program in and HIV Setting
bull Implemented in San Francisco General Hospitalrsquos Positive Health Program (PHP) in 2010-11bull Most common substances reported were tobacco
(80) alcohol (54) cocaine (54) amphetamines (47) nonmedical sedative use (34) and nonmedical opioid use (27)
bull SBI for unhealthy substance use is acceptable to patients in HIV primary care settings
bull Significant decreases observed with amphetamines and sedatives significant increase in number of patients with HIV viral suppression
SOURCE Dawson Rose et al (2012) IAC Poster
Colorados Ryan White Collaborative SBIRT Project
bull Of 2500 patients screenedbull 31 (n=775) received a BI for risky alcohol tobacco
or drug usebull 23 (n=575) were referred for therapy or specialized
treatment
bull Recommendations for standardizing SBIRT in HIV settings include
bull Apply a systematic screening approachbull Train providers to conduct BIbull Establish a referral networkbull Integrate SBIRT with adherence and retention efforts
SOURCE Fischer L (2012) Addiction Science amp Clinical Practice 7(Suppl 1) A73
Activity Adoption of SBIRT Can SBIRT work in your setting
3 minutes
End
Benefits of SBIRTSubstance abuse
SBI may reduce alcohol and drug use significantly
Morbidity and mortality SBI reduces accidents injuries trauma emergency department visits depression drug-related infections and infectious diseases
Health care costsStudies have indicated that SBI for alcohol saves $2 - $4 for each $100 expended
Other outcomes SBI may reduce work-impairment reduce DUIs and improve neonatal outcomes
Benefits of SBIRT for Practice
bull Increases cliniciansrsquo awareness of substance use issues
bull Offers clinicians more systematic approach to addressing substance use (less of a ldquojudgment callrdquo)
The Key to Successful Interventions
Brief interventions are successful when clinicians relate patientsrsquo risky substance use to improvement in patientsrsquo overall health and wellbeing
Candidates for Routine Screening
bull College students bull Primary care patientsbull Mental health patientsbull Patients in infectious disease clinicsbull People with alcohol- or drug-related
legal offenses (eg DUI)
Rationale for Conducting SBIRT in an HIV Care Setting
HIV in 2013bull HIV is now considered a manageable chronic
illnessbull HIV patients are living longer and facing
multiple health issues in addition to their HIV diseasebull Homelessness bull Disease progressionbull Mental illnessbull Substance abuse
bull Engagement retention and adherence among HIV patients continues to present challenges to HIV care providers
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
Risks of Untreated Mental Health and Substance Use Problems
bull Poorer adherence to treatment and medication regimens
bull Higher hospitalization rates for medical complications
bull Greater likelihood of treatment drop-out or being lost to follow-up
bull Greater risk for opportunistic (re-) infectionbull Greater risk of psychosocial problemsbull Greater risk of suicide or accidental death
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
SBIRT in HIV Settingsbull SBIRT in primary care settings is effective in
changing behavior and preventing adverse outcomes attributable to alcohol and other drugs
bull People living with HIV are more likely than the general population to experience substance abuse problems
bull SBI protocols have not been readily implemented in HIV care settings
SOURCE Fischer L (2012) Addiction Science amp Clinical Practice 7(Suppl 1) A73
SBIRT in HIV Settings
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
Impact of a Computer-Assisted SBIRT Program in and HIV Setting
bull Implemented in San Francisco General Hospitalrsquos Positive Health Program (PHP) in 2010-11bull Most common substances reported were tobacco
(80) alcohol (54) cocaine (54) amphetamines (47) nonmedical sedative use (34) and nonmedical opioid use (27)
bull SBI for unhealthy substance use is acceptable to patients in HIV primary care settings
bull Significant decreases observed with amphetamines and sedatives significant increase in number of patients with HIV viral suppression
SOURCE Dawson Rose et al (2012) IAC Poster
Colorados Ryan White Collaborative SBIRT Project
bull Of 2500 patients screenedbull 31 (n=775) received a BI for risky alcohol tobacco
or drug usebull 23 (n=575) were referred for therapy or specialized
treatment
bull Recommendations for standardizing SBIRT in HIV settings include
bull Apply a systematic screening approachbull Train providers to conduct BIbull Establish a referral networkbull Integrate SBIRT with adherence and retention efforts
SOURCE Fischer L (2012) Addiction Science amp Clinical Practice 7(Suppl 1) A73
Activity Adoption of SBIRT Can SBIRT work in your setting
3 minutes
End
Benefits of SBIRT for Practice
bull Increases cliniciansrsquo awareness of substance use issues
bull Offers clinicians more systematic approach to addressing substance use (less of a ldquojudgment callrdquo)
The Key to Successful Interventions
Brief interventions are successful when clinicians relate patientsrsquo risky substance use to improvement in patientsrsquo overall health and wellbeing
Candidates for Routine Screening
bull College students bull Primary care patientsbull Mental health patientsbull Patients in infectious disease clinicsbull People with alcohol- or drug-related
legal offenses (eg DUI)
Rationale for Conducting SBIRT in an HIV Care Setting
HIV in 2013bull HIV is now considered a manageable chronic
illnessbull HIV patients are living longer and facing
multiple health issues in addition to their HIV diseasebull Homelessness bull Disease progressionbull Mental illnessbull Substance abuse
bull Engagement retention and adherence among HIV patients continues to present challenges to HIV care providers
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
Risks of Untreated Mental Health and Substance Use Problems
bull Poorer adherence to treatment and medication regimens
bull Higher hospitalization rates for medical complications
bull Greater likelihood of treatment drop-out or being lost to follow-up
bull Greater risk for opportunistic (re-) infectionbull Greater risk of psychosocial problemsbull Greater risk of suicide or accidental death
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
SBIRT in HIV Settingsbull SBIRT in primary care settings is effective in
changing behavior and preventing adverse outcomes attributable to alcohol and other drugs
bull People living with HIV are more likely than the general population to experience substance abuse problems
bull SBI protocols have not been readily implemented in HIV care settings
SOURCE Fischer L (2012) Addiction Science amp Clinical Practice 7(Suppl 1) A73
SBIRT in HIV Settings
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
Impact of a Computer-Assisted SBIRT Program in and HIV Setting
bull Implemented in San Francisco General Hospitalrsquos Positive Health Program (PHP) in 2010-11bull Most common substances reported were tobacco
(80) alcohol (54) cocaine (54) amphetamines (47) nonmedical sedative use (34) and nonmedical opioid use (27)
bull SBI for unhealthy substance use is acceptable to patients in HIV primary care settings
bull Significant decreases observed with amphetamines and sedatives significant increase in number of patients with HIV viral suppression
SOURCE Dawson Rose et al (2012) IAC Poster
Colorados Ryan White Collaborative SBIRT Project
bull Of 2500 patients screenedbull 31 (n=775) received a BI for risky alcohol tobacco
or drug usebull 23 (n=575) were referred for therapy or specialized
treatment
bull Recommendations for standardizing SBIRT in HIV settings include
bull Apply a systematic screening approachbull Train providers to conduct BIbull Establish a referral networkbull Integrate SBIRT with adherence and retention efforts
SOURCE Fischer L (2012) Addiction Science amp Clinical Practice 7(Suppl 1) A73
Activity Adoption of SBIRT Can SBIRT work in your setting
3 minutes
End
The Key to Successful Interventions
Brief interventions are successful when clinicians relate patientsrsquo risky substance use to improvement in patientsrsquo overall health and wellbeing
Candidates for Routine Screening
bull College students bull Primary care patientsbull Mental health patientsbull Patients in infectious disease clinicsbull People with alcohol- or drug-related
legal offenses (eg DUI)
Rationale for Conducting SBIRT in an HIV Care Setting
HIV in 2013bull HIV is now considered a manageable chronic
illnessbull HIV patients are living longer and facing
multiple health issues in addition to their HIV diseasebull Homelessness bull Disease progressionbull Mental illnessbull Substance abuse
bull Engagement retention and adherence among HIV patients continues to present challenges to HIV care providers
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
Risks of Untreated Mental Health and Substance Use Problems
bull Poorer adherence to treatment and medication regimens
bull Higher hospitalization rates for medical complications
bull Greater likelihood of treatment drop-out or being lost to follow-up
bull Greater risk for opportunistic (re-) infectionbull Greater risk of psychosocial problemsbull Greater risk of suicide or accidental death
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
SBIRT in HIV Settingsbull SBIRT in primary care settings is effective in
changing behavior and preventing adverse outcomes attributable to alcohol and other drugs
bull People living with HIV are more likely than the general population to experience substance abuse problems
bull SBI protocols have not been readily implemented in HIV care settings
SOURCE Fischer L (2012) Addiction Science amp Clinical Practice 7(Suppl 1) A73
SBIRT in HIV Settings
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
Impact of a Computer-Assisted SBIRT Program in and HIV Setting
bull Implemented in San Francisco General Hospitalrsquos Positive Health Program (PHP) in 2010-11bull Most common substances reported were tobacco
(80) alcohol (54) cocaine (54) amphetamines (47) nonmedical sedative use (34) and nonmedical opioid use (27)
bull SBI for unhealthy substance use is acceptable to patients in HIV primary care settings
bull Significant decreases observed with amphetamines and sedatives significant increase in number of patients with HIV viral suppression
SOURCE Dawson Rose et al (2012) IAC Poster
Colorados Ryan White Collaborative SBIRT Project
bull Of 2500 patients screenedbull 31 (n=775) received a BI for risky alcohol tobacco
or drug usebull 23 (n=575) were referred for therapy or specialized
treatment
bull Recommendations for standardizing SBIRT in HIV settings include
bull Apply a systematic screening approachbull Train providers to conduct BIbull Establish a referral networkbull Integrate SBIRT with adherence and retention efforts
SOURCE Fischer L (2012) Addiction Science amp Clinical Practice 7(Suppl 1) A73
Activity Adoption of SBIRT Can SBIRT work in your setting
3 minutes
End
Candidates for Routine Screening
bull College students bull Primary care patientsbull Mental health patientsbull Patients in infectious disease clinicsbull People with alcohol- or drug-related
legal offenses (eg DUI)
Rationale for Conducting SBIRT in an HIV Care Setting
HIV in 2013bull HIV is now considered a manageable chronic
illnessbull HIV patients are living longer and facing
multiple health issues in addition to their HIV diseasebull Homelessness bull Disease progressionbull Mental illnessbull Substance abuse
bull Engagement retention and adherence among HIV patients continues to present challenges to HIV care providers
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
Risks of Untreated Mental Health and Substance Use Problems
bull Poorer adherence to treatment and medication regimens
bull Higher hospitalization rates for medical complications
bull Greater likelihood of treatment drop-out or being lost to follow-up
bull Greater risk for opportunistic (re-) infectionbull Greater risk of psychosocial problemsbull Greater risk of suicide or accidental death
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
SBIRT in HIV Settingsbull SBIRT in primary care settings is effective in
changing behavior and preventing adverse outcomes attributable to alcohol and other drugs
bull People living with HIV are more likely than the general population to experience substance abuse problems
bull SBI protocols have not been readily implemented in HIV care settings
SOURCE Fischer L (2012) Addiction Science amp Clinical Practice 7(Suppl 1) A73
SBIRT in HIV Settings
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
Impact of a Computer-Assisted SBIRT Program in and HIV Setting
bull Implemented in San Francisco General Hospitalrsquos Positive Health Program (PHP) in 2010-11bull Most common substances reported were tobacco
(80) alcohol (54) cocaine (54) amphetamines (47) nonmedical sedative use (34) and nonmedical opioid use (27)
bull SBI for unhealthy substance use is acceptable to patients in HIV primary care settings
bull Significant decreases observed with amphetamines and sedatives significant increase in number of patients with HIV viral suppression
SOURCE Dawson Rose et al (2012) IAC Poster
Colorados Ryan White Collaborative SBIRT Project
bull Of 2500 patients screenedbull 31 (n=775) received a BI for risky alcohol tobacco
or drug usebull 23 (n=575) were referred for therapy or specialized
treatment
bull Recommendations for standardizing SBIRT in HIV settings include
bull Apply a systematic screening approachbull Train providers to conduct BIbull Establish a referral networkbull Integrate SBIRT with adherence and retention efforts
SOURCE Fischer L (2012) Addiction Science amp Clinical Practice 7(Suppl 1) A73
Activity Adoption of SBIRT Can SBIRT work in your setting
3 minutes
End
Rationale for Conducting SBIRT in an HIV Care Setting
HIV in 2013bull HIV is now considered a manageable chronic
illnessbull HIV patients are living longer and facing
multiple health issues in addition to their HIV diseasebull Homelessness bull Disease progressionbull Mental illnessbull Substance abuse
bull Engagement retention and adherence among HIV patients continues to present challenges to HIV care providers
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
Risks of Untreated Mental Health and Substance Use Problems
bull Poorer adherence to treatment and medication regimens
bull Higher hospitalization rates for medical complications
bull Greater likelihood of treatment drop-out or being lost to follow-up
bull Greater risk for opportunistic (re-) infectionbull Greater risk of psychosocial problemsbull Greater risk of suicide or accidental death
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
SBIRT in HIV Settingsbull SBIRT in primary care settings is effective in
changing behavior and preventing adverse outcomes attributable to alcohol and other drugs
bull People living with HIV are more likely than the general population to experience substance abuse problems
bull SBI protocols have not been readily implemented in HIV care settings
SOURCE Fischer L (2012) Addiction Science amp Clinical Practice 7(Suppl 1) A73
SBIRT in HIV Settings
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
Impact of a Computer-Assisted SBIRT Program in and HIV Setting
bull Implemented in San Francisco General Hospitalrsquos Positive Health Program (PHP) in 2010-11bull Most common substances reported were tobacco
(80) alcohol (54) cocaine (54) amphetamines (47) nonmedical sedative use (34) and nonmedical opioid use (27)
bull SBI for unhealthy substance use is acceptable to patients in HIV primary care settings
bull Significant decreases observed with amphetamines and sedatives significant increase in number of patients with HIV viral suppression
SOURCE Dawson Rose et al (2012) IAC Poster
Colorados Ryan White Collaborative SBIRT Project
bull Of 2500 patients screenedbull 31 (n=775) received a BI for risky alcohol tobacco
or drug usebull 23 (n=575) were referred for therapy or specialized
treatment
bull Recommendations for standardizing SBIRT in HIV settings include
bull Apply a systematic screening approachbull Train providers to conduct BIbull Establish a referral networkbull Integrate SBIRT with adherence and retention efforts
SOURCE Fischer L (2012) Addiction Science amp Clinical Practice 7(Suppl 1) A73
Activity Adoption of SBIRT Can SBIRT work in your setting
3 minutes
End
HIV in 2013bull HIV is now considered a manageable chronic
illnessbull HIV patients are living longer and facing
multiple health issues in addition to their HIV diseasebull Homelessness bull Disease progressionbull Mental illnessbull Substance abuse
bull Engagement retention and adherence among HIV patients continues to present challenges to HIV care providers
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
Risks of Untreated Mental Health and Substance Use Problems
bull Poorer adherence to treatment and medication regimens
bull Higher hospitalization rates for medical complications
bull Greater likelihood of treatment drop-out or being lost to follow-up
bull Greater risk for opportunistic (re-) infectionbull Greater risk of psychosocial problemsbull Greater risk of suicide or accidental death
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
SBIRT in HIV Settingsbull SBIRT in primary care settings is effective in
changing behavior and preventing adverse outcomes attributable to alcohol and other drugs
bull People living with HIV are more likely than the general population to experience substance abuse problems
bull SBI protocols have not been readily implemented in HIV care settings
SOURCE Fischer L (2012) Addiction Science amp Clinical Practice 7(Suppl 1) A73
SBIRT in HIV Settings
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
Impact of a Computer-Assisted SBIRT Program in and HIV Setting
bull Implemented in San Francisco General Hospitalrsquos Positive Health Program (PHP) in 2010-11bull Most common substances reported were tobacco
(80) alcohol (54) cocaine (54) amphetamines (47) nonmedical sedative use (34) and nonmedical opioid use (27)
bull SBI for unhealthy substance use is acceptable to patients in HIV primary care settings
bull Significant decreases observed with amphetamines and sedatives significant increase in number of patients with HIV viral suppression
SOURCE Dawson Rose et al (2012) IAC Poster
Colorados Ryan White Collaborative SBIRT Project
bull Of 2500 patients screenedbull 31 (n=775) received a BI for risky alcohol tobacco
or drug usebull 23 (n=575) were referred for therapy or specialized
treatment
bull Recommendations for standardizing SBIRT in HIV settings include
bull Apply a systematic screening approachbull Train providers to conduct BIbull Establish a referral networkbull Integrate SBIRT with adherence and retention efforts
SOURCE Fischer L (2012) Addiction Science amp Clinical Practice 7(Suppl 1) A73
Activity Adoption of SBIRT Can SBIRT work in your setting
3 minutes
End
Risks of Untreated Mental Health and Substance Use Problems
bull Poorer adherence to treatment and medication regimens
bull Higher hospitalization rates for medical complications
bull Greater likelihood of treatment drop-out or being lost to follow-up
bull Greater risk for opportunistic (re-) infectionbull Greater risk of psychosocial problemsbull Greater risk of suicide or accidental death
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
SBIRT in HIV Settingsbull SBIRT in primary care settings is effective in
changing behavior and preventing adverse outcomes attributable to alcohol and other drugs
bull People living with HIV are more likely than the general population to experience substance abuse problems
bull SBI protocols have not been readily implemented in HIV care settings
SOURCE Fischer L (2012) Addiction Science amp Clinical Practice 7(Suppl 1) A73
SBIRT in HIV Settings
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
Impact of a Computer-Assisted SBIRT Program in and HIV Setting
bull Implemented in San Francisco General Hospitalrsquos Positive Health Program (PHP) in 2010-11bull Most common substances reported were tobacco
(80) alcohol (54) cocaine (54) amphetamines (47) nonmedical sedative use (34) and nonmedical opioid use (27)
bull SBI for unhealthy substance use is acceptable to patients in HIV primary care settings
bull Significant decreases observed with amphetamines and sedatives significant increase in number of patients with HIV viral suppression
SOURCE Dawson Rose et al (2012) IAC Poster
Colorados Ryan White Collaborative SBIRT Project
bull Of 2500 patients screenedbull 31 (n=775) received a BI for risky alcohol tobacco
or drug usebull 23 (n=575) were referred for therapy or specialized
treatment
bull Recommendations for standardizing SBIRT in HIV settings include
bull Apply a systematic screening approachbull Train providers to conduct BIbull Establish a referral networkbull Integrate SBIRT with adherence and retention efforts
SOURCE Fischer L (2012) Addiction Science amp Clinical Practice 7(Suppl 1) A73
Activity Adoption of SBIRT Can SBIRT work in your setting
3 minutes
End
SBIRT in HIV Settingsbull SBIRT in primary care settings is effective in
changing behavior and preventing adverse outcomes attributable to alcohol and other drugs
bull People living with HIV are more likely than the general population to experience substance abuse problems
bull SBI protocols have not been readily implemented in HIV care settings
SOURCE Fischer L (2012) Addiction Science amp Clinical Practice 7(Suppl 1) A73
SBIRT in HIV Settings
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
Impact of a Computer-Assisted SBIRT Program in and HIV Setting
bull Implemented in San Francisco General Hospitalrsquos Positive Health Program (PHP) in 2010-11bull Most common substances reported were tobacco
(80) alcohol (54) cocaine (54) amphetamines (47) nonmedical sedative use (34) and nonmedical opioid use (27)
bull SBI for unhealthy substance use is acceptable to patients in HIV primary care settings
bull Significant decreases observed with amphetamines and sedatives significant increase in number of patients with HIV viral suppression
SOURCE Dawson Rose et al (2012) IAC Poster
Colorados Ryan White Collaborative SBIRT Project
bull Of 2500 patients screenedbull 31 (n=775) received a BI for risky alcohol tobacco
or drug usebull 23 (n=575) were referred for therapy or specialized
treatment
bull Recommendations for standardizing SBIRT in HIV settings include
bull Apply a systematic screening approachbull Train providers to conduct BIbull Establish a referral networkbull Integrate SBIRT with adherence and retention efforts
SOURCE Fischer L (2012) Addiction Science amp Clinical Practice 7(Suppl 1) A73
Activity Adoption of SBIRT Can SBIRT work in your setting
3 minutes
End
SBIRT in HIV Settings
SOURCE Center for Community Collaboration UMBC Psychology Department (2012)
Impact of a Computer-Assisted SBIRT Program in and HIV Setting
bull Implemented in San Francisco General Hospitalrsquos Positive Health Program (PHP) in 2010-11bull Most common substances reported were tobacco
(80) alcohol (54) cocaine (54) amphetamines (47) nonmedical sedative use (34) and nonmedical opioid use (27)
bull SBI for unhealthy substance use is acceptable to patients in HIV primary care settings
bull Significant decreases observed with amphetamines and sedatives significant increase in number of patients with HIV viral suppression
SOURCE Dawson Rose et al (2012) IAC Poster
Colorados Ryan White Collaborative SBIRT Project
bull Of 2500 patients screenedbull 31 (n=775) received a BI for risky alcohol tobacco
or drug usebull 23 (n=575) were referred for therapy or specialized
treatment
bull Recommendations for standardizing SBIRT in HIV settings include
bull Apply a systematic screening approachbull Train providers to conduct BIbull Establish a referral networkbull Integrate SBIRT with adherence and retention efforts
SOURCE Fischer L (2012) Addiction Science amp Clinical Practice 7(Suppl 1) A73
Activity Adoption of SBIRT Can SBIRT work in your setting
3 minutes
End
Impact of a Computer-Assisted SBIRT Program in and HIV Setting
bull Implemented in San Francisco General Hospitalrsquos Positive Health Program (PHP) in 2010-11bull Most common substances reported were tobacco
(80) alcohol (54) cocaine (54) amphetamines (47) nonmedical sedative use (34) and nonmedical opioid use (27)
bull SBI for unhealthy substance use is acceptable to patients in HIV primary care settings
bull Significant decreases observed with amphetamines and sedatives significant increase in number of patients with HIV viral suppression
SOURCE Dawson Rose et al (2012) IAC Poster
Colorados Ryan White Collaborative SBIRT Project
bull Of 2500 patients screenedbull 31 (n=775) received a BI for risky alcohol tobacco
or drug usebull 23 (n=575) were referred for therapy or specialized
treatment
bull Recommendations for standardizing SBIRT in HIV settings include
bull Apply a systematic screening approachbull Train providers to conduct BIbull Establish a referral networkbull Integrate SBIRT with adherence and retention efforts
SOURCE Fischer L (2012) Addiction Science amp Clinical Practice 7(Suppl 1) A73
Activity Adoption of SBIRT Can SBIRT work in your setting
3 minutes
End
Colorados Ryan White Collaborative SBIRT Project
bull Of 2500 patients screenedbull 31 (n=775) received a BI for risky alcohol tobacco
or drug usebull 23 (n=575) were referred for therapy or specialized
treatment
bull Recommendations for standardizing SBIRT in HIV settings include
bull Apply a systematic screening approachbull Train providers to conduct BIbull Establish a referral networkbull Integrate SBIRT with adherence and retention efforts
SOURCE Fischer L (2012) Addiction Science amp Clinical Practice 7(Suppl 1) A73
Activity Adoption of SBIRT Can SBIRT work in your setting
3 minutes
End
Activity Adoption of SBIRT Can SBIRT work in your setting
3 minutes
End
Screening to Identify Patients At Risk for
Substance Use Problems
ScreeningAssessment
Whatrsquos going on in these pictures
Types of Screening ToolsSelf-report
bull Interviewbull Self-administered
questionnairesBiological markers
bull Breathalyzer testingbull Blood alcohol levelsbull Saliva or urine testingbull Serum drug testing
See reference list
Characteristics of a Good Screening Tool
bull Brief (10 or fewer questions)bull Flexiblebull Easy to administer easy for patientbull Addresses alcohol and other drugsbull Indicates need for further assessment or
interventionbull Has good ldquosensitivityrdquo and ldquospecificityrdquo
Benefits of Self-Report Toolsbull Provide historical
picturebull Inexpensivebull Non-invasivebull Highly sensitive for
detecting potential problems or dependence
Screen TargetPopulation
Items
Assessment Setting (most common)
Type
ASSIST(WHO)
-Adults-Validated in many cultures and languages
8 Hazardous harmful or dependent drug use (including injection drug use)
Primary Care Interview
AUDIT(WHO)
-Adults and adolescents-Validated in many cultures and languages
10 Identifies alcohol problem use and dependence Can be used as a pre-screen to identify patients in need of full screenbrief intervention
-Different settings-AUDIT C- Primary Care (3 questions)
Self-adminInterview or computerized
DAST-10 Adults 10 To identify drug-use problems in past year
Different settings
Self-admin or Interview
CRAFFT Adolescents 6 To identify alcohol and drug abuse risky behavior amp consequences of use
Different settings
Self-admin
CAGE Adults and youth gt16
4 -Signs of dependence not risky use Primary Care Self-admin or Interview
TWEAK Pregnant women
5 -Risky drinking during pregnancy Based on CAGE-Asks about number of drinks one can tolerate alcohol dependence amp related problems
Primary Care Womenrsquos organizations etc
Self-admin Interview or computerized
What is a Standard Drink
Men No more that 4 drinks on any day and 14 drinks per week
Women No more than 3 drinks on any day and 7 drinks per week
Men and Women gt65 No more than 3 drinks on any day and 7 drinks per week
NIAAA 2011
Drinking Guidelines
285 ml 100 ml 60 ml 30 ml Beer Wine Fortified Wine Liquor 12 oz 5 oz 35 oz 15 oz
Pre-Screening
Pre-screening is a very quick approach to identifying people who need to do a longer screen and brief interventionbull Self-report 1-4 questionsbull Biological blood alcohol level test
Pre-Screening ExampleNIAAA 1-item for alcohol use
ldquoHow many times in the past year have you had X or more drinks in a dayrdquo
5 for men
4 for women
bull Identifies unhealthy alcohol usebull Positive screen gt 1 or more
(provide BI)
See reference list
Pre-Screening ExampleNIDA 1-item for illicit drug use
How many times in the past year have you used an illegal drug or used a prescription medication for non-medical reasonsrdquo
bull Identifies overall drug usebull Positive screen = 1 or more
See reference list
SBI Decision Tree
AlcoholWomen = 0 ndash 2
Men = 0 ndash 4
AlcoholWomen = 4+
Men = 5+
Other DrugsAny Yes
Other DrugsAll Nos
Administer the AUDIT
Administer the DAST
Alcohol Screen Complete
Other DrugScreen Complete
LowNo RiskAlcohol = 0 ndash 7Other drugs = 0
At RiskAlcohol = 8 ndash 15
Other drugs = 1 ndash 2
ModHigh RiskAlcohol = 16 ndash 19
Other drugs = 3 ndash 5
HighSevere RiskAlcohol = 20 ndash 40
Other drugs = 6 ndash 10
Reinforce behavior Monitor
Brief Intervention Goal Lower Risk
Reduce use to acceptable levels
BIReferral to txBTGoal Encourage pt
to accept a referral to tx or engage in BT
Referral to tx Goal Encourage pt to accept referral to tx or engage in BT
Complete Pre-Screen
Review of the AUDIT
bull 10-question alcohol use screening instrument
bull Original target groups included bull Medical patients
bull Accident victims
bull DWI offenders
bull Mental health clients
bull Designed for primary health care workers
Domains of the AUDIT
Hazardous Alcohol UseQuestion 1 Frequency of DrinkingQuestion 2 Typical quantityQuestion 3 Frequency of heavy drinking
Domains of the AUDIT (cont)
Dependence SymptomsQuestion 4 Impaired control over drinkingQuestion 5 Failure to meet expectations
because of drinkingQuestion 6 Morning drinking
Domains of the AUDIT (cont)
Harmful Consequences of Alcohol UseQuestion 7 Guilt after drinkingQuestion 8 BlackoutsQuestion 9 Alcohol-related injuriesQuestion 10 Othersrsquo concerns about drinking
Activity AUDIT Practice
bull I am going to ask you some personal questions about alcohol (and other drugs) that I ask all my patients
bull Your responses will be confidentialbull These questions help me to provide the best
possible carebull You do not have to answer them if you are
uncomfortable
See reference list
Activity AUDIT Practice
Feedback Reactions
Scoring the Audit
Score Level Action
0-7 Low Encouragement
8-19 LowModerate BI
16-19 Moderate BIRT
20+ High BTRT
Enhancing Accuracy of Self-Report
Self-reports are more accurate when people are bull Alcohol- or drug-free when interviewedbull Told that their information is confidentialbull Asked clearly worded objective questionsbull Provided memory aides (calendars
response cards)
See reference list
SBI Decision TreeAdminister the AUDIT
Administer the DAST
Alcohol Screen Complete
Other DrugScreen Complete
LowNo RiskAlcohol = 0 ndash 7Other drugs = 0
At RiskAlcohol = 8 ndash 15
Other drugs = 1 ndash 2
ModHigh RiskAlcohol = 16 ndash 19
Other drugs = 3 ndash 5
HighSevere RiskAlcohol = 20 ndash 40
Other drugs = 6 ndash 10
Reinforce behavior Monitor
Brief Intervention Goal Lower Risk
Reduce use to acceptable levels
BIReferral to txBTGoal Encourage pt
to accept a referral to tx or engage in BT
Referral to tx Goal Encourage pt to accept referral to tx or engage in BT
Brief Interventions for Patients at Risk for
Substance Use Problems
What Are Brief Interventions
ldquoBriefhellipinterventions are short face-to-face conversations regarding drinking motivation to change and options for change which are provided during a window of opportunity or potentially teachable moment occasioned by a
medical eventrdquo
Dr Craig Field from the University of Texas (See reference list)
Goal of Brief Interventions
Behavior change
Awareness of problem
Motivation
Presenting problem Screening
results
Brief Intervention Effectbull Brief interventions trigger changebull A little counseling can lead to significant
change eg 5 min has same impact as 20 minbull Research is less extensive for illicit drugs but
promisingbull A randomized study with cocaine and heroin users
found that patients who received a BI had 50 greater odds of abstinence at follow up compared with controls
See reference list
Where Do I Start
What you do depends on where the patient is in the process of changing
The first step is to be able to identify where the patient is coming from
Stages of Change
Primary Tasks
1 PrecontemplationDefinition
Not yet considering change or is unwilling or unable to change
Primary TaskRaising Awareness 2 Contemplation
Definition Sees the possibility of change but
is ambivalent and uncertain
Primary TaskResolving ambivalence
Helping to choose change
3 DeterminationDefinition
Committed to changingStill considering what to do
Primary TaskHelp identify appropriate
change strategies
4 ActionDefinition
Taking steps toward change but hasnrsquot stabilized in the process
Primary TaskHelp implement change strategies
and learn to eliminate potential relapses
5 MaintenanceDefinition
Has achieved the goals and is working to maintain change
Primary TaskDevelop new skills for maintaining recovery
6 RecurrenceDefinition
Experienced a recurrence of the symptoms
Primary TaskCope with consequences and
determine what to do next
Stages of Change Intervention Matching Guide
bull Offer factual informationbull Explore the meaning of events that
brought the person to treatmentbull Explore results of previous effortsbull Explore pros and cons of targeted
behaviors
bull Explore the personrsquos sense of self-efficacy
bull Explore expectations regarding what the change will entail
bull Summarize self-motivational statements
bull Continue exploration of pros and cons
bull Offer a menu of options for changebull Help identify pros and cons of various
change optionsbull Identify and lower barriers to changebull Help person enlist social support bull Encourage person to publicly
announce plans to change
bull Support a realistic view of change through small steps
bull Help identify high-risk situations and develop coping strategies
bull Assist in finding new reinforcers of positive change
bull Help access family and social support
bull Help identify and try alternative behaviors (drug-free sources of pleasure)
bull Maintain supportive contact bull Help develop escape planbull Work to set new short and long term
goals
bull Frame recurrence as a learning opportunity
bull Explore possible behavioral psychological and social antecedents
bull Help to develop alternative coping strategies
bull Explain Stages of Change amp encourage person to stay in the process
bull Maintain supportive contact
1 Pre-contemplation
2Contemplation
3Determination
4Action
5Maintenance
6Recurrence
ldquoPeople are better persuaded by the reasons they themselves
discovered than those that come into the minds of othersrdquo
Blaise Pascal
Ambivalence
All change contains an element of ambivalence
We ldquowant to change and donrsquot want to changerdquo
Patientsrsquo ambivalence about change is the ldquoheartrdquo of the brief intervention
Activity Video ExampleYoung man is treated in the ER after a car accident He had been drinking heavily before the accident How does the doctor address drinking in this video
See reference list
(INSERT BAD SBIRT VIDEO)
Reflective Listening
bull Listen to both what the patient says and to what the person means
bull Show empathy and donrsquot judge what patient saysbull You do not have to agree
bull Be aware of intonationbull Reflect what patient says with statement not
a question eg ldquoYou couldnrsquot get up for work in the morningrdquo
Levels of Reflection
bull Repeating ndash Repeating what was just saidbull RephrasingParaphrasing ndash Restatement of
what the person said Listener infers meaning of what was said Can be thought of as continuing the thought
bull Reflecting Feeling ndash Listener reflects not just the words but the feeling or emotion underneath what the person is saying
Avoid Confrontationbull Challenging
ldquoWhat do you think you are doingrdquo
bull Warning
ldquoYou will damage your liver if you donrsquot stop drinkingrdquo
bull Finger-wagging
ldquoIf you want to be a good student you must stop drinking on school nightsrdquo
Explore Ambivalence
Benefits of change
Costs of using drugs
Benefits of using drugs
Costs of change
How to Explore Ambivalence
Avoid questions that lead to a yesno response
The good things about
______
The not- so-good things about ____
The good things about
changing
The not-so-good things
about changing
Elicit ldquoChange TalkrdquoChange talk consists of self-motivational statements that suggest
bull Recognition of a problem
bull Concern about staying the same
bull Intention to change
bull Optimism about change
Activity Video ExampleSame scenario but different doctor What does this doctor do that is different Does it work
See reference list
(INSERT GOOD SBIRT VIDEO)
Conducting a Brief Intervention
F L O
FLO The 3 tasks of a BI
Avoid Warnings
F L O WFeed
back
Listen
amp U
nd
erstand
Warn
Op
tion
s Exp
lored
(thatrsquos it)
How Does It All Fit TogetherFeedback
Setting the stage
Tell screening results
Listen amp understand
Explore pros amp cons
Explain importance
Assess readiness to change
Options explored
Discuss change options
Follow up
The 3 Tasks of a BI
F L OFeed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 1st Task Feedback
The Feedback Sandwich
Ask Permission
Give Advice
Ask for Response
The 1st Task FeedbackWhat you need to cover1 Range of scores and context2 Screening results3 Substance use norms in population4 Interpretation of results (eg risk level)5 Patient feedback about results
The 1st Task FeedbackWhat do you say
1 Range of score and context - Scores on the AUDIT range from 0-40 Most people who are social drinkers score less than 8
2 Results - Your score was 18 on the alcohol screen
3 Norms - A score of 18 means that your drinking is higher than 75 of the US adult population
4 Interpretation of results - 18 puts you in the moderate-to-high risk range At this level your use is putting you at risk for a variety of health issues
5 Patient reactionfeedback - What do you make of this
Informational Brochures
The 1st Task FeedbackHandling Resistancebull Look I donrsquot have a drug problembull My dad was an alcoholic Irsquom not like himbull I can quit using anytime I want tobull I just like the tastebull Everybody drinks in college
What would you say
Chr
onic
Pai
n
SUD
HIV
Con-fusion Medical
Issues
Pain
SUD
To avoid thishellip
LET GO
The 1st Task Feedback
The 1st Task Feedback
Easy Ways to Let Gobull Irsquom not going to push you to change
anything you donrsquot want to changebull Irsquod just like to give you some informationbull What you do is up to you
The 1st Task FeedbackFinding a Hookbull Ask the patient about their concernsbull Provide non-judgmental feedbackinformationbull Watch for signs of discomfort with status quo or
interest or ability to changebull Always ask this question ldquoWhat role if any do
you think alcohol played in your (getting injured)bull Let the patient decidebull Just asking the question is helpful
The 3 Tasks of a BI
F L O
Feed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
ScreeningAssessment
Whatrsquos going on in these pictures
Types of Screening ToolsSelf-report
bull Interviewbull Self-administered
questionnairesBiological markers
bull Breathalyzer testingbull Blood alcohol levelsbull Saliva or urine testingbull Serum drug testing
See reference list
Characteristics of a Good Screening Tool
bull Brief (10 or fewer questions)bull Flexiblebull Easy to administer easy for patientbull Addresses alcohol and other drugsbull Indicates need for further assessment or
interventionbull Has good ldquosensitivityrdquo and ldquospecificityrdquo
Benefits of Self-Report Toolsbull Provide historical
picturebull Inexpensivebull Non-invasivebull Highly sensitive for
detecting potential problems or dependence
Screen TargetPopulation
Items
Assessment Setting (most common)
Type
ASSIST(WHO)
-Adults-Validated in many cultures and languages
8 Hazardous harmful or dependent drug use (including injection drug use)
Primary Care Interview
AUDIT(WHO)
-Adults and adolescents-Validated in many cultures and languages
10 Identifies alcohol problem use and dependence Can be used as a pre-screen to identify patients in need of full screenbrief intervention
-Different settings-AUDIT C- Primary Care (3 questions)
Self-adminInterview or computerized
DAST-10 Adults 10 To identify drug-use problems in past year
Different settings
Self-admin or Interview
CRAFFT Adolescents 6 To identify alcohol and drug abuse risky behavior amp consequences of use
Different settings
Self-admin
CAGE Adults and youth gt16
4 -Signs of dependence not risky use Primary Care Self-admin or Interview
TWEAK Pregnant women
5 -Risky drinking during pregnancy Based on CAGE-Asks about number of drinks one can tolerate alcohol dependence amp related problems
Primary Care Womenrsquos organizations etc
Self-admin Interview or computerized
What is a Standard Drink
Men No more that 4 drinks on any day and 14 drinks per week
Women No more than 3 drinks on any day and 7 drinks per week
Men and Women gt65 No more than 3 drinks on any day and 7 drinks per week
NIAAA 2011
Drinking Guidelines
285 ml 100 ml 60 ml 30 ml Beer Wine Fortified Wine Liquor 12 oz 5 oz 35 oz 15 oz
Pre-Screening
Pre-screening is a very quick approach to identifying people who need to do a longer screen and brief interventionbull Self-report 1-4 questionsbull Biological blood alcohol level test
Pre-Screening ExampleNIAAA 1-item for alcohol use
ldquoHow many times in the past year have you had X or more drinks in a dayrdquo
5 for men
4 for women
bull Identifies unhealthy alcohol usebull Positive screen gt 1 or more
(provide BI)
See reference list
Pre-Screening ExampleNIDA 1-item for illicit drug use
How many times in the past year have you used an illegal drug or used a prescription medication for non-medical reasonsrdquo
bull Identifies overall drug usebull Positive screen = 1 or more
See reference list
SBI Decision Tree
AlcoholWomen = 0 ndash 2
Men = 0 ndash 4
AlcoholWomen = 4+
Men = 5+
Other DrugsAny Yes
Other DrugsAll Nos
Administer the AUDIT
Administer the DAST
Alcohol Screen Complete
Other DrugScreen Complete
LowNo RiskAlcohol = 0 ndash 7Other drugs = 0
At RiskAlcohol = 8 ndash 15
Other drugs = 1 ndash 2
ModHigh RiskAlcohol = 16 ndash 19
Other drugs = 3 ndash 5
HighSevere RiskAlcohol = 20 ndash 40
Other drugs = 6 ndash 10
Reinforce behavior Monitor
Brief Intervention Goal Lower Risk
Reduce use to acceptable levels
BIReferral to txBTGoal Encourage pt
to accept a referral to tx or engage in BT
Referral to tx Goal Encourage pt to accept referral to tx or engage in BT
Complete Pre-Screen
Review of the AUDIT
bull 10-question alcohol use screening instrument
bull Original target groups included bull Medical patients
bull Accident victims
bull DWI offenders
bull Mental health clients
bull Designed for primary health care workers
Domains of the AUDIT
Hazardous Alcohol UseQuestion 1 Frequency of DrinkingQuestion 2 Typical quantityQuestion 3 Frequency of heavy drinking
Domains of the AUDIT (cont)
Dependence SymptomsQuestion 4 Impaired control over drinkingQuestion 5 Failure to meet expectations
because of drinkingQuestion 6 Morning drinking
Domains of the AUDIT (cont)
Harmful Consequences of Alcohol UseQuestion 7 Guilt after drinkingQuestion 8 BlackoutsQuestion 9 Alcohol-related injuriesQuestion 10 Othersrsquo concerns about drinking
Activity AUDIT Practice
bull I am going to ask you some personal questions about alcohol (and other drugs) that I ask all my patients
bull Your responses will be confidentialbull These questions help me to provide the best
possible carebull You do not have to answer them if you are
uncomfortable
See reference list
Activity AUDIT Practice
Feedback Reactions
Scoring the Audit
Score Level Action
0-7 Low Encouragement
8-19 LowModerate BI
16-19 Moderate BIRT
20+ High BTRT
Enhancing Accuracy of Self-Report
Self-reports are more accurate when people are bull Alcohol- or drug-free when interviewedbull Told that their information is confidentialbull Asked clearly worded objective questionsbull Provided memory aides (calendars
response cards)
See reference list
SBI Decision TreeAdminister the AUDIT
Administer the DAST
Alcohol Screen Complete
Other DrugScreen Complete
LowNo RiskAlcohol = 0 ndash 7Other drugs = 0
At RiskAlcohol = 8 ndash 15
Other drugs = 1 ndash 2
ModHigh RiskAlcohol = 16 ndash 19
Other drugs = 3 ndash 5
HighSevere RiskAlcohol = 20 ndash 40
Other drugs = 6 ndash 10
Reinforce behavior Monitor
Brief Intervention Goal Lower Risk
Reduce use to acceptable levels
BIReferral to txBTGoal Encourage pt
to accept a referral to tx or engage in BT
Referral to tx Goal Encourage pt to accept referral to tx or engage in BT
Brief Interventions for Patients at Risk for
Substance Use Problems
What Are Brief Interventions
ldquoBriefhellipinterventions are short face-to-face conversations regarding drinking motivation to change and options for change which are provided during a window of opportunity or potentially teachable moment occasioned by a
medical eventrdquo
Dr Craig Field from the University of Texas (See reference list)
Goal of Brief Interventions
Behavior change
Awareness of problem
Motivation
Presenting problem Screening
results
Brief Intervention Effectbull Brief interventions trigger changebull A little counseling can lead to significant
change eg 5 min has same impact as 20 minbull Research is less extensive for illicit drugs but
promisingbull A randomized study with cocaine and heroin users
found that patients who received a BI had 50 greater odds of abstinence at follow up compared with controls
See reference list
Where Do I Start
What you do depends on where the patient is in the process of changing
The first step is to be able to identify where the patient is coming from
Stages of Change
Primary Tasks
1 PrecontemplationDefinition
Not yet considering change or is unwilling or unable to change
Primary TaskRaising Awareness 2 Contemplation
Definition Sees the possibility of change but
is ambivalent and uncertain
Primary TaskResolving ambivalence
Helping to choose change
3 DeterminationDefinition
Committed to changingStill considering what to do
Primary TaskHelp identify appropriate
change strategies
4 ActionDefinition
Taking steps toward change but hasnrsquot stabilized in the process
Primary TaskHelp implement change strategies
and learn to eliminate potential relapses
5 MaintenanceDefinition
Has achieved the goals and is working to maintain change
Primary TaskDevelop new skills for maintaining recovery
6 RecurrenceDefinition
Experienced a recurrence of the symptoms
Primary TaskCope with consequences and
determine what to do next
Stages of Change Intervention Matching Guide
bull Offer factual informationbull Explore the meaning of events that
brought the person to treatmentbull Explore results of previous effortsbull Explore pros and cons of targeted
behaviors
bull Explore the personrsquos sense of self-efficacy
bull Explore expectations regarding what the change will entail
bull Summarize self-motivational statements
bull Continue exploration of pros and cons
bull Offer a menu of options for changebull Help identify pros and cons of various
change optionsbull Identify and lower barriers to changebull Help person enlist social support bull Encourage person to publicly
announce plans to change
bull Support a realistic view of change through small steps
bull Help identify high-risk situations and develop coping strategies
bull Assist in finding new reinforcers of positive change
bull Help access family and social support
bull Help identify and try alternative behaviors (drug-free sources of pleasure)
bull Maintain supportive contact bull Help develop escape planbull Work to set new short and long term
goals
bull Frame recurrence as a learning opportunity
bull Explore possible behavioral psychological and social antecedents
bull Help to develop alternative coping strategies
bull Explain Stages of Change amp encourage person to stay in the process
bull Maintain supportive contact
1 Pre-contemplation
2Contemplation
3Determination
4Action
5Maintenance
6Recurrence
ldquoPeople are better persuaded by the reasons they themselves
discovered than those that come into the minds of othersrdquo
Blaise Pascal
Ambivalence
All change contains an element of ambivalence
We ldquowant to change and donrsquot want to changerdquo
Patientsrsquo ambivalence about change is the ldquoheartrdquo of the brief intervention
Activity Video ExampleYoung man is treated in the ER after a car accident He had been drinking heavily before the accident How does the doctor address drinking in this video
See reference list
(INSERT BAD SBIRT VIDEO)
Reflective Listening
bull Listen to both what the patient says and to what the person means
bull Show empathy and donrsquot judge what patient saysbull You do not have to agree
bull Be aware of intonationbull Reflect what patient says with statement not
a question eg ldquoYou couldnrsquot get up for work in the morningrdquo
Levels of Reflection
bull Repeating ndash Repeating what was just saidbull RephrasingParaphrasing ndash Restatement of
what the person said Listener infers meaning of what was said Can be thought of as continuing the thought
bull Reflecting Feeling ndash Listener reflects not just the words but the feeling or emotion underneath what the person is saying
Avoid Confrontationbull Challenging
ldquoWhat do you think you are doingrdquo
bull Warning
ldquoYou will damage your liver if you donrsquot stop drinkingrdquo
bull Finger-wagging
ldquoIf you want to be a good student you must stop drinking on school nightsrdquo
Explore Ambivalence
Benefits of change
Costs of using drugs
Benefits of using drugs
Costs of change
How to Explore Ambivalence
Avoid questions that lead to a yesno response
The good things about
______
The not- so-good things about ____
The good things about
changing
The not-so-good things
about changing
Elicit ldquoChange TalkrdquoChange talk consists of self-motivational statements that suggest
bull Recognition of a problem
bull Concern about staying the same
bull Intention to change
bull Optimism about change
Activity Video ExampleSame scenario but different doctor What does this doctor do that is different Does it work
See reference list
(INSERT GOOD SBIRT VIDEO)
Conducting a Brief Intervention
F L O
FLO The 3 tasks of a BI
Avoid Warnings
F L O WFeed
back
Listen
amp U
nd
erstand
Warn
Op
tion
s Exp
lored
(thatrsquos it)
How Does It All Fit TogetherFeedback
Setting the stage
Tell screening results
Listen amp understand
Explore pros amp cons
Explain importance
Assess readiness to change
Options explored
Discuss change options
Follow up
The 3 Tasks of a BI
F L OFeed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 1st Task Feedback
The Feedback Sandwich
Ask Permission
Give Advice
Ask for Response
The 1st Task FeedbackWhat you need to cover1 Range of scores and context2 Screening results3 Substance use norms in population4 Interpretation of results (eg risk level)5 Patient feedback about results
The 1st Task FeedbackWhat do you say
1 Range of score and context - Scores on the AUDIT range from 0-40 Most people who are social drinkers score less than 8
2 Results - Your score was 18 on the alcohol screen
3 Norms - A score of 18 means that your drinking is higher than 75 of the US adult population
4 Interpretation of results - 18 puts you in the moderate-to-high risk range At this level your use is putting you at risk for a variety of health issues
5 Patient reactionfeedback - What do you make of this
Informational Brochures
The 1st Task FeedbackHandling Resistancebull Look I donrsquot have a drug problembull My dad was an alcoholic Irsquom not like himbull I can quit using anytime I want tobull I just like the tastebull Everybody drinks in college
What would you say
Chr
onic
Pai
n
SUD
HIV
Con-fusion Medical
Issues
Pain
SUD
To avoid thishellip
LET GO
The 1st Task Feedback
The 1st Task Feedback
Easy Ways to Let Gobull Irsquom not going to push you to change
anything you donrsquot want to changebull Irsquod just like to give you some informationbull What you do is up to you
The 1st Task FeedbackFinding a Hookbull Ask the patient about their concernsbull Provide non-judgmental feedbackinformationbull Watch for signs of discomfort with status quo or
interest or ability to changebull Always ask this question ldquoWhat role if any do
you think alcohol played in your (getting injured)bull Let the patient decidebull Just asking the question is helpful
The 3 Tasks of a BI
F L O
Feed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
Types of Screening ToolsSelf-report
bull Interviewbull Self-administered
questionnairesBiological markers
bull Breathalyzer testingbull Blood alcohol levelsbull Saliva or urine testingbull Serum drug testing
See reference list
Characteristics of a Good Screening Tool
bull Brief (10 or fewer questions)bull Flexiblebull Easy to administer easy for patientbull Addresses alcohol and other drugsbull Indicates need for further assessment or
interventionbull Has good ldquosensitivityrdquo and ldquospecificityrdquo
Benefits of Self-Report Toolsbull Provide historical
picturebull Inexpensivebull Non-invasivebull Highly sensitive for
detecting potential problems or dependence
Screen TargetPopulation
Items
Assessment Setting (most common)
Type
ASSIST(WHO)
-Adults-Validated in many cultures and languages
8 Hazardous harmful or dependent drug use (including injection drug use)
Primary Care Interview
AUDIT(WHO)
-Adults and adolescents-Validated in many cultures and languages
10 Identifies alcohol problem use and dependence Can be used as a pre-screen to identify patients in need of full screenbrief intervention
-Different settings-AUDIT C- Primary Care (3 questions)
Self-adminInterview or computerized
DAST-10 Adults 10 To identify drug-use problems in past year
Different settings
Self-admin or Interview
CRAFFT Adolescents 6 To identify alcohol and drug abuse risky behavior amp consequences of use
Different settings
Self-admin
CAGE Adults and youth gt16
4 -Signs of dependence not risky use Primary Care Self-admin or Interview
TWEAK Pregnant women
5 -Risky drinking during pregnancy Based on CAGE-Asks about number of drinks one can tolerate alcohol dependence amp related problems
Primary Care Womenrsquos organizations etc
Self-admin Interview or computerized
What is a Standard Drink
Men No more that 4 drinks on any day and 14 drinks per week
Women No more than 3 drinks on any day and 7 drinks per week
Men and Women gt65 No more than 3 drinks on any day and 7 drinks per week
NIAAA 2011
Drinking Guidelines
285 ml 100 ml 60 ml 30 ml Beer Wine Fortified Wine Liquor 12 oz 5 oz 35 oz 15 oz
Pre-Screening
Pre-screening is a very quick approach to identifying people who need to do a longer screen and brief interventionbull Self-report 1-4 questionsbull Biological blood alcohol level test
Pre-Screening ExampleNIAAA 1-item for alcohol use
ldquoHow many times in the past year have you had X or more drinks in a dayrdquo
5 for men
4 for women
bull Identifies unhealthy alcohol usebull Positive screen gt 1 or more
(provide BI)
See reference list
Pre-Screening ExampleNIDA 1-item for illicit drug use
How many times in the past year have you used an illegal drug or used a prescription medication for non-medical reasonsrdquo
bull Identifies overall drug usebull Positive screen = 1 or more
See reference list
SBI Decision Tree
AlcoholWomen = 0 ndash 2
Men = 0 ndash 4
AlcoholWomen = 4+
Men = 5+
Other DrugsAny Yes
Other DrugsAll Nos
Administer the AUDIT
Administer the DAST
Alcohol Screen Complete
Other DrugScreen Complete
LowNo RiskAlcohol = 0 ndash 7Other drugs = 0
At RiskAlcohol = 8 ndash 15
Other drugs = 1 ndash 2
ModHigh RiskAlcohol = 16 ndash 19
Other drugs = 3 ndash 5
HighSevere RiskAlcohol = 20 ndash 40
Other drugs = 6 ndash 10
Reinforce behavior Monitor
Brief Intervention Goal Lower Risk
Reduce use to acceptable levels
BIReferral to txBTGoal Encourage pt
to accept a referral to tx or engage in BT
Referral to tx Goal Encourage pt to accept referral to tx or engage in BT
Complete Pre-Screen
Review of the AUDIT
bull 10-question alcohol use screening instrument
bull Original target groups included bull Medical patients
bull Accident victims
bull DWI offenders
bull Mental health clients
bull Designed for primary health care workers
Domains of the AUDIT
Hazardous Alcohol UseQuestion 1 Frequency of DrinkingQuestion 2 Typical quantityQuestion 3 Frequency of heavy drinking
Domains of the AUDIT (cont)
Dependence SymptomsQuestion 4 Impaired control over drinkingQuestion 5 Failure to meet expectations
because of drinkingQuestion 6 Morning drinking
Domains of the AUDIT (cont)
Harmful Consequences of Alcohol UseQuestion 7 Guilt after drinkingQuestion 8 BlackoutsQuestion 9 Alcohol-related injuriesQuestion 10 Othersrsquo concerns about drinking
Activity AUDIT Practice
bull I am going to ask you some personal questions about alcohol (and other drugs) that I ask all my patients
bull Your responses will be confidentialbull These questions help me to provide the best
possible carebull You do not have to answer them if you are
uncomfortable
See reference list
Activity AUDIT Practice
Feedback Reactions
Scoring the Audit
Score Level Action
0-7 Low Encouragement
8-19 LowModerate BI
16-19 Moderate BIRT
20+ High BTRT
Enhancing Accuracy of Self-Report
Self-reports are more accurate when people are bull Alcohol- or drug-free when interviewedbull Told that their information is confidentialbull Asked clearly worded objective questionsbull Provided memory aides (calendars
response cards)
See reference list
SBI Decision TreeAdminister the AUDIT
Administer the DAST
Alcohol Screen Complete
Other DrugScreen Complete
LowNo RiskAlcohol = 0 ndash 7Other drugs = 0
At RiskAlcohol = 8 ndash 15
Other drugs = 1 ndash 2
ModHigh RiskAlcohol = 16 ndash 19
Other drugs = 3 ndash 5
HighSevere RiskAlcohol = 20 ndash 40
Other drugs = 6 ndash 10
Reinforce behavior Monitor
Brief Intervention Goal Lower Risk
Reduce use to acceptable levels
BIReferral to txBTGoal Encourage pt
to accept a referral to tx or engage in BT
Referral to tx Goal Encourage pt to accept referral to tx or engage in BT
Brief Interventions for Patients at Risk for
Substance Use Problems
What Are Brief Interventions
ldquoBriefhellipinterventions are short face-to-face conversations regarding drinking motivation to change and options for change which are provided during a window of opportunity or potentially teachable moment occasioned by a
medical eventrdquo
Dr Craig Field from the University of Texas (See reference list)
Goal of Brief Interventions
Behavior change
Awareness of problem
Motivation
Presenting problem Screening
results
Brief Intervention Effectbull Brief interventions trigger changebull A little counseling can lead to significant
change eg 5 min has same impact as 20 minbull Research is less extensive for illicit drugs but
promisingbull A randomized study with cocaine and heroin users
found that patients who received a BI had 50 greater odds of abstinence at follow up compared with controls
See reference list
Where Do I Start
What you do depends on where the patient is in the process of changing
The first step is to be able to identify where the patient is coming from
Stages of Change
Primary Tasks
1 PrecontemplationDefinition
Not yet considering change or is unwilling or unable to change
Primary TaskRaising Awareness 2 Contemplation
Definition Sees the possibility of change but
is ambivalent and uncertain
Primary TaskResolving ambivalence
Helping to choose change
3 DeterminationDefinition
Committed to changingStill considering what to do
Primary TaskHelp identify appropriate
change strategies
4 ActionDefinition
Taking steps toward change but hasnrsquot stabilized in the process
Primary TaskHelp implement change strategies
and learn to eliminate potential relapses
5 MaintenanceDefinition
Has achieved the goals and is working to maintain change
Primary TaskDevelop new skills for maintaining recovery
6 RecurrenceDefinition
Experienced a recurrence of the symptoms
Primary TaskCope with consequences and
determine what to do next
Stages of Change Intervention Matching Guide
bull Offer factual informationbull Explore the meaning of events that
brought the person to treatmentbull Explore results of previous effortsbull Explore pros and cons of targeted
behaviors
bull Explore the personrsquos sense of self-efficacy
bull Explore expectations regarding what the change will entail
bull Summarize self-motivational statements
bull Continue exploration of pros and cons
bull Offer a menu of options for changebull Help identify pros and cons of various
change optionsbull Identify and lower barriers to changebull Help person enlist social support bull Encourage person to publicly
announce plans to change
bull Support a realistic view of change through small steps
bull Help identify high-risk situations and develop coping strategies
bull Assist in finding new reinforcers of positive change
bull Help access family and social support
bull Help identify and try alternative behaviors (drug-free sources of pleasure)
bull Maintain supportive contact bull Help develop escape planbull Work to set new short and long term
goals
bull Frame recurrence as a learning opportunity
bull Explore possible behavioral psychological and social antecedents
bull Help to develop alternative coping strategies
bull Explain Stages of Change amp encourage person to stay in the process
bull Maintain supportive contact
1 Pre-contemplation
2Contemplation
3Determination
4Action
5Maintenance
6Recurrence
ldquoPeople are better persuaded by the reasons they themselves
discovered than those that come into the minds of othersrdquo
Blaise Pascal
Ambivalence
All change contains an element of ambivalence
We ldquowant to change and donrsquot want to changerdquo
Patientsrsquo ambivalence about change is the ldquoheartrdquo of the brief intervention
Activity Video ExampleYoung man is treated in the ER after a car accident He had been drinking heavily before the accident How does the doctor address drinking in this video
See reference list
(INSERT BAD SBIRT VIDEO)
Reflective Listening
bull Listen to both what the patient says and to what the person means
bull Show empathy and donrsquot judge what patient saysbull You do not have to agree
bull Be aware of intonationbull Reflect what patient says with statement not
a question eg ldquoYou couldnrsquot get up for work in the morningrdquo
Levels of Reflection
bull Repeating ndash Repeating what was just saidbull RephrasingParaphrasing ndash Restatement of
what the person said Listener infers meaning of what was said Can be thought of as continuing the thought
bull Reflecting Feeling ndash Listener reflects not just the words but the feeling or emotion underneath what the person is saying
Avoid Confrontationbull Challenging
ldquoWhat do you think you are doingrdquo
bull Warning
ldquoYou will damage your liver if you donrsquot stop drinkingrdquo
bull Finger-wagging
ldquoIf you want to be a good student you must stop drinking on school nightsrdquo
Explore Ambivalence
Benefits of change
Costs of using drugs
Benefits of using drugs
Costs of change
How to Explore Ambivalence
Avoid questions that lead to a yesno response
The good things about
______
The not- so-good things about ____
The good things about
changing
The not-so-good things
about changing
Elicit ldquoChange TalkrdquoChange talk consists of self-motivational statements that suggest
bull Recognition of a problem
bull Concern about staying the same
bull Intention to change
bull Optimism about change
Activity Video ExampleSame scenario but different doctor What does this doctor do that is different Does it work
See reference list
(INSERT GOOD SBIRT VIDEO)
Conducting a Brief Intervention
F L O
FLO The 3 tasks of a BI
Avoid Warnings
F L O WFeed
back
Listen
amp U
nd
erstand
Warn
Op
tion
s Exp
lored
(thatrsquos it)
How Does It All Fit TogetherFeedback
Setting the stage
Tell screening results
Listen amp understand
Explore pros amp cons
Explain importance
Assess readiness to change
Options explored
Discuss change options
Follow up
The 3 Tasks of a BI
F L OFeed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 1st Task Feedback
The Feedback Sandwich
Ask Permission
Give Advice
Ask for Response
The 1st Task FeedbackWhat you need to cover1 Range of scores and context2 Screening results3 Substance use norms in population4 Interpretation of results (eg risk level)5 Patient feedback about results
The 1st Task FeedbackWhat do you say
1 Range of score and context - Scores on the AUDIT range from 0-40 Most people who are social drinkers score less than 8
2 Results - Your score was 18 on the alcohol screen
3 Norms - A score of 18 means that your drinking is higher than 75 of the US adult population
4 Interpretation of results - 18 puts you in the moderate-to-high risk range At this level your use is putting you at risk for a variety of health issues
5 Patient reactionfeedback - What do you make of this
Informational Brochures
The 1st Task FeedbackHandling Resistancebull Look I donrsquot have a drug problembull My dad was an alcoholic Irsquom not like himbull I can quit using anytime I want tobull I just like the tastebull Everybody drinks in college
What would you say
Chr
onic
Pai
n
SUD
HIV
Con-fusion Medical
Issues
Pain
SUD
To avoid thishellip
LET GO
The 1st Task Feedback
The 1st Task Feedback
Easy Ways to Let Gobull Irsquom not going to push you to change
anything you donrsquot want to changebull Irsquod just like to give you some informationbull What you do is up to you
The 1st Task FeedbackFinding a Hookbull Ask the patient about their concernsbull Provide non-judgmental feedbackinformationbull Watch for signs of discomfort with status quo or
interest or ability to changebull Always ask this question ldquoWhat role if any do
you think alcohol played in your (getting injured)bull Let the patient decidebull Just asking the question is helpful
The 3 Tasks of a BI
F L O
Feed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
Characteristics of a Good Screening Tool
bull Brief (10 or fewer questions)bull Flexiblebull Easy to administer easy for patientbull Addresses alcohol and other drugsbull Indicates need for further assessment or
interventionbull Has good ldquosensitivityrdquo and ldquospecificityrdquo
Benefits of Self-Report Toolsbull Provide historical
picturebull Inexpensivebull Non-invasivebull Highly sensitive for
detecting potential problems or dependence
Screen TargetPopulation
Items
Assessment Setting (most common)
Type
ASSIST(WHO)
-Adults-Validated in many cultures and languages
8 Hazardous harmful or dependent drug use (including injection drug use)
Primary Care Interview
AUDIT(WHO)
-Adults and adolescents-Validated in many cultures and languages
10 Identifies alcohol problem use and dependence Can be used as a pre-screen to identify patients in need of full screenbrief intervention
-Different settings-AUDIT C- Primary Care (3 questions)
Self-adminInterview or computerized
DAST-10 Adults 10 To identify drug-use problems in past year
Different settings
Self-admin or Interview
CRAFFT Adolescents 6 To identify alcohol and drug abuse risky behavior amp consequences of use
Different settings
Self-admin
CAGE Adults and youth gt16
4 -Signs of dependence not risky use Primary Care Self-admin or Interview
TWEAK Pregnant women
5 -Risky drinking during pregnancy Based on CAGE-Asks about number of drinks one can tolerate alcohol dependence amp related problems
Primary Care Womenrsquos organizations etc
Self-admin Interview or computerized
What is a Standard Drink
Men No more that 4 drinks on any day and 14 drinks per week
Women No more than 3 drinks on any day and 7 drinks per week
Men and Women gt65 No more than 3 drinks on any day and 7 drinks per week
NIAAA 2011
Drinking Guidelines
285 ml 100 ml 60 ml 30 ml Beer Wine Fortified Wine Liquor 12 oz 5 oz 35 oz 15 oz
Pre-Screening
Pre-screening is a very quick approach to identifying people who need to do a longer screen and brief interventionbull Self-report 1-4 questionsbull Biological blood alcohol level test
Pre-Screening ExampleNIAAA 1-item for alcohol use
ldquoHow many times in the past year have you had X or more drinks in a dayrdquo
5 for men
4 for women
bull Identifies unhealthy alcohol usebull Positive screen gt 1 or more
(provide BI)
See reference list
Pre-Screening ExampleNIDA 1-item for illicit drug use
How many times in the past year have you used an illegal drug or used a prescription medication for non-medical reasonsrdquo
bull Identifies overall drug usebull Positive screen = 1 or more
See reference list
SBI Decision Tree
AlcoholWomen = 0 ndash 2
Men = 0 ndash 4
AlcoholWomen = 4+
Men = 5+
Other DrugsAny Yes
Other DrugsAll Nos
Administer the AUDIT
Administer the DAST
Alcohol Screen Complete
Other DrugScreen Complete
LowNo RiskAlcohol = 0 ndash 7Other drugs = 0
At RiskAlcohol = 8 ndash 15
Other drugs = 1 ndash 2
ModHigh RiskAlcohol = 16 ndash 19
Other drugs = 3 ndash 5
HighSevere RiskAlcohol = 20 ndash 40
Other drugs = 6 ndash 10
Reinforce behavior Monitor
Brief Intervention Goal Lower Risk
Reduce use to acceptable levels
BIReferral to txBTGoal Encourage pt
to accept a referral to tx or engage in BT
Referral to tx Goal Encourage pt to accept referral to tx or engage in BT
Complete Pre-Screen
Review of the AUDIT
bull 10-question alcohol use screening instrument
bull Original target groups included bull Medical patients
bull Accident victims
bull DWI offenders
bull Mental health clients
bull Designed for primary health care workers
Domains of the AUDIT
Hazardous Alcohol UseQuestion 1 Frequency of DrinkingQuestion 2 Typical quantityQuestion 3 Frequency of heavy drinking
Domains of the AUDIT (cont)
Dependence SymptomsQuestion 4 Impaired control over drinkingQuestion 5 Failure to meet expectations
because of drinkingQuestion 6 Morning drinking
Domains of the AUDIT (cont)
Harmful Consequences of Alcohol UseQuestion 7 Guilt after drinkingQuestion 8 BlackoutsQuestion 9 Alcohol-related injuriesQuestion 10 Othersrsquo concerns about drinking
Activity AUDIT Practice
bull I am going to ask you some personal questions about alcohol (and other drugs) that I ask all my patients
bull Your responses will be confidentialbull These questions help me to provide the best
possible carebull You do not have to answer them if you are
uncomfortable
See reference list
Activity AUDIT Practice
Feedback Reactions
Scoring the Audit
Score Level Action
0-7 Low Encouragement
8-19 LowModerate BI
16-19 Moderate BIRT
20+ High BTRT
Enhancing Accuracy of Self-Report
Self-reports are more accurate when people are bull Alcohol- or drug-free when interviewedbull Told that their information is confidentialbull Asked clearly worded objective questionsbull Provided memory aides (calendars
response cards)
See reference list
SBI Decision TreeAdminister the AUDIT
Administer the DAST
Alcohol Screen Complete
Other DrugScreen Complete
LowNo RiskAlcohol = 0 ndash 7Other drugs = 0
At RiskAlcohol = 8 ndash 15
Other drugs = 1 ndash 2
ModHigh RiskAlcohol = 16 ndash 19
Other drugs = 3 ndash 5
HighSevere RiskAlcohol = 20 ndash 40
Other drugs = 6 ndash 10
Reinforce behavior Monitor
Brief Intervention Goal Lower Risk
Reduce use to acceptable levels
BIReferral to txBTGoal Encourage pt
to accept a referral to tx or engage in BT
Referral to tx Goal Encourage pt to accept referral to tx or engage in BT
Brief Interventions for Patients at Risk for
Substance Use Problems
What Are Brief Interventions
ldquoBriefhellipinterventions are short face-to-face conversations regarding drinking motivation to change and options for change which are provided during a window of opportunity or potentially teachable moment occasioned by a
medical eventrdquo
Dr Craig Field from the University of Texas (See reference list)
Goal of Brief Interventions
Behavior change
Awareness of problem
Motivation
Presenting problem Screening
results
Brief Intervention Effectbull Brief interventions trigger changebull A little counseling can lead to significant
change eg 5 min has same impact as 20 minbull Research is less extensive for illicit drugs but
promisingbull A randomized study with cocaine and heroin users
found that patients who received a BI had 50 greater odds of abstinence at follow up compared with controls
See reference list
Where Do I Start
What you do depends on where the patient is in the process of changing
The first step is to be able to identify where the patient is coming from
Stages of Change
Primary Tasks
1 PrecontemplationDefinition
Not yet considering change or is unwilling or unable to change
Primary TaskRaising Awareness 2 Contemplation
Definition Sees the possibility of change but
is ambivalent and uncertain
Primary TaskResolving ambivalence
Helping to choose change
3 DeterminationDefinition
Committed to changingStill considering what to do
Primary TaskHelp identify appropriate
change strategies
4 ActionDefinition
Taking steps toward change but hasnrsquot stabilized in the process
Primary TaskHelp implement change strategies
and learn to eliminate potential relapses
5 MaintenanceDefinition
Has achieved the goals and is working to maintain change
Primary TaskDevelop new skills for maintaining recovery
6 RecurrenceDefinition
Experienced a recurrence of the symptoms
Primary TaskCope with consequences and
determine what to do next
Stages of Change Intervention Matching Guide
bull Offer factual informationbull Explore the meaning of events that
brought the person to treatmentbull Explore results of previous effortsbull Explore pros and cons of targeted
behaviors
bull Explore the personrsquos sense of self-efficacy
bull Explore expectations regarding what the change will entail
bull Summarize self-motivational statements
bull Continue exploration of pros and cons
bull Offer a menu of options for changebull Help identify pros and cons of various
change optionsbull Identify and lower barriers to changebull Help person enlist social support bull Encourage person to publicly
announce plans to change
bull Support a realistic view of change through small steps
bull Help identify high-risk situations and develop coping strategies
bull Assist in finding new reinforcers of positive change
bull Help access family and social support
bull Help identify and try alternative behaviors (drug-free sources of pleasure)
bull Maintain supportive contact bull Help develop escape planbull Work to set new short and long term
goals
bull Frame recurrence as a learning opportunity
bull Explore possible behavioral psychological and social antecedents
bull Help to develop alternative coping strategies
bull Explain Stages of Change amp encourage person to stay in the process
bull Maintain supportive contact
1 Pre-contemplation
2Contemplation
3Determination
4Action
5Maintenance
6Recurrence
ldquoPeople are better persuaded by the reasons they themselves
discovered than those that come into the minds of othersrdquo
Blaise Pascal
Ambivalence
All change contains an element of ambivalence
We ldquowant to change and donrsquot want to changerdquo
Patientsrsquo ambivalence about change is the ldquoheartrdquo of the brief intervention
Activity Video ExampleYoung man is treated in the ER after a car accident He had been drinking heavily before the accident How does the doctor address drinking in this video
See reference list
(INSERT BAD SBIRT VIDEO)
Reflective Listening
bull Listen to both what the patient says and to what the person means
bull Show empathy and donrsquot judge what patient saysbull You do not have to agree
bull Be aware of intonationbull Reflect what patient says with statement not
a question eg ldquoYou couldnrsquot get up for work in the morningrdquo
Levels of Reflection
bull Repeating ndash Repeating what was just saidbull RephrasingParaphrasing ndash Restatement of
what the person said Listener infers meaning of what was said Can be thought of as continuing the thought
bull Reflecting Feeling ndash Listener reflects not just the words but the feeling or emotion underneath what the person is saying
Avoid Confrontationbull Challenging
ldquoWhat do you think you are doingrdquo
bull Warning
ldquoYou will damage your liver if you donrsquot stop drinkingrdquo
bull Finger-wagging
ldquoIf you want to be a good student you must stop drinking on school nightsrdquo
Explore Ambivalence
Benefits of change
Costs of using drugs
Benefits of using drugs
Costs of change
How to Explore Ambivalence
Avoid questions that lead to a yesno response
The good things about
______
The not- so-good things about ____
The good things about
changing
The not-so-good things
about changing
Elicit ldquoChange TalkrdquoChange talk consists of self-motivational statements that suggest
bull Recognition of a problem
bull Concern about staying the same
bull Intention to change
bull Optimism about change
Activity Video ExampleSame scenario but different doctor What does this doctor do that is different Does it work
See reference list
(INSERT GOOD SBIRT VIDEO)
Conducting a Brief Intervention
F L O
FLO The 3 tasks of a BI
Avoid Warnings
F L O WFeed
back
Listen
amp U
nd
erstand
Warn
Op
tion
s Exp
lored
(thatrsquos it)
How Does It All Fit TogetherFeedback
Setting the stage
Tell screening results
Listen amp understand
Explore pros amp cons
Explain importance
Assess readiness to change
Options explored
Discuss change options
Follow up
The 3 Tasks of a BI
F L OFeed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 1st Task Feedback
The Feedback Sandwich
Ask Permission
Give Advice
Ask for Response
The 1st Task FeedbackWhat you need to cover1 Range of scores and context2 Screening results3 Substance use norms in population4 Interpretation of results (eg risk level)5 Patient feedback about results
The 1st Task FeedbackWhat do you say
1 Range of score and context - Scores on the AUDIT range from 0-40 Most people who are social drinkers score less than 8
2 Results - Your score was 18 on the alcohol screen
3 Norms - A score of 18 means that your drinking is higher than 75 of the US adult population
4 Interpretation of results - 18 puts you in the moderate-to-high risk range At this level your use is putting you at risk for a variety of health issues
5 Patient reactionfeedback - What do you make of this
Informational Brochures
The 1st Task FeedbackHandling Resistancebull Look I donrsquot have a drug problembull My dad was an alcoholic Irsquom not like himbull I can quit using anytime I want tobull I just like the tastebull Everybody drinks in college
What would you say
Chr
onic
Pai
n
SUD
HIV
Con-fusion Medical
Issues
Pain
SUD
To avoid thishellip
LET GO
The 1st Task Feedback
The 1st Task Feedback
Easy Ways to Let Gobull Irsquom not going to push you to change
anything you donrsquot want to changebull Irsquod just like to give you some informationbull What you do is up to you
The 1st Task FeedbackFinding a Hookbull Ask the patient about their concernsbull Provide non-judgmental feedbackinformationbull Watch for signs of discomfort with status quo or
interest or ability to changebull Always ask this question ldquoWhat role if any do
you think alcohol played in your (getting injured)bull Let the patient decidebull Just asking the question is helpful
The 3 Tasks of a BI
F L O
Feed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
Benefits of Self-Report Toolsbull Provide historical
picturebull Inexpensivebull Non-invasivebull Highly sensitive for
detecting potential problems or dependence
Screen TargetPopulation
Items
Assessment Setting (most common)
Type
ASSIST(WHO)
-Adults-Validated in many cultures and languages
8 Hazardous harmful or dependent drug use (including injection drug use)
Primary Care Interview
AUDIT(WHO)
-Adults and adolescents-Validated in many cultures and languages
10 Identifies alcohol problem use and dependence Can be used as a pre-screen to identify patients in need of full screenbrief intervention
-Different settings-AUDIT C- Primary Care (3 questions)
Self-adminInterview or computerized
DAST-10 Adults 10 To identify drug-use problems in past year
Different settings
Self-admin or Interview
CRAFFT Adolescents 6 To identify alcohol and drug abuse risky behavior amp consequences of use
Different settings
Self-admin
CAGE Adults and youth gt16
4 -Signs of dependence not risky use Primary Care Self-admin or Interview
TWEAK Pregnant women
5 -Risky drinking during pregnancy Based on CAGE-Asks about number of drinks one can tolerate alcohol dependence amp related problems
Primary Care Womenrsquos organizations etc
Self-admin Interview or computerized
What is a Standard Drink
Men No more that 4 drinks on any day and 14 drinks per week
Women No more than 3 drinks on any day and 7 drinks per week
Men and Women gt65 No more than 3 drinks on any day and 7 drinks per week
NIAAA 2011
Drinking Guidelines
285 ml 100 ml 60 ml 30 ml Beer Wine Fortified Wine Liquor 12 oz 5 oz 35 oz 15 oz
Pre-Screening
Pre-screening is a very quick approach to identifying people who need to do a longer screen and brief interventionbull Self-report 1-4 questionsbull Biological blood alcohol level test
Pre-Screening ExampleNIAAA 1-item for alcohol use
ldquoHow many times in the past year have you had X or more drinks in a dayrdquo
5 for men
4 for women
bull Identifies unhealthy alcohol usebull Positive screen gt 1 or more
(provide BI)
See reference list
Pre-Screening ExampleNIDA 1-item for illicit drug use
How many times in the past year have you used an illegal drug or used a prescription medication for non-medical reasonsrdquo
bull Identifies overall drug usebull Positive screen = 1 or more
See reference list
SBI Decision Tree
AlcoholWomen = 0 ndash 2
Men = 0 ndash 4
AlcoholWomen = 4+
Men = 5+
Other DrugsAny Yes
Other DrugsAll Nos
Administer the AUDIT
Administer the DAST
Alcohol Screen Complete
Other DrugScreen Complete
LowNo RiskAlcohol = 0 ndash 7Other drugs = 0
At RiskAlcohol = 8 ndash 15
Other drugs = 1 ndash 2
ModHigh RiskAlcohol = 16 ndash 19
Other drugs = 3 ndash 5
HighSevere RiskAlcohol = 20 ndash 40
Other drugs = 6 ndash 10
Reinforce behavior Monitor
Brief Intervention Goal Lower Risk
Reduce use to acceptable levels
BIReferral to txBTGoal Encourage pt
to accept a referral to tx or engage in BT
Referral to tx Goal Encourage pt to accept referral to tx or engage in BT
Complete Pre-Screen
Review of the AUDIT
bull 10-question alcohol use screening instrument
bull Original target groups included bull Medical patients
bull Accident victims
bull DWI offenders
bull Mental health clients
bull Designed for primary health care workers
Domains of the AUDIT
Hazardous Alcohol UseQuestion 1 Frequency of DrinkingQuestion 2 Typical quantityQuestion 3 Frequency of heavy drinking
Domains of the AUDIT (cont)
Dependence SymptomsQuestion 4 Impaired control over drinkingQuestion 5 Failure to meet expectations
because of drinkingQuestion 6 Morning drinking
Domains of the AUDIT (cont)
Harmful Consequences of Alcohol UseQuestion 7 Guilt after drinkingQuestion 8 BlackoutsQuestion 9 Alcohol-related injuriesQuestion 10 Othersrsquo concerns about drinking
Activity AUDIT Practice
bull I am going to ask you some personal questions about alcohol (and other drugs) that I ask all my patients
bull Your responses will be confidentialbull These questions help me to provide the best
possible carebull You do not have to answer them if you are
uncomfortable
See reference list
Activity AUDIT Practice
Feedback Reactions
Scoring the Audit
Score Level Action
0-7 Low Encouragement
8-19 LowModerate BI
16-19 Moderate BIRT
20+ High BTRT
Enhancing Accuracy of Self-Report
Self-reports are more accurate when people are bull Alcohol- or drug-free when interviewedbull Told that their information is confidentialbull Asked clearly worded objective questionsbull Provided memory aides (calendars
response cards)
See reference list
SBI Decision TreeAdminister the AUDIT
Administer the DAST
Alcohol Screen Complete
Other DrugScreen Complete
LowNo RiskAlcohol = 0 ndash 7Other drugs = 0
At RiskAlcohol = 8 ndash 15
Other drugs = 1 ndash 2
ModHigh RiskAlcohol = 16 ndash 19
Other drugs = 3 ndash 5
HighSevere RiskAlcohol = 20 ndash 40
Other drugs = 6 ndash 10
Reinforce behavior Monitor
Brief Intervention Goal Lower Risk
Reduce use to acceptable levels
BIReferral to txBTGoal Encourage pt
to accept a referral to tx or engage in BT
Referral to tx Goal Encourage pt to accept referral to tx or engage in BT
Brief Interventions for Patients at Risk for
Substance Use Problems
What Are Brief Interventions
ldquoBriefhellipinterventions are short face-to-face conversations regarding drinking motivation to change and options for change which are provided during a window of opportunity or potentially teachable moment occasioned by a
medical eventrdquo
Dr Craig Field from the University of Texas (See reference list)
Goal of Brief Interventions
Behavior change
Awareness of problem
Motivation
Presenting problem Screening
results
Brief Intervention Effectbull Brief interventions trigger changebull A little counseling can lead to significant
change eg 5 min has same impact as 20 minbull Research is less extensive for illicit drugs but
promisingbull A randomized study with cocaine and heroin users
found that patients who received a BI had 50 greater odds of abstinence at follow up compared with controls
See reference list
Where Do I Start
What you do depends on where the patient is in the process of changing
The first step is to be able to identify where the patient is coming from
Stages of Change
Primary Tasks
1 PrecontemplationDefinition
Not yet considering change or is unwilling or unable to change
Primary TaskRaising Awareness 2 Contemplation
Definition Sees the possibility of change but
is ambivalent and uncertain
Primary TaskResolving ambivalence
Helping to choose change
3 DeterminationDefinition
Committed to changingStill considering what to do
Primary TaskHelp identify appropriate
change strategies
4 ActionDefinition
Taking steps toward change but hasnrsquot stabilized in the process
Primary TaskHelp implement change strategies
and learn to eliminate potential relapses
5 MaintenanceDefinition
Has achieved the goals and is working to maintain change
Primary TaskDevelop new skills for maintaining recovery
6 RecurrenceDefinition
Experienced a recurrence of the symptoms
Primary TaskCope with consequences and
determine what to do next
Stages of Change Intervention Matching Guide
bull Offer factual informationbull Explore the meaning of events that
brought the person to treatmentbull Explore results of previous effortsbull Explore pros and cons of targeted
behaviors
bull Explore the personrsquos sense of self-efficacy
bull Explore expectations regarding what the change will entail
bull Summarize self-motivational statements
bull Continue exploration of pros and cons
bull Offer a menu of options for changebull Help identify pros and cons of various
change optionsbull Identify and lower barriers to changebull Help person enlist social support bull Encourage person to publicly
announce plans to change
bull Support a realistic view of change through small steps
bull Help identify high-risk situations and develop coping strategies
bull Assist in finding new reinforcers of positive change
bull Help access family and social support
bull Help identify and try alternative behaviors (drug-free sources of pleasure)
bull Maintain supportive contact bull Help develop escape planbull Work to set new short and long term
goals
bull Frame recurrence as a learning opportunity
bull Explore possible behavioral psychological and social antecedents
bull Help to develop alternative coping strategies
bull Explain Stages of Change amp encourage person to stay in the process
bull Maintain supportive contact
1 Pre-contemplation
2Contemplation
3Determination
4Action
5Maintenance
6Recurrence
ldquoPeople are better persuaded by the reasons they themselves
discovered than those that come into the minds of othersrdquo
Blaise Pascal
Ambivalence
All change contains an element of ambivalence
We ldquowant to change and donrsquot want to changerdquo
Patientsrsquo ambivalence about change is the ldquoheartrdquo of the brief intervention
Activity Video ExampleYoung man is treated in the ER after a car accident He had been drinking heavily before the accident How does the doctor address drinking in this video
See reference list
(INSERT BAD SBIRT VIDEO)
Reflective Listening
bull Listen to both what the patient says and to what the person means
bull Show empathy and donrsquot judge what patient saysbull You do not have to agree
bull Be aware of intonationbull Reflect what patient says with statement not
a question eg ldquoYou couldnrsquot get up for work in the morningrdquo
Levels of Reflection
bull Repeating ndash Repeating what was just saidbull RephrasingParaphrasing ndash Restatement of
what the person said Listener infers meaning of what was said Can be thought of as continuing the thought
bull Reflecting Feeling ndash Listener reflects not just the words but the feeling or emotion underneath what the person is saying
Avoid Confrontationbull Challenging
ldquoWhat do you think you are doingrdquo
bull Warning
ldquoYou will damage your liver if you donrsquot stop drinkingrdquo
bull Finger-wagging
ldquoIf you want to be a good student you must stop drinking on school nightsrdquo
Explore Ambivalence
Benefits of change
Costs of using drugs
Benefits of using drugs
Costs of change
How to Explore Ambivalence
Avoid questions that lead to a yesno response
The good things about
______
The not- so-good things about ____
The good things about
changing
The not-so-good things
about changing
Elicit ldquoChange TalkrdquoChange talk consists of self-motivational statements that suggest
bull Recognition of a problem
bull Concern about staying the same
bull Intention to change
bull Optimism about change
Activity Video ExampleSame scenario but different doctor What does this doctor do that is different Does it work
See reference list
(INSERT GOOD SBIRT VIDEO)
Conducting a Brief Intervention
F L O
FLO The 3 tasks of a BI
Avoid Warnings
F L O WFeed
back
Listen
amp U
nd
erstand
Warn
Op
tion
s Exp
lored
(thatrsquos it)
How Does It All Fit TogetherFeedback
Setting the stage
Tell screening results
Listen amp understand
Explore pros amp cons
Explain importance
Assess readiness to change
Options explored
Discuss change options
Follow up
The 3 Tasks of a BI
F L OFeed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 1st Task Feedback
The Feedback Sandwich
Ask Permission
Give Advice
Ask for Response
The 1st Task FeedbackWhat you need to cover1 Range of scores and context2 Screening results3 Substance use norms in population4 Interpretation of results (eg risk level)5 Patient feedback about results
The 1st Task FeedbackWhat do you say
1 Range of score and context - Scores on the AUDIT range from 0-40 Most people who are social drinkers score less than 8
2 Results - Your score was 18 on the alcohol screen
3 Norms - A score of 18 means that your drinking is higher than 75 of the US adult population
4 Interpretation of results - 18 puts you in the moderate-to-high risk range At this level your use is putting you at risk for a variety of health issues
5 Patient reactionfeedback - What do you make of this
Informational Brochures
The 1st Task FeedbackHandling Resistancebull Look I donrsquot have a drug problembull My dad was an alcoholic Irsquom not like himbull I can quit using anytime I want tobull I just like the tastebull Everybody drinks in college
What would you say
Chr
onic
Pai
n
SUD
HIV
Con-fusion Medical
Issues
Pain
SUD
To avoid thishellip
LET GO
The 1st Task Feedback
The 1st Task Feedback
Easy Ways to Let Gobull Irsquom not going to push you to change
anything you donrsquot want to changebull Irsquod just like to give you some informationbull What you do is up to you
The 1st Task FeedbackFinding a Hookbull Ask the patient about their concernsbull Provide non-judgmental feedbackinformationbull Watch for signs of discomfort with status quo or
interest or ability to changebull Always ask this question ldquoWhat role if any do
you think alcohol played in your (getting injured)bull Let the patient decidebull Just asking the question is helpful
The 3 Tasks of a BI
F L O
Feed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
Screen TargetPopulation
Items
Assessment Setting (most common)
Type
ASSIST(WHO)
-Adults-Validated in many cultures and languages
8 Hazardous harmful or dependent drug use (including injection drug use)
Primary Care Interview
AUDIT(WHO)
-Adults and adolescents-Validated in many cultures and languages
10 Identifies alcohol problem use and dependence Can be used as a pre-screen to identify patients in need of full screenbrief intervention
-Different settings-AUDIT C- Primary Care (3 questions)
Self-adminInterview or computerized
DAST-10 Adults 10 To identify drug-use problems in past year
Different settings
Self-admin or Interview
CRAFFT Adolescents 6 To identify alcohol and drug abuse risky behavior amp consequences of use
Different settings
Self-admin
CAGE Adults and youth gt16
4 -Signs of dependence not risky use Primary Care Self-admin or Interview
TWEAK Pregnant women
5 -Risky drinking during pregnancy Based on CAGE-Asks about number of drinks one can tolerate alcohol dependence amp related problems
Primary Care Womenrsquos organizations etc
Self-admin Interview or computerized
What is a Standard Drink
Men No more that 4 drinks on any day and 14 drinks per week
Women No more than 3 drinks on any day and 7 drinks per week
Men and Women gt65 No more than 3 drinks on any day and 7 drinks per week
NIAAA 2011
Drinking Guidelines
285 ml 100 ml 60 ml 30 ml Beer Wine Fortified Wine Liquor 12 oz 5 oz 35 oz 15 oz
Pre-Screening
Pre-screening is a very quick approach to identifying people who need to do a longer screen and brief interventionbull Self-report 1-4 questionsbull Biological blood alcohol level test
Pre-Screening ExampleNIAAA 1-item for alcohol use
ldquoHow many times in the past year have you had X or more drinks in a dayrdquo
5 for men
4 for women
bull Identifies unhealthy alcohol usebull Positive screen gt 1 or more
(provide BI)
See reference list
Pre-Screening ExampleNIDA 1-item for illicit drug use
How many times in the past year have you used an illegal drug or used a prescription medication for non-medical reasonsrdquo
bull Identifies overall drug usebull Positive screen = 1 or more
See reference list
SBI Decision Tree
AlcoholWomen = 0 ndash 2
Men = 0 ndash 4
AlcoholWomen = 4+
Men = 5+
Other DrugsAny Yes
Other DrugsAll Nos
Administer the AUDIT
Administer the DAST
Alcohol Screen Complete
Other DrugScreen Complete
LowNo RiskAlcohol = 0 ndash 7Other drugs = 0
At RiskAlcohol = 8 ndash 15
Other drugs = 1 ndash 2
ModHigh RiskAlcohol = 16 ndash 19
Other drugs = 3 ndash 5
HighSevere RiskAlcohol = 20 ndash 40
Other drugs = 6 ndash 10
Reinforce behavior Monitor
Brief Intervention Goal Lower Risk
Reduce use to acceptable levels
BIReferral to txBTGoal Encourage pt
to accept a referral to tx or engage in BT
Referral to tx Goal Encourage pt to accept referral to tx or engage in BT
Complete Pre-Screen
Review of the AUDIT
bull 10-question alcohol use screening instrument
bull Original target groups included bull Medical patients
bull Accident victims
bull DWI offenders
bull Mental health clients
bull Designed for primary health care workers
Domains of the AUDIT
Hazardous Alcohol UseQuestion 1 Frequency of DrinkingQuestion 2 Typical quantityQuestion 3 Frequency of heavy drinking
Domains of the AUDIT (cont)
Dependence SymptomsQuestion 4 Impaired control over drinkingQuestion 5 Failure to meet expectations
because of drinkingQuestion 6 Morning drinking
Domains of the AUDIT (cont)
Harmful Consequences of Alcohol UseQuestion 7 Guilt after drinkingQuestion 8 BlackoutsQuestion 9 Alcohol-related injuriesQuestion 10 Othersrsquo concerns about drinking
Activity AUDIT Practice
bull I am going to ask you some personal questions about alcohol (and other drugs) that I ask all my patients
bull Your responses will be confidentialbull These questions help me to provide the best
possible carebull You do not have to answer them if you are
uncomfortable
See reference list
Activity AUDIT Practice
Feedback Reactions
Scoring the Audit
Score Level Action
0-7 Low Encouragement
8-19 LowModerate BI
16-19 Moderate BIRT
20+ High BTRT
Enhancing Accuracy of Self-Report
Self-reports are more accurate when people are bull Alcohol- or drug-free when interviewedbull Told that their information is confidentialbull Asked clearly worded objective questionsbull Provided memory aides (calendars
response cards)
See reference list
SBI Decision TreeAdminister the AUDIT
Administer the DAST
Alcohol Screen Complete
Other DrugScreen Complete
LowNo RiskAlcohol = 0 ndash 7Other drugs = 0
At RiskAlcohol = 8 ndash 15
Other drugs = 1 ndash 2
ModHigh RiskAlcohol = 16 ndash 19
Other drugs = 3 ndash 5
HighSevere RiskAlcohol = 20 ndash 40
Other drugs = 6 ndash 10
Reinforce behavior Monitor
Brief Intervention Goal Lower Risk
Reduce use to acceptable levels
BIReferral to txBTGoal Encourage pt
to accept a referral to tx or engage in BT
Referral to tx Goal Encourage pt to accept referral to tx or engage in BT
Brief Interventions for Patients at Risk for
Substance Use Problems
What Are Brief Interventions
ldquoBriefhellipinterventions are short face-to-face conversations regarding drinking motivation to change and options for change which are provided during a window of opportunity or potentially teachable moment occasioned by a
medical eventrdquo
Dr Craig Field from the University of Texas (See reference list)
Goal of Brief Interventions
Behavior change
Awareness of problem
Motivation
Presenting problem Screening
results
Brief Intervention Effectbull Brief interventions trigger changebull A little counseling can lead to significant
change eg 5 min has same impact as 20 minbull Research is less extensive for illicit drugs but
promisingbull A randomized study with cocaine and heroin users
found that patients who received a BI had 50 greater odds of abstinence at follow up compared with controls
See reference list
Where Do I Start
What you do depends on where the patient is in the process of changing
The first step is to be able to identify where the patient is coming from
Stages of Change
Primary Tasks
1 PrecontemplationDefinition
Not yet considering change or is unwilling or unable to change
Primary TaskRaising Awareness 2 Contemplation
Definition Sees the possibility of change but
is ambivalent and uncertain
Primary TaskResolving ambivalence
Helping to choose change
3 DeterminationDefinition
Committed to changingStill considering what to do
Primary TaskHelp identify appropriate
change strategies
4 ActionDefinition
Taking steps toward change but hasnrsquot stabilized in the process
Primary TaskHelp implement change strategies
and learn to eliminate potential relapses
5 MaintenanceDefinition
Has achieved the goals and is working to maintain change
Primary TaskDevelop new skills for maintaining recovery
6 RecurrenceDefinition
Experienced a recurrence of the symptoms
Primary TaskCope with consequences and
determine what to do next
Stages of Change Intervention Matching Guide
bull Offer factual informationbull Explore the meaning of events that
brought the person to treatmentbull Explore results of previous effortsbull Explore pros and cons of targeted
behaviors
bull Explore the personrsquos sense of self-efficacy
bull Explore expectations regarding what the change will entail
bull Summarize self-motivational statements
bull Continue exploration of pros and cons
bull Offer a menu of options for changebull Help identify pros and cons of various
change optionsbull Identify and lower barriers to changebull Help person enlist social support bull Encourage person to publicly
announce plans to change
bull Support a realistic view of change through small steps
bull Help identify high-risk situations and develop coping strategies
bull Assist in finding new reinforcers of positive change
bull Help access family and social support
bull Help identify and try alternative behaviors (drug-free sources of pleasure)
bull Maintain supportive contact bull Help develop escape planbull Work to set new short and long term
goals
bull Frame recurrence as a learning opportunity
bull Explore possible behavioral psychological and social antecedents
bull Help to develop alternative coping strategies
bull Explain Stages of Change amp encourage person to stay in the process
bull Maintain supportive contact
1 Pre-contemplation
2Contemplation
3Determination
4Action
5Maintenance
6Recurrence
ldquoPeople are better persuaded by the reasons they themselves
discovered than those that come into the minds of othersrdquo
Blaise Pascal
Ambivalence
All change contains an element of ambivalence
We ldquowant to change and donrsquot want to changerdquo
Patientsrsquo ambivalence about change is the ldquoheartrdquo of the brief intervention
Activity Video ExampleYoung man is treated in the ER after a car accident He had been drinking heavily before the accident How does the doctor address drinking in this video
See reference list
(INSERT BAD SBIRT VIDEO)
Reflective Listening
bull Listen to both what the patient says and to what the person means
bull Show empathy and donrsquot judge what patient saysbull You do not have to agree
bull Be aware of intonationbull Reflect what patient says with statement not
a question eg ldquoYou couldnrsquot get up for work in the morningrdquo
Levels of Reflection
bull Repeating ndash Repeating what was just saidbull RephrasingParaphrasing ndash Restatement of
what the person said Listener infers meaning of what was said Can be thought of as continuing the thought
bull Reflecting Feeling ndash Listener reflects not just the words but the feeling or emotion underneath what the person is saying
Avoid Confrontationbull Challenging
ldquoWhat do you think you are doingrdquo
bull Warning
ldquoYou will damage your liver if you donrsquot stop drinkingrdquo
bull Finger-wagging
ldquoIf you want to be a good student you must stop drinking on school nightsrdquo
Explore Ambivalence
Benefits of change
Costs of using drugs
Benefits of using drugs
Costs of change
How to Explore Ambivalence
Avoid questions that lead to a yesno response
The good things about
______
The not- so-good things about ____
The good things about
changing
The not-so-good things
about changing
Elicit ldquoChange TalkrdquoChange talk consists of self-motivational statements that suggest
bull Recognition of a problem
bull Concern about staying the same
bull Intention to change
bull Optimism about change
Activity Video ExampleSame scenario but different doctor What does this doctor do that is different Does it work
See reference list
(INSERT GOOD SBIRT VIDEO)
Conducting a Brief Intervention
F L O
FLO The 3 tasks of a BI
Avoid Warnings
F L O WFeed
back
Listen
amp U
nd
erstand
Warn
Op
tion
s Exp
lored
(thatrsquos it)
How Does It All Fit TogetherFeedback
Setting the stage
Tell screening results
Listen amp understand
Explore pros amp cons
Explain importance
Assess readiness to change
Options explored
Discuss change options
Follow up
The 3 Tasks of a BI
F L OFeed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 1st Task Feedback
The Feedback Sandwich
Ask Permission
Give Advice
Ask for Response
The 1st Task FeedbackWhat you need to cover1 Range of scores and context2 Screening results3 Substance use norms in population4 Interpretation of results (eg risk level)5 Patient feedback about results
The 1st Task FeedbackWhat do you say
1 Range of score and context - Scores on the AUDIT range from 0-40 Most people who are social drinkers score less than 8
2 Results - Your score was 18 on the alcohol screen
3 Norms - A score of 18 means that your drinking is higher than 75 of the US adult population
4 Interpretation of results - 18 puts you in the moderate-to-high risk range At this level your use is putting you at risk for a variety of health issues
5 Patient reactionfeedback - What do you make of this
Informational Brochures
The 1st Task FeedbackHandling Resistancebull Look I donrsquot have a drug problembull My dad was an alcoholic Irsquom not like himbull I can quit using anytime I want tobull I just like the tastebull Everybody drinks in college
What would you say
Chr
onic
Pai
n
SUD
HIV
Con-fusion Medical
Issues
Pain
SUD
To avoid thishellip
LET GO
The 1st Task Feedback
The 1st Task Feedback
Easy Ways to Let Gobull Irsquom not going to push you to change
anything you donrsquot want to changebull Irsquod just like to give you some informationbull What you do is up to you
The 1st Task FeedbackFinding a Hookbull Ask the patient about their concernsbull Provide non-judgmental feedbackinformationbull Watch for signs of discomfort with status quo or
interest or ability to changebull Always ask this question ldquoWhat role if any do
you think alcohol played in your (getting injured)bull Let the patient decidebull Just asking the question is helpful
The 3 Tasks of a BI
F L O
Feed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
What is a Standard Drink
Men No more that 4 drinks on any day and 14 drinks per week
Women No more than 3 drinks on any day and 7 drinks per week
Men and Women gt65 No more than 3 drinks on any day and 7 drinks per week
NIAAA 2011
Drinking Guidelines
285 ml 100 ml 60 ml 30 ml Beer Wine Fortified Wine Liquor 12 oz 5 oz 35 oz 15 oz
Pre-Screening
Pre-screening is a very quick approach to identifying people who need to do a longer screen and brief interventionbull Self-report 1-4 questionsbull Biological blood alcohol level test
Pre-Screening ExampleNIAAA 1-item for alcohol use
ldquoHow many times in the past year have you had X or more drinks in a dayrdquo
5 for men
4 for women
bull Identifies unhealthy alcohol usebull Positive screen gt 1 or more
(provide BI)
See reference list
Pre-Screening ExampleNIDA 1-item for illicit drug use
How many times in the past year have you used an illegal drug or used a prescription medication for non-medical reasonsrdquo
bull Identifies overall drug usebull Positive screen = 1 or more
See reference list
SBI Decision Tree
AlcoholWomen = 0 ndash 2
Men = 0 ndash 4
AlcoholWomen = 4+
Men = 5+
Other DrugsAny Yes
Other DrugsAll Nos
Administer the AUDIT
Administer the DAST
Alcohol Screen Complete
Other DrugScreen Complete
LowNo RiskAlcohol = 0 ndash 7Other drugs = 0
At RiskAlcohol = 8 ndash 15
Other drugs = 1 ndash 2
ModHigh RiskAlcohol = 16 ndash 19
Other drugs = 3 ndash 5
HighSevere RiskAlcohol = 20 ndash 40
Other drugs = 6 ndash 10
Reinforce behavior Monitor
Brief Intervention Goal Lower Risk
Reduce use to acceptable levels
BIReferral to txBTGoal Encourage pt
to accept a referral to tx or engage in BT
Referral to tx Goal Encourage pt to accept referral to tx or engage in BT
Complete Pre-Screen
Review of the AUDIT
bull 10-question alcohol use screening instrument
bull Original target groups included bull Medical patients
bull Accident victims
bull DWI offenders
bull Mental health clients
bull Designed for primary health care workers
Domains of the AUDIT
Hazardous Alcohol UseQuestion 1 Frequency of DrinkingQuestion 2 Typical quantityQuestion 3 Frequency of heavy drinking
Domains of the AUDIT (cont)
Dependence SymptomsQuestion 4 Impaired control over drinkingQuestion 5 Failure to meet expectations
because of drinkingQuestion 6 Morning drinking
Domains of the AUDIT (cont)
Harmful Consequences of Alcohol UseQuestion 7 Guilt after drinkingQuestion 8 BlackoutsQuestion 9 Alcohol-related injuriesQuestion 10 Othersrsquo concerns about drinking
Activity AUDIT Practice
bull I am going to ask you some personal questions about alcohol (and other drugs) that I ask all my patients
bull Your responses will be confidentialbull These questions help me to provide the best
possible carebull You do not have to answer them if you are
uncomfortable
See reference list
Activity AUDIT Practice
Feedback Reactions
Scoring the Audit
Score Level Action
0-7 Low Encouragement
8-19 LowModerate BI
16-19 Moderate BIRT
20+ High BTRT
Enhancing Accuracy of Self-Report
Self-reports are more accurate when people are bull Alcohol- or drug-free when interviewedbull Told that their information is confidentialbull Asked clearly worded objective questionsbull Provided memory aides (calendars
response cards)
See reference list
SBI Decision TreeAdminister the AUDIT
Administer the DAST
Alcohol Screen Complete
Other DrugScreen Complete
LowNo RiskAlcohol = 0 ndash 7Other drugs = 0
At RiskAlcohol = 8 ndash 15
Other drugs = 1 ndash 2
ModHigh RiskAlcohol = 16 ndash 19
Other drugs = 3 ndash 5
HighSevere RiskAlcohol = 20 ndash 40
Other drugs = 6 ndash 10
Reinforce behavior Monitor
Brief Intervention Goal Lower Risk
Reduce use to acceptable levels
BIReferral to txBTGoal Encourage pt
to accept a referral to tx or engage in BT
Referral to tx Goal Encourage pt to accept referral to tx or engage in BT
Brief Interventions for Patients at Risk for
Substance Use Problems
What Are Brief Interventions
ldquoBriefhellipinterventions are short face-to-face conversations regarding drinking motivation to change and options for change which are provided during a window of opportunity or potentially teachable moment occasioned by a
medical eventrdquo
Dr Craig Field from the University of Texas (See reference list)
Goal of Brief Interventions
Behavior change
Awareness of problem
Motivation
Presenting problem Screening
results
Brief Intervention Effectbull Brief interventions trigger changebull A little counseling can lead to significant
change eg 5 min has same impact as 20 minbull Research is less extensive for illicit drugs but
promisingbull A randomized study with cocaine and heroin users
found that patients who received a BI had 50 greater odds of abstinence at follow up compared with controls
See reference list
Where Do I Start
What you do depends on where the patient is in the process of changing
The first step is to be able to identify where the patient is coming from
Stages of Change
Primary Tasks
1 PrecontemplationDefinition
Not yet considering change or is unwilling or unable to change
Primary TaskRaising Awareness 2 Contemplation
Definition Sees the possibility of change but
is ambivalent and uncertain
Primary TaskResolving ambivalence
Helping to choose change
3 DeterminationDefinition
Committed to changingStill considering what to do
Primary TaskHelp identify appropriate
change strategies
4 ActionDefinition
Taking steps toward change but hasnrsquot stabilized in the process
Primary TaskHelp implement change strategies
and learn to eliminate potential relapses
5 MaintenanceDefinition
Has achieved the goals and is working to maintain change
Primary TaskDevelop new skills for maintaining recovery
6 RecurrenceDefinition
Experienced a recurrence of the symptoms
Primary TaskCope with consequences and
determine what to do next
Stages of Change Intervention Matching Guide
bull Offer factual informationbull Explore the meaning of events that
brought the person to treatmentbull Explore results of previous effortsbull Explore pros and cons of targeted
behaviors
bull Explore the personrsquos sense of self-efficacy
bull Explore expectations regarding what the change will entail
bull Summarize self-motivational statements
bull Continue exploration of pros and cons
bull Offer a menu of options for changebull Help identify pros and cons of various
change optionsbull Identify and lower barriers to changebull Help person enlist social support bull Encourage person to publicly
announce plans to change
bull Support a realistic view of change through small steps
bull Help identify high-risk situations and develop coping strategies
bull Assist in finding new reinforcers of positive change
bull Help access family and social support
bull Help identify and try alternative behaviors (drug-free sources of pleasure)
bull Maintain supportive contact bull Help develop escape planbull Work to set new short and long term
goals
bull Frame recurrence as a learning opportunity
bull Explore possible behavioral psychological and social antecedents
bull Help to develop alternative coping strategies
bull Explain Stages of Change amp encourage person to stay in the process
bull Maintain supportive contact
1 Pre-contemplation
2Contemplation
3Determination
4Action
5Maintenance
6Recurrence
ldquoPeople are better persuaded by the reasons they themselves
discovered than those that come into the minds of othersrdquo
Blaise Pascal
Ambivalence
All change contains an element of ambivalence
We ldquowant to change and donrsquot want to changerdquo
Patientsrsquo ambivalence about change is the ldquoheartrdquo of the brief intervention
Activity Video ExampleYoung man is treated in the ER after a car accident He had been drinking heavily before the accident How does the doctor address drinking in this video
See reference list
(INSERT BAD SBIRT VIDEO)
Reflective Listening
bull Listen to both what the patient says and to what the person means
bull Show empathy and donrsquot judge what patient saysbull You do not have to agree
bull Be aware of intonationbull Reflect what patient says with statement not
a question eg ldquoYou couldnrsquot get up for work in the morningrdquo
Levels of Reflection
bull Repeating ndash Repeating what was just saidbull RephrasingParaphrasing ndash Restatement of
what the person said Listener infers meaning of what was said Can be thought of as continuing the thought
bull Reflecting Feeling ndash Listener reflects not just the words but the feeling or emotion underneath what the person is saying
Avoid Confrontationbull Challenging
ldquoWhat do you think you are doingrdquo
bull Warning
ldquoYou will damage your liver if you donrsquot stop drinkingrdquo
bull Finger-wagging
ldquoIf you want to be a good student you must stop drinking on school nightsrdquo
Explore Ambivalence
Benefits of change
Costs of using drugs
Benefits of using drugs
Costs of change
How to Explore Ambivalence
Avoid questions that lead to a yesno response
The good things about
______
The not- so-good things about ____
The good things about
changing
The not-so-good things
about changing
Elicit ldquoChange TalkrdquoChange talk consists of self-motivational statements that suggest
bull Recognition of a problem
bull Concern about staying the same
bull Intention to change
bull Optimism about change
Activity Video ExampleSame scenario but different doctor What does this doctor do that is different Does it work
See reference list
(INSERT GOOD SBIRT VIDEO)
Conducting a Brief Intervention
F L O
FLO The 3 tasks of a BI
Avoid Warnings
F L O WFeed
back
Listen
amp U
nd
erstand
Warn
Op
tion
s Exp
lored
(thatrsquos it)
How Does It All Fit TogetherFeedback
Setting the stage
Tell screening results
Listen amp understand
Explore pros amp cons
Explain importance
Assess readiness to change
Options explored
Discuss change options
Follow up
The 3 Tasks of a BI
F L OFeed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 1st Task Feedback
The Feedback Sandwich
Ask Permission
Give Advice
Ask for Response
The 1st Task FeedbackWhat you need to cover1 Range of scores and context2 Screening results3 Substance use norms in population4 Interpretation of results (eg risk level)5 Patient feedback about results
The 1st Task FeedbackWhat do you say
1 Range of score and context - Scores on the AUDIT range from 0-40 Most people who are social drinkers score less than 8
2 Results - Your score was 18 on the alcohol screen
3 Norms - A score of 18 means that your drinking is higher than 75 of the US adult population
4 Interpretation of results - 18 puts you in the moderate-to-high risk range At this level your use is putting you at risk for a variety of health issues
5 Patient reactionfeedback - What do you make of this
Informational Brochures
The 1st Task FeedbackHandling Resistancebull Look I donrsquot have a drug problembull My dad was an alcoholic Irsquom not like himbull I can quit using anytime I want tobull I just like the tastebull Everybody drinks in college
What would you say
Chr
onic
Pai
n
SUD
HIV
Con-fusion Medical
Issues
Pain
SUD
To avoid thishellip
LET GO
The 1st Task Feedback
The 1st Task Feedback
Easy Ways to Let Gobull Irsquom not going to push you to change
anything you donrsquot want to changebull Irsquod just like to give you some informationbull What you do is up to you
The 1st Task FeedbackFinding a Hookbull Ask the patient about their concernsbull Provide non-judgmental feedbackinformationbull Watch for signs of discomfort with status quo or
interest or ability to changebull Always ask this question ldquoWhat role if any do
you think alcohol played in your (getting injured)bull Let the patient decidebull Just asking the question is helpful
The 3 Tasks of a BI
F L O
Feed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
Men No more that 4 drinks on any day and 14 drinks per week
Women No more than 3 drinks on any day and 7 drinks per week
Men and Women gt65 No more than 3 drinks on any day and 7 drinks per week
NIAAA 2011
Drinking Guidelines
285 ml 100 ml 60 ml 30 ml Beer Wine Fortified Wine Liquor 12 oz 5 oz 35 oz 15 oz
Pre-Screening
Pre-screening is a very quick approach to identifying people who need to do a longer screen and brief interventionbull Self-report 1-4 questionsbull Biological blood alcohol level test
Pre-Screening ExampleNIAAA 1-item for alcohol use
ldquoHow many times in the past year have you had X or more drinks in a dayrdquo
5 for men
4 for women
bull Identifies unhealthy alcohol usebull Positive screen gt 1 or more
(provide BI)
See reference list
Pre-Screening ExampleNIDA 1-item for illicit drug use
How many times in the past year have you used an illegal drug or used a prescription medication for non-medical reasonsrdquo
bull Identifies overall drug usebull Positive screen = 1 or more
See reference list
SBI Decision Tree
AlcoholWomen = 0 ndash 2
Men = 0 ndash 4
AlcoholWomen = 4+
Men = 5+
Other DrugsAny Yes
Other DrugsAll Nos
Administer the AUDIT
Administer the DAST
Alcohol Screen Complete
Other DrugScreen Complete
LowNo RiskAlcohol = 0 ndash 7Other drugs = 0
At RiskAlcohol = 8 ndash 15
Other drugs = 1 ndash 2
ModHigh RiskAlcohol = 16 ndash 19
Other drugs = 3 ndash 5
HighSevere RiskAlcohol = 20 ndash 40
Other drugs = 6 ndash 10
Reinforce behavior Monitor
Brief Intervention Goal Lower Risk
Reduce use to acceptable levels
BIReferral to txBTGoal Encourage pt
to accept a referral to tx or engage in BT
Referral to tx Goal Encourage pt to accept referral to tx or engage in BT
Complete Pre-Screen
Review of the AUDIT
bull 10-question alcohol use screening instrument
bull Original target groups included bull Medical patients
bull Accident victims
bull DWI offenders
bull Mental health clients
bull Designed for primary health care workers
Domains of the AUDIT
Hazardous Alcohol UseQuestion 1 Frequency of DrinkingQuestion 2 Typical quantityQuestion 3 Frequency of heavy drinking
Domains of the AUDIT (cont)
Dependence SymptomsQuestion 4 Impaired control over drinkingQuestion 5 Failure to meet expectations
because of drinkingQuestion 6 Morning drinking
Domains of the AUDIT (cont)
Harmful Consequences of Alcohol UseQuestion 7 Guilt after drinkingQuestion 8 BlackoutsQuestion 9 Alcohol-related injuriesQuestion 10 Othersrsquo concerns about drinking
Activity AUDIT Practice
bull I am going to ask you some personal questions about alcohol (and other drugs) that I ask all my patients
bull Your responses will be confidentialbull These questions help me to provide the best
possible carebull You do not have to answer them if you are
uncomfortable
See reference list
Activity AUDIT Practice
Feedback Reactions
Scoring the Audit
Score Level Action
0-7 Low Encouragement
8-19 LowModerate BI
16-19 Moderate BIRT
20+ High BTRT
Enhancing Accuracy of Self-Report
Self-reports are more accurate when people are bull Alcohol- or drug-free when interviewedbull Told that their information is confidentialbull Asked clearly worded objective questionsbull Provided memory aides (calendars
response cards)
See reference list
SBI Decision TreeAdminister the AUDIT
Administer the DAST
Alcohol Screen Complete
Other DrugScreen Complete
LowNo RiskAlcohol = 0 ndash 7Other drugs = 0
At RiskAlcohol = 8 ndash 15
Other drugs = 1 ndash 2
ModHigh RiskAlcohol = 16 ndash 19
Other drugs = 3 ndash 5
HighSevere RiskAlcohol = 20 ndash 40
Other drugs = 6 ndash 10
Reinforce behavior Monitor
Brief Intervention Goal Lower Risk
Reduce use to acceptable levels
BIReferral to txBTGoal Encourage pt
to accept a referral to tx or engage in BT
Referral to tx Goal Encourage pt to accept referral to tx or engage in BT
Brief Interventions for Patients at Risk for
Substance Use Problems
What Are Brief Interventions
ldquoBriefhellipinterventions are short face-to-face conversations regarding drinking motivation to change and options for change which are provided during a window of opportunity or potentially teachable moment occasioned by a
medical eventrdquo
Dr Craig Field from the University of Texas (See reference list)
Goal of Brief Interventions
Behavior change
Awareness of problem
Motivation
Presenting problem Screening
results
Brief Intervention Effectbull Brief interventions trigger changebull A little counseling can lead to significant
change eg 5 min has same impact as 20 minbull Research is less extensive for illicit drugs but
promisingbull A randomized study with cocaine and heroin users
found that patients who received a BI had 50 greater odds of abstinence at follow up compared with controls
See reference list
Where Do I Start
What you do depends on where the patient is in the process of changing
The first step is to be able to identify where the patient is coming from
Stages of Change
Primary Tasks
1 PrecontemplationDefinition
Not yet considering change or is unwilling or unable to change
Primary TaskRaising Awareness 2 Contemplation
Definition Sees the possibility of change but
is ambivalent and uncertain
Primary TaskResolving ambivalence
Helping to choose change
3 DeterminationDefinition
Committed to changingStill considering what to do
Primary TaskHelp identify appropriate
change strategies
4 ActionDefinition
Taking steps toward change but hasnrsquot stabilized in the process
Primary TaskHelp implement change strategies
and learn to eliminate potential relapses
5 MaintenanceDefinition
Has achieved the goals and is working to maintain change
Primary TaskDevelop new skills for maintaining recovery
6 RecurrenceDefinition
Experienced a recurrence of the symptoms
Primary TaskCope with consequences and
determine what to do next
Stages of Change Intervention Matching Guide
bull Offer factual informationbull Explore the meaning of events that
brought the person to treatmentbull Explore results of previous effortsbull Explore pros and cons of targeted
behaviors
bull Explore the personrsquos sense of self-efficacy
bull Explore expectations regarding what the change will entail
bull Summarize self-motivational statements
bull Continue exploration of pros and cons
bull Offer a menu of options for changebull Help identify pros and cons of various
change optionsbull Identify and lower barriers to changebull Help person enlist social support bull Encourage person to publicly
announce plans to change
bull Support a realistic view of change through small steps
bull Help identify high-risk situations and develop coping strategies
bull Assist in finding new reinforcers of positive change
bull Help access family and social support
bull Help identify and try alternative behaviors (drug-free sources of pleasure)
bull Maintain supportive contact bull Help develop escape planbull Work to set new short and long term
goals
bull Frame recurrence as a learning opportunity
bull Explore possible behavioral psychological and social antecedents
bull Help to develop alternative coping strategies
bull Explain Stages of Change amp encourage person to stay in the process
bull Maintain supportive contact
1 Pre-contemplation
2Contemplation
3Determination
4Action
5Maintenance
6Recurrence
ldquoPeople are better persuaded by the reasons they themselves
discovered than those that come into the minds of othersrdquo
Blaise Pascal
Ambivalence
All change contains an element of ambivalence
We ldquowant to change and donrsquot want to changerdquo
Patientsrsquo ambivalence about change is the ldquoheartrdquo of the brief intervention
Activity Video ExampleYoung man is treated in the ER after a car accident He had been drinking heavily before the accident How does the doctor address drinking in this video
See reference list
(INSERT BAD SBIRT VIDEO)
Reflective Listening
bull Listen to both what the patient says and to what the person means
bull Show empathy and donrsquot judge what patient saysbull You do not have to agree
bull Be aware of intonationbull Reflect what patient says with statement not
a question eg ldquoYou couldnrsquot get up for work in the morningrdquo
Levels of Reflection
bull Repeating ndash Repeating what was just saidbull RephrasingParaphrasing ndash Restatement of
what the person said Listener infers meaning of what was said Can be thought of as continuing the thought
bull Reflecting Feeling ndash Listener reflects not just the words but the feeling or emotion underneath what the person is saying
Avoid Confrontationbull Challenging
ldquoWhat do you think you are doingrdquo
bull Warning
ldquoYou will damage your liver if you donrsquot stop drinkingrdquo
bull Finger-wagging
ldquoIf you want to be a good student you must stop drinking on school nightsrdquo
Explore Ambivalence
Benefits of change
Costs of using drugs
Benefits of using drugs
Costs of change
How to Explore Ambivalence
Avoid questions that lead to a yesno response
The good things about
______
The not- so-good things about ____
The good things about
changing
The not-so-good things
about changing
Elicit ldquoChange TalkrdquoChange talk consists of self-motivational statements that suggest
bull Recognition of a problem
bull Concern about staying the same
bull Intention to change
bull Optimism about change
Activity Video ExampleSame scenario but different doctor What does this doctor do that is different Does it work
See reference list
(INSERT GOOD SBIRT VIDEO)
Conducting a Brief Intervention
F L O
FLO The 3 tasks of a BI
Avoid Warnings
F L O WFeed
back
Listen
amp U
nd
erstand
Warn
Op
tion
s Exp
lored
(thatrsquos it)
How Does It All Fit TogetherFeedback
Setting the stage
Tell screening results
Listen amp understand
Explore pros amp cons
Explain importance
Assess readiness to change
Options explored
Discuss change options
Follow up
The 3 Tasks of a BI
F L OFeed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 1st Task Feedback
The Feedback Sandwich
Ask Permission
Give Advice
Ask for Response
The 1st Task FeedbackWhat you need to cover1 Range of scores and context2 Screening results3 Substance use norms in population4 Interpretation of results (eg risk level)5 Patient feedback about results
The 1st Task FeedbackWhat do you say
1 Range of score and context - Scores on the AUDIT range from 0-40 Most people who are social drinkers score less than 8
2 Results - Your score was 18 on the alcohol screen
3 Norms - A score of 18 means that your drinking is higher than 75 of the US adult population
4 Interpretation of results - 18 puts you in the moderate-to-high risk range At this level your use is putting you at risk for a variety of health issues
5 Patient reactionfeedback - What do you make of this
Informational Brochures
The 1st Task FeedbackHandling Resistancebull Look I donrsquot have a drug problembull My dad was an alcoholic Irsquom not like himbull I can quit using anytime I want tobull I just like the tastebull Everybody drinks in college
What would you say
Chr
onic
Pai
n
SUD
HIV
Con-fusion Medical
Issues
Pain
SUD
To avoid thishellip
LET GO
The 1st Task Feedback
The 1st Task Feedback
Easy Ways to Let Gobull Irsquom not going to push you to change
anything you donrsquot want to changebull Irsquod just like to give you some informationbull What you do is up to you
The 1st Task FeedbackFinding a Hookbull Ask the patient about their concernsbull Provide non-judgmental feedbackinformationbull Watch for signs of discomfort with status quo or
interest or ability to changebull Always ask this question ldquoWhat role if any do
you think alcohol played in your (getting injured)bull Let the patient decidebull Just asking the question is helpful
The 3 Tasks of a BI
F L O
Feed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
Pre-Screening
Pre-screening is a very quick approach to identifying people who need to do a longer screen and brief interventionbull Self-report 1-4 questionsbull Biological blood alcohol level test
Pre-Screening ExampleNIAAA 1-item for alcohol use
ldquoHow many times in the past year have you had X or more drinks in a dayrdquo
5 for men
4 for women
bull Identifies unhealthy alcohol usebull Positive screen gt 1 or more
(provide BI)
See reference list
Pre-Screening ExampleNIDA 1-item for illicit drug use
How many times in the past year have you used an illegal drug or used a prescription medication for non-medical reasonsrdquo
bull Identifies overall drug usebull Positive screen = 1 or more
See reference list
SBI Decision Tree
AlcoholWomen = 0 ndash 2
Men = 0 ndash 4
AlcoholWomen = 4+
Men = 5+
Other DrugsAny Yes
Other DrugsAll Nos
Administer the AUDIT
Administer the DAST
Alcohol Screen Complete
Other DrugScreen Complete
LowNo RiskAlcohol = 0 ndash 7Other drugs = 0
At RiskAlcohol = 8 ndash 15
Other drugs = 1 ndash 2
ModHigh RiskAlcohol = 16 ndash 19
Other drugs = 3 ndash 5
HighSevere RiskAlcohol = 20 ndash 40
Other drugs = 6 ndash 10
Reinforce behavior Monitor
Brief Intervention Goal Lower Risk
Reduce use to acceptable levels
BIReferral to txBTGoal Encourage pt
to accept a referral to tx or engage in BT
Referral to tx Goal Encourage pt to accept referral to tx or engage in BT
Complete Pre-Screen
Review of the AUDIT
bull 10-question alcohol use screening instrument
bull Original target groups included bull Medical patients
bull Accident victims
bull DWI offenders
bull Mental health clients
bull Designed for primary health care workers
Domains of the AUDIT
Hazardous Alcohol UseQuestion 1 Frequency of DrinkingQuestion 2 Typical quantityQuestion 3 Frequency of heavy drinking
Domains of the AUDIT (cont)
Dependence SymptomsQuestion 4 Impaired control over drinkingQuestion 5 Failure to meet expectations
because of drinkingQuestion 6 Morning drinking
Domains of the AUDIT (cont)
Harmful Consequences of Alcohol UseQuestion 7 Guilt after drinkingQuestion 8 BlackoutsQuestion 9 Alcohol-related injuriesQuestion 10 Othersrsquo concerns about drinking
Activity AUDIT Practice
bull I am going to ask you some personal questions about alcohol (and other drugs) that I ask all my patients
bull Your responses will be confidentialbull These questions help me to provide the best
possible carebull You do not have to answer them if you are
uncomfortable
See reference list
Activity AUDIT Practice
Feedback Reactions
Scoring the Audit
Score Level Action
0-7 Low Encouragement
8-19 LowModerate BI
16-19 Moderate BIRT
20+ High BTRT
Enhancing Accuracy of Self-Report
Self-reports are more accurate when people are bull Alcohol- or drug-free when interviewedbull Told that their information is confidentialbull Asked clearly worded objective questionsbull Provided memory aides (calendars
response cards)
See reference list
SBI Decision TreeAdminister the AUDIT
Administer the DAST
Alcohol Screen Complete
Other DrugScreen Complete
LowNo RiskAlcohol = 0 ndash 7Other drugs = 0
At RiskAlcohol = 8 ndash 15
Other drugs = 1 ndash 2
ModHigh RiskAlcohol = 16 ndash 19
Other drugs = 3 ndash 5
HighSevere RiskAlcohol = 20 ndash 40
Other drugs = 6 ndash 10
Reinforce behavior Monitor
Brief Intervention Goal Lower Risk
Reduce use to acceptable levels
BIReferral to txBTGoal Encourage pt
to accept a referral to tx or engage in BT
Referral to tx Goal Encourage pt to accept referral to tx or engage in BT
Brief Interventions for Patients at Risk for
Substance Use Problems
What Are Brief Interventions
ldquoBriefhellipinterventions are short face-to-face conversations regarding drinking motivation to change and options for change which are provided during a window of opportunity or potentially teachable moment occasioned by a
medical eventrdquo
Dr Craig Field from the University of Texas (See reference list)
Goal of Brief Interventions
Behavior change
Awareness of problem
Motivation
Presenting problem Screening
results
Brief Intervention Effectbull Brief interventions trigger changebull A little counseling can lead to significant
change eg 5 min has same impact as 20 minbull Research is less extensive for illicit drugs but
promisingbull A randomized study with cocaine and heroin users
found that patients who received a BI had 50 greater odds of abstinence at follow up compared with controls
See reference list
Where Do I Start
What you do depends on where the patient is in the process of changing
The first step is to be able to identify where the patient is coming from
Stages of Change
Primary Tasks
1 PrecontemplationDefinition
Not yet considering change or is unwilling or unable to change
Primary TaskRaising Awareness 2 Contemplation
Definition Sees the possibility of change but
is ambivalent and uncertain
Primary TaskResolving ambivalence
Helping to choose change
3 DeterminationDefinition
Committed to changingStill considering what to do
Primary TaskHelp identify appropriate
change strategies
4 ActionDefinition
Taking steps toward change but hasnrsquot stabilized in the process
Primary TaskHelp implement change strategies
and learn to eliminate potential relapses
5 MaintenanceDefinition
Has achieved the goals and is working to maintain change
Primary TaskDevelop new skills for maintaining recovery
6 RecurrenceDefinition
Experienced a recurrence of the symptoms
Primary TaskCope with consequences and
determine what to do next
Stages of Change Intervention Matching Guide
bull Offer factual informationbull Explore the meaning of events that
brought the person to treatmentbull Explore results of previous effortsbull Explore pros and cons of targeted
behaviors
bull Explore the personrsquos sense of self-efficacy
bull Explore expectations regarding what the change will entail
bull Summarize self-motivational statements
bull Continue exploration of pros and cons
bull Offer a menu of options for changebull Help identify pros and cons of various
change optionsbull Identify and lower barriers to changebull Help person enlist social support bull Encourage person to publicly
announce plans to change
bull Support a realistic view of change through small steps
bull Help identify high-risk situations and develop coping strategies
bull Assist in finding new reinforcers of positive change
bull Help access family and social support
bull Help identify and try alternative behaviors (drug-free sources of pleasure)
bull Maintain supportive contact bull Help develop escape planbull Work to set new short and long term
goals
bull Frame recurrence as a learning opportunity
bull Explore possible behavioral psychological and social antecedents
bull Help to develop alternative coping strategies
bull Explain Stages of Change amp encourage person to stay in the process
bull Maintain supportive contact
1 Pre-contemplation
2Contemplation
3Determination
4Action
5Maintenance
6Recurrence
ldquoPeople are better persuaded by the reasons they themselves
discovered than those that come into the minds of othersrdquo
Blaise Pascal
Ambivalence
All change contains an element of ambivalence
We ldquowant to change and donrsquot want to changerdquo
Patientsrsquo ambivalence about change is the ldquoheartrdquo of the brief intervention
Activity Video ExampleYoung man is treated in the ER after a car accident He had been drinking heavily before the accident How does the doctor address drinking in this video
See reference list
(INSERT BAD SBIRT VIDEO)
Reflective Listening
bull Listen to both what the patient says and to what the person means
bull Show empathy and donrsquot judge what patient saysbull You do not have to agree
bull Be aware of intonationbull Reflect what patient says with statement not
a question eg ldquoYou couldnrsquot get up for work in the morningrdquo
Levels of Reflection
bull Repeating ndash Repeating what was just saidbull RephrasingParaphrasing ndash Restatement of
what the person said Listener infers meaning of what was said Can be thought of as continuing the thought
bull Reflecting Feeling ndash Listener reflects not just the words but the feeling or emotion underneath what the person is saying
Avoid Confrontationbull Challenging
ldquoWhat do you think you are doingrdquo
bull Warning
ldquoYou will damage your liver if you donrsquot stop drinkingrdquo
bull Finger-wagging
ldquoIf you want to be a good student you must stop drinking on school nightsrdquo
Explore Ambivalence
Benefits of change
Costs of using drugs
Benefits of using drugs
Costs of change
How to Explore Ambivalence
Avoid questions that lead to a yesno response
The good things about
______
The not- so-good things about ____
The good things about
changing
The not-so-good things
about changing
Elicit ldquoChange TalkrdquoChange talk consists of self-motivational statements that suggest
bull Recognition of a problem
bull Concern about staying the same
bull Intention to change
bull Optimism about change
Activity Video ExampleSame scenario but different doctor What does this doctor do that is different Does it work
See reference list
(INSERT GOOD SBIRT VIDEO)
Conducting a Brief Intervention
F L O
FLO The 3 tasks of a BI
Avoid Warnings
F L O WFeed
back
Listen
amp U
nd
erstand
Warn
Op
tion
s Exp
lored
(thatrsquos it)
How Does It All Fit TogetherFeedback
Setting the stage
Tell screening results
Listen amp understand
Explore pros amp cons
Explain importance
Assess readiness to change
Options explored
Discuss change options
Follow up
The 3 Tasks of a BI
F L OFeed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 1st Task Feedback
The Feedback Sandwich
Ask Permission
Give Advice
Ask for Response
The 1st Task FeedbackWhat you need to cover1 Range of scores and context2 Screening results3 Substance use norms in population4 Interpretation of results (eg risk level)5 Patient feedback about results
The 1st Task FeedbackWhat do you say
1 Range of score and context - Scores on the AUDIT range from 0-40 Most people who are social drinkers score less than 8
2 Results - Your score was 18 on the alcohol screen
3 Norms - A score of 18 means that your drinking is higher than 75 of the US adult population
4 Interpretation of results - 18 puts you in the moderate-to-high risk range At this level your use is putting you at risk for a variety of health issues
5 Patient reactionfeedback - What do you make of this
Informational Brochures
The 1st Task FeedbackHandling Resistancebull Look I donrsquot have a drug problembull My dad was an alcoholic Irsquom not like himbull I can quit using anytime I want tobull I just like the tastebull Everybody drinks in college
What would you say
Chr
onic
Pai
n
SUD
HIV
Con-fusion Medical
Issues
Pain
SUD
To avoid thishellip
LET GO
The 1st Task Feedback
The 1st Task Feedback
Easy Ways to Let Gobull Irsquom not going to push you to change
anything you donrsquot want to changebull Irsquod just like to give you some informationbull What you do is up to you
The 1st Task FeedbackFinding a Hookbull Ask the patient about their concernsbull Provide non-judgmental feedbackinformationbull Watch for signs of discomfort with status quo or
interest or ability to changebull Always ask this question ldquoWhat role if any do
you think alcohol played in your (getting injured)bull Let the patient decidebull Just asking the question is helpful
The 3 Tasks of a BI
F L O
Feed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
Pre-Screening ExampleNIAAA 1-item for alcohol use
ldquoHow many times in the past year have you had X or more drinks in a dayrdquo
5 for men
4 for women
bull Identifies unhealthy alcohol usebull Positive screen gt 1 or more
(provide BI)
See reference list
Pre-Screening ExampleNIDA 1-item for illicit drug use
How many times in the past year have you used an illegal drug or used a prescription medication for non-medical reasonsrdquo
bull Identifies overall drug usebull Positive screen = 1 or more
See reference list
SBI Decision Tree
AlcoholWomen = 0 ndash 2
Men = 0 ndash 4
AlcoholWomen = 4+
Men = 5+
Other DrugsAny Yes
Other DrugsAll Nos
Administer the AUDIT
Administer the DAST
Alcohol Screen Complete
Other DrugScreen Complete
LowNo RiskAlcohol = 0 ndash 7Other drugs = 0
At RiskAlcohol = 8 ndash 15
Other drugs = 1 ndash 2
ModHigh RiskAlcohol = 16 ndash 19
Other drugs = 3 ndash 5
HighSevere RiskAlcohol = 20 ndash 40
Other drugs = 6 ndash 10
Reinforce behavior Monitor
Brief Intervention Goal Lower Risk
Reduce use to acceptable levels
BIReferral to txBTGoal Encourage pt
to accept a referral to tx or engage in BT
Referral to tx Goal Encourage pt to accept referral to tx or engage in BT
Complete Pre-Screen
Review of the AUDIT
bull 10-question alcohol use screening instrument
bull Original target groups included bull Medical patients
bull Accident victims
bull DWI offenders
bull Mental health clients
bull Designed for primary health care workers
Domains of the AUDIT
Hazardous Alcohol UseQuestion 1 Frequency of DrinkingQuestion 2 Typical quantityQuestion 3 Frequency of heavy drinking
Domains of the AUDIT (cont)
Dependence SymptomsQuestion 4 Impaired control over drinkingQuestion 5 Failure to meet expectations
because of drinkingQuestion 6 Morning drinking
Domains of the AUDIT (cont)
Harmful Consequences of Alcohol UseQuestion 7 Guilt after drinkingQuestion 8 BlackoutsQuestion 9 Alcohol-related injuriesQuestion 10 Othersrsquo concerns about drinking
Activity AUDIT Practice
bull I am going to ask you some personal questions about alcohol (and other drugs) that I ask all my patients
bull Your responses will be confidentialbull These questions help me to provide the best
possible carebull You do not have to answer them if you are
uncomfortable
See reference list
Activity AUDIT Practice
Feedback Reactions
Scoring the Audit
Score Level Action
0-7 Low Encouragement
8-19 LowModerate BI
16-19 Moderate BIRT
20+ High BTRT
Enhancing Accuracy of Self-Report
Self-reports are more accurate when people are bull Alcohol- or drug-free when interviewedbull Told that their information is confidentialbull Asked clearly worded objective questionsbull Provided memory aides (calendars
response cards)
See reference list
SBI Decision TreeAdminister the AUDIT
Administer the DAST
Alcohol Screen Complete
Other DrugScreen Complete
LowNo RiskAlcohol = 0 ndash 7Other drugs = 0
At RiskAlcohol = 8 ndash 15
Other drugs = 1 ndash 2
ModHigh RiskAlcohol = 16 ndash 19
Other drugs = 3 ndash 5
HighSevere RiskAlcohol = 20 ndash 40
Other drugs = 6 ndash 10
Reinforce behavior Monitor
Brief Intervention Goal Lower Risk
Reduce use to acceptable levels
BIReferral to txBTGoal Encourage pt
to accept a referral to tx or engage in BT
Referral to tx Goal Encourage pt to accept referral to tx or engage in BT
Brief Interventions for Patients at Risk for
Substance Use Problems
What Are Brief Interventions
ldquoBriefhellipinterventions are short face-to-face conversations regarding drinking motivation to change and options for change which are provided during a window of opportunity or potentially teachable moment occasioned by a
medical eventrdquo
Dr Craig Field from the University of Texas (See reference list)
Goal of Brief Interventions
Behavior change
Awareness of problem
Motivation
Presenting problem Screening
results
Brief Intervention Effectbull Brief interventions trigger changebull A little counseling can lead to significant
change eg 5 min has same impact as 20 minbull Research is less extensive for illicit drugs but
promisingbull A randomized study with cocaine and heroin users
found that patients who received a BI had 50 greater odds of abstinence at follow up compared with controls
See reference list
Where Do I Start
What you do depends on where the patient is in the process of changing
The first step is to be able to identify where the patient is coming from
Stages of Change
Primary Tasks
1 PrecontemplationDefinition
Not yet considering change or is unwilling or unable to change
Primary TaskRaising Awareness 2 Contemplation
Definition Sees the possibility of change but
is ambivalent and uncertain
Primary TaskResolving ambivalence
Helping to choose change
3 DeterminationDefinition
Committed to changingStill considering what to do
Primary TaskHelp identify appropriate
change strategies
4 ActionDefinition
Taking steps toward change but hasnrsquot stabilized in the process
Primary TaskHelp implement change strategies
and learn to eliminate potential relapses
5 MaintenanceDefinition
Has achieved the goals and is working to maintain change
Primary TaskDevelop new skills for maintaining recovery
6 RecurrenceDefinition
Experienced a recurrence of the symptoms
Primary TaskCope with consequences and
determine what to do next
Stages of Change Intervention Matching Guide
bull Offer factual informationbull Explore the meaning of events that
brought the person to treatmentbull Explore results of previous effortsbull Explore pros and cons of targeted
behaviors
bull Explore the personrsquos sense of self-efficacy
bull Explore expectations regarding what the change will entail
bull Summarize self-motivational statements
bull Continue exploration of pros and cons
bull Offer a menu of options for changebull Help identify pros and cons of various
change optionsbull Identify and lower barriers to changebull Help person enlist social support bull Encourage person to publicly
announce plans to change
bull Support a realistic view of change through small steps
bull Help identify high-risk situations and develop coping strategies
bull Assist in finding new reinforcers of positive change
bull Help access family and social support
bull Help identify and try alternative behaviors (drug-free sources of pleasure)
bull Maintain supportive contact bull Help develop escape planbull Work to set new short and long term
goals
bull Frame recurrence as a learning opportunity
bull Explore possible behavioral psychological and social antecedents
bull Help to develop alternative coping strategies
bull Explain Stages of Change amp encourage person to stay in the process
bull Maintain supportive contact
1 Pre-contemplation
2Contemplation
3Determination
4Action
5Maintenance
6Recurrence
ldquoPeople are better persuaded by the reasons they themselves
discovered than those that come into the minds of othersrdquo
Blaise Pascal
Ambivalence
All change contains an element of ambivalence
We ldquowant to change and donrsquot want to changerdquo
Patientsrsquo ambivalence about change is the ldquoheartrdquo of the brief intervention
Activity Video ExampleYoung man is treated in the ER after a car accident He had been drinking heavily before the accident How does the doctor address drinking in this video
See reference list
(INSERT BAD SBIRT VIDEO)
Reflective Listening
bull Listen to both what the patient says and to what the person means
bull Show empathy and donrsquot judge what patient saysbull You do not have to agree
bull Be aware of intonationbull Reflect what patient says with statement not
a question eg ldquoYou couldnrsquot get up for work in the morningrdquo
Levels of Reflection
bull Repeating ndash Repeating what was just saidbull RephrasingParaphrasing ndash Restatement of
what the person said Listener infers meaning of what was said Can be thought of as continuing the thought
bull Reflecting Feeling ndash Listener reflects not just the words but the feeling or emotion underneath what the person is saying
Avoid Confrontationbull Challenging
ldquoWhat do you think you are doingrdquo
bull Warning
ldquoYou will damage your liver if you donrsquot stop drinkingrdquo
bull Finger-wagging
ldquoIf you want to be a good student you must stop drinking on school nightsrdquo
Explore Ambivalence
Benefits of change
Costs of using drugs
Benefits of using drugs
Costs of change
How to Explore Ambivalence
Avoid questions that lead to a yesno response
The good things about
______
The not- so-good things about ____
The good things about
changing
The not-so-good things
about changing
Elicit ldquoChange TalkrdquoChange talk consists of self-motivational statements that suggest
bull Recognition of a problem
bull Concern about staying the same
bull Intention to change
bull Optimism about change
Activity Video ExampleSame scenario but different doctor What does this doctor do that is different Does it work
See reference list
(INSERT GOOD SBIRT VIDEO)
Conducting a Brief Intervention
F L O
FLO The 3 tasks of a BI
Avoid Warnings
F L O WFeed
back
Listen
amp U
nd
erstand
Warn
Op
tion
s Exp
lored
(thatrsquos it)
How Does It All Fit TogetherFeedback
Setting the stage
Tell screening results
Listen amp understand
Explore pros amp cons
Explain importance
Assess readiness to change
Options explored
Discuss change options
Follow up
The 3 Tasks of a BI
F L OFeed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 1st Task Feedback
The Feedback Sandwich
Ask Permission
Give Advice
Ask for Response
The 1st Task FeedbackWhat you need to cover1 Range of scores and context2 Screening results3 Substance use norms in population4 Interpretation of results (eg risk level)5 Patient feedback about results
The 1st Task FeedbackWhat do you say
1 Range of score and context - Scores on the AUDIT range from 0-40 Most people who are social drinkers score less than 8
2 Results - Your score was 18 on the alcohol screen
3 Norms - A score of 18 means that your drinking is higher than 75 of the US adult population
4 Interpretation of results - 18 puts you in the moderate-to-high risk range At this level your use is putting you at risk for a variety of health issues
5 Patient reactionfeedback - What do you make of this
Informational Brochures
The 1st Task FeedbackHandling Resistancebull Look I donrsquot have a drug problembull My dad was an alcoholic Irsquom not like himbull I can quit using anytime I want tobull I just like the tastebull Everybody drinks in college
What would you say
Chr
onic
Pai
n
SUD
HIV
Con-fusion Medical
Issues
Pain
SUD
To avoid thishellip
LET GO
The 1st Task Feedback
The 1st Task Feedback
Easy Ways to Let Gobull Irsquom not going to push you to change
anything you donrsquot want to changebull Irsquod just like to give you some informationbull What you do is up to you
The 1st Task FeedbackFinding a Hookbull Ask the patient about their concernsbull Provide non-judgmental feedbackinformationbull Watch for signs of discomfort with status quo or
interest or ability to changebull Always ask this question ldquoWhat role if any do
you think alcohol played in your (getting injured)bull Let the patient decidebull Just asking the question is helpful
The 3 Tasks of a BI
F L O
Feed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
Pre-Screening ExampleNIDA 1-item for illicit drug use
How many times in the past year have you used an illegal drug or used a prescription medication for non-medical reasonsrdquo
bull Identifies overall drug usebull Positive screen = 1 or more
See reference list
SBI Decision Tree
AlcoholWomen = 0 ndash 2
Men = 0 ndash 4
AlcoholWomen = 4+
Men = 5+
Other DrugsAny Yes
Other DrugsAll Nos
Administer the AUDIT
Administer the DAST
Alcohol Screen Complete
Other DrugScreen Complete
LowNo RiskAlcohol = 0 ndash 7Other drugs = 0
At RiskAlcohol = 8 ndash 15
Other drugs = 1 ndash 2
ModHigh RiskAlcohol = 16 ndash 19
Other drugs = 3 ndash 5
HighSevere RiskAlcohol = 20 ndash 40
Other drugs = 6 ndash 10
Reinforce behavior Monitor
Brief Intervention Goal Lower Risk
Reduce use to acceptable levels
BIReferral to txBTGoal Encourage pt
to accept a referral to tx or engage in BT
Referral to tx Goal Encourage pt to accept referral to tx or engage in BT
Complete Pre-Screen
Review of the AUDIT
bull 10-question alcohol use screening instrument
bull Original target groups included bull Medical patients
bull Accident victims
bull DWI offenders
bull Mental health clients
bull Designed for primary health care workers
Domains of the AUDIT
Hazardous Alcohol UseQuestion 1 Frequency of DrinkingQuestion 2 Typical quantityQuestion 3 Frequency of heavy drinking
Domains of the AUDIT (cont)
Dependence SymptomsQuestion 4 Impaired control over drinkingQuestion 5 Failure to meet expectations
because of drinkingQuestion 6 Morning drinking
Domains of the AUDIT (cont)
Harmful Consequences of Alcohol UseQuestion 7 Guilt after drinkingQuestion 8 BlackoutsQuestion 9 Alcohol-related injuriesQuestion 10 Othersrsquo concerns about drinking
Activity AUDIT Practice
bull I am going to ask you some personal questions about alcohol (and other drugs) that I ask all my patients
bull Your responses will be confidentialbull These questions help me to provide the best
possible carebull You do not have to answer them if you are
uncomfortable
See reference list
Activity AUDIT Practice
Feedback Reactions
Scoring the Audit
Score Level Action
0-7 Low Encouragement
8-19 LowModerate BI
16-19 Moderate BIRT
20+ High BTRT
Enhancing Accuracy of Self-Report
Self-reports are more accurate when people are bull Alcohol- or drug-free when interviewedbull Told that their information is confidentialbull Asked clearly worded objective questionsbull Provided memory aides (calendars
response cards)
See reference list
SBI Decision TreeAdminister the AUDIT
Administer the DAST
Alcohol Screen Complete
Other DrugScreen Complete
LowNo RiskAlcohol = 0 ndash 7Other drugs = 0
At RiskAlcohol = 8 ndash 15
Other drugs = 1 ndash 2
ModHigh RiskAlcohol = 16 ndash 19
Other drugs = 3 ndash 5
HighSevere RiskAlcohol = 20 ndash 40
Other drugs = 6 ndash 10
Reinforce behavior Monitor
Brief Intervention Goal Lower Risk
Reduce use to acceptable levels
BIReferral to txBTGoal Encourage pt
to accept a referral to tx or engage in BT
Referral to tx Goal Encourage pt to accept referral to tx or engage in BT
Brief Interventions for Patients at Risk for
Substance Use Problems
What Are Brief Interventions
ldquoBriefhellipinterventions are short face-to-face conversations regarding drinking motivation to change and options for change which are provided during a window of opportunity or potentially teachable moment occasioned by a
medical eventrdquo
Dr Craig Field from the University of Texas (See reference list)
Goal of Brief Interventions
Behavior change
Awareness of problem
Motivation
Presenting problem Screening
results
Brief Intervention Effectbull Brief interventions trigger changebull A little counseling can lead to significant
change eg 5 min has same impact as 20 minbull Research is less extensive for illicit drugs but
promisingbull A randomized study with cocaine and heroin users
found that patients who received a BI had 50 greater odds of abstinence at follow up compared with controls
See reference list
Where Do I Start
What you do depends on where the patient is in the process of changing
The first step is to be able to identify where the patient is coming from
Stages of Change
Primary Tasks
1 PrecontemplationDefinition
Not yet considering change or is unwilling or unable to change
Primary TaskRaising Awareness 2 Contemplation
Definition Sees the possibility of change but
is ambivalent and uncertain
Primary TaskResolving ambivalence
Helping to choose change
3 DeterminationDefinition
Committed to changingStill considering what to do
Primary TaskHelp identify appropriate
change strategies
4 ActionDefinition
Taking steps toward change but hasnrsquot stabilized in the process
Primary TaskHelp implement change strategies
and learn to eliminate potential relapses
5 MaintenanceDefinition
Has achieved the goals and is working to maintain change
Primary TaskDevelop new skills for maintaining recovery
6 RecurrenceDefinition
Experienced a recurrence of the symptoms
Primary TaskCope with consequences and
determine what to do next
Stages of Change Intervention Matching Guide
bull Offer factual informationbull Explore the meaning of events that
brought the person to treatmentbull Explore results of previous effortsbull Explore pros and cons of targeted
behaviors
bull Explore the personrsquos sense of self-efficacy
bull Explore expectations regarding what the change will entail
bull Summarize self-motivational statements
bull Continue exploration of pros and cons
bull Offer a menu of options for changebull Help identify pros and cons of various
change optionsbull Identify and lower barriers to changebull Help person enlist social support bull Encourage person to publicly
announce plans to change
bull Support a realistic view of change through small steps
bull Help identify high-risk situations and develop coping strategies
bull Assist in finding new reinforcers of positive change
bull Help access family and social support
bull Help identify and try alternative behaviors (drug-free sources of pleasure)
bull Maintain supportive contact bull Help develop escape planbull Work to set new short and long term
goals
bull Frame recurrence as a learning opportunity
bull Explore possible behavioral psychological and social antecedents
bull Help to develop alternative coping strategies
bull Explain Stages of Change amp encourage person to stay in the process
bull Maintain supportive contact
1 Pre-contemplation
2Contemplation
3Determination
4Action
5Maintenance
6Recurrence
ldquoPeople are better persuaded by the reasons they themselves
discovered than those that come into the minds of othersrdquo
Blaise Pascal
Ambivalence
All change contains an element of ambivalence
We ldquowant to change and donrsquot want to changerdquo
Patientsrsquo ambivalence about change is the ldquoheartrdquo of the brief intervention
Activity Video ExampleYoung man is treated in the ER after a car accident He had been drinking heavily before the accident How does the doctor address drinking in this video
See reference list
(INSERT BAD SBIRT VIDEO)
Reflective Listening
bull Listen to both what the patient says and to what the person means
bull Show empathy and donrsquot judge what patient saysbull You do not have to agree
bull Be aware of intonationbull Reflect what patient says with statement not
a question eg ldquoYou couldnrsquot get up for work in the morningrdquo
Levels of Reflection
bull Repeating ndash Repeating what was just saidbull RephrasingParaphrasing ndash Restatement of
what the person said Listener infers meaning of what was said Can be thought of as continuing the thought
bull Reflecting Feeling ndash Listener reflects not just the words but the feeling or emotion underneath what the person is saying
Avoid Confrontationbull Challenging
ldquoWhat do you think you are doingrdquo
bull Warning
ldquoYou will damage your liver if you donrsquot stop drinkingrdquo
bull Finger-wagging
ldquoIf you want to be a good student you must stop drinking on school nightsrdquo
Explore Ambivalence
Benefits of change
Costs of using drugs
Benefits of using drugs
Costs of change
How to Explore Ambivalence
Avoid questions that lead to a yesno response
The good things about
______
The not- so-good things about ____
The good things about
changing
The not-so-good things
about changing
Elicit ldquoChange TalkrdquoChange talk consists of self-motivational statements that suggest
bull Recognition of a problem
bull Concern about staying the same
bull Intention to change
bull Optimism about change
Activity Video ExampleSame scenario but different doctor What does this doctor do that is different Does it work
See reference list
(INSERT GOOD SBIRT VIDEO)
Conducting a Brief Intervention
F L O
FLO The 3 tasks of a BI
Avoid Warnings
F L O WFeed
back
Listen
amp U
nd
erstand
Warn
Op
tion
s Exp
lored
(thatrsquos it)
How Does It All Fit TogetherFeedback
Setting the stage
Tell screening results
Listen amp understand
Explore pros amp cons
Explain importance
Assess readiness to change
Options explored
Discuss change options
Follow up
The 3 Tasks of a BI
F L OFeed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 1st Task Feedback
The Feedback Sandwich
Ask Permission
Give Advice
Ask for Response
The 1st Task FeedbackWhat you need to cover1 Range of scores and context2 Screening results3 Substance use norms in population4 Interpretation of results (eg risk level)5 Patient feedback about results
The 1st Task FeedbackWhat do you say
1 Range of score and context - Scores on the AUDIT range from 0-40 Most people who are social drinkers score less than 8
2 Results - Your score was 18 on the alcohol screen
3 Norms - A score of 18 means that your drinking is higher than 75 of the US adult population
4 Interpretation of results - 18 puts you in the moderate-to-high risk range At this level your use is putting you at risk for a variety of health issues
5 Patient reactionfeedback - What do you make of this
Informational Brochures
The 1st Task FeedbackHandling Resistancebull Look I donrsquot have a drug problembull My dad was an alcoholic Irsquom not like himbull I can quit using anytime I want tobull I just like the tastebull Everybody drinks in college
What would you say
Chr
onic
Pai
n
SUD
HIV
Con-fusion Medical
Issues
Pain
SUD
To avoid thishellip
LET GO
The 1st Task Feedback
The 1st Task Feedback
Easy Ways to Let Gobull Irsquom not going to push you to change
anything you donrsquot want to changebull Irsquod just like to give you some informationbull What you do is up to you
The 1st Task FeedbackFinding a Hookbull Ask the patient about their concernsbull Provide non-judgmental feedbackinformationbull Watch for signs of discomfort with status quo or
interest or ability to changebull Always ask this question ldquoWhat role if any do
you think alcohol played in your (getting injured)bull Let the patient decidebull Just asking the question is helpful
The 3 Tasks of a BI
F L O
Feed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
SBI Decision Tree
AlcoholWomen = 0 ndash 2
Men = 0 ndash 4
AlcoholWomen = 4+
Men = 5+
Other DrugsAny Yes
Other DrugsAll Nos
Administer the AUDIT
Administer the DAST
Alcohol Screen Complete
Other DrugScreen Complete
LowNo RiskAlcohol = 0 ndash 7Other drugs = 0
At RiskAlcohol = 8 ndash 15
Other drugs = 1 ndash 2
ModHigh RiskAlcohol = 16 ndash 19
Other drugs = 3 ndash 5
HighSevere RiskAlcohol = 20 ndash 40
Other drugs = 6 ndash 10
Reinforce behavior Monitor
Brief Intervention Goal Lower Risk
Reduce use to acceptable levels
BIReferral to txBTGoal Encourage pt
to accept a referral to tx or engage in BT
Referral to tx Goal Encourage pt to accept referral to tx or engage in BT
Complete Pre-Screen
Review of the AUDIT
bull 10-question alcohol use screening instrument
bull Original target groups included bull Medical patients
bull Accident victims
bull DWI offenders
bull Mental health clients
bull Designed for primary health care workers
Domains of the AUDIT
Hazardous Alcohol UseQuestion 1 Frequency of DrinkingQuestion 2 Typical quantityQuestion 3 Frequency of heavy drinking
Domains of the AUDIT (cont)
Dependence SymptomsQuestion 4 Impaired control over drinkingQuestion 5 Failure to meet expectations
because of drinkingQuestion 6 Morning drinking
Domains of the AUDIT (cont)
Harmful Consequences of Alcohol UseQuestion 7 Guilt after drinkingQuestion 8 BlackoutsQuestion 9 Alcohol-related injuriesQuestion 10 Othersrsquo concerns about drinking
Activity AUDIT Practice
bull I am going to ask you some personal questions about alcohol (and other drugs) that I ask all my patients
bull Your responses will be confidentialbull These questions help me to provide the best
possible carebull You do not have to answer them if you are
uncomfortable
See reference list
Activity AUDIT Practice
Feedback Reactions
Scoring the Audit
Score Level Action
0-7 Low Encouragement
8-19 LowModerate BI
16-19 Moderate BIRT
20+ High BTRT
Enhancing Accuracy of Self-Report
Self-reports are more accurate when people are bull Alcohol- or drug-free when interviewedbull Told that their information is confidentialbull Asked clearly worded objective questionsbull Provided memory aides (calendars
response cards)
See reference list
SBI Decision TreeAdminister the AUDIT
Administer the DAST
Alcohol Screen Complete
Other DrugScreen Complete
LowNo RiskAlcohol = 0 ndash 7Other drugs = 0
At RiskAlcohol = 8 ndash 15
Other drugs = 1 ndash 2
ModHigh RiskAlcohol = 16 ndash 19
Other drugs = 3 ndash 5
HighSevere RiskAlcohol = 20 ndash 40
Other drugs = 6 ndash 10
Reinforce behavior Monitor
Brief Intervention Goal Lower Risk
Reduce use to acceptable levels
BIReferral to txBTGoal Encourage pt
to accept a referral to tx or engage in BT
Referral to tx Goal Encourage pt to accept referral to tx or engage in BT
Brief Interventions for Patients at Risk for
Substance Use Problems
What Are Brief Interventions
ldquoBriefhellipinterventions are short face-to-face conversations regarding drinking motivation to change and options for change which are provided during a window of opportunity or potentially teachable moment occasioned by a
medical eventrdquo
Dr Craig Field from the University of Texas (See reference list)
Goal of Brief Interventions
Behavior change
Awareness of problem
Motivation
Presenting problem Screening
results
Brief Intervention Effectbull Brief interventions trigger changebull A little counseling can lead to significant
change eg 5 min has same impact as 20 minbull Research is less extensive for illicit drugs but
promisingbull A randomized study with cocaine and heroin users
found that patients who received a BI had 50 greater odds of abstinence at follow up compared with controls
See reference list
Where Do I Start
What you do depends on where the patient is in the process of changing
The first step is to be able to identify where the patient is coming from
Stages of Change
Primary Tasks
1 PrecontemplationDefinition
Not yet considering change or is unwilling or unable to change
Primary TaskRaising Awareness 2 Contemplation
Definition Sees the possibility of change but
is ambivalent and uncertain
Primary TaskResolving ambivalence
Helping to choose change
3 DeterminationDefinition
Committed to changingStill considering what to do
Primary TaskHelp identify appropriate
change strategies
4 ActionDefinition
Taking steps toward change but hasnrsquot stabilized in the process
Primary TaskHelp implement change strategies
and learn to eliminate potential relapses
5 MaintenanceDefinition
Has achieved the goals and is working to maintain change
Primary TaskDevelop new skills for maintaining recovery
6 RecurrenceDefinition
Experienced a recurrence of the symptoms
Primary TaskCope with consequences and
determine what to do next
Stages of Change Intervention Matching Guide
bull Offer factual informationbull Explore the meaning of events that
brought the person to treatmentbull Explore results of previous effortsbull Explore pros and cons of targeted
behaviors
bull Explore the personrsquos sense of self-efficacy
bull Explore expectations regarding what the change will entail
bull Summarize self-motivational statements
bull Continue exploration of pros and cons
bull Offer a menu of options for changebull Help identify pros and cons of various
change optionsbull Identify and lower barriers to changebull Help person enlist social support bull Encourage person to publicly
announce plans to change
bull Support a realistic view of change through small steps
bull Help identify high-risk situations and develop coping strategies
bull Assist in finding new reinforcers of positive change
bull Help access family and social support
bull Help identify and try alternative behaviors (drug-free sources of pleasure)
bull Maintain supportive contact bull Help develop escape planbull Work to set new short and long term
goals
bull Frame recurrence as a learning opportunity
bull Explore possible behavioral psychological and social antecedents
bull Help to develop alternative coping strategies
bull Explain Stages of Change amp encourage person to stay in the process
bull Maintain supportive contact
1 Pre-contemplation
2Contemplation
3Determination
4Action
5Maintenance
6Recurrence
ldquoPeople are better persuaded by the reasons they themselves
discovered than those that come into the minds of othersrdquo
Blaise Pascal
Ambivalence
All change contains an element of ambivalence
We ldquowant to change and donrsquot want to changerdquo
Patientsrsquo ambivalence about change is the ldquoheartrdquo of the brief intervention
Activity Video ExampleYoung man is treated in the ER after a car accident He had been drinking heavily before the accident How does the doctor address drinking in this video
See reference list
(INSERT BAD SBIRT VIDEO)
Reflective Listening
bull Listen to both what the patient says and to what the person means
bull Show empathy and donrsquot judge what patient saysbull You do not have to agree
bull Be aware of intonationbull Reflect what patient says with statement not
a question eg ldquoYou couldnrsquot get up for work in the morningrdquo
Levels of Reflection
bull Repeating ndash Repeating what was just saidbull RephrasingParaphrasing ndash Restatement of
what the person said Listener infers meaning of what was said Can be thought of as continuing the thought
bull Reflecting Feeling ndash Listener reflects not just the words but the feeling or emotion underneath what the person is saying
Avoid Confrontationbull Challenging
ldquoWhat do you think you are doingrdquo
bull Warning
ldquoYou will damage your liver if you donrsquot stop drinkingrdquo
bull Finger-wagging
ldquoIf you want to be a good student you must stop drinking on school nightsrdquo
Explore Ambivalence
Benefits of change
Costs of using drugs
Benefits of using drugs
Costs of change
How to Explore Ambivalence
Avoid questions that lead to a yesno response
The good things about
______
The not- so-good things about ____
The good things about
changing
The not-so-good things
about changing
Elicit ldquoChange TalkrdquoChange talk consists of self-motivational statements that suggest
bull Recognition of a problem
bull Concern about staying the same
bull Intention to change
bull Optimism about change
Activity Video ExampleSame scenario but different doctor What does this doctor do that is different Does it work
See reference list
(INSERT GOOD SBIRT VIDEO)
Conducting a Brief Intervention
F L O
FLO The 3 tasks of a BI
Avoid Warnings
F L O WFeed
back
Listen
amp U
nd
erstand
Warn
Op
tion
s Exp
lored
(thatrsquos it)
How Does It All Fit TogetherFeedback
Setting the stage
Tell screening results
Listen amp understand
Explore pros amp cons
Explain importance
Assess readiness to change
Options explored
Discuss change options
Follow up
The 3 Tasks of a BI
F L OFeed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 1st Task Feedback
The Feedback Sandwich
Ask Permission
Give Advice
Ask for Response
The 1st Task FeedbackWhat you need to cover1 Range of scores and context2 Screening results3 Substance use norms in population4 Interpretation of results (eg risk level)5 Patient feedback about results
The 1st Task FeedbackWhat do you say
1 Range of score and context - Scores on the AUDIT range from 0-40 Most people who are social drinkers score less than 8
2 Results - Your score was 18 on the alcohol screen
3 Norms - A score of 18 means that your drinking is higher than 75 of the US adult population
4 Interpretation of results - 18 puts you in the moderate-to-high risk range At this level your use is putting you at risk for a variety of health issues
5 Patient reactionfeedback - What do you make of this
Informational Brochures
The 1st Task FeedbackHandling Resistancebull Look I donrsquot have a drug problembull My dad was an alcoholic Irsquom not like himbull I can quit using anytime I want tobull I just like the tastebull Everybody drinks in college
What would you say
Chr
onic
Pai
n
SUD
HIV
Con-fusion Medical
Issues
Pain
SUD
To avoid thishellip
LET GO
The 1st Task Feedback
The 1st Task Feedback
Easy Ways to Let Gobull Irsquom not going to push you to change
anything you donrsquot want to changebull Irsquod just like to give you some informationbull What you do is up to you
The 1st Task FeedbackFinding a Hookbull Ask the patient about their concernsbull Provide non-judgmental feedbackinformationbull Watch for signs of discomfort with status quo or
interest or ability to changebull Always ask this question ldquoWhat role if any do
you think alcohol played in your (getting injured)bull Let the patient decidebull Just asking the question is helpful
The 3 Tasks of a BI
F L O
Feed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
Review of the AUDIT
bull 10-question alcohol use screening instrument
bull Original target groups included bull Medical patients
bull Accident victims
bull DWI offenders
bull Mental health clients
bull Designed for primary health care workers
Domains of the AUDIT
Hazardous Alcohol UseQuestion 1 Frequency of DrinkingQuestion 2 Typical quantityQuestion 3 Frequency of heavy drinking
Domains of the AUDIT (cont)
Dependence SymptomsQuestion 4 Impaired control over drinkingQuestion 5 Failure to meet expectations
because of drinkingQuestion 6 Morning drinking
Domains of the AUDIT (cont)
Harmful Consequences of Alcohol UseQuestion 7 Guilt after drinkingQuestion 8 BlackoutsQuestion 9 Alcohol-related injuriesQuestion 10 Othersrsquo concerns about drinking
Activity AUDIT Practice
bull I am going to ask you some personal questions about alcohol (and other drugs) that I ask all my patients
bull Your responses will be confidentialbull These questions help me to provide the best
possible carebull You do not have to answer them if you are
uncomfortable
See reference list
Activity AUDIT Practice
Feedback Reactions
Scoring the Audit
Score Level Action
0-7 Low Encouragement
8-19 LowModerate BI
16-19 Moderate BIRT
20+ High BTRT
Enhancing Accuracy of Self-Report
Self-reports are more accurate when people are bull Alcohol- or drug-free when interviewedbull Told that their information is confidentialbull Asked clearly worded objective questionsbull Provided memory aides (calendars
response cards)
See reference list
SBI Decision TreeAdminister the AUDIT
Administer the DAST
Alcohol Screen Complete
Other DrugScreen Complete
LowNo RiskAlcohol = 0 ndash 7Other drugs = 0
At RiskAlcohol = 8 ndash 15
Other drugs = 1 ndash 2
ModHigh RiskAlcohol = 16 ndash 19
Other drugs = 3 ndash 5
HighSevere RiskAlcohol = 20 ndash 40
Other drugs = 6 ndash 10
Reinforce behavior Monitor
Brief Intervention Goal Lower Risk
Reduce use to acceptable levels
BIReferral to txBTGoal Encourage pt
to accept a referral to tx or engage in BT
Referral to tx Goal Encourage pt to accept referral to tx or engage in BT
Brief Interventions for Patients at Risk for
Substance Use Problems
What Are Brief Interventions
ldquoBriefhellipinterventions are short face-to-face conversations regarding drinking motivation to change and options for change which are provided during a window of opportunity or potentially teachable moment occasioned by a
medical eventrdquo
Dr Craig Field from the University of Texas (See reference list)
Goal of Brief Interventions
Behavior change
Awareness of problem
Motivation
Presenting problem Screening
results
Brief Intervention Effectbull Brief interventions trigger changebull A little counseling can lead to significant
change eg 5 min has same impact as 20 minbull Research is less extensive for illicit drugs but
promisingbull A randomized study with cocaine and heroin users
found that patients who received a BI had 50 greater odds of abstinence at follow up compared with controls
See reference list
Where Do I Start
What you do depends on where the patient is in the process of changing
The first step is to be able to identify where the patient is coming from
Stages of Change
Primary Tasks
1 PrecontemplationDefinition
Not yet considering change or is unwilling or unable to change
Primary TaskRaising Awareness 2 Contemplation
Definition Sees the possibility of change but
is ambivalent and uncertain
Primary TaskResolving ambivalence
Helping to choose change
3 DeterminationDefinition
Committed to changingStill considering what to do
Primary TaskHelp identify appropriate
change strategies
4 ActionDefinition
Taking steps toward change but hasnrsquot stabilized in the process
Primary TaskHelp implement change strategies
and learn to eliminate potential relapses
5 MaintenanceDefinition
Has achieved the goals and is working to maintain change
Primary TaskDevelop new skills for maintaining recovery
6 RecurrenceDefinition
Experienced a recurrence of the symptoms
Primary TaskCope with consequences and
determine what to do next
Stages of Change Intervention Matching Guide
bull Offer factual informationbull Explore the meaning of events that
brought the person to treatmentbull Explore results of previous effortsbull Explore pros and cons of targeted
behaviors
bull Explore the personrsquos sense of self-efficacy
bull Explore expectations regarding what the change will entail
bull Summarize self-motivational statements
bull Continue exploration of pros and cons
bull Offer a menu of options for changebull Help identify pros and cons of various
change optionsbull Identify and lower barriers to changebull Help person enlist social support bull Encourage person to publicly
announce plans to change
bull Support a realistic view of change through small steps
bull Help identify high-risk situations and develop coping strategies
bull Assist in finding new reinforcers of positive change
bull Help access family and social support
bull Help identify and try alternative behaviors (drug-free sources of pleasure)
bull Maintain supportive contact bull Help develop escape planbull Work to set new short and long term
goals
bull Frame recurrence as a learning opportunity
bull Explore possible behavioral psychological and social antecedents
bull Help to develop alternative coping strategies
bull Explain Stages of Change amp encourage person to stay in the process
bull Maintain supportive contact
1 Pre-contemplation
2Contemplation
3Determination
4Action
5Maintenance
6Recurrence
ldquoPeople are better persuaded by the reasons they themselves
discovered than those that come into the minds of othersrdquo
Blaise Pascal
Ambivalence
All change contains an element of ambivalence
We ldquowant to change and donrsquot want to changerdquo
Patientsrsquo ambivalence about change is the ldquoheartrdquo of the brief intervention
Activity Video ExampleYoung man is treated in the ER after a car accident He had been drinking heavily before the accident How does the doctor address drinking in this video
See reference list
(INSERT BAD SBIRT VIDEO)
Reflective Listening
bull Listen to both what the patient says and to what the person means
bull Show empathy and donrsquot judge what patient saysbull You do not have to agree
bull Be aware of intonationbull Reflect what patient says with statement not
a question eg ldquoYou couldnrsquot get up for work in the morningrdquo
Levels of Reflection
bull Repeating ndash Repeating what was just saidbull RephrasingParaphrasing ndash Restatement of
what the person said Listener infers meaning of what was said Can be thought of as continuing the thought
bull Reflecting Feeling ndash Listener reflects not just the words but the feeling or emotion underneath what the person is saying
Avoid Confrontationbull Challenging
ldquoWhat do you think you are doingrdquo
bull Warning
ldquoYou will damage your liver if you donrsquot stop drinkingrdquo
bull Finger-wagging
ldquoIf you want to be a good student you must stop drinking on school nightsrdquo
Explore Ambivalence
Benefits of change
Costs of using drugs
Benefits of using drugs
Costs of change
How to Explore Ambivalence
Avoid questions that lead to a yesno response
The good things about
______
The not- so-good things about ____
The good things about
changing
The not-so-good things
about changing
Elicit ldquoChange TalkrdquoChange talk consists of self-motivational statements that suggest
bull Recognition of a problem
bull Concern about staying the same
bull Intention to change
bull Optimism about change
Activity Video ExampleSame scenario but different doctor What does this doctor do that is different Does it work
See reference list
(INSERT GOOD SBIRT VIDEO)
Conducting a Brief Intervention
F L O
FLO The 3 tasks of a BI
Avoid Warnings
F L O WFeed
back
Listen
amp U
nd
erstand
Warn
Op
tion
s Exp
lored
(thatrsquos it)
How Does It All Fit TogetherFeedback
Setting the stage
Tell screening results
Listen amp understand
Explore pros amp cons
Explain importance
Assess readiness to change
Options explored
Discuss change options
Follow up
The 3 Tasks of a BI
F L OFeed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 1st Task Feedback
The Feedback Sandwich
Ask Permission
Give Advice
Ask for Response
The 1st Task FeedbackWhat you need to cover1 Range of scores and context2 Screening results3 Substance use norms in population4 Interpretation of results (eg risk level)5 Patient feedback about results
The 1st Task FeedbackWhat do you say
1 Range of score and context - Scores on the AUDIT range from 0-40 Most people who are social drinkers score less than 8
2 Results - Your score was 18 on the alcohol screen
3 Norms - A score of 18 means that your drinking is higher than 75 of the US adult population
4 Interpretation of results - 18 puts you in the moderate-to-high risk range At this level your use is putting you at risk for a variety of health issues
5 Patient reactionfeedback - What do you make of this
Informational Brochures
The 1st Task FeedbackHandling Resistancebull Look I donrsquot have a drug problembull My dad was an alcoholic Irsquom not like himbull I can quit using anytime I want tobull I just like the tastebull Everybody drinks in college
What would you say
Chr
onic
Pai
n
SUD
HIV
Con-fusion Medical
Issues
Pain
SUD
To avoid thishellip
LET GO
The 1st Task Feedback
The 1st Task Feedback
Easy Ways to Let Gobull Irsquom not going to push you to change
anything you donrsquot want to changebull Irsquod just like to give you some informationbull What you do is up to you
The 1st Task FeedbackFinding a Hookbull Ask the patient about their concernsbull Provide non-judgmental feedbackinformationbull Watch for signs of discomfort with status quo or
interest or ability to changebull Always ask this question ldquoWhat role if any do
you think alcohol played in your (getting injured)bull Let the patient decidebull Just asking the question is helpful
The 3 Tasks of a BI
F L O
Feed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
Domains of the AUDIT
Hazardous Alcohol UseQuestion 1 Frequency of DrinkingQuestion 2 Typical quantityQuestion 3 Frequency of heavy drinking
Domains of the AUDIT (cont)
Dependence SymptomsQuestion 4 Impaired control over drinkingQuestion 5 Failure to meet expectations
because of drinkingQuestion 6 Morning drinking
Domains of the AUDIT (cont)
Harmful Consequences of Alcohol UseQuestion 7 Guilt after drinkingQuestion 8 BlackoutsQuestion 9 Alcohol-related injuriesQuestion 10 Othersrsquo concerns about drinking
Activity AUDIT Practice
bull I am going to ask you some personal questions about alcohol (and other drugs) that I ask all my patients
bull Your responses will be confidentialbull These questions help me to provide the best
possible carebull You do not have to answer them if you are
uncomfortable
See reference list
Activity AUDIT Practice
Feedback Reactions
Scoring the Audit
Score Level Action
0-7 Low Encouragement
8-19 LowModerate BI
16-19 Moderate BIRT
20+ High BTRT
Enhancing Accuracy of Self-Report
Self-reports are more accurate when people are bull Alcohol- or drug-free when interviewedbull Told that their information is confidentialbull Asked clearly worded objective questionsbull Provided memory aides (calendars
response cards)
See reference list
SBI Decision TreeAdminister the AUDIT
Administer the DAST
Alcohol Screen Complete
Other DrugScreen Complete
LowNo RiskAlcohol = 0 ndash 7Other drugs = 0
At RiskAlcohol = 8 ndash 15
Other drugs = 1 ndash 2
ModHigh RiskAlcohol = 16 ndash 19
Other drugs = 3 ndash 5
HighSevere RiskAlcohol = 20 ndash 40
Other drugs = 6 ndash 10
Reinforce behavior Monitor
Brief Intervention Goal Lower Risk
Reduce use to acceptable levels
BIReferral to txBTGoal Encourage pt
to accept a referral to tx or engage in BT
Referral to tx Goal Encourage pt to accept referral to tx or engage in BT
Brief Interventions for Patients at Risk for
Substance Use Problems
What Are Brief Interventions
ldquoBriefhellipinterventions are short face-to-face conversations regarding drinking motivation to change and options for change which are provided during a window of opportunity or potentially teachable moment occasioned by a
medical eventrdquo
Dr Craig Field from the University of Texas (See reference list)
Goal of Brief Interventions
Behavior change
Awareness of problem
Motivation
Presenting problem Screening
results
Brief Intervention Effectbull Brief interventions trigger changebull A little counseling can lead to significant
change eg 5 min has same impact as 20 minbull Research is less extensive for illicit drugs but
promisingbull A randomized study with cocaine and heroin users
found that patients who received a BI had 50 greater odds of abstinence at follow up compared with controls
See reference list
Where Do I Start
What you do depends on where the patient is in the process of changing
The first step is to be able to identify where the patient is coming from
Stages of Change
Primary Tasks
1 PrecontemplationDefinition
Not yet considering change or is unwilling or unable to change
Primary TaskRaising Awareness 2 Contemplation
Definition Sees the possibility of change but
is ambivalent and uncertain
Primary TaskResolving ambivalence
Helping to choose change
3 DeterminationDefinition
Committed to changingStill considering what to do
Primary TaskHelp identify appropriate
change strategies
4 ActionDefinition
Taking steps toward change but hasnrsquot stabilized in the process
Primary TaskHelp implement change strategies
and learn to eliminate potential relapses
5 MaintenanceDefinition
Has achieved the goals and is working to maintain change
Primary TaskDevelop new skills for maintaining recovery
6 RecurrenceDefinition
Experienced a recurrence of the symptoms
Primary TaskCope with consequences and
determine what to do next
Stages of Change Intervention Matching Guide
bull Offer factual informationbull Explore the meaning of events that
brought the person to treatmentbull Explore results of previous effortsbull Explore pros and cons of targeted
behaviors
bull Explore the personrsquos sense of self-efficacy
bull Explore expectations regarding what the change will entail
bull Summarize self-motivational statements
bull Continue exploration of pros and cons
bull Offer a menu of options for changebull Help identify pros and cons of various
change optionsbull Identify and lower barriers to changebull Help person enlist social support bull Encourage person to publicly
announce plans to change
bull Support a realistic view of change through small steps
bull Help identify high-risk situations and develop coping strategies
bull Assist in finding new reinforcers of positive change
bull Help access family and social support
bull Help identify and try alternative behaviors (drug-free sources of pleasure)
bull Maintain supportive contact bull Help develop escape planbull Work to set new short and long term
goals
bull Frame recurrence as a learning opportunity
bull Explore possible behavioral psychological and social antecedents
bull Help to develop alternative coping strategies
bull Explain Stages of Change amp encourage person to stay in the process
bull Maintain supportive contact
1 Pre-contemplation
2Contemplation
3Determination
4Action
5Maintenance
6Recurrence
ldquoPeople are better persuaded by the reasons they themselves
discovered than those that come into the minds of othersrdquo
Blaise Pascal
Ambivalence
All change contains an element of ambivalence
We ldquowant to change and donrsquot want to changerdquo
Patientsrsquo ambivalence about change is the ldquoheartrdquo of the brief intervention
Activity Video ExampleYoung man is treated in the ER after a car accident He had been drinking heavily before the accident How does the doctor address drinking in this video
See reference list
(INSERT BAD SBIRT VIDEO)
Reflective Listening
bull Listen to both what the patient says and to what the person means
bull Show empathy and donrsquot judge what patient saysbull You do not have to agree
bull Be aware of intonationbull Reflect what patient says with statement not
a question eg ldquoYou couldnrsquot get up for work in the morningrdquo
Levels of Reflection
bull Repeating ndash Repeating what was just saidbull RephrasingParaphrasing ndash Restatement of
what the person said Listener infers meaning of what was said Can be thought of as continuing the thought
bull Reflecting Feeling ndash Listener reflects not just the words but the feeling or emotion underneath what the person is saying
Avoid Confrontationbull Challenging
ldquoWhat do you think you are doingrdquo
bull Warning
ldquoYou will damage your liver if you donrsquot stop drinkingrdquo
bull Finger-wagging
ldquoIf you want to be a good student you must stop drinking on school nightsrdquo
Explore Ambivalence
Benefits of change
Costs of using drugs
Benefits of using drugs
Costs of change
How to Explore Ambivalence
Avoid questions that lead to a yesno response
The good things about
______
The not- so-good things about ____
The good things about
changing
The not-so-good things
about changing
Elicit ldquoChange TalkrdquoChange talk consists of self-motivational statements that suggest
bull Recognition of a problem
bull Concern about staying the same
bull Intention to change
bull Optimism about change
Activity Video ExampleSame scenario but different doctor What does this doctor do that is different Does it work
See reference list
(INSERT GOOD SBIRT VIDEO)
Conducting a Brief Intervention
F L O
FLO The 3 tasks of a BI
Avoid Warnings
F L O WFeed
back
Listen
amp U
nd
erstand
Warn
Op
tion
s Exp
lored
(thatrsquos it)
How Does It All Fit TogetherFeedback
Setting the stage
Tell screening results
Listen amp understand
Explore pros amp cons
Explain importance
Assess readiness to change
Options explored
Discuss change options
Follow up
The 3 Tasks of a BI
F L OFeed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 1st Task Feedback
The Feedback Sandwich
Ask Permission
Give Advice
Ask for Response
The 1st Task FeedbackWhat you need to cover1 Range of scores and context2 Screening results3 Substance use norms in population4 Interpretation of results (eg risk level)5 Patient feedback about results
The 1st Task FeedbackWhat do you say
1 Range of score and context - Scores on the AUDIT range from 0-40 Most people who are social drinkers score less than 8
2 Results - Your score was 18 on the alcohol screen
3 Norms - A score of 18 means that your drinking is higher than 75 of the US adult population
4 Interpretation of results - 18 puts you in the moderate-to-high risk range At this level your use is putting you at risk for a variety of health issues
5 Patient reactionfeedback - What do you make of this
Informational Brochures
The 1st Task FeedbackHandling Resistancebull Look I donrsquot have a drug problembull My dad was an alcoholic Irsquom not like himbull I can quit using anytime I want tobull I just like the tastebull Everybody drinks in college
What would you say
Chr
onic
Pai
n
SUD
HIV
Con-fusion Medical
Issues
Pain
SUD
To avoid thishellip
LET GO
The 1st Task Feedback
The 1st Task Feedback
Easy Ways to Let Gobull Irsquom not going to push you to change
anything you donrsquot want to changebull Irsquod just like to give you some informationbull What you do is up to you
The 1st Task FeedbackFinding a Hookbull Ask the patient about their concernsbull Provide non-judgmental feedbackinformationbull Watch for signs of discomfort with status quo or
interest or ability to changebull Always ask this question ldquoWhat role if any do
you think alcohol played in your (getting injured)bull Let the patient decidebull Just asking the question is helpful
The 3 Tasks of a BI
F L O
Feed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
Domains of the AUDIT (cont)
Dependence SymptomsQuestion 4 Impaired control over drinkingQuestion 5 Failure to meet expectations
because of drinkingQuestion 6 Morning drinking
Domains of the AUDIT (cont)
Harmful Consequences of Alcohol UseQuestion 7 Guilt after drinkingQuestion 8 BlackoutsQuestion 9 Alcohol-related injuriesQuestion 10 Othersrsquo concerns about drinking
Activity AUDIT Practice
bull I am going to ask you some personal questions about alcohol (and other drugs) that I ask all my patients
bull Your responses will be confidentialbull These questions help me to provide the best
possible carebull You do not have to answer them if you are
uncomfortable
See reference list
Activity AUDIT Practice
Feedback Reactions
Scoring the Audit
Score Level Action
0-7 Low Encouragement
8-19 LowModerate BI
16-19 Moderate BIRT
20+ High BTRT
Enhancing Accuracy of Self-Report
Self-reports are more accurate when people are bull Alcohol- or drug-free when interviewedbull Told that their information is confidentialbull Asked clearly worded objective questionsbull Provided memory aides (calendars
response cards)
See reference list
SBI Decision TreeAdminister the AUDIT
Administer the DAST
Alcohol Screen Complete
Other DrugScreen Complete
LowNo RiskAlcohol = 0 ndash 7Other drugs = 0
At RiskAlcohol = 8 ndash 15
Other drugs = 1 ndash 2
ModHigh RiskAlcohol = 16 ndash 19
Other drugs = 3 ndash 5
HighSevere RiskAlcohol = 20 ndash 40
Other drugs = 6 ndash 10
Reinforce behavior Monitor
Brief Intervention Goal Lower Risk
Reduce use to acceptable levels
BIReferral to txBTGoal Encourage pt
to accept a referral to tx or engage in BT
Referral to tx Goal Encourage pt to accept referral to tx or engage in BT
Brief Interventions for Patients at Risk for
Substance Use Problems
What Are Brief Interventions
ldquoBriefhellipinterventions are short face-to-face conversations regarding drinking motivation to change and options for change which are provided during a window of opportunity or potentially teachable moment occasioned by a
medical eventrdquo
Dr Craig Field from the University of Texas (See reference list)
Goal of Brief Interventions
Behavior change
Awareness of problem
Motivation
Presenting problem Screening
results
Brief Intervention Effectbull Brief interventions trigger changebull A little counseling can lead to significant
change eg 5 min has same impact as 20 minbull Research is less extensive for illicit drugs but
promisingbull A randomized study with cocaine and heroin users
found that patients who received a BI had 50 greater odds of abstinence at follow up compared with controls
See reference list
Where Do I Start
What you do depends on where the patient is in the process of changing
The first step is to be able to identify where the patient is coming from
Stages of Change
Primary Tasks
1 PrecontemplationDefinition
Not yet considering change or is unwilling or unable to change
Primary TaskRaising Awareness 2 Contemplation
Definition Sees the possibility of change but
is ambivalent and uncertain
Primary TaskResolving ambivalence
Helping to choose change
3 DeterminationDefinition
Committed to changingStill considering what to do
Primary TaskHelp identify appropriate
change strategies
4 ActionDefinition
Taking steps toward change but hasnrsquot stabilized in the process
Primary TaskHelp implement change strategies
and learn to eliminate potential relapses
5 MaintenanceDefinition
Has achieved the goals and is working to maintain change
Primary TaskDevelop new skills for maintaining recovery
6 RecurrenceDefinition
Experienced a recurrence of the symptoms
Primary TaskCope with consequences and
determine what to do next
Stages of Change Intervention Matching Guide
bull Offer factual informationbull Explore the meaning of events that
brought the person to treatmentbull Explore results of previous effortsbull Explore pros and cons of targeted
behaviors
bull Explore the personrsquos sense of self-efficacy
bull Explore expectations regarding what the change will entail
bull Summarize self-motivational statements
bull Continue exploration of pros and cons
bull Offer a menu of options for changebull Help identify pros and cons of various
change optionsbull Identify and lower barriers to changebull Help person enlist social support bull Encourage person to publicly
announce plans to change
bull Support a realistic view of change through small steps
bull Help identify high-risk situations and develop coping strategies
bull Assist in finding new reinforcers of positive change
bull Help access family and social support
bull Help identify and try alternative behaviors (drug-free sources of pleasure)
bull Maintain supportive contact bull Help develop escape planbull Work to set new short and long term
goals
bull Frame recurrence as a learning opportunity
bull Explore possible behavioral psychological and social antecedents
bull Help to develop alternative coping strategies
bull Explain Stages of Change amp encourage person to stay in the process
bull Maintain supportive contact
1 Pre-contemplation
2Contemplation
3Determination
4Action
5Maintenance
6Recurrence
ldquoPeople are better persuaded by the reasons they themselves
discovered than those that come into the minds of othersrdquo
Blaise Pascal
Ambivalence
All change contains an element of ambivalence
We ldquowant to change and donrsquot want to changerdquo
Patientsrsquo ambivalence about change is the ldquoheartrdquo of the brief intervention
Activity Video ExampleYoung man is treated in the ER after a car accident He had been drinking heavily before the accident How does the doctor address drinking in this video
See reference list
(INSERT BAD SBIRT VIDEO)
Reflective Listening
bull Listen to both what the patient says and to what the person means
bull Show empathy and donrsquot judge what patient saysbull You do not have to agree
bull Be aware of intonationbull Reflect what patient says with statement not
a question eg ldquoYou couldnrsquot get up for work in the morningrdquo
Levels of Reflection
bull Repeating ndash Repeating what was just saidbull RephrasingParaphrasing ndash Restatement of
what the person said Listener infers meaning of what was said Can be thought of as continuing the thought
bull Reflecting Feeling ndash Listener reflects not just the words but the feeling or emotion underneath what the person is saying
Avoid Confrontationbull Challenging
ldquoWhat do you think you are doingrdquo
bull Warning
ldquoYou will damage your liver if you donrsquot stop drinkingrdquo
bull Finger-wagging
ldquoIf you want to be a good student you must stop drinking on school nightsrdquo
Explore Ambivalence
Benefits of change
Costs of using drugs
Benefits of using drugs
Costs of change
How to Explore Ambivalence
Avoid questions that lead to a yesno response
The good things about
______
The not- so-good things about ____
The good things about
changing
The not-so-good things
about changing
Elicit ldquoChange TalkrdquoChange talk consists of self-motivational statements that suggest
bull Recognition of a problem
bull Concern about staying the same
bull Intention to change
bull Optimism about change
Activity Video ExampleSame scenario but different doctor What does this doctor do that is different Does it work
See reference list
(INSERT GOOD SBIRT VIDEO)
Conducting a Brief Intervention
F L O
FLO The 3 tasks of a BI
Avoid Warnings
F L O WFeed
back
Listen
amp U
nd
erstand
Warn
Op
tion
s Exp
lored
(thatrsquos it)
How Does It All Fit TogetherFeedback
Setting the stage
Tell screening results
Listen amp understand
Explore pros amp cons
Explain importance
Assess readiness to change
Options explored
Discuss change options
Follow up
The 3 Tasks of a BI
F L OFeed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 1st Task Feedback
The Feedback Sandwich
Ask Permission
Give Advice
Ask for Response
The 1st Task FeedbackWhat you need to cover1 Range of scores and context2 Screening results3 Substance use norms in population4 Interpretation of results (eg risk level)5 Patient feedback about results
The 1st Task FeedbackWhat do you say
1 Range of score and context - Scores on the AUDIT range from 0-40 Most people who are social drinkers score less than 8
2 Results - Your score was 18 on the alcohol screen
3 Norms - A score of 18 means that your drinking is higher than 75 of the US adult population
4 Interpretation of results - 18 puts you in the moderate-to-high risk range At this level your use is putting you at risk for a variety of health issues
5 Patient reactionfeedback - What do you make of this
Informational Brochures
The 1st Task FeedbackHandling Resistancebull Look I donrsquot have a drug problembull My dad was an alcoholic Irsquom not like himbull I can quit using anytime I want tobull I just like the tastebull Everybody drinks in college
What would you say
Chr
onic
Pai
n
SUD
HIV
Con-fusion Medical
Issues
Pain
SUD
To avoid thishellip
LET GO
The 1st Task Feedback
The 1st Task Feedback
Easy Ways to Let Gobull Irsquom not going to push you to change
anything you donrsquot want to changebull Irsquod just like to give you some informationbull What you do is up to you
The 1st Task FeedbackFinding a Hookbull Ask the patient about their concernsbull Provide non-judgmental feedbackinformationbull Watch for signs of discomfort with status quo or
interest or ability to changebull Always ask this question ldquoWhat role if any do
you think alcohol played in your (getting injured)bull Let the patient decidebull Just asking the question is helpful
The 3 Tasks of a BI
F L O
Feed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
Domains of the AUDIT (cont)
Harmful Consequences of Alcohol UseQuestion 7 Guilt after drinkingQuestion 8 BlackoutsQuestion 9 Alcohol-related injuriesQuestion 10 Othersrsquo concerns about drinking
Activity AUDIT Practice
bull I am going to ask you some personal questions about alcohol (and other drugs) that I ask all my patients
bull Your responses will be confidentialbull These questions help me to provide the best
possible carebull You do not have to answer them if you are
uncomfortable
See reference list
Activity AUDIT Practice
Feedback Reactions
Scoring the Audit
Score Level Action
0-7 Low Encouragement
8-19 LowModerate BI
16-19 Moderate BIRT
20+ High BTRT
Enhancing Accuracy of Self-Report
Self-reports are more accurate when people are bull Alcohol- or drug-free when interviewedbull Told that their information is confidentialbull Asked clearly worded objective questionsbull Provided memory aides (calendars
response cards)
See reference list
SBI Decision TreeAdminister the AUDIT
Administer the DAST
Alcohol Screen Complete
Other DrugScreen Complete
LowNo RiskAlcohol = 0 ndash 7Other drugs = 0
At RiskAlcohol = 8 ndash 15
Other drugs = 1 ndash 2
ModHigh RiskAlcohol = 16 ndash 19
Other drugs = 3 ndash 5
HighSevere RiskAlcohol = 20 ndash 40
Other drugs = 6 ndash 10
Reinforce behavior Monitor
Brief Intervention Goal Lower Risk
Reduce use to acceptable levels
BIReferral to txBTGoal Encourage pt
to accept a referral to tx or engage in BT
Referral to tx Goal Encourage pt to accept referral to tx or engage in BT
Brief Interventions for Patients at Risk for
Substance Use Problems
What Are Brief Interventions
ldquoBriefhellipinterventions are short face-to-face conversations regarding drinking motivation to change and options for change which are provided during a window of opportunity or potentially teachable moment occasioned by a
medical eventrdquo
Dr Craig Field from the University of Texas (See reference list)
Goal of Brief Interventions
Behavior change
Awareness of problem
Motivation
Presenting problem Screening
results
Brief Intervention Effectbull Brief interventions trigger changebull A little counseling can lead to significant
change eg 5 min has same impact as 20 minbull Research is less extensive for illicit drugs but
promisingbull A randomized study with cocaine and heroin users
found that patients who received a BI had 50 greater odds of abstinence at follow up compared with controls
See reference list
Where Do I Start
What you do depends on where the patient is in the process of changing
The first step is to be able to identify where the patient is coming from
Stages of Change
Primary Tasks
1 PrecontemplationDefinition
Not yet considering change or is unwilling or unable to change
Primary TaskRaising Awareness 2 Contemplation
Definition Sees the possibility of change but
is ambivalent and uncertain
Primary TaskResolving ambivalence
Helping to choose change
3 DeterminationDefinition
Committed to changingStill considering what to do
Primary TaskHelp identify appropriate
change strategies
4 ActionDefinition
Taking steps toward change but hasnrsquot stabilized in the process
Primary TaskHelp implement change strategies
and learn to eliminate potential relapses
5 MaintenanceDefinition
Has achieved the goals and is working to maintain change
Primary TaskDevelop new skills for maintaining recovery
6 RecurrenceDefinition
Experienced a recurrence of the symptoms
Primary TaskCope with consequences and
determine what to do next
Stages of Change Intervention Matching Guide
bull Offer factual informationbull Explore the meaning of events that
brought the person to treatmentbull Explore results of previous effortsbull Explore pros and cons of targeted
behaviors
bull Explore the personrsquos sense of self-efficacy
bull Explore expectations regarding what the change will entail
bull Summarize self-motivational statements
bull Continue exploration of pros and cons
bull Offer a menu of options for changebull Help identify pros and cons of various
change optionsbull Identify and lower barriers to changebull Help person enlist social support bull Encourage person to publicly
announce plans to change
bull Support a realistic view of change through small steps
bull Help identify high-risk situations and develop coping strategies
bull Assist in finding new reinforcers of positive change
bull Help access family and social support
bull Help identify and try alternative behaviors (drug-free sources of pleasure)
bull Maintain supportive contact bull Help develop escape planbull Work to set new short and long term
goals
bull Frame recurrence as a learning opportunity
bull Explore possible behavioral psychological and social antecedents
bull Help to develop alternative coping strategies
bull Explain Stages of Change amp encourage person to stay in the process
bull Maintain supportive contact
1 Pre-contemplation
2Contemplation
3Determination
4Action
5Maintenance
6Recurrence
ldquoPeople are better persuaded by the reasons they themselves
discovered than those that come into the minds of othersrdquo
Blaise Pascal
Ambivalence
All change contains an element of ambivalence
We ldquowant to change and donrsquot want to changerdquo
Patientsrsquo ambivalence about change is the ldquoheartrdquo of the brief intervention
Activity Video ExampleYoung man is treated in the ER after a car accident He had been drinking heavily before the accident How does the doctor address drinking in this video
See reference list
(INSERT BAD SBIRT VIDEO)
Reflective Listening
bull Listen to both what the patient says and to what the person means
bull Show empathy and donrsquot judge what patient saysbull You do not have to agree
bull Be aware of intonationbull Reflect what patient says with statement not
a question eg ldquoYou couldnrsquot get up for work in the morningrdquo
Levels of Reflection
bull Repeating ndash Repeating what was just saidbull RephrasingParaphrasing ndash Restatement of
what the person said Listener infers meaning of what was said Can be thought of as continuing the thought
bull Reflecting Feeling ndash Listener reflects not just the words but the feeling or emotion underneath what the person is saying
Avoid Confrontationbull Challenging
ldquoWhat do you think you are doingrdquo
bull Warning
ldquoYou will damage your liver if you donrsquot stop drinkingrdquo
bull Finger-wagging
ldquoIf you want to be a good student you must stop drinking on school nightsrdquo
Explore Ambivalence
Benefits of change
Costs of using drugs
Benefits of using drugs
Costs of change
How to Explore Ambivalence
Avoid questions that lead to a yesno response
The good things about
______
The not- so-good things about ____
The good things about
changing
The not-so-good things
about changing
Elicit ldquoChange TalkrdquoChange talk consists of self-motivational statements that suggest
bull Recognition of a problem
bull Concern about staying the same
bull Intention to change
bull Optimism about change
Activity Video ExampleSame scenario but different doctor What does this doctor do that is different Does it work
See reference list
(INSERT GOOD SBIRT VIDEO)
Conducting a Brief Intervention
F L O
FLO The 3 tasks of a BI
Avoid Warnings
F L O WFeed
back
Listen
amp U
nd
erstand
Warn
Op
tion
s Exp
lored
(thatrsquos it)
How Does It All Fit TogetherFeedback
Setting the stage
Tell screening results
Listen amp understand
Explore pros amp cons
Explain importance
Assess readiness to change
Options explored
Discuss change options
Follow up
The 3 Tasks of a BI
F L OFeed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 1st Task Feedback
The Feedback Sandwich
Ask Permission
Give Advice
Ask for Response
The 1st Task FeedbackWhat you need to cover1 Range of scores and context2 Screening results3 Substance use norms in population4 Interpretation of results (eg risk level)5 Patient feedback about results
The 1st Task FeedbackWhat do you say
1 Range of score and context - Scores on the AUDIT range from 0-40 Most people who are social drinkers score less than 8
2 Results - Your score was 18 on the alcohol screen
3 Norms - A score of 18 means that your drinking is higher than 75 of the US adult population
4 Interpretation of results - 18 puts you in the moderate-to-high risk range At this level your use is putting you at risk for a variety of health issues
5 Patient reactionfeedback - What do you make of this
Informational Brochures
The 1st Task FeedbackHandling Resistancebull Look I donrsquot have a drug problembull My dad was an alcoholic Irsquom not like himbull I can quit using anytime I want tobull I just like the tastebull Everybody drinks in college
What would you say
Chr
onic
Pai
n
SUD
HIV
Con-fusion Medical
Issues
Pain
SUD
To avoid thishellip
LET GO
The 1st Task Feedback
The 1st Task Feedback
Easy Ways to Let Gobull Irsquom not going to push you to change
anything you donrsquot want to changebull Irsquod just like to give you some informationbull What you do is up to you
The 1st Task FeedbackFinding a Hookbull Ask the patient about their concernsbull Provide non-judgmental feedbackinformationbull Watch for signs of discomfort with status quo or
interest or ability to changebull Always ask this question ldquoWhat role if any do
you think alcohol played in your (getting injured)bull Let the patient decidebull Just asking the question is helpful
The 3 Tasks of a BI
F L O
Feed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
Activity AUDIT Practice
bull I am going to ask you some personal questions about alcohol (and other drugs) that I ask all my patients
bull Your responses will be confidentialbull These questions help me to provide the best
possible carebull You do not have to answer them if you are
uncomfortable
See reference list
Activity AUDIT Practice
Feedback Reactions
Scoring the Audit
Score Level Action
0-7 Low Encouragement
8-19 LowModerate BI
16-19 Moderate BIRT
20+ High BTRT
Enhancing Accuracy of Self-Report
Self-reports are more accurate when people are bull Alcohol- or drug-free when interviewedbull Told that their information is confidentialbull Asked clearly worded objective questionsbull Provided memory aides (calendars
response cards)
See reference list
SBI Decision TreeAdminister the AUDIT
Administer the DAST
Alcohol Screen Complete
Other DrugScreen Complete
LowNo RiskAlcohol = 0 ndash 7Other drugs = 0
At RiskAlcohol = 8 ndash 15
Other drugs = 1 ndash 2
ModHigh RiskAlcohol = 16 ndash 19
Other drugs = 3 ndash 5
HighSevere RiskAlcohol = 20 ndash 40
Other drugs = 6 ndash 10
Reinforce behavior Monitor
Brief Intervention Goal Lower Risk
Reduce use to acceptable levels
BIReferral to txBTGoal Encourage pt
to accept a referral to tx or engage in BT
Referral to tx Goal Encourage pt to accept referral to tx or engage in BT
Brief Interventions for Patients at Risk for
Substance Use Problems
What Are Brief Interventions
ldquoBriefhellipinterventions are short face-to-face conversations regarding drinking motivation to change and options for change which are provided during a window of opportunity or potentially teachable moment occasioned by a
medical eventrdquo
Dr Craig Field from the University of Texas (See reference list)
Goal of Brief Interventions
Behavior change
Awareness of problem
Motivation
Presenting problem Screening
results
Brief Intervention Effectbull Brief interventions trigger changebull A little counseling can lead to significant
change eg 5 min has same impact as 20 minbull Research is less extensive for illicit drugs but
promisingbull A randomized study with cocaine and heroin users
found that patients who received a BI had 50 greater odds of abstinence at follow up compared with controls
See reference list
Where Do I Start
What you do depends on where the patient is in the process of changing
The first step is to be able to identify where the patient is coming from
Stages of Change
Primary Tasks
1 PrecontemplationDefinition
Not yet considering change or is unwilling or unable to change
Primary TaskRaising Awareness 2 Contemplation
Definition Sees the possibility of change but
is ambivalent and uncertain
Primary TaskResolving ambivalence
Helping to choose change
3 DeterminationDefinition
Committed to changingStill considering what to do
Primary TaskHelp identify appropriate
change strategies
4 ActionDefinition
Taking steps toward change but hasnrsquot stabilized in the process
Primary TaskHelp implement change strategies
and learn to eliminate potential relapses
5 MaintenanceDefinition
Has achieved the goals and is working to maintain change
Primary TaskDevelop new skills for maintaining recovery
6 RecurrenceDefinition
Experienced a recurrence of the symptoms
Primary TaskCope with consequences and
determine what to do next
Stages of Change Intervention Matching Guide
bull Offer factual informationbull Explore the meaning of events that
brought the person to treatmentbull Explore results of previous effortsbull Explore pros and cons of targeted
behaviors
bull Explore the personrsquos sense of self-efficacy
bull Explore expectations regarding what the change will entail
bull Summarize self-motivational statements
bull Continue exploration of pros and cons
bull Offer a menu of options for changebull Help identify pros and cons of various
change optionsbull Identify and lower barriers to changebull Help person enlist social support bull Encourage person to publicly
announce plans to change
bull Support a realistic view of change through small steps
bull Help identify high-risk situations and develop coping strategies
bull Assist in finding new reinforcers of positive change
bull Help access family and social support
bull Help identify and try alternative behaviors (drug-free sources of pleasure)
bull Maintain supportive contact bull Help develop escape planbull Work to set new short and long term
goals
bull Frame recurrence as a learning opportunity
bull Explore possible behavioral psychological and social antecedents
bull Help to develop alternative coping strategies
bull Explain Stages of Change amp encourage person to stay in the process
bull Maintain supportive contact
1 Pre-contemplation
2Contemplation
3Determination
4Action
5Maintenance
6Recurrence
ldquoPeople are better persuaded by the reasons they themselves
discovered than those that come into the minds of othersrdquo
Blaise Pascal
Ambivalence
All change contains an element of ambivalence
We ldquowant to change and donrsquot want to changerdquo
Patientsrsquo ambivalence about change is the ldquoheartrdquo of the brief intervention
Activity Video ExampleYoung man is treated in the ER after a car accident He had been drinking heavily before the accident How does the doctor address drinking in this video
See reference list
(INSERT BAD SBIRT VIDEO)
Reflective Listening
bull Listen to both what the patient says and to what the person means
bull Show empathy and donrsquot judge what patient saysbull You do not have to agree
bull Be aware of intonationbull Reflect what patient says with statement not
a question eg ldquoYou couldnrsquot get up for work in the morningrdquo
Levels of Reflection
bull Repeating ndash Repeating what was just saidbull RephrasingParaphrasing ndash Restatement of
what the person said Listener infers meaning of what was said Can be thought of as continuing the thought
bull Reflecting Feeling ndash Listener reflects not just the words but the feeling or emotion underneath what the person is saying
Avoid Confrontationbull Challenging
ldquoWhat do you think you are doingrdquo
bull Warning
ldquoYou will damage your liver if you donrsquot stop drinkingrdquo
bull Finger-wagging
ldquoIf you want to be a good student you must stop drinking on school nightsrdquo
Explore Ambivalence
Benefits of change
Costs of using drugs
Benefits of using drugs
Costs of change
How to Explore Ambivalence
Avoid questions that lead to a yesno response
The good things about
______
The not- so-good things about ____
The good things about
changing
The not-so-good things
about changing
Elicit ldquoChange TalkrdquoChange talk consists of self-motivational statements that suggest
bull Recognition of a problem
bull Concern about staying the same
bull Intention to change
bull Optimism about change
Activity Video ExampleSame scenario but different doctor What does this doctor do that is different Does it work
See reference list
(INSERT GOOD SBIRT VIDEO)
Conducting a Brief Intervention
F L O
FLO The 3 tasks of a BI
Avoid Warnings
F L O WFeed
back
Listen
amp U
nd
erstand
Warn
Op
tion
s Exp
lored
(thatrsquos it)
How Does It All Fit TogetherFeedback
Setting the stage
Tell screening results
Listen amp understand
Explore pros amp cons
Explain importance
Assess readiness to change
Options explored
Discuss change options
Follow up
The 3 Tasks of a BI
F L OFeed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 1st Task Feedback
The Feedback Sandwich
Ask Permission
Give Advice
Ask for Response
The 1st Task FeedbackWhat you need to cover1 Range of scores and context2 Screening results3 Substance use norms in population4 Interpretation of results (eg risk level)5 Patient feedback about results
The 1st Task FeedbackWhat do you say
1 Range of score and context - Scores on the AUDIT range from 0-40 Most people who are social drinkers score less than 8
2 Results - Your score was 18 on the alcohol screen
3 Norms - A score of 18 means that your drinking is higher than 75 of the US adult population
4 Interpretation of results - 18 puts you in the moderate-to-high risk range At this level your use is putting you at risk for a variety of health issues
5 Patient reactionfeedback - What do you make of this
Informational Brochures
The 1st Task FeedbackHandling Resistancebull Look I donrsquot have a drug problembull My dad was an alcoholic Irsquom not like himbull I can quit using anytime I want tobull I just like the tastebull Everybody drinks in college
What would you say
Chr
onic
Pai
n
SUD
HIV
Con-fusion Medical
Issues
Pain
SUD
To avoid thishellip
LET GO
The 1st Task Feedback
The 1st Task Feedback
Easy Ways to Let Gobull Irsquom not going to push you to change
anything you donrsquot want to changebull Irsquod just like to give you some informationbull What you do is up to you
The 1st Task FeedbackFinding a Hookbull Ask the patient about their concernsbull Provide non-judgmental feedbackinformationbull Watch for signs of discomfort with status quo or
interest or ability to changebull Always ask this question ldquoWhat role if any do
you think alcohol played in your (getting injured)bull Let the patient decidebull Just asking the question is helpful
The 3 Tasks of a BI
F L O
Feed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
Activity AUDIT Practice
Feedback Reactions
Scoring the Audit
Score Level Action
0-7 Low Encouragement
8-19 LowModerate BI
16-19 Moderate BIRT
20+ High BTRT
Enhancing Accuracy of Self-Report
Self-reports are more accurate when people are bull Alcohol- or drug-free when interviewedbull Told that their information is confidentialbull Asked clearly worded objective questionsbull Provided memory aides (calendars
response cards)
See reference list
SBI Decision TreeAdminister the AUDIT
Administer the DAST
Alcohol Screen Complete
Other DrugScreen Complete
LowNo RiskAlcohol = 0 ndash 7Other drugs = 0
At RiskAlcohol = 8 ndash 15
Other drugs = 1 ndash 2
ModHigh RiskAlcohol = 16 ndash 19
Other drugs = 3 ndash 5
HighSevere RiskAlcohol = 20 ndash 40
Other drugs = 6 ndash 10
Reinforce behavior Monitor
Brief Intervention Goal Lower Risk
Reduce use to acceptable levels
BIReferral to txBTGoal Encourage pt
to accept a referral to tx or engage in BT
Referral to tx Goal Encourage pt to accept referral to tx or engage in BT
Brief Interventions for Patients at Risk for
Substance Use Problems
What Are Brief Interventions
ldquoBriefhellipinterventions are short face-to-face conversations regarding drinking motivation to change and options for change which are provided during a window of opportunity or potentially teachable moment occasioned by a
medical eventrdquo
Dr Craig Field from the University of Texas (See reference list)
Goal of Brief Interventions
Behavior change
Awareness of problem
Motivation
Presenting problem Screening
results
Brief Intervention Effectbull Brief interventions trigger changebull A little counseling can lead to significant
change eg 5 min has same impact as 20 minbull Research is less extensive for illicit drugs but
promisingbull A randomized study with cocaine and heroin users
found that patients who received a BI had 50 greater odds of abstinence at follow up compared with controls
See reference list
Where Do I Start
What you do depends on where the patient is in the process of changing
The first step is to be able to identify where the patient is coming from
Stages of Change
Primary Tasks
1 PrecontemplationDefinition
Not yet considering change or is unwilling or unable to change
Primary TaskRaising Awareness 2 Contemplation
Definition Sees the possibility of change but
is ambivalent and uncertain
Primary TaskResolving ambivalence
Helping to choose change
3 DeterminationDefinition
Committed to changingStill considering what to do
Primary TaskHelp identify appropriate
change strategies
4 ActionDefinition
Taking steps toward change but hasnrsquot stabilized in the process
Primary TaskHelp implement change strategies
and learn to eliminate potential relapses
5 MaintenanceDefinition
Has achieved the goals and is working to maintain change
Primary TaskDevelop new skills for maintaining recovery
6 RecurrenceDefinition
Experienced a recurrence of the symptoms
Primary TaskCope with consequences and
determine what to do next
Stages of Change Intervention Matching Guide
bull Offer factual informationbull Explore the meaning of events that
brought the person to treatmentbull Explore results of previous effortsbull Explore pros and cons of targeted
behaviors
bull Explore the personrsquos sense of self-efficacy
bull Explore expectations regarding what the change will entail
bull Summarize self-motivational statements
bull Continue exploration of pros and cons
bull Offer a menu of options for changebull Help identify pros and cons of various
change optionsbull Identify and lower barriers to changebull Help person enlist social support bull Encourage person to publicly
announce plans to change
bull Support a realistic view of change through small steps
bull Help identify high-risk situations and develop coping strategies
bull Assist in finding new reinforcers of positive change
bull Help access family and social support
bull Help identify and try alternative behaviors (drug-free sources of pleasure)
bull Maintain supportive contact bull Help develop escape planbull Work to set new short and long term
goals
bull Frame recurrence as a learning opportunity
bull Explore possible behavioral psychological and social antecedents
bull Help to develop alternative coping strategies
bull Explain Stages of Change amp encourage person to stay in the process
bull Maintain supportive contact
1 Pre-contemplation
2Contemplation
3Determination
4Action
5Maintenance
6Recurrence
ldquoPeople are better persuaded by the reasons they themselves
discovered than those that come into the minds of othersrdquo
Blaise Pascal
Ambivalence
All change contains an element of ambivalence
We ldquowant to change and donrsquot want to changerdquo
Patientsrsquo ambivalence about change is the ldquoheartrdquo of the brief intervention
Activity Video ExampleYoung man is treated in the ER after a car accident He had been drinking heavily before the accident How does the doctor address drinking in this video
See reference list
(INSERT BAD SBIRT VIDEO)
Reflective Listening
bull Listen to both what the patient says and to what the person means
bull Show empathy and donrsquot judge what patient saysbull You do not have to agree
bull Be aware of intonationbull Reflect what patient says with statement not
a question eg ldquoYou couldnrsquot get up for work in the morningrdquo
Levels of Reflection
bull Repeating ndash Repeating what was just saidbull RephrasingParaphrasing ndash Restatement of
what the person said Listener infers meaning of what was said Can be thought of as continuing the thought
bull Reflecting Feeling ndash Listener reflects not just the words but the feeling or emotion underneath what the person is saying
Avoid Confrontationbull Challenging
ldquoWhat do you think you are doingrdquo
bull Warning
ldquoYou will damage your liver if you donrsquot stop drinkingrdquo
bull Finger-wagging
ldquoIf you want to be a good student you must stop drinking on school nightsrdquo
Explore Ambivalence
Benefits of change
Costs of using drugs
Benefits of using drugs
Costs of change
How to Explore Ambivalence
Avoid questions that lead to a yesno response
The good things about
______
The not- so-good things about ____
The good things about
changing
The not-so-good things
about changing
Elicit ldquoChange TalkrdquoChange talk consists of self-motivational statements that suggest
bull Recognition of a problem
bull Concern about staying the same
bull Intention to change
bull Optimism about change
Activity Video ExampleSame scenario but different doctor What does this doctor do that is different Does it work
See reference list
(INSERT GOOD SBIRT VIDEO)
Conducting a Brief Intervention
F L O
FLO The 3 tasks of a BI
Avoid Warnings
F L O WFeed
back
Listen
amp U
nd
erstand
Warn
Op
tion
s Exp
lored
(thatrsquos it)
How Does It All Fit TogetherFeedback
Setting the stage
Tell screening results
Listen amp understand
Explore pros amp cons
Explain importance
Assess readiness to change
Options explored
Discuss change options
Follow up
The 3 Tasks of a BI
F L OFeed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 1st Task Feedback
The Feedback Sandwich
Ask Permission
Give Advice
Ask for Response
The 1st Task FeedbackWhat you need to cover1 Range of scores and context2 Screening results3 Substance use norms in population4 Interpretation of results (eg risk level)5 Patient feedback about results
The 1st Task FeedbackWhat do you say
1 Range of score and context - Scores on the AUDIT range from 0-40 Most people who are social drinkers score less than 8
2 Results - Your score was 18 on the alcohol screen
3 Norms - A score of 18 means that your drinking is higher than 75 of the US adult population
4 Interpretation of results - 18 puts you in the moderate-to-high risk range At this level your use is putting you at risk for a variety of health issues
5 Patient reactionfeedback - What do you make of this
Informational Brochures
The 1st Task FeedbackHandling Resistancebull Look I donrsquot have a drug problembull My dad was an alcoholic Irsquom not like himbull I can quit using anytime I want tobull I just like the tastebull Everybody drinks in college
What would you say
Chr
onic
Pai
n
SUD
HIV
Con-fusion Medical
Issues
Pain
SUD
To avoid thishellip
LET GO
The 1st Task Feedback
The 1st Task Feedback
Easy Ways to Let Gobull Irsquom not going to push you to change
anything you donrsquot want to changebull Irsquod just like to give you some informationbull What you do is up to you
The 1st Task FeedbackFinding a Hookbull Ask the patient about their concernsbull Provide non-judgmental feedbackinformationbull Watch for signs of discomfort with status quo or
interest or ability to changebull Always ask this question ldquoWhat role if any do
you think alcohol played in your (getting injured)bull Let the patient decidebull Just asking the question is helpful
The 3 Tasks of a BI
F L O
Feed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
Scoring the Audit
Score Level Action
0-7 Low Encouragement
8-19 LowModerate BI
16-19 Moderate BIRT
20+ High BTRT
Enhancing Accuracy of Self-Report
Self-reports are more accurate when people are bull Alcohol- or drug-free when interviewedbull Told that their information is confidentialbull Asked clearly worded objective questionsbull Provided memory aides (calendars
response cards)
See reference list
SBI Decision TreeAdminister the AUDIT
Administer the DAST
Alcohol Screen Complete
Other DrugScreen Complete
LowNo RiskAlcohol = 0 ndash 7Other drugs = 0
At RiskAlcohol = 8 ndash 15
Other drugs = 1 ndash 2
ModHigh RiskAlcohol = 16 ndash 19
Other drugs = 3 ndash 5
HighSevere RiskAlcohol = 20 ndash 40
Other drugs = 6 ndash 10
Reinforce behavior Monitor
Brief Intervention Goal Lower Risk
Reduce use to acceptable levels
BIReferral to txBTGoal Encourage pt
to accept a referral to tx or engage in BT
Referral to tx Goal Encourage pt to accept referral to tx or engage in BT
Brief Interventions for Patients at Risk for
Substance Use Problems
What Are Brief Interventions
ldquoBriefhellipinterventions are short face-to-face conversations regarding drinking motivation to change and options for change which are provided during a window of opportunity or potentially teachable moment occasioned by a
medical eventrdquo
Dr Craig Field from the University of Texas (See reference list)
Goal of Brief Interventions
Behavior change
Awareness of problem
Motivation
Presenting problem Screening
results
Brief Intervention Effectbull Brief interventions trigger changebull A little counseling can lead to significant
change eg 5 min has same impact as 20 minbull Research is less extensive for illicit drugs but
promisingbull A randomized study with cocaine and heroin users
found that patients who received a BI had 50 greater odds of abstinence at follow up compared with controls
See reference list
Where Do I Start
What you do depends on where the patient is in the process of changing
The first step is to be able to identify where the patient is coming from
Stages of Change
Primary Tasks
1 PrecontemplationDefinition
Not yet considering change or is unwilling or unable to change
Primary TaskRaising Awareness 2 Contemplation
Definition Sees the possibility of change but
is ambivalent and uncertain
Primary TaskResolving ambivalence
Helping to choose change
3 DeterminationDefinition
Committed to changingStill considering what to do
Primary TaskHelp identify appropriate
change strategies
4 ActionDefinition
Taking steps toward change but hasnrsquot stabilized in the process
Primary TaskHelp implement change strategies
and learn to eliminate potential relapses
5 MaintenanceDefinition
Has achieved the goals and is working to maintain change
Primary TaskDevelop new skills for maintaining recovery
6 RecurrenceDefinition
Experienced a recurrence of the symptoms
Primary TaskCope with consequences and
determine what to do next
Stages of Change Intervention Matching Guide
bull Offer factual informationbull Explore the meaning of events that
brought the person to treatmentbull Explore results of previous effortsbull Explore pros and cons of targeted
behaviors
bull Explore the personrsquos sense of self-efficacy
bull Explore expectations regarding what the change will entail
bull Summarize self-motivational statements
bull Continue exploration of pros and cons
bull Offer a menu of options for changebull Help identify pros and cons of various
change optionsbull Identify and lower barriers to changebull Help person enlist social support bull Encourage person to publicly
announce plans to change
bull Support a realistic view of change through small steps
bull Help identify high-risk situations and develop coping strategies
bull Assist in finding new reinforcers of positive change
bull Help access family and social support
bull Help identify and try alternative behaviors (drug-free sources of pleasure)
bull Maintain supportive contact bull Help develop escape planbull Work to set new short and long term
goals
bull Frame recurrence as a learning opportunity
bull Explore possible behavioral psychological and social antecedents
bull Help to develop alternative coping strategies
bull Explain Stages of Change amp encourage person to stay in the process
bull Maintain supportive contact
1 Pre-contemplation
2Contemplation
3Determination
4Action
5Maintenance
6Recurrence
ldquoPeople are better persuaded by the reasons they themselves
discovered than those that come into the minds of othersrdquo
Blaise Pascal
Ambivalence
All change contains an element of ambivalence
We ldquowant to change and donrsquot want to changerdquo
Patientsrsquo ambivalence about change is the ldquoheartrdquo of the brief intervention
Activity Video ExampleYoung man is treated in the ER after a car accident He had been drinking heavily before the accident How does the doctor address drinking in this video
See reference list
(INSERT BAD SBIRT VIDEO)
Reflective Listening
bull Listen to both what the patient says and to what the person means
bull Show empathy and donrsquot judge what patient saysbull You do not have to agree
bull Be aware of intonationbull Reflect what patient says with statement not
a question eg ldquoYou couldnrsquot get up for work in the morningrdquo
Levels of Reflection
bull Repeating ndash Repeating what was just saidbull RephrasingParaphrasing ndash Restatement of
what the person said Listener infers meaning of what was said Can be thought of as continuing the thought
bull Reflecting Feeling ndash Listener reflects not just the words but the feeling or emotion underneath what the person is saying
Avoid Confrontationbull Challenging
ldquoWhat do you think you are doingrdquo
bull Warning
ldquoYou will damage your liver if you donrsquot stop drinkingrdquo
bull Finger-wagging
ldquoIf you want to be a good student you must stop drinking on school nightsrdquo
Explore Ambivalence
Benefits of change
Costs of using drugs
Benefits of using drugs
Costs of change
How to Explore Ambivalence
Avoid questions that lead to a yesno response
The good things about
______
The not- so-good things about ____
The good things about
changing
The not-so-good things
about changing
Elicit ldquoChange TalkrdquoChange talk consists of self-motivational statements that suggest
bull Recognition of a problem
bull Concern about staying the same
bull Intention to change
bull Optimism about change
Activity Video ExampleSame scenario but different doctor What does this doctor do that is different Does it work
See reference list
(INSERT GOOD SBIRT VIDEO)
Conducting a Brief Intervention
F L O
FLO The 3 tasks of a BI
Avoid Warnings
F L O WFeed
back
Listen
amp U
nd
erstand
Warn
Op
tion
s Exp
lored
(thatrsquos it)
How Does It All Fit TogetherFeedback
Setting the stage
Tell screening results
Listen amp understand
Explore pros amp cons
Explain importance
Assess readiness to change
Options explored
Discuss change options
Follow up
The 3 Tasks of a BI
F L OFeed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 1st Task Feedback
The Feedback Sandwich
Ask Permission
Give Advice
Ask for Response
The 1st Task FeedbackWhat you need to cover1 Range of scores and context2 Screening results3 Substance use norms in population4 Interpretation of results (eg risk level)5 Patient feedback about results
The 1st Task FeedbackWhat do you say
1 Range of score and context - Scores on the AUDIT range from 0-40 Most people who are social drinkers score less than 8
2 Results - Your score was 18 on the alcohol screen
3 Norms - A score of 18 means that your drinking is higher than 75 of the US adult population
4 Interpretation of results - 18 puts you in the moderate-to-high risk range At this level your use is putting you at risk for a variety of health issues
5 Patient reactionfeedback - What do you make of this
Informational Brochures
The 1st Task FeedbackHandling Resistancebull Look I donrsquot have a drug problembull My dad was an alcoholic Irsquom not like himbull I can quit using anytime I want tobull I just like the tastebull Everybody drinks in college
What would you say
Chr
onic
Pai
n
SUD
HIV
Con-fusion Medical
Issues
Pain
SUD
To avoid thishellip
LET GO
The 1st Task Feedback
The 1st Task Feedback
Easy Ways to Let Gobull Irsquom not going to push you to change
anything you donrsquot want to changebull Irsquod just like to give you some informationbull What you do is up to you
The 1st Task FeedbackFinding a Hookbull Ask the patient about their concernsbull Provide non-judgmental feedbackinformationbull Watch for signs of discomfort with status quo or
interest or ability to changebull Always ask this question ldquoWhat role if any do
you think alcohol played in your (getting injured)bull Let the patient decidebull Just asking the question is helpful
The 3 Tasks of a BI
F L O
Feed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
Enhancing Accuracy of Self-Report
Self-reports are more accurate when people are bull Alcohol- or drug-free when interviewedbull Told that their information is confidentialbull Asked clearly worded objective questionsbull Provided memory aides (calendars
response cards)
See reference list
SBI Decision TreeAdminister the AUDIT
Administer the DAST
Alcohol Screen Complete
Other DrugScreen Complete
LowNo RiskAlcohol = 0 ndash 7Other drugs = 0
At RiskAlcohol = 8 ndash 15
Other drugs = 1 ndash 2
ModHigh RiskAlcohol = 16 ndash 19
Other drugs = 3 ndash 5
HighSevere RiskAlcohol = 20 ndash 40
Other drugs = 6 ndash 10
Reinforce behavior Monitor
Brief Intervention Goal Lower Risk
Reduce use to acceptable levels
BIReferral to txBTGoal Encourage pt
to accept a referral to tx or engage in BT
Referral to tx Goal Encourage pt to accept referral to tx or engage in BT
Brief Interventions for Patients at Risk for
Substance Use Problems
What Are Brief Interventions
ldquoBriefhellipinterventions are short face-to-face conversations regarding drinking motivation to change and options for change which are provided during a window of opportunity or potentially teachable moment occasioned by a
medical eventrdquo
Dr Craig Field from the University of Texas (See reference list)
Goal of Brief Interventions
Behavior change
Awareness of problem
Motivation
Presenting problem Screening
results
Brief Intervention Effectbull Brief interventions trigger changebull A little counseling can lead to significant
change eg 5 min has same impact as 20 minbull Research is less extensive for illicit drugs but
promisingbull A randomized study with cocaine and heroin users
found that patients who received a BI had 50 greater odds of abstinence at follow up compared with controls
See reference list
Where Do I Start
What you do depends on where the patient is in the process of changing
The first step is to be able to identify where the patient is coming from
Stages of Change
Primary Tasks
1 PrecontemplationDefinition
Not yet considering change or is unwilling or unable to change
Primary TaskRaising Awareness 2 Contemplation
Definition Sees the possibility of change but
is ambivalent and uncertain
Primary TaskResolving ambivalence
Helping to choose change
3 DeterminationDefinition
Committed to changingStill considering what to do
Primary TaskHelp identify appropriate
change strategies
4 ActionDefinition
Taking steps toward change but hasnrsquot stabilized in the process
Primary TaskHelp implement change strategies
and learn to eliminate potential relapses
5 MaintenanceDefinition
Has achieved the goals and is working to maintain change
Primary TaskDevelop new skills for maintaining recovery
6 RecurrenceDefinition
Experienced a recurrence of the symptoms
Primary TaskCope with consequences and
determine what to do next
Stages of Change Intervention Matching Guide
bull Offer factual informationbull Explore the meaning of events that
brought the person to treatmentbull Explore results of previous effortsbull Explore pros and cons of targeted
behaviors
bull Explore the personrsquos sense of self-efficacy
bull Explore expectations regarding what the change will entail
bull Summarize self-motivational statements
bull Continue exploration of pros and cons
bull Offer a menu of options for changebull Help identify pros and cons of various
change optionsbull Identify and lower barriers to changebull Help person enlist social support bull Encourage person to publicly
announce plans to change
bull Support a realistic view of change through small steps
bull Help identify high-risk situations and develop coping strategies
bull Assist in finding new reinforcers of positive change
bull Help access family and social support
bull Help identify and try alternative behaviors (drug-free sources of pleasure)
bull Maintain supportive contact bull Help develop escape planbull Work to set new short and long term
goals
bull Frame recurrence as a learning opportunity
bull Explore possible behavioral psychological and social antecedents
bull Help to develop alternative coping strategies
bull Explain Stages of Change amp encourage person to stay in the process
bull Maintain supportive contact
1 Pre-contemplation
2Contemplation
3Determination
4Action
5Maintenance
6Recurrence
ldquoPeople are better persuaded by the reasons they themselves
discovered than those that come into the minds of othersrdquo
Blaise Pascal
Ambivalence
All change contains an element of ambivalence
We ldquowant to change and donrsquot want to changerdquo
Patientsrsquo ambivalence about change is the ldquoheartrdquo of the brief intervention
Activity Video ExampleYoung man is treated in the ER after a car accident He had been drinking heavily before the accident How does the doctor address drinking in this video
See reference list
(INSERT BAD SBIRT VIDEO)
Reflective Listening
bull Listen to both what the patient says and to what the person means
bull Show empathy and donrsquot judge what patient saysbull You do not have to agree
bull Be aware of intonationbull Reflect what patient says with statement not
a question eg ldquoYou couldnrsquot get up for work in the morningrdquo
Levels of Reflection
bull Repeating ndash Repeating what was just saidbull RephrasingParaphrasing ndash Restatement of
what the person said Listener infers meaning of what was said Can be thought of as continuing the thought
bull Reflecting Feeling ndash Listener reflects not just the words but the feeling or emotion underneath what the person is saying
Avoid Confrontationbull Challenging
ldquoWhat do you think you are doingrdquo
bull Warning
ldquoYou will damage your liver if you donrsquot stop drinkingrdquo
bull Finger-wagging
ldquoIf you want to be a good student you must stop drinking on school nightsrdquo
Explore Ambivalence
Benefits of change
Costs of using drugs
Benefits of using drugs
Costs of change
How to Explore Ambivalence
Avoid questions that lead to a yesno response
The good things about
______
The not- so-good things about ____
The good things about
changing
The not-so-good things
about changing
Elicit ldquoChange TalkrdquoChange talk consists of self-motivational statements that suggest
bull Recognition of a problem
bull Concern about staying the same
bull Intention to change
bull Optimism about change
Activity Video ExampleSame scenario but different doctor What does this doctor do that is different Does it work
See reference list
(INSERT GOOD SBIRT VIDEO)
Conducting a Brief Intervention
F L O
FLO The 3 tasks of a BI
Avoid Warnings
F L O WFeed
back
Listen
amp U
nd
erstand
Warn
Op
tion
s Exp
lored
(thatrsquos it)
How Does It All Fit TogetherFeedback
Setting the stage
Tell screening results
Listen amp understand
Explore pros amp cons
Explain importance
Assess readiness to change
Options explored
Discuss change options
Follow up
The 3 Tasks of a BI
F L OFeed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 1st Task Feedback
The Feedback Sandwich
Ask Permission
Give Advice
Ask for Response
The 1st Task FeedbackWhat you need to cover1 Range of scores and context2 Screening results3 Substance use norms in population4 Interpretation of results (eg risk level)5 Patient feedback about results
The 1st Task FeedbackWhat do you say
1 Range of score and context - Scores on the AUDIT range from 0-40 Most people who are social drinkers score less than 8
2 Results - Your score was 18 on the alcohol screen
3 Norms - A score of 18 means that your drinking is higher than 75 of the US adult population
4 Interpretation of results - 18 puts you in the moderate-to-high risk range At this level your use is putting you at risk for a variety of health issues
5 Patient reactionfeedback - What do you make of this
Informational Brochures
The 1st Task FeedbackHandling Resistancebull Look I donrsquot have a drug problembull My dad was an alcoholic Irsquom not like himbull I can quit using anytime I want tobull I just like the tastebull Everybody drinks in college
What would you say
Chr
onic
Pai
n
SUD
HIV
Con-fusion Medical
Issues
Pain
SUD
To avoid thishellip
LET GO
The 1st Task Feedback
The 1st Task Feedback
Easy Ways to Let Gobull Irsquom not going to push you to change
anything you donrsquot want to changebull Irsquod just like to give you some informationbull What you do is up to you
The 1st Task FeedbackFinding a Hookbull Ask the patient about their concernsbull Provide non-judgmental feedbackinformationbull Watch for signs of discomfort with status quo or
interest or ability to changebull Always ask this question ldquoWhat role if any do
you think alcohol played in your (getting injured)bull Let the patient decidebull Just asking the question is helpful
The 3 Tasks of a BI
F L O
Feed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
SBI Decision TreeAdminister the AUDIT
Administer the DAST
Alcohol Screen Complete
Other DrugScreen Complete
LowNo RiskAlcohol = 0 ndash 7Other drugs = 0
At RiskAlcohol = 8 ndash 15
Other drugs = 1 ndash 2
ModHigh RiskAlcohol = 16 ndash 19
Other drugs = 3 ndash 5
HighSevere RiskAlcohol = 20 ndash 40
Other drugs = 6 ndash 10
Reinforce behavior Monitor
Brief Intervention Goal Lower Risk
Reduce use to acceptable levels
BIReferral to txBTGoal Encourage pt
to accept a referral to tx or engage in BT
Referral to tx Goal Encourage pt to accept referral to tx or engage in BT
Brief Interventions for Patients at Risk for
Substance Use Problems
What Are Brief Interventions
ldquoBriefhellipinterventions are short face-to-face conversations regarding drinking motivation to change and options for change which are provided during a window of opportunity or potentially teachable moment occasioned by a
medical eventrdquo
Dr Craig Field from the University of Texas (See reference list)
Goal of Brief Interventions
Behavior change
Awareness of problem
Motivation
Presenting problem Screening
results
Brief Intervention Effectbull Brief interventions trigger changebull A little counseling can lead to significant
change eg 5 min has same impact as 20 minbull Research is less extensive for illicit drugs but
promisingbull A randomized study with cocaine and heroin users
found that patients who received a BI had 50 greater odds of abstinence at follow up compared with controls
See reference list
Where Do I Start
What you do depends on where the patient is in the process of changing
The first step is to be able to identify where the patient is coming from
Stages of Change
Primary Tasks
1 PrecontemplationDefinition
Not yet considering change or is unwilling or unable to change
Primary TaskRaising Awareness 2 Contemplation
Definition Sees the possibility of change but
is ambivalent and uncertain
Primary TaskResolving ambivalence
Helping to choose change
3 DeterminationDefinition
Committed to changingStill considering what to do
Primary TaskHelp identify appropriate
change strategies
4 ActionDefinition
Taking steps toward change but hasnrsquot stabilized in the process
Primary TaskHelp implement change strategies
and learn to eliminate potential relapses
5 MaintenanceDefinition
Has achieved the goals and is working to maintain change
Primary TaskDevelop new skills for maintaining recovery
6 RecurrenceDefinition
Experienced a recurrence of the symptoms
Primary TaskCope with consequences and
determine what to do next
Stages of Change Intervention Matching Guide
bull Offer factual informationbull Explore the meaning of events that
brought the person to treatmentbull Explore results of previous effortsbull Explore pros and cons of targeted
behaviors
bull Explore the personrsquos sense of self-efficacy
bull Explore expectations regarding what the change will entail
bull Summarize self-motivational statements
bull Continue exploration of pros and cons
bull Offer a menu of options for changebull Help identify pros and cons of various
change optionsbull Identify and lower barriers to changebull Help person enlist social support bull Encourage person to publicly
announce plans to change
bull Support a realistic view of change through small steps
bull Help identify high-risk situations and develop coping strategies
bull Assist in finding new reinforcers of positive change
bull Help access family and social support
bull Help identify and try alternative behaviors (drug-free sources of pleasure)
bull Maintain supportive contact bull Help develop escape planbull Work to set new short and long term
goals
bull Frame recurrence as a learning opportunity
bull Explore possible behavioral psychological and social antecedents
bull Help to develop alternative coping strategies
bull Explain Stages of Change amp encourage person to stay in the process
bull Maintain supportive contact
1 Pre-contemplation
2Contemplation
3Determination
4Action
5Maintenance
6Recurrence
ldquoPeople are better persuaded by the reasons they themselves
discovered than those that come into the minds of othersrdquo
Blaise Pascal
Ambivalence
All change contains an element of ambivalence
We ldquowant to change and donrsquot want to changerdquo
Patientsrsquo ambivalence about change is the ldquoheartrdquo of the brief intervention
Activity Video ExampleYoung man is treated in the ER after a car accident He had been drinking heavily before the accident How does the doctor address drinking in this video
See reference list
(INSERT BAD SBIRT VIDEO)
Reflective Listening
bull Listen to both what the patient says and to what the person means
bull Show empathy and donrsquot judge what patient saysbull You do not have to agree
bull Be aware of intonationbull Reflect what patient says with statement not
a question eg ldquoYou couldnrsquot get up for work in the morningrdquo
Levels of Reflection
bull Repeating ndash Repeating what was just saidbull RephrasingParaphrasing ndash Restatement of
what the person said Listener infers meaning of what was said Can be thought of as continuing the thought
bull Reflecting Feeling ndash Listener reflects not just the words but the feeling or emotion underneath what the person is saying
Avoid Confrontationbull Challenging
ldquoWhat do you think you are doingrdquo
bull Warning
ldquoYou will damage your liver if you donrsquot stop drinkingrdquo
bull Finger-wagging
ldquoIf you want to be a good student you must stop drinking on school nightsrdquo
Explore Ambivalence
Benefits of change
Costs of using drugs
Benefits of using drugs
Costs of change
How to Explore Ambivalence
Avoid questions that lead to a yesno response
The good things about
______
The not- so-good things about ____
The good things about
changing
The not-so-good things
about changing
Elicit ldquoChange TalkrdquoChange talk consists of self-motivational statements that suggest
bull Recognition of a problem
bull Concern about staying the same
bull Intention to change
bull Optimism about change
Activity Video ExampleSame scenario but different doctor What does this doctor do that is different Does it work
See reference list
(INSERT GOOD SBIRT VIDEO)
Conducting a Brief Intervention
F L O
FLO The 3 tasks of a BI
Avoid Warnings
F L O WFeed
back
Listen
amp U
nd
erstand
Warn
Op
tion
s Exp
lored
(thatrsquos it)
How Does It All Fit TogetherFeedback
Setting the stage
Tell screening results
Listen amp understand
Explore pros amp cons
Explain importance
Assess readiness to change
Options explored
Discuss change options
Follow up
The 3 Tasks of a BI
F L OFeed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 1st Task Feedback
The Feedback Sandwich
Ask Permission
Give Advice
Ask for Response
The 1st Task FeedbackWhat you need to cover1 Range of scores and context2 Screening results3 Substance use norms in population4 Interpretation of results (eg risk level)5 Patient feedback about results
The 1st Task FeedbackWhat do you say
1 Range of score and context - Scores on the AUDIT range from 0-40 Most people who are social drinkers score less than 8
2 Results - Your score was 18 on the alcohol screen
3 Norms - A score of 18 means that your drinking is higher than 75 of the US adult population
4 Interpretation of results - 18 puts you in the moderate-to-high risk range At this level your use is putting you at risk for a variety of health issues
5 Patient reactionfeedback - What do you make of this
Informational Brochures
The 1st Task FeedbackHandling Resistancebull Look I donrsquot have a drug problembull My dad was an alcoholic Irsquom not like himbull I can quit using anytime I want tobull I just like the tastebull Everybody drinks in college
What would you say
Chr
onic
Pai
n
SUD
HIV
Con-fusion Medical
Issues
Pain
SUD
To avoid thishellip
LET GO
The 1st Task Feedback
The 1st Task Feedback
Easy Ways to Let Gobull Irsquom not going to push you to change
anything you donrsquot want to changebull Irsquod just like to give you some informationbull What you do is up to you
The 1st Task FeedbackFinding a Hookbull Ask the patient about their concernsbull Provide non-judgmental feedbackinformationbull Watch for signs of discomfort with status quo or
interest or ability to changebull Always ask this question ldquoWhat role if any do
you think alcohol played in your (getting injured)bull Let the patient decidebull Just asking the question is helpful
The 3 Tasks of a BI
F L O
Feed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
Brief Interventions for Patients at Risk for
Substance Use Problems
What Are Brief Interventions
ldquoBriefhellipinterventions are short face-to-face conversations regarding drinking motivation to change and options for change which are provided during a window of opportunity or potentially teachable moment occasioned by a
medical eventrdquo
Dr Craig Field from the University of Texas (See reference list)
Goal of Brief Interventions
Behavior change
Awareness of problem
Motivation
Presenting problem Screening
results
Brief Intervention Effectbull Brief interventions trigger changebull A little counseling can lead to significant
change eg 5 min has same impact as 20 minbull Research is less extensive for illicit drugs but
promisingbull A randomized study with cocaine and heroin users
found that patients who received a BI had 50 greater odds of abstinence at follow up compared with controls
See reference list
Where Do I Start
What you do depends on where the patient is in the process of changing
The first step is to be able to identify where the patient is coming from
Stages of Change
Primary Tasks
1 PrecontemplationDefinition
Not yet considering change or is unwilling or unable to change
Primary TaskRaising Awareness 2 Contemplation
Definition Sees the possibility of change but
is ambivalent and uncertain
Primary TaskResolving ambivalence
Helping to choose change
3 DeterminationDefinition
Committed to changingStill considering what to do
Primary TaskHelp identify appropriate
change strategies
4 ActionDefinition
Taking steps toward change but hasnrsquot stabilized in the process
Primary TaskHelp implement change strategies
and learn to eliminate potential relapses
5 MaintenanceDefinition
Has achieved the goals and is working to maintain change
Primary TaskDevelop new skills for maintaining recovery
6 RecurrenceDefinition
Experienced a recurrence of the symptoms
Primary TaskCope with consequences and
determine what to do next
Stages of Change Intervention Matching Guide
bull Offer factual informationbull Explore the meaning of events that
brought the person to treatmentbull Explore results of previous effortsbull Explore pros and cons of targeted
behaviors
bull Explore the personrsquos sense of self-efficacy
bull Explore expectations regarding what the change will entail
bull Summarize self-motivational statements
bull Continue exploration of pros and cons
bull Offer a menu of options for changebull Help identify pros and cons of various
change optionsbull Identify and lower barriers to changebull Help person enlist social support bull Encourage person to publicly
announce plans to change
bull Support a realistic view of change through small steps
bull Help identify high-risk situations and develop coping strategies
bull Assist in finding new reinforcers of positive change
bull Help access family and social support
bull Help identify and try alternative behaviors (drug-free sources of pleasure)
bull Maintain supportive contact bull Help develop escape planbull Work to set new short and long term
goals
bull Frame recurrence as a learning opportunity
bull Explore possible behavioral psychological and social antecedents
bull Help to develop alternative coping strategies
bull Explain Stages of Change amp encourage person to stay in the process
bull Maintain supportive contact
1 Pre-contemplation
2Contemplation
3Determination
4Action
5Maintenance
6Recurrence
ldquoPeople are better persuaded by the reasons they themselves
discovered than those that come into the minds of othersrdquo
Blaise Pascal
Ambivalence
All change contains an element of ambivalence
We ldquowant to change and donrsquot want to changerdquo
Patientsrsquo ambivalence about change is the ldquoheartrdquo of the brief intervention
Activity Video ExampleYoung man is treated in the ER after a car accident He had been drinking heavily before the accident How does the doctor address drinking in this video
See reference list
(INSERT BAD SBIRT VIDEO)
Reflective Listening
bull Listen to both what the patient says and to what the person means
bull Show empathy and donrsquot judge what patient saysbull You do not have to agree
bull Be aware of intonationbull Reflect what patient says with statement not
a question eg ldquoYou couldnrsquot get up for work in the morningrdquo
Levels of Reflection
bull Repeating ndash Repeating what was just saidbull RephrasingParaphrasing ndash Restatement of
what the person said Listener infers meaning of what was said Can be thought of as continuing the thought
bull Reflecting Feeling ndash Listener reflects not just the words but the feeling or emotion underneath what the person is saying
Avoid Confrontationbull Challenging
ldquoWhat do you think you are doingrdquo
bull Warning
ldquoYou will damage your liver if you donrsquot stop drinkingrdquo
bull Finger-wagging
ldquoIf you want to be a good student you must stop drinking on school nightsrdquo
Explore Ambivalence
Benefits of change
Costs of using drugs
Benefits of using drugs
Costs of change
How to Explore Ambivalence
Avoid questions that lead to a yesno response
The good things about
______
The not- so-good things about ____
The good things about
changing
The not-so-good things
about changing
Elicit ldquoChange TalkrdquoChange talk consists of self-motivational statements that suggest
bull Recognition of a problem
bull Concern about staying the same
bull Intention to change
bull Optimism about change
Activity Video ExampleSame scenario but different doctor What does this doctor do that is different Does it work
See reference list
(INSERT GOOD SBIRT VIDEO)
Conducting a Brief Intervention
F L O
FLO The 3 tasks of a BI
Avoid Warnings
F L O WFeed
back
Listen
amp U
nd
erstand
Warn
Op
tion
s Exp
lored
(thatrsquos it)
How Does It All Fit TogetherFeedback
Setting the stage
Tell screening results
Listen amp understand
Explore pros amp cons
Explain importance
Assess readiness to change
Options explored
Discuss change options
Follow up
The 3 Tasks of a BI
F L OFeed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 1st Task Feedback
The Feedback Sandwich
Ask Permission
Give Advice
Ask for Response
The 1st Task FeedbackWhat you need to cover1 Range of scores and context2 Screening results3 Substance use norms in population4 Interpretation of results (eg risk level)5 Patient feedback about results
The 1st Task FeedbackWhat do you say
1 Range of score and context - Scores on the AUDIT range from 0-40 Most people who are social drinkers score less than 8
2 Results - Your score was 18 on the alcohol screen
3 Norms - A score of 18 means that your drinking is higher than 75 of the US adult population
4 Interpretation of results - 18 puts you in the moderate-to-high risk range At this level your use is putting you at risk for a variety of health issues
5 Patient reactionfeedback - What do you make of this
Informational Brochures
The 1st Task FeedbackHandling Resistancebull Look I donrsquot have a drug problembull My dad was an alcoholic Irsquom not like himbull I can quit using anytime I want tobull I just like the tastebull Everybody drinks in college
What would you say
Chr
onic
Pai
n
SUD
HIV
Con-fusion Medical
Issues
Pain
SUD
To avoid thishellip
LET GO
The 1st Task Feedback
The 1st Task Feedback
Easy Ways to Let Gobull Irsquom not going to push you to change
anything you donrsquot want to changebull Irsquod just like to give you some informationbull What you do is up to you
The 1st Task FeedbackFinding a Hookbull Ask the patient about their concernsbull Provide non-judgmental feedbackinformationbull Watch for signs of discomfort with status quo or
interest or ability to changebull Always ask this question ldquoWhat role if any do
you think alcohol played in your (getting injured)bull Let the patient decidebull Just asking the question is helpful
The 3 Tasks of a BI
F L O
Feed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
What Are Brief Interventions
ldquoBriefhellipinterventions are short face-to-face conversations regarding drinking motivation to change and options for change which are provided during a window of opportunity or potentially teachable moment occasioned by a
medical eventrdquo
Dr Craig Field from the University of Texas (See reference list)
Goal of Brief Interventions
Behavior change
Awareness of problem
Motivation
Presenting problem Screening
results
Brief Intervention Effectbull Brief interventions trigger changebull A little counseling can lead to significant
change eg 5 min has same impact as 20 minbull Research is less extensive for illicit drugs but
promisingbull A randomized study with cocaine and heroin users
found that patients who received a BI had 50 greater odds of abstinence at follow up compared with controls
See reference list
Where Do I Start
What you do depends on where the patient is in the process of changing
The first step is to be able to identify where the patient is coming from
Stages of Change
Primary Tasks
1 PrecontemplationDefinition
Not yet considering change or is unwilling or unable to change
Primary TaskRaising Awareness 2 Contemplation
Definition Sees the possibility of change but
is ambivalent and uncertain
Primary TaskResolving ambivalence
Helping to choose change
3 DeterminationDefinition
Committed to changingStill considering what to do
Primary TaskHelp identify appropriate
change strategies
4 ActionDefinition
Taking steps toward change but hasnrsquot stabilized in the process
Primary TaskHelp implement change strategies
and learn to eliminate potential relapses
5 MaintenanceDefinition
Has achieved the goals and is working to maintain change
Primary TaskDevelop new skills for maintaining recovery
6 RecurrenceDefinition
Experienced a recurrence of the symptoms
Primary TaskCope with consequences and
determine what to do next
Stages of Change Intervention Matching Guide
bull Offer factual informationbull Explore the meaning of events that
brought the person to treatmentbull Explore results of previous effortsbull Explore pros and cons of targeted
behaviors
bull Explore the personrsquos sense of self-efficacy
bull Explore expectations regarding what the change will entail
bull Summarize self-motivational statements
bull Continue exploration of pros and cons
bull Offer a menu of options for changebull Help identify pros and cons of various
change optionsbull Identify and lower barriers to changebull Help person enlist social support bull Encourage person to publicly
announce plans to change
bull Support a realistic view of change through small steps
bull Help identify high-risk situations and develop coping strategies
bull Assist in finding new reinforcers of positive change
bull Help access family and social support
bull Help identify and try alternative behaviors (drug-free sources of pleasure)
bull Maintain supportive contact bull Help develop escape planbull Work to set new short and long term
goals
bull Frame recurrence as a learning opportunity
bull Explore possible behavioral psychological and social antecedents
bull Help to develop alternative coping strategies
bull Explain Stages of Change amp encourage person to stay in the process
bull Maintain supportive contact
1 Pre-contemplation
2Contemplation
3Determination
4Action
5Maintenance
6Recurrence
ldquoPeople are better persuaded by the reasons they themselves
discovered than those that come into the minds of othersrdquo
Blaise Pascal
Ambivalence
All change contains an element of ambivalence
We ldquowant to change and donrsquot want to changerdquo
Patientsrsquo ambivalence about change is the ldquoheartrdquo of the brief intervention
Activity Video ExampleYoung man is treated in the ER after a car accident He had been drinking heavily before the accident How does the doctor address drinking in this video
See reference list
(INSERT BAD SBIRT VIDEO)
Reflective Listening
bull Listen to both what the patient says and to what the person means
bull Show empathy and donrsquot judge what patient saysbull You do not have to agree
bull Be aware of intonationbull Reflect what patient says with statement not
a question eg ldquoYou couldnrsquot get up for work in the morningrdquo
Levels of Reflection
bull Repeating ndash Repeating what was just saidbull RephrasingParaphrasing ndash Restatement of
what the person said Listener infers meaning of what was said Can be thought of as continuing the thought
bull Reflecting Feeling ndash Listener reflects not just the words but the feeling or emotion underneath what the person is saying
Avoid Confrontationbull Challenging
ldquoWhat do you think you are doingrdquo
bull Warning
ldquoYou will damage your liver if you donrsquot stop drinkingrdquo
bull Finger-wagging
ldquoIf you want to be a good student you must stop drinking on school nightsrdquo
Explore Ambivalence
Benefits of change
Costs of using drugs
Benefits of using drugs
Costs of change
How to Explore Ambivalence
Avoid questions that lead to a yesno response
The good things about
______
The not- so-good things about ____
The good things about
changing
The not-so-good things
about changing
Elicit ldquoChange TalkrdquoChange talk consists of self-motivational statements that suggest
bull Recognition of a problem
bull Concern about staying the same
bull Intention to change
bull Optimism about change
Activity Video ExampleSame scenario but different doctor What does this doctor do that is different Does it work
See reference list
(INSERT GOOD SBIRT VIDEO)
Conducting a Brief Intervention
F L O
FLO The 3 tasks of a BI
Avoid Warnings
F L O WFeed
back
Listen
amp U
nd
erstand
Warn
Op
tion
s Exp
lored
(thatrsquos it)
How Does It All Fit TogetherFeedback
Setting the stage
Tell screening results
Listen amp understand
Explore pros amp cons
Explain importance
Assess readiness to change
Options explored
Discuss change options
Follow up
The 3 Tasks of a BI
F L OFeed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 1st Task Feedback
The Feedback Sandwich
Ask Permission
Give Advice
Ask for Response
The 1st Task FeedbackWhat you need to cover1 Range of scores and context2 Screening results3 Substance use norms in population4 Interpretation of results (eg risk level)5 Patient feedback about results
The 1st Task FeedbackWhat do you say
1 Range of score and context - Scores on the AUDIT range from 0-40 Most people who are social drinkers score less than 8
2 Results - Your score was 18 on the alcohol screen
3 Norms - A score of 18 means that your drinking is higher than 75 of the US adult population
4 Interpretation of results - 18 puts you in the moderate-to-high risk range At this level your use is putting you at risk for a variety of health issues
5 Patient reactionfeedback - What do you make of this
Informational Brochures
The 1st Task FeedbackHandling Resistancebull Look I donrsquot have a drug problembull My dad was an alcoholic Irsquom not like himbull I can quit using anytime I want tobull I just like the tastebull Everybody drinks in college
What would you say
Chr
onic
Pai
n
SUD
HIV
Con-fusion Medical
Issues
Pain
SUD
To avoid thishellip
LET GO
The 1st Task Feedback
The 1st Task Feedback
Easy Ways to Let Gobull Irsquom not going to push you to change
anything you donrsquot want to changebull Irsquod just like to give you some informationbull What you do is up to you
The 1st Task FeedbackFinding a Hookbull Ask the patient about their concernsbull Provide non-judgmental feedbackinformationbull Watch for signs of discomfort with status quo or
interest or ability to changebull Always ask this question ldquoWhat role if any do
you think alcohol played in your (getting injured)bull Let the patient decidebull Just asking the question is helpful
The 3 Tasks of a BI
F L O
Feed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
Goal of Brief Interventions
Behavior change
Awareness of problem
Motivation
Presenting problem Screening
results
Brief Intervention Effectbull Brief interventions trigger changebull A little counseling can lead to significant
change eg 5 min has same impact as 20 minbull Research is less extensive for illicit drugs but
promisingbull A randomized study with cocaine and heroin users
found that patients who received a BI had 50 greater odds of abstinence at follow up compared with controls
See reference list
Where Do I Start
What you do depends on where the patient is in the process of changing
The first step is to be able to identify where the patient is coming from
Stages of Change
Primary Tasks
1 PrecontemplationDefinition
Not yet considering change or is unwilling or unable to change
Primary TaskRaising Awareness 2 Contemplation
Definition Sees the possibility of change but
is ambivalent and uncertain
Primary TaskResolving ambivalence
Helping to choose change
3 DeterminationDefinition
Committed to changingStill considering what to do
Primary TaskHelp identify appropriate
change strategies
4 ActionDefinition
Taking steps toward change but hasnrsquot stabilized in the process
Primary TaskHelp implement change strategies
and learn to eliminate potential relapses
5 MaintenanceDefinition
Has achieved the goals and is working to maintain change
Primary TaskDevelop new skills for maintaining recovery
6 RecurrenceDefinition
Experienced a recurrence of the symptoms
Primary TaskCope with consequences and
determine what to do next
Stages of Change Intervention Matching Guide
bull Offer factual informationbull Explore the meaning of events that
brought the person to treatmentbull Explore results of previous effortsbull Explore pros and cons of targeted
behaviors
bull Explore the personrsquos sense of self-efficacy
bull Explore expectations regarding what the change will entail
bull Summarize self-motivational statements
bull Continue exploration of pros and cons
bull Offer a menu of options for changebull Help identify pros and cons of various
change optionsbull Identify and lower barriers to changebull Help person enlist social support bull Encourage person to publicly
announce plans to change
bull Support a realistic view of change through small steps
bull Help identify high-risk situations and develop coping strategies
bull Assist in finding new reinforcers of positive change
bull Help access family and social support
bull Help identify and try alternative behaviors (drug-free sources of pleasure)
bull Maintain supportive contact bull Help develop escape planbull Work to set new short and long term
goals
bull Frame recurrence as a learning opportunity
bull Explore possible behavioral psychological and social antecedents
bull Help to develop alternative coping strategies
bull Explain Stages of Change amp encourage person to stay in the process
bull Maintain supportive contact
1 Pre-contemplation
2Contemplation
3Determination
4Action
5Maintenance
6Recurrence
ldquoPeople are better persuaded by the reasons they themselves
discovered than those that come into the minds of othersrdquo
Blaise Pascal
Ambivalence
All change contains an element of ambivalence
We ldquowant to change and donrsquot want to changerdquo
Patientsrsquo ambivalence about change is the ldquoheartrdquo of the brief intervention
Activity Video ExampleYoung man is treated in the ER after a car accident He had been drinking heavily before the accident How does the doctor address drinking in this video
See reference list
(INSERT BAD SBIRT VIDEO)
Reflective Listening
bull Listen to both what the patient says and to what the person means
bull Show empathy and donrsquot judge what patient saysbull You do not have to agree
bull Be aware of intonationbull Reflect what patient says with statement not
a question eg ldquoYou couldnrsquot get up for work in the morningrdquo
Levels of Reflection
bull Repeating ndash Repeating what was just saidbull RephrasingParaphrasing ndash Restatement of
what the person said Listener infers meaning of what was said Can be thought of as continuing the thought
bull Reflecting Feeling ndash Listener reflects not just the words but the feeling or emotion underneath what the person is saying
Avoid Confrontationbull Challenging
ldquoWhat do you think you are doingrdquo
bull Warning
ldquoYou will damage your liver if you donrsquot stop drinkingrdquo
bull Finger-wagging
ldquoIf you want to be a good student you must stop drinking on school nightsrdquo
Explore Ambivalence
Benefits of change
Costs of using drugs
Benefits of using drugs
Costs of change
How to Explore Ambivalence
Avoid questions that lead to a yesno response
The good things about
______
The not- so-good things about ____
The good things about
changing
The not-so-good things
about changing
Elicit ldquoChange TalkrdquoChange talk consists of self-motivational statements that suggest
bull Recognition of a problem
bull Concern about staying the same
bull Intention to change
bull Optimism about change
Activity Video ExampleSame scenario but different doctor What does this doctor do that is different Does it work
See reference list
(INSERT GOOD SBIRT VIDEO)
Conducting a Brief Intervention
F L O
FLO The 3 tasks of a BI
Avoid Warnings
F L O WFeed
back
Listen
amp U
nd
erstand
Warn
Op
tion
s Exp
lored
(thatrsquos it)
How Does It All Fit TogetherFeedback
Setting the stage
Tell screening results
Listen amp understand
Explore pros amp cons
Explain importance
Assess readiness to change
Options explored
Discuss change options
Follow up
The 3 Tasks of a BI
F L OFeed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 1st Task Feedback
The Feedback Sandwich
Ask Permission
Give Advice
Ask for Response
The 1st Task FeedbackWhat you need to cover1 Range of scores and context2 Screening results3 Substance use norms in population4 Interpretation of results (eg risk level)5 Patient feedback about results
The 1st Task FeedbackWhat do you say
1 Range of score and context - Scores on the AUDIT range from 0-40 Most people who are social drinkers score less than 8
2 Results - Your score was 18 on the alcohol screen
3 Norms - A score of 18 means that your drinking is higher than 75 of the US adult population
4 Interpretation of results - 18 puts you in the moderate-to-high risk range At this level your use is putting you at risk for a variety of health issues
5 Patient reactionfeedback - What do you make of this
Informational Brochures
The 1st Task FeedbackHandling Resistancebull Look I donrsquot have a drug problembull My dad was an alcoholic Irsquom not like himbull I can quit using anytime I want tobull I just like the tastebull Everybody drinks in college
What would you say
Chr
onic
Pai
n
SUD
HIV
Con-fusion Medical
Issues
Pain
SUD
To avoid thishellip
LET GO
The 1st Task Feedback
The 1st Task Feedback
Easy Ways to Let Gobull Irsquom not going to push you to change
anything you donrsquot want to changebull Irsquod just like to give you some informationbull What you do is up to you
The 1st Task FeedbackFinding a Hookbull Ask the patient about their concernsbull Provide non-judgmental feedbackinformationbull Watch for signs of discomfort with status quo or
interest or ability to changebull Always ask this question ldquoWhat role if any do
you think alcohol played in your (getting injured)bull Let the patient decidebull Just asking the question is helpful
The 3 Tasks of a BI
F L O
Feed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
Brief Intervention Effectbull Brief interventions trigger changebull A little counseling can lead to significant
change eg 5 min has same impact as 20 minbull Research is less extensive for illicit drugs but
promisingbull A randomized study with cocaine and heroin users
found that patients who received a BI had 50 greater odds of abstinence at follow up compared with controls
See reference list
Where Do I Start
What you do depends on where the patient is in the process of changing
The first step is to be able to identify where the patient is coming from
Stages of Change
Primary Tasks
1 PrecontemplationDefinition
Not yet considering change or is unwilling or unable to change
Primary TaskRaising Awareness 2 Contemplation
Definition Sees the possibility of change but
is ambivalent and uncertain
Primary TaskResolving ambivalence
Helping to choose change
3 DeterminationDefinition
Committed to changingStill considering what to do
Primary TaskHelp identify appropriate
change strategies
4 ActionDefinition
Taking steps toward change but hasnrsquot stabilized in the process
Primary TaskHelp implement change strategies
and learn to eliminate potential relapses
5 MaintenanceDefinition
Has achieved the goals and is working to maintain change
Primary TaskDevelop new skills for maintaining recovery
6 RecurrenceDefinition
Experienced a recurrence of the symptoms
Primary TaskCope with consequences and
determine what to do next
Stages of Change Intervention Matching Guide
bull Offer factual informationbull Explore the meaning of events that
brought the person to treatmentbull Explore results of previous effortsbull Explore pros and cons of targeted
behaviors
bull Explore the personrsquos sense of self-efficacy
bull Explore expectations regarding what the change will entail
bull Summarize self-motivational statements
bull Continue exploration of pros and cons
bull Offer a menu of options for changebull Help identify pros and cons of various
change optionsbull Identify and lower barriers to changebull Help person enlist social support bull Encourage person to publicly
announce plans to change
bull Support a realistic view of change through small steps
bull Help identify high-risk situations and develop coping strategies
bull Assist in finding new reinforcers of positive change
bull Help access family and social support
bull Help identify and try alternative behaviors (drug-free sources of pleasure)
bull Maintain supportive contact bull Help develop escape planbull Work to set new short and long term
goals
bull Frame recurrence as a learning opportunity
bull Explore possible behavioral psychological and social antecedents
bull Help to develop alternative coping strategies
bull Explain Stages of Change amp encourage person to stay in the process
bull Maintain supportive contact
1 Pre-contemplation
2Contemplation
3Determination
4Action
5Maintenance
6Recurrence
ldquoPeople are better persuaded by the reasons they themselves
discovered than those that come into the minds of othersrdquo
Blaise Pascal
Ambivalence
All change contains an element of ambivalence
We ldquowant to change and donrsquot want to changerdquo
Patientsrsquo ambivalence about change is the ldquoheartrdquo of the brief intervention
Activity Video ExampleYoung man is treated in the ER after a car accident He had been drinking heavily before the accident How does the doctor address drinking in this video
See reference list
(INSERT BAD SBIRT VIDEO)
Reflective Listening
bull Listen to both what the patient says and to what the person means
bull Show empathy and donrsquot judge what patient saysbull You do not have to agree
bull Be aware of intonationbull Reflect what patient says with statement not
a question eg ldquoYou couldnrsquot get up for work in the morningrdquo
Levels of Reflection
bull Repeating ndash Repeating what was just saidbull RephrasingParaphrasing ndash Restatement of
what the person said Listener infers meaning of what was said Can be thought of as continuing the thought
bull Reflecting Feeling ndash Listener reflects not just the words but the feeling or emotion underneath what the person is saying
Avoid Confrontationbull Challenging
ldquoWhat do you think you are doingrdquo
bull Warning
ldquoYou will damage your liver if you donrsquot stop drinkingrdquo
bull Finger-wagging
ldquoIf you want to be a good student you must stop drinking on school nightsrdquo
Explore Ambivalence
Benefits of change
Costs of using drugs
Benefits of using drugs
Costs of change
How to Explore Ambivalence
Avoid questions that lead to a yesno response
The good things about
______
The not- so-good things about ____
The good things about
changing
The not-so-good things
about changing
Elicit ldquoChange TalkrdquoChange talk consists of self-motivational statements that suggest
bull Recognition of a problem
bull Concern about staying the same
bull Intention to change
bull Optimism about change
Activity Video ExampleSame scenario but different doctor What does this doctor do that is different Does it work
See reference list
(INSERT GOOD SBIRT VIDEO)
Conducting a Brief Intervention
F L O
FLO The 3 tasks of a BI
Avoid Warnings
F L O WFeed
back
Listen
amp U
nd
erstand
Warn
Op
tion
s Exp
lored
(thatrsquos it)
How Does It All Fit TogetherFeedback
Setting the stage
Tell screening results
Listen amp understand
Explore pros amp cons
Explain importance
Assess readiness to change
Options explored
Discuss change options
Follow up
The 3 Tasks of a BI
F L OFeed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 1st Task Feedback
The Feedback Sandwich
Ask Permission
Give Advice
Ask for Response
The 1st Task FeedbackWhat you need to cover1 Range of scores and context2 Screening results3 Substance use norms in population4 Interpretation of results (eg risk level)5 Patient feedback about results
The 1st Task FeedbackWhat do you say
1 Range of score and context - Scores on the AUDIT range from 0-40 Most people who are social drinkers score less than 8
2 Results - Your score was 18 on the alcohol screen
3 Norms - A score of 18 means that your drinking is higher than 75 of the US adult population
4 Interpretation of results - 18 puts you in the moderate-to-high risk range At this level your use is putting you at risk for a variety of health issues
5 Patient reactionfeedback - What do you make of this
Informational Brochures
The 1st Task FeedbackHandling Resistancebull Look I donrsquot have a drug problembull My dad was an alcoholic Irsquom not like himbull I can quit using anytime I want tobull I just like the tastebull Everybody drinks in college
What would you say
Chr
onic
Pai
n
SUD
HIV
Con-fusion Medical
Issues
Pain
SUD
To avoid thishellip
LET GO
The 1st Task Feedback
The 1st Task Feedback
Easy Ways to Let Gobull Irsquom not going to push you to change
anything you donrsquot want to changebull Irsquod just like to give you some informationbull What you do is up to you
The 1st Task FeedbackFinding a Hookbull Ask the patient about their concernsbull Provide non-judgmental feedbackinformationbull Watch for signs of discomfort with status quo or
interest or ability to changebull Always ask this question ldquoWhat role if any do
you think alcohol played in your (getting injured)bull Let the patient decidebull Just asking the question is helpful
The 3 Tasks of a BI
F L O
Feed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
Where Do I Start
What you do depends on where the patient is in the process of changing
The first step is to be able to identify where the patient is coming from
Stages of Change
Primary Tasks
1 PrecontemplationDefinition
Not yet considering change or is unwilling or unable to change
Primary TaskRaising Awareness 2 Contemplation
Definition Sees the possibility of change but
is ambivalent and uncertain
Primary TaskResolving ambivalence
Helping to choose change
3 DeterminationDefinition
Committed to changingStill considering what to do
Primary TaskHelp identify appropriate
change strategies
4 ActionDefinition
Taking steps toward change but hasnrsquot stabilized in the process
Primary TaskHelp implement change strategies
and learn to eliminate potential relapses
5 MaintenanceDefinition
Has achieved the goals and is working to maintain change
Primary TaskDevelop new skills for maintaining recovery
6 RecurrenceDefinition
Experienced a recurrence of the symptoms
Primary TaskCope with consequences and
determine what to do next
Stages of Change Intervention Matching Guide
bull Offer factual informationbull Explore the meaning of events that
brought the person to treatmentbull Explore results of previous effortsbull Explore pros and cons of targeted
behaviors
bull Explore the personrsquos sense of self-efficacy
bull Explore expectations regarding what the change will entail
bull Summarize self-motivational statements
bull Continue exploration of pros and cons
bull Offer a menu of options for changebull Help identify pros and cons of various
change optionsbull Identify and lower barriers to changebull Help person enlist social support bull Encourage person to publicly
announce plans to change
bull Support a realistic view of change through small steps
bull Help identify high-risk situations and develop coping strategies
bull Assist in finding new reinforcers of positive change
bull Help access family and social support
bull Help identify and try alternative behaviors (drug-free sources of pleasure)
bull Maintain supportive contact bull Help develop escape planbull Work to set new short and long term
goals
bull Frame recurrence as a learning opportunity
bull Explore possible behavioral psychological and social antecedents
bull Help to develop alternative coping strategies
bull Explain Stages of Change amp encourage person to stay in the process
bull Maintain supportive contact
1 Pre-contemplation
2Contemplation
3Determination
4Action
5Maintenance
6Recurrence
ldquoPeople are better persuaded by the reasons they themselves
discovered than those that come into the minds of othersrdquo
Blaise Pascal
Ambivalence
All change contains an element of ambivalence
We ldquowant to change and donrsquot want to changerdquo
Patientsrsquo ambivalence about change is the ldquoheartrdquo of the brief intervention
Activity Video ExampleYoung man is treated in the ER after a car accident He had been drinking heavily before the accident How does the doctor address drinking in this video
See reference list
(INSERT BAD SBIRT VIDEO)
Reflective Listening
bull Listen to both what the patient says and to what the person means
bull Show empathy and donrsquot judge what patient saysbull You do not have to agree
bull Be aware of intonationbull Reflect what patient says with statement not
a question eg ldquoYou couldnrsquot get up for work in the morningrdquo
Levels of Reflection
bull Repeating ndash Repeating what was just saidbull RephrasingParaphrasing ndash Restatement of
what the person said Listener infers meaning of what was said Can be thought of as continuing the thought
bull Reflecting Feeling ndash Listener reflects not just the words but the feeling or emotion underneath what the person is saying
Avoid Confrontationbull Challenging
ldquoWhat do you think you are doingrdquo
bull Warning
ldquoYou will damage your liver if you donrsquot stop drinkingrdquo
bull Finger-wagging
ldquoIf you want to be a good student you must stop drinking on school nightsrdquo
Explore Ambivalence
Benefits of change
Costs of using drugs
Benefits of using drugs
Costs of change
How to Explore Ambivalence
Avoid questions that lead to a yesno response
The good things about
______
The not- so-good things about ____
The good things about
changing
The not-so-good things
about changing
Elicit ldquoChange TalkrdquoChange talk consists of self-motivational statements that suggest
bull Recognition of a problem
bull Concern about staying the same
bull Intention to change
bull Optimism about change
Activity Video ExampleSame scenario but different doctor What does this doctor do that is different Does it work
See reference list
(INSERT GOOD SBIRT VIDEO)
Conducting a Brief Intervention
F L O
FLO The 3 tasks of a BI
Avoid Warnings
F L O WFeed
back
Listen
amp U
nd
erstand
Warn
Op
tion
s Exp
lored
(thatrsquos it)
How Does It All Fit TogetherFeedback
Setting the stage
Tell screening results
Listen amp understand
Explore pros amp cons
Explain importance
Assess readiness to change
Options explored
Discuss change options
Follow up
The 3 Tasks of a BI
F L OFeed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 1st Task Feedback
The Feedback Sandwich
Ask Permission
Give Advice
Ask for Response
The 1st Task FeedbackWhat you need to cover1 Range of scores and context2 Screening results3 Substance use norms in population4 Interpretation of results (eg risk level)5 Patient feedback about results
The 1st Task FeedbackWhat do you say
1 Range of score and context - Scores on the AUDIT range from 0-40 Most people who are social drinkers score less than 8
2 Results - Your score was 18 on the alcohol screen
3 Norms - A score of 18 means that your drinking is higher than 75 of the US adult population
4 Interpretation of results - 18 puts you in the moderate-to-high risk range At this level your use is putting you at risk for a variety of health issues
5 Patient reactionfeedback - What do you make of this
Informational Brochures
The 1st Task FeedbackHandling Resistancebull Look I donrsquot have a drug problembull My dad was an alcoholic Irsquom not like himbull I can quit using anytime I want tobull I just like the tastebull Everybody drinks in college
What would you say
Chr
onic
Pai
n
SUD
HIV
Con-fusion Medical
Issues
Pain
SUD
To avoid thishellip
LET GO
The 1st Task Feedback
The 1st Task Feedback
Easy Ways to Let Gobull Irsquom not going to push you to change
anything you donrsquot want to changebull Irsquod just like to give you some informationbull What you do is up to you
The 1st Task FeedbackFinding a Hookbull Ask the patient about their concernsbull Provide non-judgmental feedbackinformationbull Watch for signs of discomfort with status quo or
interest or ability to changebull Always ask this question ldquoWhat role if any do
you think alcohol played in your (getting injured)bull Let the patient decidebull Just asking the question is helpful
The 3 Tasks of a BI
F L O
Feed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
Stages of Change
Primary Tasks
1 PrecontemplationDefinition
Not yet considering change or is unwilling or unable to change
Primary TaskRaising Awareness 2 Contemplation
Definition Sees the possibility of change but
is ambivalent and uncertain
Primary TaskResolving ambivalence
Helping to choose change
3 DeterminationDefinition
Committed to changingStill considering what to do
Primary TaskHelp identify appropriate
change strategies
4 ActionDefinition
Taking steps toward change but hasnrsquot stabilized in the process
Primary TaskHelp implement change strategies
and learn to eliminate potential relapses
5 MaintenanceDefinition
Has achieved the goals and is working to maintain change
Primary TaskDevelop new skills for maintaining recovery
6 RecurrenceDefinition
Experienced a recurrence of the symptoms
Primary TaskCope with consequences and
determine what to do next
Stages of Change Intervention Matching Guide
bull Offer factual informationbull Explore the meaning of events that
brought the person to treatmentbull Explore results of previous effortsbull Explore pros and cons of targeted
behaviors
bull Explore the personrsquos sense of self-efficacy
bull Explore expectations regarding what the change will entail
bull Summarize self-motivational statements
bull Continue exploration of pros and cons
bull Offer a menu of options for changebull Help identify pros and cons of various
change optionsbull Identify and lower barriers to changebull Help person enlist social support bull Encourage person to publicly
announce plans to change
bull Support a realistic view of change through small steps
bull Help identify high-risk situations and develop coping strategies
bull Assist in finding new reinforcers of positive change
bull Help access family and social support
bull Help identify and try alternative behaviors (drug-free sources of pleasure)
bull Maintain supportive contact bull Help develop escape planbull Work to set new short and long term
goals
bull Frame recurrence as a learning opportunity
bull Explore possible behavioral psychological and social antecedents
bull Help to develop alternative coping strategies
bull Explain Stages of Change amp encourage person to stay in the process
bull Maintain supportive contact
1 Pre-contemplation
2Contemplation
3Determination
4Action
5Maintenance
6Recurrence
ldquoPeople are better persuaded by the reasons they themselves
discovered than those that come into the minds of othersrdquo
Blaise Pascal
Ambivalence
All change contains an element of ambivalence
We ldquowant to change and donrsquot want to changerdquo
Patientsrsquo ambivalence about change is the ldquoheartrdquo of the brief intervention
Activity Video ExampleYoung man is treated in the ER after a car accident He had been drinking heavily before the accident How does the doctor address drinking in this video
See reference list
(INSERT BAD SBIRT VIDEO)
Reflective Listening
bull Listen to both what the patient says and to what the person means
bull Show empathy and donrsquot judge what patient saysbull You do not have to agree
bull Be aware of intonationbull Reflect what patient says with statement not
a question eg ldquoYou couldnrsquot get up for work in the morningrdquo
Levels of Reflection
bull Repeating ndash Repeating what was just saidbull RephrasingParaphrasing ndash Restatement of
what the person said Listener infers meaning of what was said Can be thought of as continuing the thought
bull Reflecting Feeling ndash Listener reflects not just the words but the feeling or emotion underneath what the person is saying
Avoid Confrontationbull Challenging
ldquoWhat do you think you are doingrdquo
bull Warning
ldquoYou will damage your liver if you donrsquot stop drinkingrdquo
bull Finger-wagging
ldquoIf you want to be a good student you must stop drinking on school nightsrdquo
Explore Ambivalence
Benefits of change
Costs of using drugs
Benefits of using drugs
Costs of change
How to Explore Ambivalence
Avoid questions that lead to a yesno response
The good things about
______
The not- so-good things about ____
The good things about
changing
The not-so-good things
about changing
Elicit ldquoChange TalkrdquoChange talk consists of self-motivational statements that suggest
bull Recognition of a problem
bull Concern about staying the same
bull Intention to change
bull Optimism about change
Activity Video ExampleSame scenario but different doctor What does this doctor do that is different Does it work
See reference list
(INSERT GOOD SBIRT VIDEO)
Conducting a Brief Intervention
F L O
FLO The 3 tasks of a BI
Avoid Warnings
F L O WFeed
back
Listen
amp U
nd
erstand
Warn
Op
tion
s Exp
lored
(thatrsquos it)
How Does It All Fit TogetherFeedback
Setting the stage
Tell screening results
Listen amp understand
Explore pros amp cons
Explain importance
Assess readiness to change
Options explored
Discuss change options
Follow up
The 3 Tasks of a BI
F L OFeed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 1st Task Feedback
The Feedback Sandwich
Ask Permission
Give Advice
Ask for Response
The 1st Task FeedbackWhat you need to cover1 Range of scores and context2 Screening results3 Substance use norms in population4 Interpretation of results (eg risk level)5 Patient feedback about results
The 1st Task FeedbackWhat do you say
1 Range of score and context - Scores on the AUDIT range from 0-40 Most people who are social drinkers score less than 8
2 Results - Your score was 18 on the alcohol screen
3 Norms - A score of 18 means that your drinking is higher than 75 of the US adult population
4 Interpretation of results - 18 puts you in the moderate-to-high risk range At this level your use is putting you at risk for a variety of health issues
5 Patient reactionfeedback - What do you make of this
Informational Brochures
The 1st Task FeedbackHandling Resistancebull Look I donrsquot have a drug problembull My dad was an alcoholic Irsquom not like himbull I can quit using anytime I want tobull I just like the tastebull Everybody drinks in college
What would you say
Chr
onic
Pai
n
SUD
HIV
Con-fusion Medical
Issues
Pain
SUD
To avoid thishellip
LET GO
The 1st Task Feedback
The 1st Task Feedback
Easy Ways to Let Gobull Irsquom not going to push you to change
anything you donrsquot want to changebull Irsquod just like to give you some informationbull What you do is up to you
The 1st Task FeedbackFinding a Hookbull Ask the patient about their concernsbull Provide non-judgmental feedbackinformationbull Watch for signs of discomfort with status quo or
interest or ability to changebull Always ask this question ldquoWhat role if any do
you think alcohol played in your (getting injured)bull Let the patient decidebull Just asking the question is helpful
The 3 Tasks of a BI
F L O
Feed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
Stages of Change Intervention Matching Guide
bull Offer factual informationbull Explore the meaning of events that
brought the person to treatmentbull Explore results of previous effortsbull Explore pros and cons of targeted
behaviors
bull Explore the personrsquos sense of self-efficacy
bull Explore expectations regarding what the change will entail
bull Summarize self-motivational statements
bull Continue exploration of pros and cons
bull Offer a menu of options for changebull Help identify pros and cons of various
change optionsbull Identify and lower barriers to changebull Help person enlist social support bull Encourage person to publicly
announce plans to change
bull Support a realistic view of change through small steps
bull Help identify high-risk situations and develop coping strategies
bull Assist in finding new reinforcers of positive change
bull Help access family and social support
bull Help identify and try alternative behaviors (drug-free sources of pleasure)
bull Maintain supportive contact bull Help develop escape planbull Work to set new short and long term
goals
bull Frame recurrence as a learning opportunity
bull Explore possible behavioral psychological and social antecedents
bull Help to develop alternative coping strategies
bull Explain Stages of Change amp encourage person to stay in the process
bull Maintain supportive contact
1 Pre-contemplation
2Contemplation
3Determination
4Action
5Maintenance
6Recurrence
ldquoPeople are better persuaded by the reasons they themselves
discovered than those that come into the minds of othersrdquo
Blaise Pascal
Ambivalence
All change contains an element of ambivalence
We ldquowant to change and donrsquot want to changerdquo
Patientsrsquo ambivalence about change is the ldquoheartrdquo of the brief intervention
Activity Video ExampleYoung man is treated in the ER after a car accident He had been drinking heavily before the accident How does the doctor address drinking in this video
See reference list
(INSERT BAD SBIRT VIDEO)
Reflective Listening
bull Listen to both what the patient says and to what the person means
bull Show empathy and donrsquot judge what patient saysbull You do not have to agree
bull Be aware of intonationbull Reflect what patient says with statement not
a question eg ldquoYou couldnrsquot get up for work in the morningrdquo
Levels of Reflection
bull Repeating ndash Repeating what was just saidbull RephrasingParaphrasing ndash Restatement of
what the person said Listener infers meaning of what was said Can be thought of as continuing the thought
bull Reflecting Feeling ndash Listener reflects not just the words but the feeling or emotion underneath what the person is saying
Avoid Confrontationbull Challenging
ldquoWhat do you think you are doingrdquo
bull Warning
ldquoYou will damage your liver if you donrsquot stop drinkingrdquo
bull Finger-wagging
ldquoIf you want to be a good student you must stop drinking on school nightsrdquo
Explore Ambivalence
Benefits of change
Costs of using drugs
Benefits of using drugs
Costs of change
How to Explore Ambivalence
Avoid questions that lead to a yesno response
The good things about
______
The not- so-good things about ____
The good things about
changing
The not-so-good things
about changing
Elicit ldquoChange TalkrdquoChange talk consists of self-motivational statements that suggest
bull Recognition of a problem
bull Concern about staying the same
bull Intention to change
bull Optimism about change
Activity Video ExampleSame scenario but different doctor What does this doctor do that is different Does it work
See reference list
(INSERT GOOD SBIRT VIDEO)
Conducting a Brief Intervention
F L O
FLO The 3 tasks of a BI
Avoid Warnings
F L O WFeed
back
Listen
amp U
nd
erstand
Warn
Op
tion
s Exp
lored
(thatrsquos it)
How Does It All Fit TogetherFeedback
Setting the stage
Tell screening results
Listen amp understand
Explore pros amp cons
Explain importance
Assess readiness to change
Options explored
Discuss change options
Follow up
The 3 Tasks of a BI
F L OFeed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 1st Task Feedback
The Feedback Sandwich
Ask Permission
Give Advice
Ask for Response
The 1st Task FeedbackWhat you need to cover1 Range of scores and context2 Screening results3 Substance use norms in population4 Interpretation of results (eg risk level)5 Patient feedback about results
The 1st Task FeedbackWhat do you say
1 Range of score and context - Scores on the AUDIT range from 0-40 Most people who are social drinkers score less than 8
2 Results - Your score was 18 on the alcohol screen
3 Norms - A score of 18 means that your drinking is higher than 75 of the US adult population
4 Interpretation of results - 18 puts you in the moderate-to-high risk range At this level your use is putting you at risk for a variety of health issues
5 Patient reactionfeedback - What do you make of this
Informational Brochures
The 1st Task FeedbackHandling Resistancebull Look I donrsquot have a drug problembull My dad was an alcoholic Irsquom not like himbull I can quit using anytime I want tobull I just like the tastebull Everybody drinks in college
What would you say
Chr
onic
Pai
n
SUD
HIV
Con-fusion Medical
Issues
Pain
SUD
To avoid thishellip
LET GO
The 1st Task Feedback
The 1st Task Feedback
Easy Ways to Let Gobull Irsquom not going to push you to change
anything you donrsquot want to changebull Irsquod just like to give you some informationbull What you do is up to you
The 1st Task FeedbackFinding a Hookbull Ask the patient about their concernsbull Provide non-judgmental feedbackinformationbull Watch for signs of discomfort with status quo or
interest or ability to changebull Always ask this question ldquoWhat role if any do
you think alcohol played in your (getting injured)bull Let the patient decidebull Just asking the question is helpful
The 3 Tasks of a BI
F L O
Feed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
ldquoPeople are better persuaded by the reasons they themselves
discovered than those that come into the minds of othersrdquo
Blaise Pascal
Ambivalence
All change contains an element of ambivalence
We ldquowant to change and donrsquot want to changerdquo
Patientsrsquo ambivalence about change is the ldquoheartrdquo of the brief intervention
Activity Video ExampleYoung man is treated in the ER after a car accident He had been drinking heavily before the accident How does the doctor address drinking in this video
See reference list
(INSERT BAD SBIRT VIDEO)
Reflective Listening
bull Listen to both what the patient says and to what the person means
bull Show empathy and donrsquot judge what patient saysbull You do not have to agree
bull Be aware of intonationbull Reflect what patient says with statement not
a question eg ldquoYou couldnrsquot get up for work in the morningrdquo
Levels of Reflection
bull Repeating ndash Repeating what was just saidbull RephrasingParaphrasing ndash Restatement of
what the person said Listener infers meaning of what was said Can be thought of as continuing the thought
bull Reflecting Feeling ndash Listener reflects not just the words but the feeling or emotion underneath what the person is saying
Avoid Confrontationbull Challenging
ldquoWhat do you think you are doingrdquo
bull Warning
ldquoYou will damage your liver if you donrsquot stop drinkingrdquo
bull Finger-wagging
ldquoIf you want to be a good student you must stop drinking on school nightsrdquo
Explore Ambivalence
Benefits of change
Costs of using drugs
Benefits of using drugs
Costs of change
How to Explore Ambivalence
Avoid questions that lead to a yesno response
The good things about
______
The not- so-good things about ____
The good things about
changing
The not-so-good things
about changing
Elicit ldquoChange TalkrdquoChange talk consists of self-motivational statements that suggest
bull Recognition of a problem
bull Concern about staying the same
bull Intention to change
bull Optimism about change
Activity Video ExampleSame scenario but different doctor What does this doctor do that is different Does it work
See reference list
(INSERT GOOD SBIRT VIDEO)
Conducting a Brief Intervention
F L O
FLO The 3 tasks of a BI
Avoid Warnings
F L O WFeed
back
Listen
amp U
nd
erstand
Warn
Op
tion
s Exp
lored
(thatrsquos it)
How Does It All Fit TogetherFeedback
Setting the stage
Tell screening results
Listen amp understand
Explore pros amp cons
Explain importance
Assess readiness to change
Options explored
Discuss change options
Follow up
The 3 Tasks of a BI
F L OFeed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 1st Task Feedback
The Feedback Sandwich
Ask Permission
Give Advice
Ask for Response
The 1st Task FeedbackWhat you need to cover1 Range of scores and context2 Screening results3 Substance use norms in population4 Interpretation of results (eg risk level)5 Patient feedback about results
The 1st Task FeedbackWhat do you say
1 Range of score and context - Scores on the AUDIT range from 0-40 Most people who are social drinkers score less than 8
2 Results - Your score was 18 on the alcohol screen
3 Norms - A score of 18 means that your drinking is higher than 75 of the US adult population
4 Interpretation of results - 18 puts you in the moderate-to-high risk range At this level your use is putting you at risk for a variety of health issues
5 Patient reactionfeedback - What do you make of this
Informational Brochures
The 1st Task FeedbackHandling Resistancebull Look I donrsquot have a drug problembull My dad was an alcoholic Irsquom not like himbull I can quit using anytime I want tobull I just like the tastebull Everybody drinks in college
What would you say
Chr
onic
Pai
n
SUD
HIV
Con-fusion Medical
Issues
Pain
SUD
To avoid thishellip
LET GO
The 1st Task Feedback
The 1st Task Feedback
Easy Ways to Let Gobull Irsquom not going to push you to change
anything you donrsquot want to changebull Irsquod just like to give you some informationbull What you do is up to you
The 1st Task FeedbackFinding a Hookbull Ask the patient about their concernsbull Provide non-judgmental feedbackinformationbull Watch for signs of discomfort with status quo or
interest or ability to changebull Always ask this question ldquoWhat role if any do
you think alcohol played in your (getting injured)bull Let the patient decidebull Just asking the question is helpful
The 3 Tasks of a BI
F L O
Feed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
Ambivalence
All change contains an element of ambivalence
We ldquowant to change and donrsquot want to changerdquo
Patientsrsquo ambivalence about change is the ldquoheartrdquo of the brief intervention
Activity Video ExampleYoung man is treated in the ER after a car accident He had been drinking heavily before the accident How does the doctor address drinking in this video
See reference list
(INSERT BAD SBIRT VIDEO)
Reflective Listening
bull Listen to both what the patient says and to what the person means
bull Show empathy and donrsquot judge what patient saysbull You do not have to agree
bull Be aware of intonationbull Reflect what patient says with statement not
a question eg ldquoYou couldnrsquot get up for work in the morningrdquo
Levels of Reflection
bull Repeating ndash Repeating what was just saidbull RephrasingParaphrasing ndash Restatement of
what the person said Listener infers meaning of what was said Can be thought of as continuing the thought
bull Reflecting Feeling ndash Listener reflects not just the words but the feeling or emotion underneath what the person is saying
Avoid Confrontationbull Challenging
ldquoWhat do you think you are doingrdquo
bull Warning
ldquoYou will damage your liver if you donrsquot stop drinkingrdquo
bull Finger-wagging
ldquoIf you want to be a good student you must stop drinking on school nightsrdquo
Explore Ambivalence
Benefits of change
Costs of using drugs
Benefits of using drugs
Costs of change
How to Explore Ambivalence
Avoid questions that lead to a yesno response
The good things about
______
The not- so-good things about ____
The good things about
changing
The not-so-good things
about changing
Elicit ldquoChange TalkrdquoChange talk consists of self-motivational statements that suggest
bull Recognition of a problem
bull Concern about staying the same
bull Intention to change
bull Optimism about change
Activity Video ExampleSame scenario but different doctor What does this doctor do that is different Does it work
See reference list
(INSERT GOOD SBIRT VIDEO)
Conducting a Brief Intervention
F L O
FLO The 3 tasks of a BI
Avoid Warnings
F L O WFeed
back
Listen
amp U
nd
erstand
Warn
Op
tion
s Exp
lored
(thatrsquos it)
How Does It All Fit TogetherFeedback
Setting the stage
Tell screening results
Listen amp understand
Explore pros amp cons
Explain importance
Assess readiness to change
Options explored
Discuss change options
Follow up
The 3 Tasks of a BI
F L OFeed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 1st Task Feedback
The Feedback Sandwich
Ask Permission
Give Advice
Ask for Response
The 1st Task FeedbackWhat you need to cover1 Range of scores and context2 Screening results3 Substance use norms in population4 Interpretation of results (eg risk level)5 Patient feedback about results
The 1st Task FeedbackWhat do you say
1 Range of score and context - Scores on the AUDIT range from 0-40 Most people who are social drinkers score less than 8
2 Results - Your score was 18 on the alcohol screen
3 Norms - A score of 18 means that your drinking is higher than 75 of the US adult population
4 Interpretation of results - 18 puts you in the moderate-to-high risk range At this level your use is putting you at risk for a variety of health issues
5 Patient reactionfeedback - What do you make of this
Informational Brochures
The 1st Task FeedbackHandling Resistancebull Look I donrsquot have a drug problembull My dad was an alcoholic Irsquom not like himbull I can quit using anytime I want tobull I just like the tastebull Everybody drinks in college
What would you say
Chr
onic
Pai
n
SUD
HIV
Con-fusion Medical
Issues
Pain
SUD
To avoid thishellip
LET GO
The 1st Task Feedback
The 1st Task Feedback
Easy Ways to Let Gobull Irsquom not going to push you to change
anything you donrsquot want to changebull Irsquod just like to give you some informationbull What you do is up to you
The 1st Task FeedbackFinding a Hookbull Ask the patient about their concernsbull Provide non-judgmental feedbackinformationbull Watch for signs of discomfort with status quo or
interest or ability to changebull Always ask this question ldquoWhat role if any do
you think alcohol played in your (getting injured)bull Let the patient decidebull Just asking the question is helpful
The 3 Tasks of a BI
F L O
Feed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
Activity Video ExampleYoung man is treated in the ER after a car accident He had been drinking heavily before the accident How does the doctor address drinking in this video
See reference list
(INSERT BAD SBIRT VIDEO)
Reflective Listening
bull Listen to both what the patient says and to what the person means
bull Show empathy and donrsquot judge what patient saysbull You do not have to agree
bull Be aware of intonationbull Reflect what patient says with statement not
a question eg ldquoYou couldnrsquot get up for work in the morningrdquo
Levels of Reflection
bull Repeating ndash Repeating what was just saidbull RephrasingParaphrasing ndash Restatement of
what the person said Listener infers meaning of what was said Can be thought of as continuing the thought
bull Reflecting Feeling ndash Listener reflects not just the words but the feeling or emotion underneath what the person is saying
Avoid Confrontationbull Challenging
ldquoWhat do you think you are doingrdquo
bull Warning
ldquoYou will damage your liver if you donrsquot stop drinkingrdquo
bull Finger-wagging
ldquoIf you want to be a good student you must stop drinking on school nightsrdquo
Explore Ambivalence
Benefits of change
Costs of using drugs
Benefits of using drugs
Costs of change
How to Explore Ambivalence
Avoid questions that lead to a yesno response
The good things about
______
The not- so-good things about ____
The good things about
changing
The not-so-good things
about changing
Elicit ldquoChange TalkrdquoChange talk consists of self-motivational statements that suggest
bull Recognition of a problem
bull Concern about staying the same
bull Intention to change
bull Optimism about change
Activity Video ExampleSame scenario but different doctor What does this doctor do that is different Does it work
See reference list
(INSERT GOOD SBIRT VIDEO)
Conducting a Brief Intervention
F L O
FLO The 3 tasks of a BI
Avoid Warnings
F L O WFeed
back
Listen
amp U
nd
erstand
Warn
Op
tion
s Exp
lored
(thatrsquos it)
How Does It All Fit TogetherFeedback
Setting the stage
Tell screening results
Listen amp understand
Explore pros amp cons
Explain importance
Assess readiness to change
Options explored
Discuss change options
Follow up
The 3 Tasks of a BI
F L OFeed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 1st Task Feedback
The Feedback Sandwich
Ask Permission
Give Advice
Ask for Response
The 1st Task FeedbackWhat you need to cover1 Range of scores and context2 Screening results3 Substance use norms in population4 Interpretation of results (eg risk level)5 Patient feedback about results
The 1st Task FeedbackWhat do you say
1 Range of score and context - Scores on the AUDIT range from 0-40 Most people who are social drinkers score less than 8
2 Results - Your score was 18 on the alcohol screen
3 Norms - A score of 18 means that your drinking is higher than 75 of the US adult population
4 Interpretation of results - 18 puts you in the moderate-to-high risk range At this level your use is putting you at risk for a variety of health issues
5 Patient reactionfeedback - What do you make of this
Informational Brochures
The 1st Task FeedbackHandling Resistancebull Look I donrsquot have a drug problembull My dad was an alcoholic Irsquom not like himbull I can quit using anytime I want tobull I just like the tastebull Everybody drinks in college
What would you say
Chr
onic
Pai
n
SUD
HIV
Con-fusion Medical
Issues
Pain
SUD
To avoid thishellip
LET GO
The 1st Task Feedback
The 1st Task Feedback
Easy Ways to Let Gobull Irsquom not going to push you to change
anything you donrsquot want to changebull Irsquod just like to give you some informationbull What you do is up to you
The 1st Task FeedbackFinding a Hookbull Ask the patient about their concernsbull Provide non-judgmental feedbackinformationbull Watch for signs of discomfort with status quo or
interest or ability to changebull Always ask this question ldquoWhat role if any do
you think alcohol played in your (getting injured)bull Let the patient decidebull Just asking the question is helpful
The 3 Tasks of a BI
F L O
Feed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
Reflective Listening
bull Listen to both what the patient says and to what the person means
bull Show empathy and donrsquot judge what patient saysbull You do not have to agree
bull Be aware of intonationbull Reflect what patient says with statement not
a question eg ldquoYou couldnrsquot get up for work in the morningrdquo
Levels of Reflection
bull Repeating ndash Repeating what was just saidbull RephrasingParaphrasing ndash Restatement of
what the person said Listener infers meaning of what was said Can be thought of as continuing the thought
bull Reflecting Feeling ndash Listener reflects not just the words but the feeling or emotion underneath what the person is saying
Avoid Confrontationbull Challenging
ldquoWhat do you think you are doingrdquo
bull Warning
ldquoYou will damage your liver if you donrsquot stop drinkingrdquo
bull Finger-wagging
ldquoIf you want to be a good student you must stop drinking on school nightsrdquo
Explore Ambivalence
Benefits of change
Costs of using drugs
Benefits of using drugs
Costs of change
How to Explore Ambivalence
Avoid questions that lead to a yesno response
The good things about
______
The not- so-good things about ____
The good things about
changing
The not-so-good things
about changing
Elicit ldquoChange TalkrdquoChange talk consists of self-motivational statements that suggest
bull Recognition of a problem
bull Concern about staying the same
bull Intention to change
bull Optimism about change
Activity Video ExampleSame scenario but different doctor What does this doctor do that is different Does it work
See reference list
(INSERT GOOD SBIRT VIDEO)
Conducting a Brief Intervention
F L O
FLO The 3 tasks of a BI
Avoid Warnings
F L O WFeed
back
Listen
amp U
nd
erstand
Warn
Op
tion
s Exp
lored
(thatrsquos it)
How Does It All Fit TogetherFeedback
Setting the stage
Tell screening results
Listen amp understand
Explore pros amp cons
Explain importance
Assess readiness to change
Options explored
Discuss change options
Follow up
The 3 Tasks of a BI
F L OFeed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 1st Task Feedback
The Feedback Sandwich
Ask Permission
Give Advice
Ask for Response
The 1st Task FeedbackWhat you need to cover1 Range of scores and context2 Screening results3 Substance use norms in population4 Interpretation of results (eg risk level)5 Patient feedback about results
The 1st Task FeedbackWhat do you say
1 Range of score and context - Scores on the AUDIT range from 0-40 Most people who are social drinkers score less than 8
2 Results - Your score was 18 on the alcohol screen
3 Norms - A score of 18 means that your drinking is higher than 75 of the US adult population
4 Interpretation of results - 18 puts you in the moderate-to-high risk range At this level your use is putting you at risk for a variety of health issues
5 Patient reactionfeedback - What do you make of this
Informational Brochures
The 1st Task FeedbackHandling Resistancebull Look I donrsquot have a drug problembull My dad was an alcoholic Irsquom not like himbull I can quit using anytime I want tobull I just like the tastebull Everybody drinks in college
What would you say
Chr
onic
Pai
n
SUD
HIV
Con-fusion Medical
Issues
Pain
SUD
To avoid thishellip
LET GO
The 1st Task Feedback
The 1st Task Feedback
Easy Ways to Let Gobull Irsquom not going to push you to change
anything you donrsquot want to changebull Irsquod just like to give you some informationbull What you do is up to you
The 1st Task FeedbackFinding a Hookbull Ask the patient about their concernsbull Provide non-judgmental feedbackinformationbull Watch for signs of discomfort with status quo or
interest or ability to changebull Always ask this question ldquoWhat role if any do
you think alcohol played in your (getting injured)bull Let the patient decidebull Just asking the question is helpful
The 3 Tasks of a BI
F L O
Feed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
Levels of Reflection
bull Repeating ndash Repeating what was just saidbull RephrasingParaphrasing ndash Restatement of
what the person said Listener infers meaning of what was said Can be thought of as continuing the thought
bull Reflecting Feeling ndash Listener reflects not just the words but the feeling or emotion underneath what the person is saying
Avoid Confrontationbull Challenging
ldquoWhat do you think you are doingrdquo
bull Warning
ldquoYou will damage your liver if you donrsquot stop drinkingrdquo
bull Finger-wagging
ldquoIf you want to be a good student you must stop drinking on school nightsrdquo
Explore Ambivalence
Benefits of change
Costs of using drugs
Benefits of using drugs
Costs of change
How to Explore Ambivalence
Avoid questions that lead to a yesno response
The good things about
______
The not- so-good things about ____
The good things about
changing
The not-so-good things
about changing
Elicit ldquoChange TalkrdquoChange talk consists of self-motivational statements that suggest
bull Recognition of a problem
bull Concern about staying the same
bull Intention to change
bull Optimism about change
Activity Video ExampleSame scenario but different doctor What does this doctor do that is different Does it work
See reference list
(INSERT GOOD SBIRT VIDEO)
Conducting a Brief Intervention
F L O
FLO The 3 tasks of a BI
Avoid Warnings
F L O WFeed
back
Listen
amp U
nd
erstand
Warn
Op
tion
s Exp
lored
(thatrsquos it)
How Does It All Fit TogetherFeedback
Setting the stage
Tell screening results
Listen amp understand
Explore pros amp cons
Explain importance
Assess readiness to change
Options explored
Discuss change options
Follow up
The 3 Tasks of a BI
F L OFeed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 1st Task Feedback
The Feedback Sandwich
Ask Permission
Give Advice
Ask for Response
The 1st Task FeedbackWhat you need to cover1 Range of scores and context2 Screening results3 Substance use norms in population4 Interpretation of results (eg risk level)5 Patient feedback about results
The 1st Task FeedbackWhat do you say
1 Range of score and context - Scores on the AUDIT range from 0-40 Most people who are social drinkers score less than 8
2 Results - Your score was 18 on the alcohol screen
3 Norms - A score of 18 means that your drinking is higher than 75 of the US adult population
4 Interpretation of results - 18 puts you in the moderate-to-high risk range At this level your use is putting you at risk for a variety of health issues
5 Patient reactionfeedback - What do you make of this
Informational Brochures
The 1st Task FeedbackHandling Resistancebull Look I donrsquot have a drug problembull My dad was an alcoholic Irsquom not like himbull I can quit using anytime I want tobull I just like the tastebull Everybody drinks in college
What would you say
Chr
onic
Pai
n
SUD
HIV
Con-fusion Medical
Issues
Pain
SUD
To avoid thishellip
LET GO
The 1st Task Feedback
The 1st Task Feedback
Easy Ways to Let Gobull Irsquom not going to push you to change
anything you donrsquot want to changebull Irsquod just like to give you some informationbull What you do is up to you
The 1st Task FeedbackFinding a Hookbull Ask the patient about their concernsbull Provide non-judgmental feedbackinformationbull Watch for signs of discomfort with status quo or
interest or ability to changebull Always ask this question ldquoWhat role if any do
you think alcohol played in your (getting injured)bull Let the patient decidebull Just asking the question is helpful
The 3 Tasks of a BI
F L O
Feed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
Avoid Confrontationbull Challenging
ldquoWhat do you think you are doingrdquo
bull Warning
ldquoYou will damage your liver if you donrsquot stop drinkingrdquo
bull Finger-wagging
ldquoIf you want to be a good student you must stop drinking on school nightsrdquo
Explore Ambivalence
Benefits of change
Costs of using drugs
Benefits of using drugs
Costs of change
How to Explore Ambivalence
Avoid questions that lead to a yesno response
The good things about
______
The not- so-good things about ____
The good things about
changing
The not-so-good things
about changing
Elicit ldquoChange TalkrdquoChange talk consists of self-motivational statements that suggest
bull Recognition of a problem
bull Concern about staying the same
bull Intention to change
bull Optimism about change
Activity Video ExampleSame scenario but different doctor What does this doctor do that is different Does it work
See reference list
(INSERT GOOD SBIRT VIDEO)
Conducting a Brief Intervention
F L O
FLO The 3 tasks of a BI
Avoid Warnings
F L O WFeed
back
Listen
amp U
nd
erstand
Warn
Op
tion
s Exp
lored
(thatrsquos it)
How Does It All Fit TogetherFeedback
Setting the stage
Tell screening results
Listen amp understand
Explore pros amp cons
Explain importance
Assess readiness to change
Options explored
Discuss change options
Follow up
The 3 Tasks of a BI
F L OFeed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 1st Task Feedback
The Feedback Sandwich
Ask Permission
Give Advice
Ask for Response
The 1st Task FeedbackWhat you need to cover1 Range of scores and context2 Screening results3 Substance use norms in population4 Interpretation of results (eg risk level)5 Patient feedback about results
The 1st Task FeedbackWhat do you say
1 Range of score and context - Scores on the AUDIT range from 0-40 Most people who are social drinkers score less than 8
2 Results - Your score was 18 on the alcohol screen
3 Norms - A score of 18 means that your drinking is higher than 75 of the US adult population
4 Interpretation of results - 18 puts you in the moderate-to-high risk range At this level your use is putting you at risk for a variety of health issues
5 Patient reactionfeedback - What do you make of this
Informational Brochures
The 1st Task FeedbackHandling Resistancebull Look I donrsquot have a drug problembull My dad was an alcoholic Irsquom not like himbull I can quit using anytime I want tobull I just like the tastebull Everybody drinks in college
What would you say
Chr
onic
Pai
n
SUD
HIV
Con-fusion Medical
Issues
Pain
SUD
To avoid thishellip
LET GO
The 1st Task Feedback
The 1st Task Feedback
Easy Ways to Let Gobull Irsquom not going to push you to change
anything you donrsquot want to changebull Irsquod just like to give you some informationbull What you do is up to you
The 1st Task FeedbackFinding a Hookbull Ask the patient about their concernsbull Provide non-judgmental feedbackinformationbull Watch for signs of discomfort with status quo or
interest or ability to changebull Always ask this question ldquoWhat role if any do
you think alcohol played in your (getting injured)bull Let the patient decidebull Just asking the question is helpful
The 3 Tasks of a BI
F L O
Feed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
Explore Ambivalence
Benefits of change
Costs of using drugs
Benefits of using drugs
Costs of change
How to Explore Ambivalence
Avoid questions that lead to a yesno response
The good things about
______
The not- so-good things about ____
The good things about
changing
The not-so-good things
about changing
Elicit ldquoChange TalkrdquoChange talk consists of self-motivational statements that suggest
bull Recognition of a problem
bull Concern about staying the same
bull Intention to change
bull Optimism about change
Activity Video ExampleSame scenario but different doctor What does this doctor do that is different Does it work
See reference list
(INSERT GOOD SBIRT VIDEO)
Conducting a Brief Intervention
F L O
FLO The 3 tasks of a BI
Avoid Warnings
F L O WFeed
back
Listen
amp U
nd
erstand
Warn
Op
tion
s Exp
lored
(thatrsquos it)
How Does It All Fit TogetherFeedback
Setting the stage
Tell screening results
Listen amp understand
Explore pros amp cons
Explain importance
Assess readiness to change
Options explored
Discuss change options
Follow up
The 3 Tasks of a BI
F L OFeed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 1st Task Feedback
The Feedback Sandwich
Ask Permission
Give Advice
Ask for Response
The 1st Task FeedbackWhat you need to cover1 Range of scores and context2 Screening results3 Substance use norms in population4 Interpretation of results (eg risk level)5 Patient feedback about results
The 1st Task FeedbackWhat do you say
1 Range of score and context - Scores on the AUDIT range from 0-40 Most people who are social drinkers score less than 8
2 Results - Your score was 18 on the alcohol screen
3 Norms - A score of 18 means that your drinking is higher than 75 of the US adult population
4 Interpretation of results - 18 puts you in the moderate-to-high risk range At this level your use is putting you at risk for a variety of health issues
5 Patient reactionfeedback - What do you make of this
Informational Brochures
The 1st Task FeedbackHandling Resistancebull Look I donrsquot have a drug problembull My dad was an alcoholic Irsquom not like himbull I can quit using anytime I want tobull I just like the tastebull Everybody drinks in college
What would you say
Chr
onic
Pai
n
SUD
HIV
Con-fusion Medical
Issues
Pain
SUD
To avoid thishellip
LET GO
The 1st Task Feedback
The 1st Task Feedback
Easy Ways to Let Gobull Irsquom not going to push you to change
anything you donrsquot want to changebull Irsquod just like to give you some informationbull What you do is up to you
The 1st Task FeedbackFinding a Hookbull Ask the patient about their concernsbull Provide non-judgmental feedbackinformationbull Watch for signs of discomfort with status quo or
interest or ability to changebull Always ask this question ldquoWhat role if any do
you think alcohol played in your (getting injured)bull Let the patient decidebull Just asking the question is helpful
The 3 Tasks of a BI
F L O
Feed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
How to Explore Ambivalence
Avoid questions that lead to a yesno response
The good things about
______
The not- so-good things about ____
The good things about
changing
The not-so-good things
about changing
Elicit ldquoChange TalkrdquoChange talk consists of self-motivational statements that suggest
bull Recognition of a problem
bull Concern about staying the same
bull Intention to change
bull Optimism about change
Activity Video ExampleSame scenario but different doctor What does this doctor do that is different Does it work
See reference list
(INSERT GOOD SBIRT VIDEO)
Conducting a Brief Intervention
F L O
FLO The 3 tasks of a BI
Avoid Warnings
F L O WFeed
back
Listen
amp U
nd
erstand
Warn
Op
tion
s Exp
lored
(thatrsquos it)
How Does It All Fit TogetherFeedback
Setting the stage
Tell screening results
Listen amp understand
Explore pros amp cons
Explain importance
Assess readiness to change
Options explored
Discuss change options
Follow up
The 3 Tasks of a BI
F L OFeed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 1st Task Feedback
The Feedback Sandwich
Ask Permission
Give Advice
Ask for Response
The 1st Task FeedbackWhat you need to cover1 Range of scores and context2 Screening results3 Substance use norms in population4 Interpretation of results (eg risk level)5 Patient feedback about results
The 1st Task FeedbackWhat do you say
1 Range of score and context - Scores on the AUDIT range from 0-40 Most people who are social drinkers score less than 8
2 Results - Your score was 18 on the alcohol screen
3 Norms - A score of 18 means that your drinking is higher than 75 of the US adult population
4 Interpretation of results - 18 puts you in the moderate-to-high risk range At this level your use is putting you at risk for a variety of health issues
5 Patient reactionfeedback - What do you make of this
Informational Brochures
The 1st Task FeedbackHandling Resistancebull Look I donrsquot have a drug problembull My dad was an alcoholic Irsquom not like himbull I can quit using anytime I want tobull I just like the tastebull Everybody drinks in college
What would you say
Chr
onic
Pai
n
SUD
HIV
Con-fusion Medical
Issues
Pain
SUD
To avoid thishellip
LET GO
The 1st Task Feedback
The 1st Task Feedback
Easy Ways to Let Gobull Irsquom not going to push you to change
anything you donrsquot want to changebull Irsquod just like to give you some informationbull What you do is up to you
The 1st Task FeedbackFinding a Hookbull Ask the patient about their concernsbull Provide non-judgmental feedbackinformationbull Watch for signs of discomfort with status quo or
interest or ability to changebull Always ask this question ldquoWhat role if any do
you think alcohol played in your (getting injured)bull Let the patient decidebull Just asking the question is helpful
The 3 Tasks of a BI
F L O
Feed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
Elicit ldquoChange TalkrdquoChange talk consists of self-motivational statements that suggest
bull Recognition of a problem
bull Concern about staying the same
bull Intention to change
bull Optimism about change
Activity Video ExampleSame scenario but different doctor What does this doctor do that is different Does it work
See reference list
(INSERT GOOD SBIRT VIDEO)
Conducting a Brief Intervention
F L O
FLO The 3 tasks of a BI
Avoid Warnings
F L O WFeed
back
Listen
amp U
nd
erstand
Warn
Op
tion
s Exp
lored
(thatrsquos it)
How Does It All Fit TogetherFeedback
Setting the stage
Tell screening results
Listen amp understand
Explore pros amp cons
Explain importance
Assess readiness to change
Options explored
Discuss change options
Follow up
The 3 Tasks of a BI
F L OFeed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 1st Task Feedback
The Feedback Sandwich
Ask Permission
Give Advice
Ask for Response
The 1st Task FeedbackWhat you need to cover1 Range of scores and context2 Screening results3 Substance use norms in population4 Interpretation of results (eg risk level)5 Patient feedback about results
The 1st Task FeedbackWhat do you say
1 Range of score and context - Scores on the AUDIT range from 0-40 Most people who are social drinkers score less than 8
2 Results - Your score was 18 on the alcohol screen
3 Norms - A score of 18 means that your drinking is higher than 75 of the US adult population
4 Interpretation of results - 18 puts you in the moderate-to-high risk range At this level your use is putting you at risk for a variety of health issues
5 Patient reactionfeedback - What do you make of this
Informational Brochures
The 1st Task FeedbackHandling Resistancebull Look I donrsquot have a drug problembull My dad was an alcoholic Irsquom not like himbull I can quit using anytime I want tobull I just like the tastebull Everybody drinks in college
What would you say
Chr
onic
Pai
n
SUD
HIV
Con-fusion Medical
Issues
Pain
SUD
To avoid thishellip
LET GO
The 1st Task Feedback
The 1st Task Feedback
Easy Ways to Let Gobull Irsquom not going to push you to change
anything you donrsquot want to changebull Irsquod just like to give you some informationbull What you do is up to you
The 1st Task FeedbackFinding a Hookbull Ask the patient about their concernsbull Provide non-judgmental feedbackinformationbull Watch for signs of discomfort with status quo or
interest or ability to changebull Always ask this question ldquoWhat role if any do
you think alcohol played in your (getting injured)bull Let the patient decidebull Just asking the question is helpful
The 3 Tasks of a BI
F L O
Feed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
Activity Video ExampleSame scenario but different doctor What does this doctor do that is different Does it work
See reference list
(INSERT GOOD SBIRT VIDEO)
Conducting a Brief Intervention
F L O
FLO The 3 tasks of a BI
Avoid Warnings
F L O WFeed
back
Listen
amp U
nd
erstand
Warn
Op
tion
s Exp
lored
(thatrsquos it)
How Does It All Fit TogetherFeedback
Setting the stage
Tell screening results
Listen amp understand
Explore pros amp cons
Explain importance
Assess readiness to change
Options explored
Discuss change options
Follow up
The 3 Tasks of a BI
F L OFeed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 1st Task Feedback
The Feedback Sandwich
Ask Permission
Give Advice
Ask for Response
The 1st Task FeedbackWhat you need to cover1 Range of scores and context2 Screening results3 Substance use norms in population4 Interpretation of results (eg risk level)5 Patient feedback about results
The 1st Task FeedbackWhat do you say
1 Range of score and context - Scores on the AUDIT range from 0-40 Most people who are social drinkers score less than 8
2 Results - Your score was 18 on the alcohol screen
3 Norms - A score of 18 means that your drinking is higher than 75 of the US adult population
4 Interpretation of results - 18 puts you in the moderate-to-high risk range At this level your use is putting you at risk for a variety of health issues
5 Patient reactionfeedback - What do you make of this
Informational Brochures
The 1st Task FeedbackHandling Resistancebull Look I donrsquot have a drug problembull My dad was an alcoholic Irsquom not like himbull I can quit using anytime I want tobull I just like the tastebull Everybody drinks in college
What would you say
Chr
onic
Pai
n
SUD
HIV
Con-fusion Medical
Issues
Pain
SUD
To avoid thishellip
LET GO
The 1st Task Feedback
The 1st Task Feedback
Easy Ways to Let Gobull Irsquom not going to push you to change
anything you donrsquot want to changebull Irsquod just like to give you some informationbull What you do is up to you
The 1st Task FeedbackFinding a Hookbull Ask the patient about their concernsbull Provide non-judgmental feedbackinformationbull Watch for signs of discomfort with status quo or
interest or ability to changebull Always ask this question ldquoWhat role if any do
you think alcohol played in your (getting injured)bull Let the patient decidebull Just asking the question is helpful
The 3 Tasks of a BI
F L O
Feed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
Conducting a Brief Intervention
F L O
FLO The 3 tasks of a BI
Avoid Warnings
F L O WFeed
back
Listen
amp U
nd
erstand
Warn
Op
tion
s Exp
lored
(thatrsquos it)
How Does It All Fit TogetherFeedback
Setting the stage
Tell screening results
Listen amp understand
Explore pros amp cons
Explain importance
Assess readiness to change
Options explored
Discuss change options
Follow up
The 3 Tasks of a BI
F L OFeed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 1st Task Feedback
The Feedback Sandwich
Ask Permission
Give Advice
Ask for Response
The 1st Task FeedbackWhat you need to cover1 Range of scores and context2 Screening results3 Substance use norms in population4 Interpretation of results (eg risk level)5 Patient feedback about results
The 1st Task FeedbackWhat do you say
1 Range of score and context - Scores on the AUDIT range from 0-40 Most people who are social drinkers score less than 8
2 Results - Your score was 18 on the alcohol screen
3 Norms - A score of 18 means that your drinking is higher than 75 of the US adult population
4 Interpretation of results - 18 puts you in the moderate-to-high risk range At this level your use is putting you at risk for a variety of health issues
5 Patient reactionfeedback - What do you make of this
Informational Brochures
The 1st Task FeedbackHandling Resistancebull Look I donrsquot have a drug problembull My dad was an alcoholic Irsquom not like himbull I can quit using anytime I want tobull I just like the tastebull Everybody drinks in college
What would you say
Chr
onic
Pai
n
SUD
HIV
Con-fusion Medical
Issues
Pain
SUD
To avoid thishellip
LET GO
The 1st Task Feedback
The 1st Task Feedback
Easy Ways to Let Gobull Irsquom not going to push you to change
anything you donrsquot want to changebull Irsquod just like to give you some informationbull What you do is up to you
The 1st Task FeedbackFinding a Hookbull Ask the patient about their concernsbull Provide non-judgmental feedbackinformationbull Watch for signs of discomfort with status quo or
interest or ability to changebull Always ask this question ldquoWhat role if any do
you think alcohol played in your (getting injured)bull Let the patient decidebull Just asking the question is helpful
The 3 Tasks of a BI
F L O
Feed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
FLO The 3 tasks of a BI
Avoid Warnings
F L O WFeed
back
Listen
amp U
nd
erstand
Warn
Op
tion
s Exp
lored
(thatrsquos it)
How Does It All Fit TogetherFeedback
Setting the stage
Tell screening results
Listen amp understand
Explore pros amp cons
Explain importance
Assess readiness to change
Options explored
Discuss change options
Follow up
The 3 Tasks of a BI
F L OFeed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 1st Task Feedback
The Feedback Sandwich
Ask Permission
Give Advice
Ask for Response
The 1st Task FeedbackWhat you need to cover1 Range of scores and context2 Screening results3 Substance use norms in population4 Interpretation of results (eg risk level)5 Patient feedback about results
The 1st Task FeedbackWhat do you say
1 Range of score and context - Scores on the AUDIT range from 0-40 Most people who are social drinkers score less than 8
2 Results - Your score was 18 on the alcohol screen
3 Norms - A score of 18 means that your drinking is higher than 75 of the US adult population
4 Interpretation of results - 18 puts you in the moderate-to-high risk range At this level your use is putting you at risk for a variety of health issues
5 Patient reactionfeedback - What do you make of this
Informational Brochures
The 1st Task FeedbackHandling Resistancebull Look I donrsquot have a drug problembull My dad was an alcoholic Irsquom not like himbull I can quit using anytime I want tobull I just like the tastebull Everybody drinks in college
What would you say
Chr
onic
Pai
n
SUD
HIV
Con-fusion Medical
Issues
Pain
SUD
To avoid thishellip
LET GO
The 1st Task Feedback
The 1st Task Feedback
Easy Ways to Let Gobull Irsquom not going to push you to change
anything you donrsquot want to changebull Irsquod just like to give you some informationbull What you do is up to you
The 1st Task FeedbackFinding a Hookbull Ask the patient about their concernsbull Provide non-judgmental feedbackinformationbull Watch for signs of discomfort with status quo or
interest or ability to changebull Always ask this question ldquoWhat role if any do
you think alcohol played in your (getting injured)bull Let the patient decidebull Just asking the question is helpful
The 3 Tasks of a BI
F L O
Feed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
How Does It All Fit TogetherFeedback
Setting the stage
Tell screening results
Listen amp understand
Explore pros amp cons
Explain importance
Assess readiness to change
Options explored
Discuss change options
Follow up
The 3 Tasks of a BI
F L OFeed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 1st Task Feedback
The Feedback Sandwich
Ask Permission
Give Advice
Ask for Response
The 1st Task FeedbackWhat you need to cover1 Range of scores and context2 Screening results3 Substance use norms in population4 Interpretation of results (eg risk level)5 Patient feedback about results
The 1st Task FeedbackWhat do you say
1 Range of score and context - Scores on the AUDIT range from 0-40 Most people who are social drinkers score less than 8
2 Results - Your score was 18 on the alcohol screen
3 Norms - A score of 18 means that your drinking is higher than 75 of the US adult population
4 Interpretation of results - 18 puts you in the moderate-to-high risk range At this level your use is putting you at risk for a variety of health issues
5 Patient reactionfeedback - What do you make of this
Informational Brochures
The 1st Task FeedbackHandling Resistancebull Look I donrsquot have a drug problembull My dad was an alcoholic Irsquom not like himbull I can quit using anytime I want tobull I just like the tastebull Everybody drinks in college
What would you say
Chr
onic
Pai
n
SUD
HIV
Con-fusion Medical
Issues
Pain
SUD
To avoid thishellip
LET GO
The 1st Task Feedback
The 1st Task Feedback
Easy Ways to Let Gobull Irsquom not going to push you to change
anything you donrsquot want to changebull Irsquod just like to give you some informationbull What you do is up to you
The 1st Task FeedbackFinding a Hookbull Ask the patient about their concernsbull Provide non-judgmental feedbackinformationbull Watch for signs of discomfort with status quo or
interest or ability to changebull Always ask this question ldquoWhat role if any do
you think alcohol played in your (getting injured)bull Let the patient decidebull Just asking the question is helpful
The 3 Tasks of a BI
F L O
Feed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
The 3 Tasks of a BI
F L OFeed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 1st Task Feedback
The Feedback Sandwich
Ask Permission
Give Advice
Ask for Response
The 1st Task FeedbackWhat you need to cover1 Range of scores and context2 Screening results3 Substance use norms in population4 Interpretation of results (eg risk level)5 Patient feedback about results
The 1st Task FeedbackWhat do you say
1 Range of score and context - Scores on the AUDIT range from 0-40 Most people who are social drinkers score less than 8
2 Results - Your score was 18 on the alcohol screen
3 Norms - A score of 18 means that your drinking is higher than 75 of the US adult population
4 Interpretation of results - 18 puts you in the moderate-to-high risk range At this level your use is putting you at risk for a variety of health issues
5 Patient reactionfeedback - What do you make of this
Informational Brochures
The 1st Task FeedbackHandling Resistancebull Look I donrsquot have a drug problembull My dad was an alcoholic Irsquom not like himbull I can quit using anytime I want tobull I just like the tastebull Everybody drinks in college
What would you say
Chr
onic
Pai
n
SUD
HIV
Con-fusion Medical
Issues
Pain
SUD
To avoid thishellip
LET GO
The 1st Task Feedback
The 1st Task Feedback
Easy Ways to Let Gobull Irsquom not going to push you to change
anything you donrsquot want to changebull Irsquod just like to give you some informationbull What you do is up to you
The 1st Task FeedbackFinding a Hookbull Ask the patient about their concernsbull Provide non-judgmental feedbackinformationbull Watch for signs of discomfort with status quo or
interest or ability to changebull Always ask this question ldquoWhat role if any do
you think alcohol played in your (getting injured)bull Let the patient decidebull Just asking the question is helpful
The 3 Tasks of a BI
F L O
Feed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
The 1st Task Feedback
The Feedback Sandwich
Ask Permission
Give Advice
Ask for Response
The 1st Task FeedbackWhat you need to cover1 Range of scores and context2 Screening results3 Substance use norms in population4 Interpretation of results (eg risk level)5 Patient feedback about results
The 1st Task FeedbackWhat do you say
1 Range of score and context - Scores on the AUDIT range from 0-40 Most people who are social drinkers score less than 8
2 Results - Your score was 18 on the alcohol screen
3 Norms - A score of 18 means that your drinking is higher than 75 of the US adult population
4 Interpretation of results - 18 puts you in the moderate-to-high risk range At this level your use is putting you at risk for a variety of health issues
5 Patient reactionfeedback - What do you make of this
Informational Brochures
The 1st Task FeedbackHandling Resistancebull Look I donrsquot have a drug problembull My dad was an alcoholic Irsquom not like himbull I can quit using anytime I want tobull I just like the tastebull Everybody drinks in college
What would you say
Chr
onic
Pai
n
SUD
HIV
Con-fusion Medical
Issues
Pain
SUD
To avoid thishellip
LET GO
The 1st Task Feedback
The 1st Task Feedback
Easy Ways to Let Gobull Irsquom not going to push you to change
anything you donrsquot want to changebull Irsquod just like to give you some informationbull What you do is up to you
The 1st Task FeedbackFinding a Hookbull Ask the patient about their concernsbull Provide non-judgmental feedbackinformationbull Watch for signs of discomfort with status quo or
interest or ability to changebull Always ask this question ldquoWhat role if any do
you think alcohol played in your (getting injured)bull Let the patient decidebull Just asking the question is helpful
The 3 Tasks of a BI
F L O
Feed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
The 1st Task FeedbackWhat you need to cover1 Range of scores and context2 Screening results3 Substance use norms in population4 Interpretation of results (eg risk level)5 Patient feedback about results
The 1st Task FeedbackWhat do you say
1 Range of score and context - Scores on the AUDIT range from 0-40 Most people who are social drinkers score less than 8
2 Results - Your score was 18 on the alcohol screen
3 Norms - A score of 18 means that your drinking is higher than 75 of the US adult population
4 Interpretation of results - 18 puts you in the moderate-to-high risk range At this level your use is putting you at risk for a variety of health issues
5 Patient reactionfeedback - What do you make of this
Informational Brochures
The 1st Task FeedbackHandling Resistancebull Look I donrsquot have a drug problembull My dad was an alcoholic Irsquom not like himbull I can quit using anytime I want tobull I just like the tastebull Everybody drinks in college
What would you say
Chr
onic
Pai
n
SUD
HIV
Con-fusion Medical
Issues
Pain
SUD
To avoid thishellip
LET GO
The 1st Task Feedback
The 1st Task Feedback
Easy Ways to Let Gobull Irsquom not going to push you to change
anything you donrsquot want to changebull Irsquod just like to give you some informationbull What you do is up to you
The 1st Task FeedbackFinding a Hookbull Ask the patient about their concernsbull Provide non-judgmental feedbackinformationbull Watch for signs of discomfort with status quo or
interest or ability to changebull Always ask this question ldquoWhat role if any do
you think alcohol played in your (getting injured)bull Let the patient decidebull Just asking the question is helpful
The 3 Tasks of a BI
F L O
Feed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
The 1st Task FeedbackWhat do you say
1 Range of score and context - Scores on the AUDIT range from 0-40 Most people who are social drinkers score less than 8
2 Results - Your score was 18 on the alcohol screen
3 Norms - A score of 18 means that your drinking is higher than 75 of the US adult population
4 Interpretation of results - 18 puts you in the moderate-to-high risk range At this level your use is putting you at risk for a variety of health issues
5 Patient reactionfeedback - What do you make of this
Informational Brochures
The 1st Task FeedbackHandling Resistancebull Look I donrsquot have a drug problembull My dad was an alcoholic Irsquom not like himbull I can quit using anytime I want tobull I just like the tastebull Everybody drinks in college
What would you say
Chr
onic
Pai
n
SUD
HIV
Con-fusion Medical
Issues
Pain
SUD
To avoid thishellip
LET GO
The 1st Task Feedback
The 1st Task Feedback
Easy Ways to Let Gobull Irsquom not going to push you to change
anything you donrsquot want to changebull Irsquod just like to give you some informationbull What you do is up to you
The 1st Task FeedbackFinding a Hookbull Ask the patient about their concernsbull Provide non-judgmental feedbackinformationbull Watch for signs of discomfort with status quo or
interest or ability to changebull Always ask this question ldquoWhat role if any do
you think alcohol played in your (getting injured)bull Let the patient decidebull Just asking the question is helpful
The 3 Tasks of a BI
F L O
Feed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
Informational Brochures
The 1st Task FeedbackHandling Resistancebull Look I donrsquot have a drug problembull My dad was an alcoholic Irsquom not like himbull I can quit using anytime I want tobull I just like the tastebull Everybody drinks in college
What would you say
Chr
onic
Pai
n
SUD
HIV
Con-fusion Medical
Issues
Pain
SUD
To avoid thishellip
LET GO
The 1st Task Feedback
The 1st Task Feedback
Easy Ways to Let Gobull Irsquom not going to push you to change
anything you donrsquot want to changebull Irsquod just like to give you some informationbull What you do is up to you
The 1st Task FeedbackFinding a Hookbull Ask the patient about their concernsbull Provide non-judgmental feedbackinformationbull Watch for signs of discomfort with status quo or
interest or ability to changebull Always ask this question ldquoWhat role if any do
you think alcohol played in your (getting injured)bull Let the patient decidebull Just asking the question is helpful
The 3 Tasks of a BI
F L O
Feed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
The 1st Task FeedbackHandling Resistancebull Look I donrsquot have a drug problembull My dad was an alcoholic Irsquom not like himbull I can quit using anytime I want tobull I just like the tastebull Everybody drinks in college
What would you say
Chr
onic
Pai
n
SUD
HIV
Con-fusion Medical
Issues
Pain
SUD
To avoid thishellip
LET GO
The 1st Task Feedback
The 1st Task Feedback
Easy Ways to Let Gobull Irsquom not going to push you to change
anything you donrsquot want to changebull Irsquod just like to give you some informationbull What you do is up to you
The 1st Task FeedbackFinding a Hookbull Ask the patient about their concernsbull Provide non-judgmental feedbackinformationbull Watch for signs of discomfort with status quo or
interest or ability to changebull Always ask this question ldquoWhat role if any do
you think alcohol played in your (getting injured)bull Let the patient decidebull Just asking the question is helpful
The 3 Tasks of a BI
F L O
Feed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
Chr
onic
Pai
n
SUD
HIV
Con-fusion Medical
Issues
Pain
SUD
To avoid thishellip
LET GO
The 1st Task Feedback
The 1st Task Feedback
Easy Ways to Let Gobull Irsquom not going to push you to change
anything you donrsquot want to changebull Irsquod just like to give you some informationbull What you do is up to you
The 1st Task FeedbackFinding a Hookbull Ask the patient about their concernsbull Provide non-judgmental feedbackinformationbull Watch for signs of discomfort with status quo or
interest or ability to changebull Always ask this question ldquoWhat role if any do
you think alcohol played in your (getting injured)bull Let the patient decidebull Just asking the question is helpful
The 3 Tasks of a BI
F L O
Feed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
To avoid thishellip
LET GO
The 1st Task Feedback
The 1st Task Feedback
Easy Ways to Let Gobull Irsquom not going to push you to change
anything you donrsquot want to changebull Irsquod just like to give you some informationbull What you do is up to you
The 1st Task FeedbackFinding a Hookbull Ask the patient about their concernsbull Provide non-judgmental feedbackinformationbull Watch for signs of discomfort with status quo or
interest or ability to changebull Always ask this question ldquoWhat role if any do
you think alcohol played in your (getting injured)bull Let the patient decidebull Just asking the question is helpful
The 3 Tasks of a BI
F L O
Feed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
The 1st Task Feedback
Easy Ways to Let Gobull Irsquom not going to push you to change
anything you donrsquot want to changebull Irsquod just like to give you some informationbull What you do is up to you
The 1st Task FeedbackFinding a Hookbull Ask the patient about their concernsbull Provide non-judgmental feedbackinformationbull Watch for signs of discomfort with status quo or
interest or ability to changebull Always ask this question ldquoWhat role if any do
you think alcohol played in your (getting injured)bull Let the patient decidebull Just asking the question is helpful
The 3 Tasks of a BI
F L O
Feed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
The 1st Task FeedbackFinding a Hookbull Ask the patient about their concernsbull Provide non-judgmental feedbackinformationbull Watch for signs of discomfort with status quo or
interest or ability to changebull Always ask this question ldquoWhat role if any do
you think alcohol played in your (getting injured)bull Let the patient decidebull Just asking the question is helpful
The 3 Tasks of a BI
F L O
Feed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
The 3 Tasks of a BI
F L O
Feed
back
Listen
amp U
nd
erstand
Op
tion
s Exp
lored
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
The 2nd Task Listen amp Understand
Ambivalence is Normal
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
The 2nd Task Listen amp Understand
Tools for Change Talk
bull Pros and Cons
bull ImportanceReadiness Ruler
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
The 2nd Task Listen amp UnderstandStrategies for Weighing the Pros and Consbull What do you like about drinking
bull What do you see as the downside of drinking
bull What else
Summarize Both Pros and Cons
ldquoOn the one hand you said
and on the other you saidhelliprdquo
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
The 2nd Task Listen amp Understand
Listen for the Change Talkbull Maybe drinking did play a role in what happened
bull If I wasnrsquot drinking this would never have happened
bull Using is not really much fun anymore
bull I canrsquot afford to be in this mess again
bull The last thing I want to do is hurt someone else
bull I know I can quit because Irsquove stopped before
Summarize so they hear it twice
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
The 2nd Task Listen amp UnderstandImportanceConfidenceReadiness
On a scale of 1ndash10hellip
bull How important is it for you to change your drinking
bull How confident are you that you can change your drinking
bull How ready are you to change your drinking
For each ask
bull Why didnrsquot you give it a lower number
bull What would it take to raise that number
1 2 3 4 5 6 7 8 9 10
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
OOp
tion
s Exp
lored
The 3 Tasks of a BI
F L
Feed
back
Listen
amp U
nd
erstand
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
What nowbull What do you think you will do
bull What changes are you thinking about making
bull What do you see as your options
bull Where do we go from here
bull What happens next
The 3rd Task Options for Change
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
Offer a Menu of Options
bull Manage drinkinguse (cut down to low-risk limits)
bull Eliminate your drinkingdrug use (quit)
bull Never drink and drive (reduce harm)
bull Utterly nothing (no change)
bull Seek help (refer to treatment)
The 3rd Task Options for Change
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
During MENUS you can also explore previous strengths resources and successesbull Have you stopped drinkingusing drugs before
bull What personal strengths allowed you to do it
bull Who helped you and what did you do
bull Have you made other kinds of changes successfully in the past
bull How did you accomplish these things
The 3rd Task Options for Change
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
The 3rd Task Options for Change
Giving Advice Without Telling Someone What to Dobull Provide Clear Information (Advise or Feedback )
bull What happens to some people is thathellipbull My recommendation would be thathellip
bull Elicit their reactionbull What do you thinkbull What are your thoughts
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
The 3rd Task Options for Change
The Advice Sandwich
Ask Permission
Give Advice
Ask for Response
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
The 3rd Task Options for ChangeClosing the Conversation (ldquoSEWrdquo)
bull Summarize patients views (especially the pro)
bull Encourage them to share their views
bull What agreement was reached (repeat it)
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
Activity Putting It All TogetherFeedbackbull Range
Listen and Understandbull Pros and Consbull ImportanceConfidenceReadiness Scalesbull Summary
Options Exploredbull Menu of Options
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
Encourage Follow-Up Visits
At follow-up visitbull Inquire about usebull Review goals and progressbull Reinforce and motivatebull Review tips for progress
See reference list
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
Enhancing Motivation for Change Inservice TrainingBased Treatment Improvement Protocol (TIP) 35
Published by the Center for Substance Abuse Treatmentwwwsamhsagov
See reference list
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
Referral to Treatment for Patients at Risk for
Substance Dependence
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
Referral to Treatmentbull Approximately 5 of patients screened will
require referral to substance use evaluation and treatment
bull A patient may be appropriate for referral whenbull Assessment of the patientrsquos responses to the screening
reveals serious medical social legal or interpersonal consequences associated with their substance use
These high risk patients will receive a brief intervention followed by referral
See reference list
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
ldquoWarm hand-offrdquo Approach to Referrals
bull Describe treatment options to patients based on available services
bull Develop relationships between health centers who do screening and local treatment centers
bull Facilitate hand-off bybull Calling to make appointment for patientstudent
bull Providing directions and clinic hours to patientstudent
bull Coordinating transportation when needed
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
Practice FLO
bull Try screening and giving feedback only
bull After several practices with F add in L amp O
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
Activity Wrap-Up
What I
learned
What Irsquod like
to work on
nexthellip
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
SBIRT Implementation Recommendations
bull Identify champions within primary care HIV and substance abuse settings
bull Promote SBI as a standard of care for all patients
bull Have an openness to new modalities such as brief intervention and brief treatment
bull Expand scope of focus to include high-risk alcohol and drug use not only dependence
SOURCE (2012) J Esquibel Colorado SBIRT wwwimprovinghealthcoloradoorg
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
Test Your Knowledge
103
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
Test Your Knowledge
1 What is the maximum number of standard drinks that are within the low-risk drinking range for a healthy non-pregnant 35 year-old womanA No more than 1 drink per occasionB No more than 2 drinks per occasionC No more than 3 drinks per occasionD No more than 4 drinks per occasion
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
Test Your Knowledge
2 Please identify what the 5-letters in the AUDIT acronym stand for
A Alcohol Use Disease Inventory TestB Alcohol Use Disorders Identification TestC Alcohol Use Disorders Inventory TestD Alcohol Use Disease Inventory Training
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
Test Your Knowledge
3 Because of the linkage between substance use and HIV screening and brief intervention protocols have been adopted throughout the United StatesA TrueB False
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
Test Your Knowledge
4 Brief interventions often include A Feedback about the patientrsquos drug andor
alcohol useB Advice on how to cut down on onersquos alcohol
andor drug useC Motivational techniquesD A and B onlyE All of the above
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
Take Home Points for Cliniciansbull Alcohol and drug problems are common
identifiable and treatable conditions in a variety of medical settings
bull Screening helps HIV providers to understand and address the consequences of untreated substance use disorders
bull Screening and brief intervention strategies can be used to maximize a ldquoteachable momentrdquo with your HIV patients
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
Key SBIRT Resourcesbull Foundations of SBIRT Self-Paced Online Course
(wwwattcelearnorg) bull SBIRT Implementation Guide for HIV Care Service
Programs (wwwcenterforcommunitycollaborationorg )
bull NIAAA SBIRT Pocket Guide (httppubsniaaanihgovpublicationsPractitionerPocketGuidepocketpdf)
bull SAMHSA SBIRT White Paper (httpwwwsamhsagovpreventionsbirt)
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
Key SBIRT Resourcesbull SAMHSA-HRSA Center for Integrated Health
Solutions ndash SBIRT Page (httpwwwintegrationsamhsagovclinical-practicesbirt)
bull Alcohol SBI Guide for Public Health Professionals (httpwwwaphaorgNRrdonlyresB03B4514-CCBA-47B9-82B0-5FEB4D2DC9830 SBImanualfinal4_16pdf)
bull National SBIRT ATTC (httpwwwattcnetworkorgregcentersindex_nfa_sbirtasp)
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-
Thank You
For more informationTom Freese tfreesemednetuclaedu
Beth Rutkowski brutkowskimednetuclaeduMaya Talisa Gil-Cantu mayaHIVtrainingCDUorg
Pacific Southwest ATTC wwwpsattcorgPAETC Training calendar wwwHIVtrainingCDUorg
- Slide 1
- Training Collaborators
- Test Your Knowledge
- Test Your Knowledge
- Test Your Knowledge (2)
- Test Your Knowledge (3)
- Test Your Knowledge (4)
- Introductions
- Training Overview
- What Will You Learn
- Activity Reflection
- SBIRT Review of Key Terms
- Benefits of SBIRT
- Benefits of SBIRT for Practice
- The Key to Successful Interventions
- Candidates for Routine Screening
- Rationale for Conducting SBIRT in an HIV Care Setting
- HIV in 2013
- Risks of Untreated Mental Health and Substance Use Problems
- SBIRT in HIV Settings
- SBIRT in HIV Settings (2)
- Impact of a Computer-Assisted SBIRT Program in and HIV Setting
- Colorados Ryan White Collaborative SBIRT Project
- Activity Adoption of SBIRT
- Screening to Identify Patients At Risk for Substance Use Prob
- Slide 26
- Types of Screening Tools
- Characteristics of a Good Screening Tool
- Benefits of Self-Report Tools
- Slide 30
- Slide 31
- Slide 32
- Pre-Screening
- Pre-Screening Example
- Pre-Screening Example (2)
- SBI Decision Tree
- Review of the AUDIT
- Domains of the AUDIT
- Domains of the AUDIT (cont)
- Domains of the AUDIT (cont) (2)
- Activity AUDIT Practice
- Activity AUDIT Practice (2)
- Scoring the Audit
- Enhancing Accuracy of Self-Report
- SBI Decision Tree (2)
- Brief Interventions for Patients at Risk for Substance Use Pr
- What Are Brief Interventions
- Goal of Brief Interventions
- Brief Intervention Effect
- Where Do I Start
- Slide 51
- Slide 52
- ldquoPeople are better persuaded by the reasons they themselves dis
- Ambivalence
- Activity Video Example
- Reflective Listening
- Levels of Reflection
- Avoid Confrontation
- Explore Ambivalence
- How to Explore Ambivalence
- Elicit ldquoChange Talkrdquo
- Activity Video Example (2)
- Conducting a Brief Intervention
- FLO The 3 tasks of a BI
- How Does It All Fit Together
- The 3 Tasks of a BI
- The 1st Task Feedback
- The 1st Task Feedback (2)
- The 1st Task Feedback (3)
- Informational Brochures
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 79
- The 2nd Task Listen amp Understand
- The 2nd Task Listen amp Understand (2)
- The 2nd Task Listen amp Understand (3)
- The 2nd Task Listen amp Understand (4)
- The 2nd Task Listen amp Understand (5)
- Slide 86
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- The 3rd Task Options for Change (3)
- The 3rd Task Options for Change (4)
- The 3rd Task Options for Change
- The 3rd Task Options for Change (2)
- Activity Putting It All Together
- Encourage Follow-Up Visits
- Slide 96
- Referral to Treatment for Patients at Risk for Substance Depen
- Referral to Treatment
- ldquoWarm hand-offrdquo Approach to Referrals
- Practice FLO
- Activity Wrap-Up
- SBIRT Implementation Recommendations
- Test Your Knowledge (2)
- Test Your Knowledge (5)
- Test Your Knowledge (6)
- Test Your Knowledge (7)
- Test Your Knowledge (8)
- Take Home Points for Clinicians
- Key SBIRT Resources
- Key SBIRT Resources (2)
- Thank You
-