SB

IRT

Screening, Brief Intervention and Referral to Treatment

SBIRT Works – Saving Lives, Money and Time with Screening, Brief

Intervention and Referral to Treatment in the Emergency

DepartmentPresented by Research Into Action – A Knowledge

Translation Initiative

The University of Texas School of Public Health

Institute for Health Policy

SB

IRT

Screening, Brief Intervention and Referral to Treatment

Overview

•What is SBIRT?

•Why implement SBIRT?

•Where do we go from here?

•Resources

SB

IRT

Screening, Brief Intervention and Referral to Treatment

What Is SBIRT?

•SBIRT is the acronym for Screening, Brief Intervention and Referral to Treatment

•SBIRT is designed to identify, intervene and treat people with substance abuse problems

SB

IRT

Screening, Brief Intervention and Referral to Treatment

Why Implement SBIRT?

•SBIRT works

•SBIRT saves money

SB

IRT

Screening, Brief Intervention and Referral to Treatment

SBIRT WorksSBIRT reduces injuries and ED re-admissionsSBIRT reduces substance misuse and abuse

•Brief interventions as short as 30 minutes significantly reduced problem drinking. Also, a 47 percent reduction in injuries requiring ED or trauma center re-admission at three years.Gentilello, et al., Alcohol Interventions in a Trauma Center as a Means of Reducing the Risk of Injury Recurrence, Annals of Surgery, 1999

•Collaborative study by NIAAA and SAMHSA indicated that speaking to ED patients about their alcohol consumption reduces hazardous drinking in those patients.Alcohol & Drug Abuse Weekly, January 2008

SB

IRT

Screening, Brief Intervention and Referral to Treatment

SBIRT Works (continued)•Meta-analysis of 21 randomized trials in primary care found that SBIRT recipients reduced alcohol intake by three drinks per week. Results consistent across all trials.Kaner, et al., Brief Intervention in Primary Care for Alcohol Misuse, International Journal of Epidemiology, 2007

SB

IRT

Screening, Brief Intervention and Referral to Treatment

SBIRT Saves Money•Each $1 spent on screening and brief intervention saves almost $4 in other health care-related costs.Gentilello, et al., Alcohol Interventions for Trauma Patients Treated in EDs and Hospitals: A Cost-Benefit Analysis, Annals of Surgery, 2005

•In January 2005, Alcohol & Drug Abuse Weekly estimated that emergency rooms and trauma centers could save up to $2 billion by offering brief substance abuse interventions to injured patients.

SB

IRT

Screening, Brief Intervention and Referral to Treatment

Where Do We Go From Here?•Obtaining funding•Overcoming staff resistance•Effective SBIRT training•Navigating the insurance rapids•Picking the right assessment tool

SB

IRT

Screening, Brief Intervention and Referral to Treatment

Obtaining FundingThere are a number of state and national programs offering funding for SBIRT studies:•Project InSight – Austin, Texas – www.insightforhealth.com

•SAMHSA funding of SBIRT initiatives – http://sbirt.samhsa.gov/csat_awards/funding_opps.htm

•National Institute on Alcohol Abuse and Alcoholism – Funding Opportunitieswww.niaaa.nih.gov/researchinformation/extramuralresearch/#funding

SB

IRT

Screening, Brief Intervention and Referral to Treatment

Overcoming Staff Resistance

•SBI Toolkit for Healthcare – www.ensuringsolutions.org/resources/resources_list.htm?cat_id=2005

•NIAAA Helping Patients Who Drink Too Much: A Clinician’s Guide – http://pubs.niaaa.nih.gov/publications/Practitioner/CliniciansGuide2005/clinicians_guide.htm

•Emergency Nurses Association SBIRT Toolkit – http://www.ena.org/ipinstitute/SBIRT/ToolKit/Pages/toolkit.aspx

SB

IRT

Screening, Brief Intervention and Referral to Treatment

Effective SBIRT Training•SAMHSA – http://sbirt.samhsa.gov/tools_resources/curriculum.htm

•Boston University –http://www.bu.edu/act/

•InSight Provider Training –http://www.insightforhealth.com/provider.html

12

SB

IRT

Screening, Brief Intervention and Referral to Treatment

Effective SBIRT Training (continued)•Experienced trainers in Texas – • Carrie L. Dodrill, Ph.D

Veterans Affairs Medical Center Houston, TX Voice: 713-791-1414 x 6490

• Mary Marden Velasquez, Ph.D The University of Texas at Austin School of Social WorkAustin, TXPhone: (512) 471-7019

• Kirk von Sternberg, Ph.DThe University of Texas at Austin School of Social WorkAustin, TX(512) 232-0633

SB

IRT

Screening, Brief Intervention and Referral to Treatment

Navigating the Insurance Rapids•As of April 2004, 38 states (including Texas) still had Uniform Accident and Sickness Policy Provision (UPPL) laws. UPPL repeal successful in several states, American College of Surgeons Cross Country, 2007

•UPPL laws allow insurers to deny coverage when injury is alcohol- or drug-related.

•Key informants for our study in Harris County did not cite UPPL as a barrier to treating patients found to be under the influence.

SB

IRT

Screening, Brief Intervention and Referral to Treatment

Navigating the Insurance Rapids(continued)•A 2008 survey shows that 58 percent of U.S. health plans pay for screening and brief intervention, and that the federal government covers 5.8 million of its workers.Feds cover screening, brief intervention, Nation’s Health, 2008

•With its efficacy proven, current procedural terminology (CPT) codes for SBIRT have been created:

-CPT 99408 for 15-30 minutes SBI-CPT 99409 for > 30 minutes SBI

American Medical Association, CPT 2008, Professional Edition, 2008

SB

IRT

Screening, Brief Intervention and Referral to Treatment

Navigating the Insurance Rapids(continued)•Centers for Medicare and Medicaid Services (CMS) also have codes:

-MedicareG0396 SBI >15 minutesG0397 SBI > 30 minutes

-MedicaidH0049 ScreeningH0050 Brief Intervention

American Medical Association, HCPCS 2008: Medicare’s National Level II Codes, 2008

SB

IRT

Screening, Brief Intervention and Referral to Treatment

Picking the Right Assessment Tool

•A SAMHSA guide reviews five major screening tools: AUDIT, CAGE, CRAFFT, BAC, and the binge drinking question.Alcohol Screening and Brief Intervention for Trauma Patients: Committee on Trauma Quick Guide, Alcoholism & Drug Abuse Weekly, May 2007

•CAGE and AUDIT have emerged as most commonly used screening tools in emergency departments.Vaca & Winn, The Basics of Alcohol Screening, Brief Intervention and Referral to Treatment in the Emergency Department, Western Journal of Emergency Medicine, 2007

SB

IRT

Screening, Brief Intervention and Referral to Treatment

More Resources•Funding:

-National Institute on Drug Abuse www.nida.nih.gov/researchers.html

-Texas Department of State Health Services http://www.dshs.state.tx.us/fic/default.shtm

-Project Mainstream

www.projectmainstream.net/projectmainstream.asp?cid=82

SB

IRT

Screening, Brief Intervention and Referral to Treatment

More Resources (continued)•Training:

-Community Health Association of Mountain and Plain States

http://www.champsonline.org/events/Distance_Library.asp#Vol15-18

-Society for Academic Emergency Medicine

http://www.saem.org/saemdnn/Home/Communities/InterestGroups/PublicHealth/tabid/136/Default.aspx

19

SB

IRT

Screening, Brief Intervention and Referral to Treatment

You Can Start Your SBIRT Program Now!•Research Into Action has prepared an all-inclusive resource guide.

•You can start setting up your SBIRT program TODAY.

SB

IRT

Screening, Brief Intervention and Referral to Treatment

This program was produced and distributed byResearch Into Action – A Knowledge Translation Initiative

The University of Texas School of Public HealthInstitute for Health Policy

For more information about Research Into Action and the subject of knowledge translation, visit our Web site, www.ktexchange.org,

or contact us at Researchintoaction@uth.tmc.edu