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Depression Screening & SBIRT (Screening, Brief Intervention and Referral to Treatment) January 25 th 2018 Presentation
DSRIP Calendar MY4 July 1, 2017 – June 30, 2018 Demonstration Year (DY) Measurement Year (MY) DY3 April 1, 2017 – March 30, 2018 MPA Period April 1, 2017 – June 30, 2018
Depression Screening agenda Substantiation Algorithm Best Practice
Millennium MPA - Depression Activity Substantiation P rovide evidence of appropriate M CC shall conduct initial medical review documentation and at least 75% audit. If original findings by MCC indicate documentation accuracy of depression less than 75% documentation accuracy, screen with follow-up then MCC will re-audit again at a later time.
Millennium MPA – Major Depression Activity P articipate in MCC-facilitated education and training on depression best practices Substantiation D evelop and implement practice workflow to care manage patients diagnosed with S ign-in sheets for education and training Major Depression sessions. P roduce baseline reports of patients that P roduce baseline reports received an initial Dx of Major Depressive P rovide evidence of improvement by 10%, Disorder in the primary care office that 15% or 20% over baseline had a F/U visit w/in 12 wks. of diagnosis. I mprove F/U w/patients receiving an initial Dx of Major Depression in the PCP office w/in 12 weeks of diagnosis
Depression Algorithm
BH Best Practice
Millennium MPA - SBIRT Substantiation Activity Demonstrate completion of training (i.e. certificates or sign-in Train at least one key clinical member per site sheets) Implement SBIRT Provide workflows and quarterly reporting on number of screenings
But not in that particular order…
WHY is the issue of Substance Abuse Important for Primary Care Providers?(WHERE) It is a common problem There are health implications It affects the person, family & society WE CAN DO SOMETHING ABOUT IT!!!
Why not? Patient resistance Sensitive topic High failure rates Inadequate training Difficulty w/ linkages Work overload Staff frustration
Prevalence of Substance Use
Prevalence for Alcohol Use and Abuse Most damage from misuse and/or binge drinking Early Intervention is KEY!
WHAT is SBIRT? And HOW can we do a better job? Screening Brief Intervention and Referral to Treatment Builds on medical principles 1 S creen Initial triage for level of severity of problem 2 B rief Optimize level of recognition and motivation to I ntervention change, if needed 1-3 sessions 3 R eferral to Severity, co-morbidity, on-site capacity, T reatment routine follow-up recommended
Benefits of SBIRT (WHY) Patient Acceptance is high It is evidence-based (with long-term benefits) Ease of implementation by using existing staff Time-efficient and cost-effective Can generate additional revenue
SBIRT Algorithm How can we do a better job?
SCREENING: WHEN? and WHO? KEYS Routinely screen ALL patients over age 12 annually at well visit – also screen if relevant to primary complaint Use OASAS standardized instruments Triage patient information • Non-Risky • Risky • Substance Use Disorder WHO screens? Self-administered or by trained staff If positive screen – next steps may require further information (BH dx, blood pressure, blood sugar)
Approved Screening Tools **Remember to PRE-SCREEN FIRST!!
ASESSMENT (if patient screens positive) Establish a preliminary substance use diagnosis Severity of problem Incorporate co-morbidity Identify strengths Performed in primary care office setting
NON RISKY Assessment Feedback to Patient Non Risky Reinforce current behaviors Rescreen annually
BRIEF INTERVENTION Risky Substance Use Disorder Brief Intervention Encourage linkage and follow-up over to treatment and time monitor over time Follow-up Follow-up
Keys to Brief Intervention* Build on patients’ concerns & motivation based on their goals Listen, show empathy, be non-judgmental Involve patient in joint decision making Compared to standard medical advice; this is non- confrontational; clear but not directive Can be completed in about 5-7 minutes Can be administered by PCP, NP, PA, RN, MSW, etc. *This is NOT an intervention as seen on TV
REFERRAL TO TREATMENT Provide LINKAGES and NOT just phone #’s Establish bi-directional methods of communication to ensure progress of patient Can be referred on site to qualified Behavioral Health professional OR off site to licensed Behavioral Health facility
Brief Intervention Examples http://youtu.be/fX90j4jD9Sc Teen Example http://youtu.be/ebsqETBWEdQ Adult Example
Many Resources • available – packets will be distributed to sites New York State SBIRT • Publications: contact Communications@oasas.ny.gov to order additional publications
Next Steps Continue quarterly Patient Engagement-including SBIRT screens Create or update workflows to include SBIRT processes Provide certification from 4 hours SBIRT training for at least 1 key clinician from each site
Training Videos MILLENNIUM LINK TO 4 HOUR CERTIFICATION COURSE https://www.hwapps.org/dsrip/new-york/mcc/training- center/courses/?task=search_course&st=sbirt&partner_type=&project=&c _require=&credit_type=&=Find+Courses OASAS APPROVED Certification Courses https://cumc.co1.qualtrics.com/jfe/form/SV_1MLQ2Ub4uMqzV mB https://www.sbirttraining.com/ http://www1.nyc.gov/site/doh/providers/health-topics/sbirt- online-learning.page
Next Webinar What –PAM/CFA/LNU When- February Where- Webinar format
QUESTIONS? Contact your Millennium Collaborative Care Relationship Manager
References WHY A. L. Bahorik, D. D. Satre, A. H. Kline-Simon, C. M. Weisner and C. I. Campbell Alcohol, Cannabis, and Opioid Use Disorders, and Disease Burden in an Integrated Health Care System https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5291754/ REVIEWS B. Shapiro, D. Coffa and E. F. McCance-Katz A Primary Care Approach to Substance Misuse https://www.aafp.org/afp/2013/0715/p113.pdf SAMSHA Substance Use Disorders https://www.samhsa.gov/disorders/substance-use NIDA Screening for Drug Abuse in General Medical Settings: A Resource Guide For Providers https://www.drugabuse.gov/sites/default/files/resource_guide.pdf D. E. Jonas and J. C. Garbutt Screening and Counseling for Unhealthy Alcohol Use in Primary Care Settings https://www.ncbi.nlm.nih.gov/pubmed/28577629 IRETA Why Mainstream Healthcare Can't Ignore Substance Use http://ireta.org/2014/05/28/infographic-why-mainstream-healthcare-cant-ignore-substance-Use/?utm_
References (OBGyn and Pediatrics) OB_GYN T. E. Wright, M. Trepan, S. J. Undersea, C. Boyce, K. Yonkers, G. Chang and A. A. Cringe The role of screening, brief intervention, and referral to treatment in the perinatal period. https://www.ncbi.nlm.nih.gov/pubmed/27373599 A. L. Suit Behavioral and Pharmacotherapy Interventions for Tobacco Smoking Cessation in Adults, Including Pregnant Women: U.S. Preventive Services Task Force Recommendation Statement http://annals.org/aim/fullarticle/2443060/behavioral- pharmacotherapy-interventions-tobacco-smoking-cessation-adults-including-pregnant-women Pediatrics American Academy of Pediatrics . Prevention Substance use Screening, Brief intervention and Referral to Treatment . 2016 http://pediatrics.aappublications.org/content/pediatrics/138/1/e20161210.full.pdf D. J. Pilowsky and L.-T. Wu Screening instruments for substance use and brief interventions targeting adolescents in primary care: A literature review http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3623552/ S. J. Levy and J. F. Williams Substance Use Screening, Brief Intervention, and Referral to Treatment http://pediatrics.aappublications.org/content/pediatrics/138/1/e20161210.full.pdf K. Harris, J. Louis-Jacques and J. R. Knight Screening and brief intervention for alcohol and other abuse American College of Obstetrics and Gynecology. At Risk Drinking and Alcohol Dependence https://www.acog.org/- /media/Committee-Opinions/Committee-on-Health-Care-for-Underserved- Women/co496.pdf?dmc=1&ts=20180115T1719535250L.
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